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Sample records for abdominis plane catheters

  1. Medial open transversus abdominis plane (MOTAP) catheters for analgesia following open liver resection: study protocol for a randomized controlled trial

    PubMed Central

    2014-01-01

    Background The current standard for pain control following liver surgery is intravenous, patient-controlled analgesia (IV PCA) or epidural analgesia. We have developed a modification of a regional technique called medial open transversus abdominis plane (MOTAP) catheter analgesia. The MOTAP technique involves surgically placed catheters through the open surgical site into a plane between the internal oblique muscle and the transverse abdominis muscle superiorly. The objective of this trial is to assess the efficacy of this technique. Methods/design This protocol describes a multicentre, prospective, blinded, randomized controlled trial. One hundred and twenty patients scheduled for open liver resection through a subcostal incision will be enrolled. All patients will have two MOTAP catheters placed at the conclusion of surgery. Patients will be randomized to one of two parallel groups: experimental (local anaesthetic through MOTAP catheters) or placebo (normal saline through MOTAP catheters). Both groups will also receive IV PCA. The primary endpoint is mean cumulative postoperative opioid consumption over the first 2 postoperative days (48 hours). Secondary outcomes include pain intensity, patient functional outcomes, and the incidence of complications. Discussion This trial has been approved by the ethics boards at participating centres and is currently enrolling patients. Data collection will be completed by the end of 2014 with analysis mid-2015 and publication by the end of 2015. Trial registration The study is registered with http://clinicaltrials.gov ( NCT01960049; 23 September 2013) PMID:24950773

  2. Colostomy with Transversus Abdominis Plane Block.

    PubMed

    Tekelioğlu, Ümit Yaşar; Demirhan, Abdullah; Şit, Mustafa; Kurt, Adem Deniz; Bilgi, Murat; Koçoğlu, Hasan

    2015-12-01

    Transversus abdominis plane (TAP) block is one of the abdominal field block. The TAP block is used for both anaesthetic management and post-operative pain therapy in lower abdominal surgery. TAP block is a procedure in which local anaesthetic agents are applied to the anatomic neurofacial space between the internal oblique and the transversus abdominis muscle. TAP block is a good method for post-operative pain control as well as allows for short operations involving the abdominal area. In this article, a case of colostomy under TAP block is presented. PMID:27366540

  3. Transversus abdominis plane block for an emergency laparotomy in a high-risk, elderly patient

    PubMed Central

    Patil, Surekha S; Pawar, Shonali C; Divekar, VM; Bakhshi, Rochana G

    2010-01-01

    A 72-year-old male patient with gall bladder perforation and small intestinal obstruction from impacted gall stone was posted for emergency laparotomy. He had congestive heart failure, severe hypertension at admission and history of multiple other coexisting diseases. On admission, he developed pulmonary oedema from systolic hypertension which was controlled by ventilatory support, nitroglycerine and furosemide. Preoperative international normalized ratio was 2.34 and left ventricular ejection fraction was only 20%. Because of risk of exaggerated fall in blood pressure during induction of anaesthesia (general or neuraxial), a transversus abdominis plane block via combined Petit triangle and subcostal technique was administered and supplemented with Propofol sedation. PMID:20885876

  4. Useful Points of Geometry and Topography of the Lumbar Triangle for Transversus Abdominis Plane Block

    PubMed Central

    Ziętek, Zbigniew; Starczewski, Kamil; Sulikowski, Tadeusz; Iwan-Ziętek, Iza; Żukowski, Maciej; Kamiński, Marek; Ziętek-Czeszak, Angelika

    2015-01-01

    Background A new look at the topography of the lumbar triangle becomes a challenge for modern anesthesia. The aim of this study was to redefine the topography of the lumbar triangle for transverse abdominis plane block. Material/Methods We explored 74 lumbar regions in 37 preserved cadavers (17 F and 20 M). Results The lumbar triangle was identified in 66 (89%) out of all explored cadavers’ lumbar regions. The predominant triangle was the acute-angled shaped. It was identified in 39 (59%) out of all explored lumbar regions. The second type of dissected triangles had the obtuse-angled shaped. Most triangles of acute-angled shaped and obtuse-angled shaped (36) had medium surface (range from 3 cm2 to 6 cm2), which accounted for 55% of all dissected lumbar triangles. The mean surface of the lumbar triangle was 3.6±2.2 cm2. Based on other measurements, we demonstrated that the majority of the lumbar triangles (62 triangles) were beyond the posterior axillary line. Conclusions According to the obtained results, the randomized searching for lumbar triangle should be limited to the area situated beyond of the posterior axillary line. The region situated anteriorly to the midaxillary line was defined in the study as the critical area for finding the lumbar triangle. Outcomes from the study revealed that the size and the location of the lumbar triangle as the gate for the transverse abdominal plane block may be responsible for difficulties encountered by anesthetists. Thus, establishing the area with the highest probability of localization of the lumbar triangle can improve both safety and efficiency of transversus abdominis plane block. PMID:26714659

  5. 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

  6. Efficacy of laparoscopic transversus abdominis plane block for elective laparoscopic cholecystectomy in elderly patients

    PubMed Central

    Tihan, Deniz; Totoz, Tolga; Tokocin, Merve; Ercan, Gulcin; Calikoglu, Tugba Koc; Vartanoglu, Talar; Celebi, Fatih; Dandin, Ozgur; Kafa, Ilker Mustafa

    2016-01-01

    Transversus abdominis plane (TAP) block technique seems to offer one of the most efficient methods for a local pain control. Our aim is to demonstrate the effectiveness and safety of TAP block for post-operative pain control under laparoscopic vision in elderly patients during laparoscopic cholecystectomy. The patients aged more than 65 years old, who had cholecystectomy due to symptomatic cholelithiasis, were retrospectively evaluated. The patients that were operated under general anesthesia + laparoscopic TAP block and those who were operated only under only general anesthesia were compared according to their’ age and gender, comorbidities, American Society of Anesthesiologists scores, visual analog scale (VAS) for pain and length of stay in the hospital. Median (±interquartile range) values of post-operative 24th-hour-VAS for pain was found consecutively 2 (±1-3) in TAP block + group and 3 (±2-5) in TAP block - group. The median post-operative 24th-hour-VAS value in overall patients was three. Patients’ VAS values were higher in the TAP block – group with a statistically significant difference (p = 0.001). Furthermore, no statistically significant difference was found for other parameters in two groups. The laparoscopic-guided TAP block can easily be performed and has potential for lower visceral injury risk and shorter operational time. Efficacy, safety and other advantages (analgesic requirements, etc.) make it an ideal abdominal field block in elderly patients. PMID:26773187

  7. 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. PMID:26984687

  8. Ultrasound-guided continuous transverse abdominis plane block for abdominal surgery

    PubMed Central

    Kadam, Rao V; Field, J B

    2011-01-01

    Introduction: Transversus abdominis plane (TAP) block is a new regional analgesic technique for postoperative pain in abdominal surgery. Its efficacy is not clear, and thus it needs to be explored for its regular utilisation on prolonged period. The objective was to study the continuous local anaesthetic infusion effect on postoperative analgesia. Continuous use of TAP block as an analgesic technique has not been evaluated prospectively in clinical trials. This study evaluates the efficacy of ultrasound-guided TAP block in comparison with PCA fentanyl in major abdominal surgery. Materials and Methods: There were 20 patients in the study, allocated to TAP and control groups. The parameters measured were pain scores on a numerical rating scale (NRS) of 0-10 at various time intervals and the amount of fentanyl used as rescue analgesia. Patient satisfaction scores were recorded in the TAP block group and along with any complications related to the block. Results: The postoperative median pain scores on coughing on day one were 6.0 for control group and 2.0 for the TAP group (P = 0.02); on day two, the equivalent scores were 7.0 and 2.0 (P = 0.01). The fentanyl requirement at one hour was 203 μ for the control group and 78 μg for the TAP group (P = 0.03); at day one, the control and TAP requirements were 1237 μg and 664 μg respectively (P = 0.01). Three TAP patients rated their satisfaction as ‘excellent’, four as ‘satisfied, and two as ‘poor’. Conclusion: TAP block is a promising technique for postoperative analgesia in major abdominal surgeries. Our study demonstrated lower pain scores in the TAP group with reduced fentanyl requirement. Further, a large scale study is needed to establish the efficacy of TAP block in this setting. PMID:21897502

  9. Effect of Transversus Abdominis Plane Block on Cost of Laparoscopic Cholecystectomy Anesthesia

    PubMed Central

    Kokulu, Serdar; Bakı, Elif Doğan; Kaçar, Emre; Bal, Ahmet; Şenay, Hasan; Üstün, Kübra Demir; Yılmaz, Sezgin; Ela, Yüksel; Sıvacı, Remziye Gül

    2014-01-01

    Background Use of transversus abdominis plane (TAP) block for postoperative analgesia is continuously increasing. However, few studies have investigated intraoperative effects of TAP block. We aimed to study the effects of TAP block in terms of cost-effectiveness and consumption of inhalation agents. Material/Methods Forty patients undergoing laparoscopic cholecystectomy were enrolled in this study. Patients were randomly divided into 2 groups: Group 1 (n=20) patients received TAP block and Group 2 (n=20) patients did not receive TAP block. Standard anesthesia induction was used in all patients. For the maintenance of anesthesia, fractional inspired oxygen (FIO2) of 50% in air with desflurane was used with a fresh gas flow of 4 L/min. All patients were monitored with electrocardiography and for peripheral oxygen saturation (SpO2), end-tidal carbon dioxide (ET), heart rate (HR), noninvasive mean blood pressure (MBP), and bispectral index (BIS). Bilateral TAP blocks were performed under ultrasound guidance to Group 1 patients. The BIS value was maintained at between 40 and 50 during the surgery. The Dion formula was used to calculate consumption of desflurane for each patient. Results There was no difference between the groups with respect to demographic characteristics of the patients. Duration of anesthesia, surgery time, and dosage of fentanyl were similar in the 2 groups. However, the cost and consumption of desflurane was significantly lower in Group 1. Conclusions Total anesthesia consumption was lower and the cost-effectiveness of anesthesia was better in TAP block patients with general anesthesia than in non-TAP block patients undergoing laparoscopic cholecystectomy. PMID:25534331

  10. Is transverse abdominis plane block effective following local anesthetic infiltration in laparoscopic totally extraperitoneal hernia repair?

    PubMed Central

    Kim, Mun Gyu; Ok, Si Young; Kim, Sang Ho; Lee, Se-Jin; Park, Sun Young; Yoo, Jae-Hwa; Cho, Ana; Hur, Kyung Yul; Kim, Myung Jin

    2014-01-01

    Background Transverse abdominis plane (TAP) block can be recommended as a multimodal method to reduce postoperative pain in laparoscopic abdominal surgery. However, it is unclear whether TAP block following local anesthetic infiltration is effective. We planned this study to evaluate the effectiveness of the latter technique in laparoscopic totally extraperitoneal hernia repair (TEP). Methods We randomly divided patients into two groups: the control group (n = 37) and TAP group (n = 37). Following the induction of general anesthesia, as a preemptive method, all of the patients were subjected to local anesthetic infiltration at the trocar sites, and the TAP group was subjected to ultrasound-guided bilateral TAP block with 30 ml of 0.375% ropivacaine in addition before TEP. Pain was assessed in the recovery room and post-surgery at 4, 8, and 24 h. Additionally, during the postoperative 24 h, the total injected dose of analgesics and incidence of nausea were recorded. Results: On arrival in the recovery room, the pain score of the TAP group (4.33 ± 1.83) was found to be significantly lower than that of the control group (5.73 ± 2.04). However, the pain score was not significantly different between the TAP group and control group at 4, 8, and 24 h post-surgery. The total amounts of analgesics used in the TAP group were significantly less than in the control group. No significant difference was found in the incidence of nausea between the two groups. Conclusions TAP block following local infiltration had a clinical advantage only in the recovery room. PMID:25558340

  11. 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

  12. 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

  13. 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

  14. Efficacy of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing inguinal hernia repair

    PubMed Central

    Venkatraman, Rajagopalan; Abhinaya, Ranganathan Jothi; Sakthivel, Ayyanar; Sivarajan, Govindarajan

    2016-01-01

    Background and aim Transversus abdominis plane block (TAP block) is a novel procedure to provide postoperative analgesia following inguinal hernia surgery. The utilization of ultrasound has greatly augmented the success rate of this block and additionally avoiding complications. The aim of our study was to gauge the analgesic efficacy of ultrasound-guided TAP block in patients undergoing unilateral inguinal hernia repair. Materials and methods Sixty patients scheduled for elective inguinal hernia repair were selected for the study. At the end of the surgical procedure, they were randomly divided into two groups. Ultrasound-guided TAP block was performed with 20 mL of ropivacaine 0.2% (group A) or normal saline (group B). Visual analog scale (VAS) scores were used to assess pain. Paracetamol was given if VAS > 3 and tramadol was used when VAS > 6. Patients were monitored for VAS scores and total analgesic consumption for the 24-hour period. Results The TAP block with ropivacaine (group A) reduced VAS scores at 4, 6, and 12 hours. There was no distinction in VAS scores at 0, 2, and 24 hours between the two groups. The duration of analgesia for TAP block with ropivacaine lasted for 390 minutes. Total analgesics consumption was also significantly reduced in group A than group B. No complication was reported to TAP block in both the groups. Conclusion The ultrasound-guided TAP block provides good postoperative analgesia, reduces analgesic requirements, and provides good VAS scores with fewer complications following inguinal hernia surgery. PMID:26848274

  15. Transversus abdominis plane block versus local anaesthetic wound infiltration for postoperative analgesia: A systematic review and meta-analysis

    PubMed Central

    Guo, Qingduo; Li, Rui; Wang, Lixian; Zhang, Dong; Ma, Yali

    2015-01-01

    Background: Transversus abdominis plane (TAP) block and local anaesthetic wound infiltration can provide effective pain relief at the wound site after surgery. However, the relative efficacy of two techniques for postoperative analgesia remains controversial. Methods: We searched PUBMED, EMBASE and CENTRAL databases for randomized controlled trials (RCTs) comparing TAP block with wound infiltration for pain relief after surgery. The primary outcomes were pain scores at rest and on movement at 1, 8 and 24 hours postoperatively and cumulative morphine consumption over 24 hours. The secondary outcomes were time to first rescue analgesic, number of rescue analgesic use and opioids-related side-effects. Results: Nine RCTs with a total of 500 participants were included. TAP block was associated with significant lower rest and dynamic pain scores at 8 hour [MD = -1.08, 95% CI (-1.89-0.26), P = 0.009] and 24 hour [MD = -0.83, 95% CI (-1.60, -0.06), P = 0.03] postoperatively than wound infiltration, but no significant difference was found at 1 hour [MD = -0.94, 95% CI (-1.97, 0.09), P = 0.08] postoperatively. In adults, TAP block significantly reduced 24-hour overall morphine consumption by 3.85 mg [MD = -3.85, 95% CI (-7.47, -0.22), P = 0.04] compared with wound infiltration. Subgroup analysis showed that adults received TAP block appeared to have lower rest pain scores at 24 hour than children (P = 0.008). Conclusion: TAP block provides superior analgesia compared with wound infiltration in the setting of a multimodal analgesic regimen. Subgroup analysis indicated that adults may have benefits additional to the analgesic effect than children. PMID:26770326

  16. Adding magnesium sulfate to bupivacaine in transversus abdominis plane block for laparoscopic cholecystectomy: A single blinded randomized controlled trial

    PubMed Central

    Al-Refaey, K; Usama, EM; Al-Hefnawey, E

    2016-01-01

    Introduction and Aim: Use of transversus abdominis plane block (TAP) in the management of postoperative pain after the laparoscopic cholecystectomy (LC) has been a common anesthetic practice. This study evaluates the effect of adding magnesium sulfate to bupivacaine in TAP block in LC regarding postoperative analgesia and analgesic consumption. Patients and Methods: Ninety patients of American Society of Anesthesiologists I and II was divided into three groups: Control group (C group, n = 30), bupivacaine group (B group, n = 30), bupivacaine magnesium group (M group, n = 30). Results: M group showed better analgesic profile in the 1st postoperative day in the form of lower mean visual analog scale score (2.8 ± 0.6 for C group, 2.1 ± 0.5 for B group, 2.2 ± 0.5 for M group, P < 0.001), longer duration of analgesia (7 ± 2.8 h for C group, 16 ± 2.5 h for B group, 19 ± 2.2 h for M group, P < 0.006), lower morphine consumption (2 ± 0.1 mg for C group, 0.9 ± 0.1 mg for B group, 0.5 ± 0.1 mg for M group, P < 0.011). There was a significant lower incidence of postoperative nausea and vomiting (PONV) (32% for C group, 6% B group, 7% M group, P < 0.004). Conclusion: Adding MgSo4 as an adjuvant to bupivacaine in TAP block; during anesthesia for LC; improved postoperative analgesia in the form of increased duration, decreased analgesic requirements and PONV. PMID:27051371

  17. Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block for abdominal hysterectomy: A prospective randomized controlled trial

    PubMed Central

    Ammar, Amany S.; Mahmoud, Khaled M.

    2012-01-01

    Purpose: Different adjuvants have been used to improve the quality and increase the duration of local anesthetics during various nerve block techniques. The current study was aimed to evaluate the effect of adding dexamethasone to bupivacaine on the quality and duration of transversus abdominis plane (TAP) block. Methods: Sixty adult patients undergoing elective open abdominal hysterectomy were randomly allocated to receive TAP block using 20 mL of bupivacaine hydrochloride 0.25% + 2 mL saline 0.9% (control group, n=30) or 20 mL of bupivacaine hydrochloride 0.25% + 2 mL dexamethasone “8 mg” (dexamethasone group, n=30). The primary outcome was postoperative pain, as evaluated by visual analog scale (VAS) for pain scoring at 1, 2, 4, 12, 24 and 48 h postoperatively, whereas the secondary outcomes were time to first analgesia (TFA), morphine consumption and the occurrence of nausea, vomiting or somnolence. Results: The pain VAS score was significantly lower at the postoperative 2 h (4.9 vs. 28.1, P=0.01), 4 h (12.2 vs. 31.1, P=0.01) and 12 h (15.7 vs. 25.4, P=0.02). Furthermore, TFA was significantly longer in the dexamethasone group (459.8 vs. 325.4 min, P=0.002), with lesser morphine requirements in the postoperative 48 h (4.9 vs. 21.2 mg, P=0.003) and lower incidence of nausea and vomiting (6 vs. 14, P=0.03). No complications attributed to the block were recorded. Conclusion: Addition of dexamethasone to bupivacaine in TAP block prolonged the duration of the block and decreased the incidence of nausea and vomiting. PMID:23162395

  18. 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

  19. Unilateral Ultrasound-Guided Transversus Abdominis Plane Block After Nephrectomy; Postoperative Pain and Use of Opioids

    PubMed Central

    Azawi, Nessn H.; Mosholt, Karina Sif Sondergaard; Fode, Mikkel

    2016-01-01

    Background Pain has a wide spectrum of effects on the body and inadequately controlled postoperative pain may have harmful physiologic and psychological consequences and increase morbidity. In addition, opioid anesthetic agents in high doses can blunt endocrine and metabolic responses following surgery and are associated with side effects including dizziness, nausea, vomiting, constipation, and respiratory depression. Objectives The current study aimed to investigate if unilateral ultrasound-guided transverse abdominal plane block (TAP-block) could reduce pain and postoperative use of patient requested analgesics following nephrectomy compared to local injection of the same ropivacaine dose in the surgical wound. Patients and Methods Retrospective chart reviews were performed in 42 consecutive patients who received TAP-block in conjunction with nephrectomy from November 2013 to August 2014 (group A). For comparison, data were used from 40 other nephrectomy patients registered as part of a previous study (group B). In this group the patients had received local ropivacaine injection in the surgical wound. On univariate analyses, the groups were compared by t-test and the Fisher exact test. Multivariate analyses were conducted by multiple linear regression. Results Mean surgical time was 162 minutes in group A and 92 minutes in group B (P < 0.0001). The means of visual analogue scale (VAS) were 3.05 and 1.55 in A and B groups, respectively (P = 0.001). The means of morphine consumption were 5.2 mg and 5.9 mg in groups A and B, respectively (P = 0.58); while the means of sufentanil use were 9.8 μg and 6.0 μg in groups A and B, respectively (P = 0.06). When controlling for age, tumor size and American society of anesthesiologists classification (ASA) score on multivariate analysis, TAP-block was associated with a significant increase in VAS (+1.4 [95% CI, 0.6 - 2.3], P = 0.001) and sufentanil use (+6.2 μg [95% CI, 2.3 - 10.2], P = 0.003). There was no difference in

  20. Ultrasound-Guided Transversus Abdominis Plane Block versus Continuous Wound Infusion for Post-Caesarean Analgesia: A Randomized Trial

    PubMed Central

    Chandon, Michel; Bonnet, Agnès; Burg, Yannick; Barnichon, Carole; DesMesnards-Smaja, Véronique; Sitbon, Brigitte; Foiret, Christine; Dreyfus, Jean-François; Rahmani, Jamil; Laloë, Pierre-Antoine; Fischler, Marc; Le Guen, Morgan

    2014-01-01

    Objective To compare the analgesic effect of ultrasound-guided Transversus Abdominis Plane (TAP) block versus Continuous Wound Infusion (CWI) with levobupivacaine after caesarean delivery. Methods We recruited parturients undergoing elective caesareans for this multicenter study. Following written informed consent, they received a spinal anaesthetic without intrathecal morphine for their caesarean section. The postoperative analgesia was randomized to either a bilateral ultrasound guided TAP block (levobupivicaine = 150 mg) or a CWI through an elastomeric pump for 48 hours (levobupivacaine = 150 mg the first day and 12.5 mg/h thereafter). Every woman received regular analgesics along with oral morphine if required. The primary outcome was comparison of the 48-hour area under the curve (AUC) pain scores. Secondary outcomes included morphine consumption, adverse events, and persistent pain one month postoperatively. Results Recruitment of 120 women was planned but the study was prematurely terminated due to the occurrence of generalized seizures in one patient of the TAP group. By then, 36 patients with TAP and 29 with CWI had completed the study. AUC of pain at rest and during mobilization were not significantly different: 50 [22.5–80] in TAP versus 50 [27.5–130] in CWI (P = 0.4) and 190 [130–240] versus 160 [112.5–247.5] (P = 0.5), respectively. Morphine consumption (0 [0–20] mg in the TAP group and 10 [0–32.5] mg in the CWI group (P = 0.09)) and persistent pain at one month were similar in both groups (respectively 29.6% and 26.6% (P = 0.73)). Conclusion In cases of morphine-free spinal anesthesia for cesarean delivery, no difference between TAP block and CWI for postoperative analgesia was suggested. TAP block may induce seizures in this specific context. Consequently, such a technique after a caesarean section cannot be recommended. Trial Registration ClinicalTrials.gov NCT01151943 PMID:25093663

  1. 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

  2. Levobupivacaine - dextran mixture for transversus abdominis plane block and rectus sheath block in patients undergoing laparoscopic colectomy: a randomised controlled trial.

    PubMed

    Hamada, T; Tsuchiya, M; Mizutani, K; Takahashi, R; Muguruma, K; Maeda, K; Ueda, W; Nishikawa, K

    2016-04-01

    We performed a randomised controlled double-blinded study of patients having laparoscopic colectomy with bilateral transversus abdominis plane block plus rectus sheath block, comparing a control group receiving 80 ml levobupivacaine 0.2% in saline with a dextran group receiving 80 ml levobupivacaine 0.2% in 8% low-molecular weight dextran. Twenty-seven patients were studied in each group. The mean (SD) maximum plasma concentration of levobupivacaine in the control group (1410 (322) ng.ml(-1) ) was higher than the dextran group (1141 (287) ng.ml(-1) ; p = 0.004), and was reached more quickly (50.6 (30.2) min vs 73.2 (24.6) min; p = 0.006). The area under the plasma concentration-time curve from 0 min to 240 min in the control group (229,124 (87,254) ng.min.ml(-1) ) was larger than in the dextran group (172,484 (50,502) ng.min.ml(-1) ; p = 0.007). The median (IQR [range]) of the summated numerical pain rating score at rest during the first postoperative 24 h in the control group (16 (9-20 [3-31]) was higher than in the dextran group (8 (2-11 [0-18]); p = 0.0001). In this study, adding dextran to levobupivacaine decreased the risk of levobupivacaine toxicity while providing better analgesia. PMID:26919568

  3. 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

  4. Magnesium sulphate as an adjuvant to bupivacaine in ultrasound-guided transversus abdominis plane block in patients scheduled for total abdominal hysterectomy under subarachnoid block

    PubMed Central

    Rana, Shelly; Verma, Ravinder Kumar; Singh, Jai; Chaudhary, Sudarshan Kumar; Chandel, Ankita

    2016-01-01

    Background and Aims: Transversus abdominis plane (TAP) block has proven to be an effective component of multimodal analgesic regimens for a variety of abdominal procedures. Magnesium sulphate (MgSO4) N-methyl-D-aspartate receptor antagonist has the potential to be an ideal adjuvant in TAP block. We studied the efficacy of MgSO4 as an adjuvant to bupivacaine in TAP block in patients scheduled for total abdominal hysterectomy (TAH) under subarachnoid block (SAB). Methods: Sixty-five women belonging to American Society of Anesthesiologists physical status 1 or 2, aged between 35 and 70 years, scheduled for TAH under SAB were recruited. Patients in Group B (n = 32) received 18 mL 0.25% bupivacaine (45 mg) with 2 mL normal saline (NS), whereas those in Group BM (n = 33) received 18 mL 0.25% bupivacaine (45 mg) with 1.5 mL (150 mg) MgSO4 and 0.5 mL NS in the ultrasound (USG)-guided TAP block performed on each side after the completion of the surgery under SAB. They were evaluated for pain at 0, 2, 4, 6, 12 and 24 h, time to first rescue analgesic and duration of postoperative analgesia were noted. Results: The post-operative visual analogue scale (VAS) scores were lower in Group BM at 4, 6 and 12 h (P < 0.05). Mean duration of analgesia was significantly prolonged in Group BM with lesser requirement of rescue analgesic (P < 0.05) up to 12 h. Conclusion: MgSO4 (150 mg) as an adjuvant to bupivacaine in USG-guided TAP block reduces post-operative pain scores, prolongs the duration of analgesia and decreases demands for rescue analgesics. PMID:27053780

  5. 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

  6. The analgesic efficacy of ultrasound-guided transversus abdominis plane block with mid-axillary approach after gynecologic laparoscopic surgery: A randomized controlled trial

    PubMed Central

    Kawahara, Ryoko; Tamai, Yutaka; Yamasaki, Kyoko; Okuno, Satoko; Hanada, Rumi; Funato, Takao

    2015-01-01

    Background and Aims: The transversus abdominis plane (TAP) block is widely used in clinical practice as a part of the multimodal analgesic regimen after abdominal surgery. The analgesic efficacy of ultrasound (US)-guided TAP block with the mid-axillary approach was investigated in patients undergoing laparoscopic gynecologic surgery in a randomized controlled clinical trial. Materials and Methods: Adult patients (n = 119) undergoing laparoscopic gynecologic surgery were randomized to undergo either TAP block with ropivacaine (Group A, n = 60) or that with saline (Group B, n = 59), in a blinded manner. Following general anesthesia, TAP block was performed bilaterally by infusion of either 20-mL 0.375% ropivacaine/one side in Group A or 20-mL saline/one side in Group B, under US guidance with a mid-axillary approach. Patient-controlled analgesia (PCA) was performed postoperatively with tramadol. The analgesic effect was postoperatively evaluated using a four-grade pain score and the prince Henry pain scale (PHS) at 0, 6, 12, and 24 h. Postoperative tramadol PCA consumption and vomiting/nausea were recorded. Statistical analyses were performed using the Mann-Whitney U-test or Fisher's exact probability test. A P < 0.05 was considered significant. Results: There was no statistically significant difference in background characteristics. The dose of remifentanil was significantly higher in Group B (P = 0.01). The pain score (P = 0.02) and PHS (P = 0.01) were significantly lower in Group A at 0 h. Tramadol PCA consumption in the period of 0-6 h (P = 0.01) and postoperative nausea (P = 0.04) were significantly less in Group A. Conclusion: Postoperative pain/nausea and PCA consumption were significantly lower in patients with TAP block in the early postoperative stage. TAP block with a mid-axillary approach holds considerable promise as a part of a balanced postoperative analgesic regimen following laparoscopic gynecologic surgery. PMID:25788776

  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. Evaluation of postoperative pain scores following ultrasound guided transversus abdominis plane block versus local infiltration following day surgery laparoscopic cholecystectomy-retrospective study

    PubMed Central

    Kadam, Vasanth Rao; Howell, Stuart; Kadam, V.

    2016-01-01

    Background and Aims: Postoperative pain for day surgery laparoscopic cholecystectomy has traditionally been managed with the surgeon infiltrating the wound with local anesthetic (LA). However, transversus abdominis plane (TAP) block has recently been used, although its superiority over LA remains uncertain. The primary aim was to compare LA and TAP block pain scores and analgesia used. The secondary aim was to assess satisfaction score and cost. Material and Methods: This retrospective study was commenced after ethics committee approval and ANZ clinical trial registry (ACTRN: 12612000737831). The data were collected from the theatre database and medical records of patients presenting for day case laparoscopic cholecystectomy. The sample included patients who received either bilateral port site LA infiltration with 20 ml of 0.25% Bupivacaine or bilateral TAP block with 20 ml of 0.5% ropivacaine and fentanyl postoperative pain protocol. The patients with incomplete medical records were excluded as were those admitted to an inpatient ward. Demographics and clinical characteristics were obtained from the hospital record along with pain score and postsurgery analgesia use. Postoperative pain satisfaction scores were collected by telephonic interview 30-180 days postsurgery. Results: Of 51 patients analyzed, 19 were in TAP group 29 in LA group. There were no significant differences between the LA and TAP groups with respect to postoperative pain scores (P = 0.31) or patient satisfaction scores (1 and 2+) (P = 0.36). However, fentanyl consumption in the recovery room was significantly lower in TAP group (P = 0.0079.). The consumables cost were >3 times higher in the TAP when compared to LA group. Conclusion: The performance of the TAP block with respect to pain management was comparable to LA. However, LA remains more cost effective. PMID:27006547

  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. Ultrasound-guided subcostal transversus abdominis plane blocks with liposomal bupivacaine vs. non-liposomal bupivacaine for postoperative pain control after laparoscopic hand-assisted donor nephrectomy: a prospective randomised observer-blinded study.

    PubMed

    Hutchins, J L; Kesha, R; Blanco, F; Dunn, T; Hochhalter, R

    2016-08-01

    We compared the effect of subcostal transversus abdominis plane (TAP) block with liposomal bupivacaine to TAP block with non-liposomal bupivacaine on postoperative maximal pain scores in patients undergoing donor nephrectomy. Sixty patients were prospectively randomly assigned to receive ultrasound-guided bilateral TAPs with either 1.3% liposomal bupivacaine and normal saline or 0.25% non-liposomal bupivacaine with adrenaline. There was a significant decrease in maximal pain scores in the liposomal bupivacaine TAP group when compared with the non-liposomal bupivacaine group median (IQR [range]), 24-48 h after injection, 5 (3.0-5.2 [0-10]) vs. 6 (4.5-7.0 [1--9]) p = 0.009; 48-72 h after injection, 3 (2.0-5.0 [0-8]) vs. 5 (3.0-7.0 [0-10]) p = 0.02; and in opioid use 48-72 h after injection, mean (SD) μg equivalents of fentanyl 105 (97) vs. 182 (162) p = 0.03. Liposomal bupivacaine via subcostal TAP infiltration provided superior analgesia up to 72 h after injection when compared with non-liposomal bupivacaine. PMID:27238859

  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. PMID:17957025

  12. 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

  13. 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 ...

  14. Umbilical catheters

    MedlinePlus

    ... pregnancy. Two arteries and one vein in the umbilical cord carry blood back and forth. If the ... catheter is a long, soft, hollow tube. An umbilical artery catheter (UAC) allows blood to be taken ...

  15. Urinary catheters

    MedlinePlus

    ... that you use a catheter if you have: Urinary incontinence (leaking urine or being unable to control when ... Surgery Bladder Diseases Spinal Cord Injuries Urethral Disorders Urinary Incontinence Urine and Urination Browse the Encyclopedia A.D. ...

  16. Catheter Angiography

    MedlinePlus

    ... Catheter Angiography? Angiography is a minimally invasive medical test that helps physicians diagnose and treat medical conditions. Angiography uses one of three imaging technologies and, in most cases, a contrast material injection ...

  17. In-Plane Ultrasound-Guided Lumbar Plexus Block Using Catheter-Over-Needle Technique in a 14-Month-Old Baby.

    PubMed

    Tognù, Andrea; Cauli, Veronica; de Simone, Nicola; Aurini, Lucia; Manfrini, Marco; Bonarelli, Stefano

    2016-01-01

    This case report details the feasibility of a continuous lumbar plexus block obtained with a paramedian transverse scan of the lumbar paravertebral region, using a catheter-over-needle system, as a main postoperative orthopedic analgesia, in a 14-month-old patient undergoing surgical treatment of a localized Ewing family tumor of the right proximal femur. After surgery, the patient remained in the intensive care unit for 3 days; pain was assessed regularly using the Children's and Infants' Postoperative Pain Scale, and comfort was monitored. Analgesia was provided with continuous levobupivacaine 0.2% infusion 0.2 mL kg h, rectal paracetamol 15 mg kg, and oral ibuprofen 60 mg twice per day, with a dose of morphine 0.05 mg kg intravenously as rescue. Pain relief was excellent, and no additional morphine was needed during the postoperative course. Nausea, vomiting, and disturbed sleep were not reported. Oral diet was resumed on the first postoperative day. In conclusion, this case represents successful postoperative management of orthopedic pain in a child using continuous posterior lumbar plexus infusion. PMID:27281724

  18. Differential activity of regions of transversus abdominis during trunk rotation.

    PubMed

    Urquhart, Donna M; Hodges, Paul W

    2005-05-01

    The role of the abdominal muscles in trunk rotation is not comprehensively understood. This study investigated the electromyographic (EMG) activity of anatomically distinct regions of the abdominal muscles during trunk rotation in six subjects with no history of spinal pain. Fine-wire electrodes were inserted into the right abdominal wall; upper region of transversus abdominis (TrA), middle region of TrA, obliquus internus abdominis (OI) and obliquus externus abdominis (OE), and lower region of TrA and OI. Surface electrodes were placed over right rectus abdominis (RA). Subjects performed trunk rotation to the left and right in sitting by rotating their pelvis relative to a fixed thorax. EMG activity was recorded in relaxed supine and sitting, and during an isometric hold at end range. TrA was consistently active during trunk rotation, with the recruitment patterns of the upper fascicles opposite to that of the middle and lower fascicles. During left rotation, there was greater activity of the lower and middle regions of contralateral TrA and the lower region of contralateral OI. The upper region of ipsilateral TrA and OE were predominately active during right rotation. In contrast, there was no difference in activity of RA and middle OI between directions (although middle OI was different between directions for all but one subject). This study indicates that TrA is active during trunk rotation, but this activity varies between muscle regions. These normative data will assist in understanding the role of TrA in lumbopelvic control and movement, and the effect of spinal pain on abdominal muscle recruitment. PMID:15940481

  19. 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

  20. Automated Pointing of Cardiac Imaging Catheters.

    PubMed

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

    2013-12-31

    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. Comparison of catheter tip migration using flexible and stimulating catheters inserted into the adductor canal in a cadaver model.

    PubMed

    Webb, Christopher A J; Kim, T Edward; Funck, Natasha; Howard, Steven K; Harrison, T Kyle; Ganaway, Toni; Keng, Heidi; Mariano, Edward R

    2015-06-01

    Use of adductor canal blocks and catheters for perioperative pain management following total knee arthroplasty is becoming increasingly common. However, the optimal equipment, timing of catheter insertion, and catheter dislodgement rate remain unknown. A previous study has suggested, but not proven, that non-tunneled stimulating catheters may be at increased risk for catheter migration and dislodgement after knee manipulation. We designed this follow-up study to directly compare tip migration of two catheter types after knee range of motion exercises. In a male unembalmed human cadaver, 30 catheter insertion trials were randomly assigned to one of two catheter types: flexible or stimulating. All catheters were inserted using an ultrasound-guided short-axis in-plane technique. Intraoperative knee manipulation similar to that performed during surgery was simulated by five sequential range of motion exercises. A blinded regional anesthesiologist performed caliper measurements on the ultrasound images before and after exercise. Changes in catheter tip to nerve distance (p = 0.547) and catheter length within the adductor canal (p = 0.498) were not different between groups. Therefore, catheter type may not affect the risk of catheter tip migration when placed prior to knee arthroplasty. PMID:25510467

  2. Rectus abdominis myocutaneous flap for primary vaginal reconstruction.

    PubMed

    Carlson, J W; Soisson, A P; Fowler, J M; Carter, J R; Twiggs, L B; Carson, L F

    1993-12-01

    Reconstructive procedures are being performed with increasing frequency in conjunction with pelvic exenterations and other radical gynecologic surgeries. The most common reconstructive procedures include continent urinary diversion, rectosigmoid anastomosis, and vaginal reconstruction. Historically, the gracilis myocutaneous flap has been the procedure of choice for vaginal reconstruction. However, the gracilis myocutaneous flap has a history of partial to severe necrosis, a propensity to prolapse, and leaves ipsilateral donor scars on the thigh. In contrast, neovaginal reconstruction using a relatively new procedure, the distally based rectus abdominis myocutaneous flaps, has the advantage of using a large, single flap that can be incorporated into the primary incision. This flap is mobilized on a long vascular pedicle, the rectus muscle. In relation to the underlying rectus muscle, the orientation of the cutaneous portion of this flap may be customized to accommodate the pelvic defect or the surgeon's preference. Depending on their primary orientation, they are referred to as either a vertical or transverse rectus abdominis myocutaneous flap. The versatility and reliability of the rectus flap is demonstrated here through the presentation of a small pilot series of seven patients. The technique was used for vaginal reconstruction, primarily in conjunction with pelvic exenteration. The flaps were mobilized from the supraumbilical area and had a flap viability of 100% for the 2 years that they have been followed. There were no postoperative incisional or flap infections. There was one infraumbilical fascial dehiscence. The advantages of primary pelvic reconstruction along with the description of the operative techniques are presented. PMID:8112640

  3. Gynecologic reconstruction with a rectus abdominis myocutaneous flap: an update.

    PubMed

    Carlson, J W; Carter, J R; Saltzman, A K; Carson, L F; Fowler, J M; Twiggs, L B

    1996-06-01

    This series reports the outcomes and significant complications associated with the rectus myocutaneous flap when used for pelvic or inguinal reconstruction in patients with gynecologic cancers. Perioperative variables were retrospectively reviewed to identify social and medical risk factors as well as intraoperative and postoperative complications that predisposed to rectus flap failure. Fifteen patients with gynecologic malignancies underwent reconstructive procedures using a vertically oriented rectus abdominis myocutaneous flap for either vaginal (n = 14) or inguinal (n = 1) reconstruction. The patients' primary cancers were cervical (n = 11), rectal (n = 1), ovarian (n = 1), vulvar (n = 1), and vaginal (n = 1). The median age was 50 years. The median follow-up was 17 months. All flaps were mobilized in conjunction with a radical salvage operation. There were no cases of vaginal prolapse and no abdominal wound infections. However, 4 patients (27%) had major postoperative morbidity in this small series. There was one wound dehiscence and three episodes of necrosis of the subcutaneous and cutaneous portions of the flap. All 4 of these patients required additional operative intervention or debridement. Eleven patients had complete healing of the flap. The rectus abdominis myocutaneous flap is a valuable option for gynecologic reconstructive procedures. Perioperative strategies for improving flap viability include the identification of risk factors that may compromise flap perfusions such as prior abdominal incisions, peripheral vascular disease, and obesity. Meticulous surgical technique is required to preserve the vascular pedicle. These strategies may be useful in preoperative counseling, the perioperative evaluation, and the intraoperative management. PMID:8641616

  4. Central venous catheters - ports

    MedlinePlus

    Central venous catheter - subcutaneous; Port-a-Cath; InfusaPort; PasPort; Subclavian port; Medi - port; Central venous line - port ... catheter is attached to a device called a port that will be under your skin. The port ...

  5. Rectus abdominis muscle endometriosis after cesarean section--case report.

    PubMed

    Dordević, Momcilo; Jovanović, Bozidar; Mitrović, Slobodanka; Dordević, Gordana; Radovanović, Dragce; Sazdanović, Predrag

    2009-09-01

    Endometriosis is defined by the presence of functional endometrial tissue outside the uterus, where it is normally located. Endometriosis is one of the most common gynecologic entities affecting 8%-18% of menstrual women. Endometriosis can occur at intra- and extrapelvic localizations. The most common intrapelvic localizations are those involving the ovaries, Douglas' area, pelvic peritoneum, uterus, bladder and rectum. Abdominal endometriosis is the most common localization of extrapelvic endometriosis and usually develops in connective tissue. Extra-pelvic implantation of endometrial tissue may develop in any organ including the skin, lungs, liver, extremities, brain and stomach. Three years after cesarean section, a 35-year-old female was operated on for suspected anterior abdominal hernia at the site of previous section. An egg-sized tumor was removed from the rectus abdominis muscle and referred for histopathologic and immunohistochemical analyses. The results showed endometriosis of the muscle with positive estrogen and progesterone receptors. A year after the procedure, treatment with gonadotropin-releasing hormone analogs was continued due to recurrent pain in the scar area, along with ultrasonography and biochemical marker (carbohydrate antigen 125) follow-up. Clinical diagnosis of scar endometriosis can be made by thorough history and physical, ultrasonography and biochemical examinations. Scar endometriosis should always be considered when the symptoms occur in a cyclic and hormone-dependent pattern, mostly after gynecologic operations, and worsening during menstruation. Definitive diagnosis is based on histopathologic analysis. PMID:20405641

  6. 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

  7. Variation in Tendinous Intersections of Rectus Abdominis Muscle in North Indian Population with Clinical Implications

    PubMed Central

    Haque, Mahboobul; Gupta, Amrita; Nasar, Areeba

    2015-01-01

    Aim of the study Incisions through the abdominal wall are based on anatomical principles and Rectus abdominis muscle provides an excellent myocutaneous flap. The present work was proposed to identify variations in numbers and location of tendinous intersections of the Rectus Abdominis muscle in the cadavers as a guide to the surgical procedures. Materials and Methods The study was conducted on 54 cadavers of North Indian origin allotted to undergraduate medical student for Anatomy dissection classes. Manual dissection was done to identify tendinous intersections of the Rectus Abdominis muscle with reference to number and location. Results In the present study one cadaver had five tendinous intersections (1.85%), one cadaver had four tendinous intersections (1.85%) and 52 cadavers had three tendinous intersections (96.29%). Conclusion The present study is an effort to provide data about the anatomical variation in numbers and location of tendinous intersections of the Rectus Abdomini muscles. Rectus abdominis muscle provides an excellent myocutaneous flap because the muscle belly is separated from surrounding tissue within the rectus sheath. This study is representative of a small study of the human population and only serves to illustrate the variations in the anatomy of the tendinous intersections. More extensive studies are required to establish a definitive pattern among local populations to serve as a guide for surgical procedures. PMID:26266107

  8. [Suprapubic catheter insertion].

    PubMed

    Neumann, Eva; Schwentner, Christian

    2016-01-01

    The suprapubic catheter enables a percutaneous drainage of urine. The insertion is made superior of the pubic bone through the abdominal wall into the bladder. It allows a permanent drainage of urine bypassing the urethra. The insertion of a suprapubic catheter requires knowledge and expertise. This paper summarizes the basic background and allows to follow the practical application step by step. PMID:26800072

  9. Auditing urinary catheter care.

    PubMed

    Dailly, Sue

    Urinary catheters are the main cause of hospital-acquired urinary tract infections among inpatients. Healthcare staff can reduce the risk of patients developing an infection by ensuring they give evidence-based care and by removing the catheter as soon as it is no longer necessary. An audit conducted in a Hampshire hospital demonstrated there was poor documented evidence that best practice was being carried out. Therefore a urinary catheter assessment and monitoring tool was designed to promote best practice and produce clear evidence that care had been provided. PMID:22375340

  10. 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

  11. 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 ...

  12. Indwelling catheter care

    MedlinePlus

    ... Common reasons to have an indwelling catheter are urinary incontinence (leakage), urinary retention (not being able to urinate), ... gov/pubmed/22094023 . Read More Radical prostatectomy Stress urinary incontinence Transurethral resection of the prostate Urge incontinence Urinary ...

  13. Suprapubic catheter care

    MedlinePlus

    ... You may need a catheter because you have urinary incontinence (leakage), urinary retention (not being able to urinate), ... vaginal wall repair Inflatable artificial sphincter Radical prostatectomy Urinary incontinence - injectable implant Urinary incontinence - retropubic suspension Urinary incontinence - ...

  14. Suprapubic catheter care

    MedlinePlus

    ... store. Other supplies you will need are sterile gloves, a catheter pack, syringes, sterile solution to clean ... your back. Put on two pairs of sterile gloves, one over the other. Then: Make sure your ...

  15. 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 ...

  16. [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. PMID:18578409

  17. Magnetic Catheter Manipulation in the Interventional MRI Environment

    PubMed Central

    Wilson, Mark W.; Martin, Alastair B.; Lillaney, Prasheel; Losey, Aaron D.; Yee, Erin J.; Bernhardt, Anthony; Malba, Vincent; Evans, Lee; Sincic, Ryan; Saeed, Maythem; Arenson, Ronald L.; Hetts, Steven W.

    2013-01-01

    Purpose To evaluate deflection capability of a prototype endovascular catheter, which is remotely magnetically steerable, for use in the interventional MRI environment. Materials and Methods Copper coils were mounted on the tips of commercially available 2.3 – 3.0 Fr microcatheters. The coils were fabricated in a novel manner by plasma vapor deposition of a copper layer followed by laser lithography of the layer into coils. Orthogonal helical (solenoid) and saddle-shaped (Helmholtz) coils were mounted on a single catheter tip. Microcatheters were tested in water bath phantoms in a 1.5T clinical MRI scanner, with variable simultaneous currents applied to the coils. Catheter tip deflection was imaged in the axial plane utilizing a “real-time” steady-state free precession (SSFP) MRI sequence. Degree of deflection and catheter tip orientation were measured for each current application. Results The catheter tip was clearly visible in the longitudinal and axial planes. Magnetic field artifacts were visible when the orthogonal coils at the catheter tip were energized. Variable amounts of current applied to a single coil demonstrated consistent catheter deflection in all water bath experiments. Changing current polarity reversed the observed direction of deflection, whereas current applied to two different coils resulted in deflection represented by the composite vector of individual coil activations. Microcatheter navigation through the vascular phantom was successful through control of applied current to one or more coils. Conclusion Controlled catheter deflection is possible with laser lithographed multi-axis coil tipped catheters in the MRI environment. PMID:23707097

  18. Peripherally inserted central catheter - insertion

    MedlinePlus

    ... central catheters and nontunneled central venous catheters. In: Mauro MA, Murphy KPJ, Thomson KR, et al., eds. ... Procedures . 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:chap 4. Mansour JC, Neiderhuber JE. Establishing and ...

  19. Breast reconstruction with a turbocharged transverse rectus abdominis myocutaneous flap on the contralateral perforator.

    PubMed

    Sbalchiero, Juliano Carlos; de Albuquerque Leal, Paulo Roberto; dos Santos, César Cabello

    2014-11-01

    Seventeen patients were submitted to delayed unilateral breast reconstruction using pedicled, muscle-sparing turbocharged transverse rectus abdominis myocutaneous flap based on the contralateral perforator vessels. The lateral portion of the rectus abdominis muscle on the pedicled side was preserved in 12 patients. Zones II and IV were included in the flap in all cases. Mean duration of surgery was 7 hours and 15 minutes. Four complications developed in the abdominal donor site: contralateral abdominal bulging (n=1), minor suture dehiscence (n=2), and epidermolysis at the border of the abdominal flap and umbilical scar (n=1). Three partial losses (10%-30%) occurred in the reconstructed breast (17.64% of cases), whereas 2 cases of fat necrosis were associated with partial losses. One patient developed deep vein thrombosis with pulmonary embolism; however, outcome was favorable. This proved a viable alternative for breast reconstruction, with satisfactory results in most patients and acceptable morbidity and surgical time. PMID:24625511

  20. Herpes Zoster in a Free Transverse Rectus Abdominis Myocutaneous Flap After Delayed Breast Reconstruction

    PubMed Central

    Lee, Jeong Hui; Ahn, Hee Chang; Chung, Min Sung

    2015-01-01

    Abstract In concert with advances in surgical reconstruction techniques and improved survival after breast cancer, both the aesthetic and functional outcomes, especially sensory recovery, of breast reconstruction have been addressed. Most studies on sensory recovery in reconstructed breasts have utilized patients’ subjective responses to touch, pain, temperature, and pressure. In contrast, this report describes a case of herpes zoster that developed in a free transverse rectus abdominis myocutaneous flap, which provides objective evidence of spontaneous reinnervation after breast reconstruction. PMID:25974118

  1. 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

  2. Heuristic estimation of electromagnetically tracked catheter shape for image-guided vascular procedures

    NASA Astrophysics Data System (ADS)

    Mefleh, Fuad N.; Baker, G. Hamilton; Kwartowitz, David M.

    2014-03-01

    In our previous work we presented a novel image-guided surgery (IGS) system, Kit for Navigation by Image Focused Exploration (KNIFE).1,2 KNIFE has been demonstrated to be effective in guiding mock clinical procedures with the tip of an electromagnetically tracked catheter overlaid onto a pre-captured bi-plane fluoroscopic loop. Representation of the catheter in KNIFE differs greatly from what is captured by the fluoroscope, due to distortions and other properties of fluoroscopic images. When imaged by a fluoroscope, catheters can be visualized due to the inclusion of radiopaque materials (i.e. Bi, Ba, W) in the polymer blend.3 However, in KNIFE catheter location is determined using a single tracking seed located in the catheter tip that is represented as a single point overlaid on pre-captured fluoroscopic images. To bridge the gap in catheter representation between KNIFE and traditional methods we constructed a catheter with five tracking seeds positioned along the distal 70 mm of the catheter. We have currently investigated the use of four spline interpolation methods for estimation of true catheter shape and have assesed the error in their estimation of true catheter shape. In this work we present a method for the evaluation of interpolation algorithms with respect to catheter shape determination.

  3. [Free rectus abdominis muscle perforating artery flaps for reconstruction of the head and neck defects].

    PubMed

    Koshima, I; Handa, T; Satoh, Y; Akisada, K; Orita, Y; Yamamoto, H

    1995-01-01

    During the past eight years, tissue defects of the head and neck region in a total of 45 patients were repaired with free rectus abdominis muscle perforating artery flaps. These flaps are subclassified into (1) reduced musculocutaneous flaps, (2) thin reduced musculocutaneous flaps, (3) paraumbilical perforator-based flaps, and (4) thin paraumbilical perforator-based flaps. The advantages of these flaps are as follows. Since the flaps involve no or only a small portion of the rectus abdominis muscle, (1) the muscle can be left intact on the abdominal wall, and (2) a thin flap can be easily created by simple defatting of the flap. These flaps overcome the major disadvantages of the conventional rectus abdominis musculocutaneous flap, i.e., bulkiness of the flap and frequent postoperative abdominal herniation. The territory of the thin flaps is within 10 cm around the perforator. These flaps are suitable for defects in the head and neck region, because simultaneous flap elevation is possible at the time of tumor resection. Paraumbilical perforator-based flaps are suitable for young females and elderly patients. PMID:7897566

  4. Indwelling catheter care

    MedlinePlus

    ... clean between your fingers and under your nails. Wet one of the washcloths with warm water and soap it up. Gently wash all around the area where the catheter goes in with the soapy washcloth. Females should wipe from front to back. Males should wipe from ...

  5. Catheter-related bloodstream infection.

    PubMed

    Goede, Matthew R; Coopersmith, Craig M

    2009-04-01

    Catheter-related bloodstream infections (CR-BSIs) are a common, frequently preventable complication of central venous catheterization. CR-BSIs can be prevented by strict attention to insertion and maintenance of central venous catheters and removing unneeded catheters as soon as possible. Antiseptic- or antibiotic-impregnated catheters are also an effective tool to prevent infections. The diagnosis of CR-BSI is made largely based on culture results. CR-BSIs should always be treated with antibiotics, and except in rare circumstances the infected catheter needs to be removed. PMID:19281894

  6. Catheter associated urinary tract infections

    PubMed Central

    2014-01-01

    Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities. As biofilm ultimately develops on all of these devices, the major determinant for development of bacteriuria is duration of catheterization. While the proportion of bacteriuric subjects who develop symptomatic infection is low, the high frequency of use of indwelling urinary catheters means there is a substantial burden attributable to these infections. Catheter-acquired urinary infection is the source for about 20% of episodes of health-care acquired bacteremia in acute care facilities, and over 50% in long term care facilities. The most important interventions to prevent bacteriuria and infection are to limit indwelling catheter use and, when catheter use is necessary, to discontinue the catheter as soon as clinically feasible. Infection control programs in health care facilities must implement and monitor strategies to limit catheter-acquired urinary infection, including surveillance of catheter use, appropriateness of catheter indications, and complications. Ultimately, prevention of these infections will require technical advances in catheter materials which prevent biofilm formation. PMID:25075308

  7. 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.

  8. FAQs about Catheter-Associated Bloodstream Infections

    MedlinePlus

    ... Wear a mask, cap, sterile gown, and sterile gloves when putting in the catheter to keep it ... putting in the catheter. • Clean their hands, wear gloves, and clean the catheter opening with an antiseptic ...

  9. Heart catheter cable and connector

    NASA Technical Reports Server (NTRS)

    Harrison, D. R.; Cota, F. L.; Sandler, H.

    1972-01-01

    Ultraminiature catheter cables that are stiff enough for intravenous insertion yet flexible at the tip, sterilizable, and economical are fabricated entirely from commercially available parts. Assembly includes air passageway for reference pressures and coaxial cable for transmission of signals from the tip of catheter.

  10. Quantitative end qualitative analysis of the electrical activity of rectus abdominis muscle portions.

    PubMed

    Negrão Filho, R de Faria; Bérzin, F; Souza, G da Cunha

    2003-01-01

    The purpose of this study was to investigate the electrical behavior pattern of the Rectus abdominis muscle by qualitative and quantitative analysis of the electromyographic signal obtained from its superior, medium and inferior portions during dynamic and static activities. Ten voluntaries (aged X = 17.8 years, SD = 1.6) athletic males were studied without history of muscle skeletal disfunction. For the quantitative analysis the RMS (Root Mean Square) values obtained in the electromyographic signal during the isometric exercises were normalized and expressed in maximum voluntary isometric contraction percentages. For the qualitative analysis of the dynamic activity the electromyographic signal was processed by full-wave rectification, linear envelope and normalization (amplitude and time), so that the resulting curve of the processed signal was submitted to descriptive graphic analysis. The results of the quantitative study show that there is not a statistically significant difference among the portions of the muscle. Qualitative analysis demonstrated two aspects: the presence of a common activation electric pattern in the portions of Rectus abdominis muscle and the absence of significant difference in the inclination angles in the electrical activity curve during the isotonic exercises. PMID:12964259

  11. 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

  12. Microwave catheter design.

    PubMed

    Nevels, R D; Arndt, G D; Raffoul, G W; Carl, J R; Pacifico, A

    1998-07-01

    A microwave antenna system for transcatheter ablation of cardiac tissue is investigated. A numerical model based on the finite-difference time-domain method incorporating a Gaussian pulse excitation has been constructed and frequency domain electric and magnetic fields are obtained through Fourier transformation. Results are presented for a coaxial line fed monopole catheter which is modified by the successive inclusion of a Teflon sheath outer coating, a terminating disk at the tip of the antenna, a sleeve choke, and a high dielectric constant cylinder surrounding the monopole antenna. The effects of these design features are characterized in terms of specific absorption rate (SAR) and return loss (RL). Numerical calculations are confirmed by comparing with the RL measurement of a Teflon-coated monopole containing a disk and choke. PMID:9644897

  13. 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.

  14. [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. PMID:15792563

  15. Central venous catheter - dressing change

    MedlinePlus

    ... will need: Sterile gloves Cleaning solution A special sponge A special patch, called a Biopatch A clear ... around the catheter. Clean the skin with the sponge and cleaning solution. Air dry after cleaning. Place ...

  16. 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 ...

  17. 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 ...

  18. Reconstruction of large composite oromandibulomaxillary defects with free vertical rectus abdominis myocutaneous flaps.

    PubMed

    Butler, Charles E; Lewin, Jan S

    2004-02-01

    Large composite oromandibulomaxillary defects resulting from oncologic resection can be challenging to reconstruct with a single flap, and functional outcomes remain anecdotal. The purpose of this study was to evaluate the authors' surgical experience and scientifically analyze and describe the functional outcomes associated with the use of the vertical rectus abdominis myocutaneous flap for reconstruction of these defects. The records of seven patients (mean age, 62 years) who underwent composite resection including hemimandibulectomy, partial maxillectomy, partial pharyngectomy, and floor-of-mouth resection followed by immediate free vertical rectus abdominis myocutaneous flap reconstruction at The University of Texas M. D. Anderson Cancer Center (1998 to 2002) were retrospectively reviewed. The tumor type was squamous cell carcinoma in all seven cases; four patients had T4 primary lesions and three had local recurrences. Radiotherapy was used preoperatively in each of the three recurrent cases (mean dose, 70.6 Gy) and postoperatively in three of the four patients with primary tumors (mean dose, 63.0 Gy). The mean length of hospitalization was 8.7 days. There were no major flap complications, fistulas, or donor-site complications. Partial flap necrosis (4 percent of flap area) occurred in one patient and dehiscence of the neck incision occurred in another. Both cases were managed with surgical débridement and closure. A third patient developed a 0.75-cm superficial suture line abscess that healed with dressing changes. The mean postoperative follow-up was 15 months. Six of the seven patients remained tube dependent for their nutrition despite some swallowing improvement; one patient returned to full oral intake. The most common swallowing deficit was impaired laryngeal excursion, which occurred in all six patients evaluated with videofluoroscopic examination and resulted in risk for aspiration in patients and frank aspiration in 83 percent. Speech was

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

    PubMed

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

    2012-04-01

    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

  20. 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

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

    PubMed

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

    2016-06-01

    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

  2. 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

  3. 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.

  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...

  5. 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...

  6. 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...

  7. 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...

  8. 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...

  9. 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

  10. Initial experience with breast reconstruction using the transverse rectus abdominis myocutaneous flap: a study of 45 patients.

    PubMed Central

    Andrews, E.; Bond, J.; Dolan, S.; Kirk, S.

    1999-01-01

    Breast conserving surgery for breast cancer has led to an increased interest in reconstruction following mastectomy. The transverse rectus abdominis myocutaneous flap has been proven to give good results in terms of restoration of body symmetry with near normal contour and consistency. Furthermore, immediate reconstruction has the advantage of a single procedure with less psychological morbidity, and reduction in hospital stay and overall complication rate. The aim of this study was to review our experience with the transverse rectus abdominis myocutaneous flap procedure an initial series of 45 patients. The overall complication rate of 27% is similar to that reported in the literature, with no total flap loss and nine patients with partial flap loss. There was no delay in commencement of adjuvant chemotherapy or radiotherapy and we believe our ability to detect local recurrence has not been compromised. We consider that immediate breast reconstruction is now an integral part of the surgical treatment of breast cancer. PMID:10489808

  11. Peculiar indications for the pedicled or free rectus abdominis flap in reconstructive surgery. A review of our experience.

    PubMed

    Sinsel, N K; Guelinckx, P J

    1995-01-01

    Among all known flaps, the rectus abdominis muscle flap possesses an unique diversity in flap designs due to the special vascular supply of the abdominal wall. The axial vascularization of the rectus abdominis muscle gives ofF several musculocutaneous perforators, which are mainly located in the periumbilical region. Abdominal wall skin perfusion is guaranteed by spoke-wheel like vessels arising from these perforators. Subsequently several designs (muscle, myocutaneous and myosubcutaneous) are possible, by varying the included tissue and the position of the skin island. We described 7 cases where the rectus abdominis muscle was used as a muscle or myocutaneous flap for reconstruction of large defects. In most cases a pedicled transfer was necessary, possible and sufficient to reconstruct the difficult defects in various body regions. Great amounts of well perfused tissue can be transferred with still possible primary closure of the donor site. Due to its rich perfusion and constancy of vascular pattern, it represents an excellent and safe pedicled reconstructive procedure for large defects of the thorax, the abdomen, the forearm or the hip and pelvis where free tissue transfers are impossible or contraindicated. No other local transposition would have achieved this goal, due to the lack of volume and mobility. Moreover the flap is ideal for reconstruction of contour deficiencies due to the abundance of fat, as for example in breast or buttock reconstruction. However the flap is not the first choice for traumatic and infected wounds where fat tissue is not desired. PMID:8571724

  12. Surface electromyography activity of the rectus abdominis, internal oblique, and external oblique muscles during forced expiration in healthy adults.

    PubMed

    Ito, Kenichi; Nonaka, Koji; Ogaya, Shinya; Ogi, Atsushi; Matsunaka, Chiaki; Horie, Jun

    2016-06-01

    We aimed to characterize rectus abdominis, internal oblique, and external oblique muscle activity in healthy adults under expiratory resistance using surface electromyography. We randomly assigned 42 healthy adult subjects to 3 groups: 30%, 20%, and 10% maximal expiratory intraoral pressure (PEmax). After measuring 100% PEmax and muscle activity during 100% PEmax, the activity and maximum voluntary contraction of each muscle during the assigned experimental condition were measured. At 100% PEmax, the external oblique (p<0.01) and internal oblique (p<0.01) showed significantly elevated activity compared with the rectus abdominis muscle. Furthermore, at 20% and 30% PEmax, the external oblique (p<0.05 and<0.01, respectively) and the internal oblique (p<0.05 and<0.01, respectively) showed significantly elevated activity compared with the rectus abdominis muscle. At 10% PEmax, no significant differences were observed in muscle activity. Although we observed no significant difference between 10% and 20% PEmax, activity during 30% PEmax was significantly greater than during 20% PEmax (external oblique: p<0.05; internal oblique: p<0.01). The abdominal oblique muscles are the most active during forced expiration. Moreover, 30% PEmax is the minimum intensity required to achieve significant, albeit very slight, muscle activity during expiratory resistance. PMID:27077819

  13. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    .... This generic type of device includes the suprapubic catheter and tube, Malecot catheter, catheter punch... (performance standards). (2) Class I for the catheter punch instrument, nondisposable cannula and trocar,...

  14. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    .... This generic type of device includes the suprapubic catheter and tube, Malecot catheter, catheter punch... (performance standards). (2) Class I for the catheter punch instrument, nondisposable cannula and trocar,...

  15. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    .... This generic type of device includes the suprapubic catheter and tube, Malecot catheter, catheter punch... (performance standards). (2) Class I for the catheter punch instrument, nondisposable cannula and trocar,...

  16. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    .... This generic type of device includes the suprapubic catheter and tube, Malecot catheter, catheter punch... (performance standards). (2) Class I for the catheter punch instrument, nondisposable cannula and trocar,...

  17. Per-catheter ASD closure.

    PubMed

    Latson, L A

    1998-01-01

    Per-catheter devices for atrial septal defect (ASD) closure have been evolving since 1974. The four major devices available for use on a limited basis in early 1997 are reviewed. These include (in alphabetical order) the Angel Wing device, the ASDOS device, the Buttoned device, and the CardioSeal device (successor to the Clamshell). Sufficient data have been collected to indicate that transcatheter ASD closure is a viable alternative to surgery in selected patients. The advantages of the concept of per-catheter closure over surgical closure should lead to the continued development of devices and techniques for per-catheter treatment of ASD and other septal defects in the years to come. PMID:9396853

  18. 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.

  19. 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

  20. Unintentional epidural placement of a thoracic paravertebral catheter inserted using an ultrasound-guided technique: a case report.

    PubMed

    Yoshida, Takayuki; Shimizu, Hiroki; Furutani, Kenta; Baba, Hiroshi

    2016-08-01

    This is the first case report describing the epidural misplacement of an infusion catheter, which was intended to be located in the thoracic paravertebral space using an ultrasound-guided technique. The patient was a 57-year-old female undergoing a laparoscopy-assisted left partial nephrectomy. Before surgery, a Tuohy needle was inserted into the paravertebral space at the left ninth intercostal space using an in-plane transverse ultrasound-guided approach in the lateral-to-medial direction. A catheter was then threaded into the paravertebral space through the needle. Subsequently, the catheter position was secured, although ultrasound-guided confirmation of air injected through the catheter into the paravertebral space was not obtained. Twenty milliliters of 0.5 % levobupivacaine was administered through the catheter at both the initiation and conclusion of surgery. A neurologic examination following surgery revealed paraplegia, along with sensory deficits in the bilateral T3-S5 dermatome. The motor dysfunction in the lower extremities lasted 7 h, and the sensory block lasted 13.5 h. Postoperative radiologic confirmation of the catheter position concomitant with the spread of radiopaque dye revealed that the tip of the catheter was lying in the epidural space. Unless precise attention is paid to detection of the catheter tip location, a thoracic paravertebral catheter can enter into the epidural space even under ultrasound guidance. PMID:27040105

  1. A novel guide catheter enabling intracranial placement.

    PubMed

    Hurley, Michael C; Sherma, Arun K; Surdell, Daniel; Shaibani, Ali; Bendok, Bernard R

    2009-11-15

    We describe use of a novel guide, catheter with a soft and pliable, 6-cm or 12-cm distal segment that enables distal, including intracranial, placement--the Neuron guide catheter (Penumbra, San Leandro, CA)--in the treatment of 11 cases with a range of neuroendovascular lesions. We were able to advance the Neuron guide catheter to the intended level in each case and suffered no complications related to catheter spasm, dissection, thrombosis or thromboembolism. PMID:19670314

  2. Hemodialysis Catheter Care: Identifying Best Cleansing Agents.

    PubMed

    Stupak, Deborah M; Trubilla, Jennifer A; Groller, Susann R

    2016-01-01

    In an attempt to create a standardized resource for cleansing both non-tunneled and tunneled hemodialysis catheters, it was discovered that all disinfectants are not compatible with all catheters. This article describes the process used to identify best practices for hemodialysis catheter care and steps taken to standardize practice throughout a hospital network. Standardized evidence-based practice preserves the integrity of catheters while allowing nurses to provide quality care to patients. PMID:27254970

  3. 21 CFR 876.5090 - Suprapubic urological catheter and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    .... This generic type of device includes the suprapubic catheter and tube, Malecot catheter, catheter punch... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Suprapubic urological catheter and accessories... Suprapubic urological catheter and accessories. (a) Identification. A suprapubic urological catheter...

  4. An Electromagnetic Catheter Blood Flow Meter of Minimal Lateral Dimensions*

    PubMed Central

    Kolin, Alexander

    1970-01-01

    A method is described to reduce the lateral dimensions of an electromagnetic catheter blood flow meter to the maximum possible extent. To achieve this, the magnetic field is generated by a magnet placed outside the subject. Thus, only the electrodes and a minimal supporting structure have to be introduced into the blood vessel to pick up the electromotive force induced in the blood streaming at right angles to the magnetic field. To suppress induction of a transformer electromotive force in the electrode leads, the latter form a co-axial lead system of small gauge. One electrode is at the tip of the insulated external tube of this lead system (a gauge no. 28 hypodermic tube) and is insulated from it. The other electrode is a bare section of the external tube about 2 cm from its tip. The tube is bent at an angle of about 30° just below the second electrode. Thus, this bent section places the two electrodes near two diametrically opposite wall sections of the blood vessels after insertion of the fine catheter via a hollow catheter through a branch blood vessel into the main vessel. The catheter is rotated until the plane containing the bent section is perpendicular to the magnetic field. The potential difference between the two electrodes measures the volume rate of flow through the blood vessel. This principle can be used to monitor the flow in the major blood vessels as well as in their branches. Catheter flow meters down to about 0.5 mm in external diameter have thus been made and much smaller ones can be made without excessive difficulty. Images PMID:5273901

  5. 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.

  6. 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

  7. Association Between Rectus Abdominis Denervation and Ventilation Dysfunction in Patients with Amyotrophic Lateral Sclerosis

    PubMed Central

    Zhang, Hua-Gang; Zhang, Shuo; Xu, Ying-Sheng; Zhang, Nan; Fan, Dong-Sheng

    2016-01-01

    Background: Spontaneous potentials in electromyography (EMG) of paraspinal muscles are associated with diaphragm denervation and, therefore, poor respiratory function in amyotrophic lateral sclerosis (ALS) is understandable. EMG changes in the rectus abdominis (RA) display an effect similar to those in paraspinal muscles with respect to the function of lower motor neurons in the thoracic spinal cord. The RA denervation was examined to determine its association with ventilation dysfunction in ALS. Methods: We collected the clinical data of 128 patients with sporadic ALS in Department of Neurology of Peking University Third Hospital from 2009 to 2013. EMG, Revised ALS Functional Rating Scale (ALSFRS-R) and forced vital capacity (FVC) were performed in all patients and the differences in the EMG changes in RA between those with and without FVC ≥ 80% were analysed. Results: The mean FVC value was 83.4% ± 17.1% (range: 45%–131%) of the predicted value. A total of 79 patients displayed FVC ≥80%, and 49 patients displayed FVC <80%. Compared with the patients displaying a normal FVC (60/79, 75.9%), spontaneous activity in RA was significantly different among those patients displaying an FVC <80% (47/49, 95.9%). In addition, spontaneous potentials in RA were more frequently detected in patients exhibiting dyspnea (32/33, 97.0%) than in patients without dyspnea (75/95, 78.9%). Conclusion: Spontaneous potentials in RA are associated with ventilation dysfunction and dyspnea in ALS patients. PMID:27569232

  8. Closure and augmentation of bladder exstrophy using rectus abdominis musculo-peritoneal flap

    PubMed Central

    Agarwal, P.

    2011-01-01

    Background: The aim of this study was to investigate the efficacy of the rectus abdominis myo-peritoneal flap (RAMP) technique for the closure and augmentation of small, non-elastic, non-compliant bladder exstrophies. Materials and Methods: The RAMP technique was used in three boys with bladder exstrophy who presented late with small, non-elastic, non-compliant bladder. The clinical outcome, imaging, cystoscopy, biochemical and microbiological studies were assessed during a follow-up of 36 months. Results: Bladder closure and augmentation was achieved in all patients without any complications. There were no urinary tract infections, metabolic problems or electrolyte disturbances and the kidney function remained normal in all patients. Radiography confirmed intact function and anatomy of the urinary tract and cystoscopy showed complete coverage of the inner peritoneal layer of RAMP with uroepithelium. No stone formation or mucous production was detected. Conclusions: The RAMP technique is a good alternative for closing bladder exstrophies and achieves an increase in bladder capacity and compliance. The technique is indicated in the closure of large bladder defects, bladder exstrophies with small, inelastic, non-compliant bladder remnants and failed primary closures. PMID:22279277

  9. Patency and Complications of Translumbar Dialysis Catheters.

    PubMed

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

    2015-01-01

    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. 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. 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/minute) 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. This study data suggest that TLDC might serve as a safe, alternate access for dialysis patients in short-term who have exhausted conventional vascular access. PMID:25800550

  10. Minimizing the complications associated with migrating catheters.

    PubMed

    Billington, A; Crane, C; Jownally, S; Kirkwood, L; Roodhouse, A

    2008-11-01

    This article seeks to explore the clinical practice of urinary catheter fixation. Traditionally, this area of practice has been neglected and nurses are familiar with tension lesions and dermal problems associated with inappropriate or incorrect urinary catheter fixation. A novel solution to this problem is a catheter fixation device. This device secures the catheter safely, making clinical practice safer and the experience of catheterization more tolerable for the patient. An example of a urinary catheter fixation device available in the UK is Bard's StatLock. PMID:18981965

  11. 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. PMID:26756600

  12. Cryo-Balloon Catheter Localization Based on a Support-Vector-Machine Approach.

    PubMed

    Kurzendorfer, Tanja; Mewes, Philip W; Maier, Andreas; Strobel, Norbert; Brost, Alexander

    2016-08-01

    Cryo-balloon catheters have attracted an increasing amount of interest in the medical community as they can reduce patient risk during left atrial pulmonary vein ablation procedures. As cryo-balloon catheters are not equipped with electrodes, they cannot be localized automatically by electro-anatomical mapping systems. As a consequence, X-ray fluoroscopy has remained an important means for guidance during the procedure. Most recently, image guidance methods for fluoroscopy-based procedures have been proposed, but they provide only limited support for cryo-balloon catheters and require significant user interaction. To improve this situation, we propose a novel method for automatic cryo-balloon catheter detection in fluoroscopic images by detecting the cryo-balloon catheter's built-in X-ray marker. Our approach is based on a blob detection algorithm to find possible X-ray marker candidates. Several of these candidates are then excluded using prior knowledge. For the remaining candidates, several catheter specific features are introduced. They are processed using a machine learning approach to arrive at the final X-ray marker position. Our method was evaluated on 75 biplane fluoroscopy images from 40 patients, from two sites, acquired with a biplane angiography system. The method yielded a success rate of 99.0% in plane A and 90.6% in plane B, respectively. The detection achieved an accuracy of 1.00 mm±0.82 mm in plane A and 1.13 mm±0.24 mm in plane B. The localization in 3-D was associated with an average error of 0.36 mm±0.86 mm. PMID:26978663

  13. Calcium phosphate in catheter encrustation.

    PubMed

    Cox, A J; Harries, J E; Hukins, D W; Kennedy, A P; Sutton, T M

    1987-02-01

    Encrusted catheters from nine female patients were the source of samples of deposits which were examined by X-ray diffraction, atomic absorption spectroscopy, infra-red spectroscopy and extended X-ray absorption fine structure (EXAFS) spectroscopy. In eight samples the only crystalline phase which could be clearly distinguished by X-ray diffraction was ammonium magnesium orthophosphate hexahydrate, NH4MgPO4 X 6H2O, which occurs naturally as the mineral struvite. However, atomic absorption spectroscopy revealed an appreciable concentration of calcium in all samples. Calcium phosphates have previously been detected in catheter deposits. Infra-red and EXAFS spectra were consistent with the calcium phosphate being present as a poorly crystalline hydroxyapatite. Thus the deposits appear to consist of a mixture of crystalline struvite and a form of hydroxyapatite which is not fully crystalline. PMID:3030487

  14. Internal Oblique and Transversus Abdominis Muscle Fatigue Induced by Slumped Sitting Posture after 1 Hour of Sitting in Office Workers

    PubMed Central

    Waongenngarm, Pooriput; Rajaratnam, Bala S.; Janwantanakul, Prawit

    2015-01-01

    Background Prolonged sitting leads to low back discomfort and lumbopelvic muscle fatigue. This study examined the characteristics of body perceived discomfort and trunk muscle fatigue during 1 hour of sitting in three postures in office workers. Methods Thirty workers sat for 1 hour in one of three sitting postures (i.e., upright, slumped, and forward leaning postures). Body discomfort was assessed using the Body Perceived Discomfort scale at the beginning and after 1 hour of sitting. Electromyographic (EMG) signals were recorded from superficial lumbar multifidus, iliocostalis lumborum pars thoracis, internal oblique (IO)/transversus abdominis (TrA), and rectus abdominis muscles during 1 hour of sitting. The median frequency (MDF) of the EMG power spectrum was calculated. Results Regardless of the sitting posture, the Body Perceived Discomfort scores in the neck, shoulder, upper back, low back, and buttock significantly increased after 1 hour of sitting compared with baseline values (t(9) = −11.97 to −2.69, p < 0.05). The MDF value of the EMG signal of rectus abdominis, iliocostalis lumborum pars thoracis, and multifidus muscles was unchanged over time in all three sitting postures. Only the right and left IO/TrA in the slumped sitting posture was significantly associated with decreased MDF over time (p = 0.019 to 0.041). Conclusion Prolonged sitting led to increased body discomfort in the neck, shoulder, upper back, low back, and buttock. No sign of trunk muscle fatigue was detected over 1 hour of sitting in the upright and forward leaning postures. Prolonged slumped sitting may relate to IO/TrA muscle fatigue, which may compromise the stability of the spine, making it susceptible to injury. PMID:27014491

  15. Proteasome activities in the rectus abdominis muscle of young and older individuals.

    PubMed

    Bossola, Maurizio; Pacelli, Fabio; Costelli, Paola; Tortorelli, Antonio; Rosa, Fausto; Doglietto, Giovan Battista

    2008-08-01

    Sarcopenia is one of the most striking effects of age, the causes and the pathogenic mechanisms being largely unknown. Unfortunately, there is limited information on the effect of aging on muscle protein breakdown in basal conditions. The present study aimed at investigating if skeletal muscle ubiquitn mRNA levels and proteasome activities vary with age in healthy individuals. Ub mRNA levels were measured by northern blot analysis whereas proteasome activities were determined by evaluating the cleavage of specific fluorogenic substrates in the rectus abdominis muscle of 14 healthy male individuals. Patients were divided in three groups according to the age: (1) 20-30 years (N = 3); (2) 31-64 years (N = 5); (3) > or = 65 years (N = 6). Quantitation of the ubiquitin mRNA levels (expressed in arbitrary units) (mean (SD) showed no differences among the three groups of age (20-30 years: 1352 +/- 441; 31-64 years: 1324 +/- 439; > or = 65 years: 884 +/- 400; P = 0.33). The correlation between age and muscle ubiquitin mRNA levels was not statistically significant (r = -0.4, P = 0.26). The three proteasome activities, chymotrypsin-like (CTL), trypsin-like (TL) and peptidyl-gutamyl-peptidase (PGP), expressed as nkatal x 10(-3)/mg protein, were similar in the three groups of patients stratified according to the age. There was no correlation between age with either CTL (r = 0.22, P = 0.4), PGP (r = 0.002, P = 0.9), and TL (r = 0.28, P = 0.33) activities. In conclusion, the present study shows that the skeletal muscle proteasome activities do not differ with age in healthy male individuals. PMID:18330717

  16. Use of the rectus abdominis muscle and fascia flap in reconstruction of epispadias/exstrophy.

    PubMed

    Horton, C E; Sadove, R C; Jordan, G H; Sagher, U

    1988-07-01

    Inferiorly based rectus abdominis muscle flaps and fascial flaps have been used to construct a firm abdominal wall without hernias and to provide coverage of the bladder, bladder neck, and proximal urethra in the secondary reconstruction of patients with epispadias/exstrophy complex. They have also been used to produce an elevation of the mons area, which is lacking in the typical exstrophy patient. Rectus fascial flaps have been the mainstay of abdominal closure when wide diastasis of the rectal muscles is present and when the lower abdomen lacks fascial support. We are pleased with the results of utilizing either the rectus muscle or rectus fascia in this complex condition. We have been using fascial flaps for over 10 years in our epispadias/exstrophy closures and abdominal wall strengthening procedures. We have been using bone grafts and the rectus muscle for the construction of a mons for the past 5 years. Although the rectus muscle procedure to cover the bladder and the bladder neck has been in use for only 2 years, we have seen patients with incontinence restored to a continent state; these patients have not been plagued with fistula problems when a neourethra has to be constructed to elongate the phallus. Previous attempts at urethral repair in this area have been successful in the main, but an occasional fistula at the junction between the penile skin and the abdominopubic skin has resulted. Since using the rectus muscle to cover the bladder and bladder neck area, we have not had this problem. Patients with epispadias/exstrophy remain such difficult problems that every advance in technique should be used to improve results.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3391008

  17. Abdominal wall competence after free transverse rectus abdominis musculocutaneous flap harvest: a prospective study.

    PubMed

    Suominen, S; Asko-Seljavaara, S; Kinnunen, J; Sainio, P; Alaranta, H

    1997-09-01

    A prospective study was designed to evaluate the possible changes in abdominal wall strength following free transverse rectus abdominis musculocutaneous (TRAM) flap surgery for breast reconstruction. Twenty-two patients were examined 1 day before surgery, and at 3, 6, and 12 months postoperatively. Trunk muscle strength was measured by the same physiotherapist using an isokinetic dynamometer (Lido Multi Joint II, Loredan Biomedical Inc., Davies, CA). The peak torque and average torque for both flexion and extension at 60 degrees per second angular velocity were recorded from the curves obtained. There was a significant reduction in trunk flexion strength at 3 months postoperatively (peak torque mean, 92% of the preoperative value; p = 0.04), but this was corrected by 6 months (mean, 96%), and improved to 98% by 12 months. The patient's ability to do curled trunk sit-ups was evaluated by the same physiotherapist and graded on a scale from 1 to 6. In 9 of 19 patients the operation had no effect on sit-up performance during follow-up. In 10 of 19 patients there was a reduction of one or two grades at 3 months that did not improve by 12 months. Magnetic resonance imaging of the abdominal wall was performed on 9 patients. The mean area of the upper third of both rectus muscles was measured on the axial images. At 3 months postoperatively the mean area of the upper third of the donor muscle was significantly larger than the contralateral (p = 0.03). There was no difference in size at 6 months, and by 12 months the donor side was smaller. This prospective study shows that harvesting of a free TRAM flap can cause a subclinical reduction in abdominal strength, although this was not noticed by the patients themselves. PMID:9326701

  18. 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

  19. Optimization of dialysis catheter function.

    PubMed

    Gallieni, Maurizio; Giordano, Antonino; Rossi, Umberto; Cariati, Maurizio

    2016-03-01

    Central venous catheters (CVCs) are essential in the management of hemodialysis patients, but they also carry unintended negative consequences and in particular thrombosis and infection, adversely affecting patient morbidity and mortality. This review will focus on the etiology, prevention, and management of CVC-related dysfunction, which is mainly associated with inadequate blood flow. CVC dysfunction is a major cause of inadequate depuration. Thrombus, intraluminal and extrinsic, as well as fibrous connective tissue sheath (traditionally indicated as fibrin sheath) formation play a central role in establishing CVC dysfunction. Thrombolysis with urokinase or recombinant tissue plasminogen activator (rTPA) can be undertaken in the dialysis unit, restoring adequate blood flow in most patients, preserving the existing catheter, and avoiding an interventional procedure. If thrombolytics fail, mainly because of the presence of fibrous connective tissue sheath, catheter exchange with fibrin sheath disruption may be successful and preserve the venous access site. Prevention of CVC dysfunction is important for containing costly pharmacologic and interventional treatments, which also affect patients' quality of life. Prevention is based on the use of anticoagulant and/or thrombolytic CVC locks, which are only partially effective. Chronic oral anticoagulation with warfarin has also been proposed, but its use for this indication is controversial and its overall risk-benefit profile has not been clearly established. PMID:26951903

  20. 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. PMID:24709460

  1. [Perineal soft-tissue reconstruction with vertical rectus abdominis myocutan (VRAM) flap following extended abdomino-perineal resection for cancer].

    PubMed

    Bognár, Gábor; Novák, András; István, Gábor; Lóderer, Zoltán; Ledniczky, György; Ondrejka, Pál

    2012-10-01

    Perineal wound healing problems following extended abdomino-perineal resection of ano-rectal cancer represent a great challenge to the surgeon. Perineal soft-tissue reconstruction with a myocutan flap was thought to reduce surgical wound healing complications. A review of the relevant literature was carried out on perineal soft-tissue reconstruction with rectus abdominis myocutan (VRAM) flap following extended abdomino-perineal rectal resection for cancer. The more commonly used neoadjuvant chemo- and radiotherapy as well as extended surgical radicality resulted in increased perioperative risks, therefore combined procedures between the colorectal and plastic surgical teams are inevitable. This case report illustrates the above trend. PMID:23086826

  2. Tensile set behavior of Foley catheter balloons.

    PubMed

    Joseph, R; Ramesh, P; Sivakumar, R

    1999-01-01

    The removal of indwelling urinary balloon catheters from patients is usually associated with many problems. The problems such as balloon deflation failure; encrustations on balloons, eyes, and lumen; and catheter associated infections are widely discussed in the literature. The tensile set exhibited by the catheter balloon material could also play a role and further complicate the removal process. This article addresses this issue by comparing the tensile set behavior of the balloon material from three commercially available Foley catheters. The balloon materials were subjected to aging in synthetic urine at 37 degrees C for 28 days to simulate clinical conditions. The deflation time of catheter balloons aged in similar conditions were also measured. It was found that different brands of catheters exhibited statistically significant differences in their properties. The tensile set data of the aged samples could be correlated with the deflation time of the balloons. The clinical significance of the tensile set is also highlighted. PMID:10029146

  3. Position Control of Motion Compensation Cardiac Catheters.

    PubMed

    Kesner, Samuel B; Howe, Robert D

    2011-07-21

    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

  4. 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

  5. Translumbar placement of paired hemodialysis catheters (Tesio Catheters) and follow-up in 10 patients

    SciTech Connect

    Biswal, Rajiv; Nosher, John L.; Siegel, Randall L.; Bodner, Leonard J.

    2000-01-15

    For lack of other suitable access, 10 consecutive patients received paired hemodialysis catheters for long-term hemodialysis using a translumbar approach to the inferior vena cava (IVC). All attempts were successful. Five paired catheters were placed using the single-puncture technique, and five using the dual-puncture technique. Catheters were in place for a total of 2252 catheter days. The average duration of catheter placement was 250 days (range 30-580 days). All catheters were functioning up to the time the study was completed or the patient died. The most common complication was partial dislodgment of the catheter in 3 of 23 catheters (13%), all occurring in obese patients. One episode of retroperitoneal hemorrhage was noted in a patient having the single-access technique. There were no episodes of infection or IVC thrombosis.

  6. 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,...

  7. 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,...

  8. 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,...

  9. 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,...

  10. 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,...

  11. 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.

  12. Tandem balloon catheter for coronary angioplasty.

    PubMed

    Finci, L; Meier, B; Steffenino, G; Rutishauser, W

    1986-01-01

    The Tandem balloon catheter is a triple lumen steerable catheter for coronary angioplasty with two separately inflatable balloons of different diameters. Indications and results of 26 consecutive patients treated with a Tandem balloon catheter are reviewed. Adequate distal pressure measurements were obtained in 71% of the cases. In ten patients, the Tandem balloon catheter was selected for two stenoses in different segments of the same coronary artery. Angioplasty was successful for all lesions in five and for at least the strategic lesions in five patients (in one only after changing to a single-balloon catheter). In the seven patients with stenoses in two different coronary arteries of various calibers, angioplasty was successful for both vessels in three and for one vessel in four patients. In the six patients with a very tight stenosis, where the Tandem balloon catheter was selected to predilate with the small balloon, the procedure was technically successful in all, but there was a myocardial infarction in one patient. In the three patients with a chronic total occlusion, where the stiffness of the Tandem balloon was the reason for selection, one recanalization was successful. The Tandem balloon catheter provides a handy tool for complex coronary angioplasty. It offers comparable ease in manipulation and pressure transmission and may save time, money, and radiation exposure by avoiding catheter exchanges. PMID:2949848

  13. 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....

  14. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 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....

  15. 21 CFR 874.4175 - Nasopharyngeal catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 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....

  16. 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....

  17. 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....

  18. Spontaneous Intravesical Knotting of Urethral Catheter

    PubMed Central

    2011-01-01

    Infant feeding tubes (IFT) have been universally used as urethral catheters in neonates and children for several decades. Though generally a safe procedure, it may cause significant morbidity if the catheter spontaneously knots inside the bladder. We report this complication in three children including a neonate. PMID:22953288

  19. Use of ultrasound guidance to remove entrapped stimulating popliteal catheters

    PubMed Central

    Hulin, James B.; Daniels, Don J.

    2016-01-01

    Peripheral nerve catheters are beneficial for continuous pain relief following surgery or trauma to an extremity. However, spring-loaded peripheral nerve catheters can become uncoiled and entrapped, resulting in difficulty in catheter removal. We present two cases where ultrasound guidance provided significant assistance in the safe removal of entrapped peripheral nerve catheters without neurologic sequelae. One of the catheters was adhered to nearby tissue, and one had become uncoiled and anchored in place by the distal tip. Guidelines for the safe management of entrapped catheters are suggested, including the use of saline injections through the catheter under ultrasound guidance to assist in the evaluation and removal of the catheters. PMID:27034548

  20. In vivo quantitative assessment of catheter patency in rats

    PubMed Central

    Yang, Jun; Maarek, Jean-Michel I; Holschneider, Daniel P

    2014-01-01

    Summary Formation of fibrin sleeves around catheter tips is a central factor in catheter failure during chronic implantation, and such tissue growth can occur despite administration of anticoagulants. We developed a novel method for monitoring catheter patency. This method recognizes the progressive nature of catheter occlusion, and tracks this process over time through measurement of changes in catheter resistance to a standardized 1 mL bolus infusion from a pressurized reservoir. Two indirect measures of catheter patency were used: (a) reservoir residual pressure and (b) reservoir discharge time. This method was applied to the study of catheter patency in rats comparing the effect of catheter material (silastic, polyurethane, Microrenathane™), lock solution (heparin, heparin/dexamethasone) and two different cannulation sites (superior vena cava via the external jugular vein, inferior vena cava via the femoral vein). Our findings reveal that application of flexible smaller-size silastic catheters and a dexamethasone lock solution resulted in prolonged catheter patency. Patency could be maintained over nine weeks with the femoral vein catheters, compared with five weeks with the external jugular vein catheters. The current method for measuring catheter patency provides a useful index for the assessment of tissue growth around the catheter tip. The method also provides an objective and quantitative way of comparing changes in catheter patency for different surgical methods and catheter types. Our method improves on the conventional method of assessing catheter occlusion by judging the ability to aspirate from the catheter. PMID:16004684

  1. 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.

  2. Nonoperative replacement of a jejunostomy feeding catheter.

    PubMed

    Stogdill, B J; Page, C P; Pestana, C

    1984-02-01

    Nonoperative replacement of lost or occluded jejunal feeding catheters proved successful in 8 of 11 patients. This technique is recommended as a nonoperative means of replacing a needle catheter jejunostomy when it is accidentally lost or becomes occluded. Adherence to sterile technique and gentle advancement of the guide wire to avoid injury to the bowel are important. Since the technique depends on an established tract between the skin and the bowel, catheter replacement should not be attempted when the feeding catheter is lost or becomes occluded in the immediate postoperative period. In addition, confirmation of catheter patency and intraluminal position with sterile water-soluble contrast medium is critical to the safe use of this technique. PMID:6421183

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. Catheter associated infections in hemodialysis patients.

    PubMed

    Sanavi, Suzan; Ghods, Ahad; Afshar, Reza

    2007-03-01

    Hemodialysis catheter related infections (HCRI) are one of the major causes of increasing mortality, morbidity and cost of therapy in hemodialysis patients. Prevention of HCRI requires the identification of predisposing risk factors. To determine the frequency of HCRI risk factors, we studied 116 patients (54% male, mean age of 49.5+/-16 years) patients with HCRI between 2003-2004. Forty one percent of the patients were diabetic. There was a history of previous catheter placement and infection in 41% and 32% of patients, respectively. Pathogenic organisms isolated from blood cultures included Staphylococcus-aureus 42%, Coagulase-negative Staphylococci 20%, E. Coli 19%, Enterococci 7%, Streptococcus D 7%, Pseudomonas aeruginosa 4%, and Klebsiella 1%. Bacterial resistance to vancomycin and amikacin was present in 7% and 4% of the cases, respectively. Hemodialysis catheter related blood borne infections comprised 67% of the total blood-borne infections in our hospital. No significant statistical association was found between HCRI and age, gender, diabetes mellitus, serum albumin level <30 g/L, leukocyte count, erythrocyte sedimentation rate, anatomical location of catheter, mean duration of antibiotic therapy, mean catheter duration, frequency of hemodialysis sessions, pathogenic organisms, and history of previous catheter infection. We conclude that the prevalence of pathogenic organisms of HCRI were similar to previous studies. However, bacterial resistance to antibiotics was low. The mean duration of catheter usage was longer than previously reported. PMID:17237890

  9. 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

  10. [Catheter-associated urinary tract infections].

    PubMed

    Liedl, B

    2015-09-01

    In patients with indwelling urethral catheters significant bacteriuria develops within 4 weeks of indwelling time in practically 100% of the cases. Catheter encrustation and obstruction can occur in approximately 40% of patients. Symptomatic ascending urinary tract infections, urethral complications and urolithiasis can occur in significant numbers in the long term. Regular educational and surveillance programs in nursing homes, hospitals and in home care are important to instruct personnel in hygiene procedures, to learn the indications for catheterization, to keep the indwelling time of catheters as short as possible, to detect any complications early and to initiate appropriate diagnostics and therapy by the urologist. PMID:26275988

  11. [Pericardial tamponade due to malpositioned cooling catheter].

    PubMed

    Löwer, C; Niedeggen, A; Janssens, U

    2016-05-01

    The case of a 60-year-old woman who received prehospital cardiopulmonary resuscitation for cardiopulmonary arrest is reported. In the hospital, coronary angiography was performed including percutaneous coronary intervention of the left anterior descending artery and placement of a cooling catheter. After approximately 30 min, severe hypotension progressively developed. Pericardial tamponade was identified and treated by pericardial puncture. Clear fluid was drained. Transesophageal echocardiography detected a perforation of the right atrial roof by the cooling catheter. Open surgery was performed immediately and the catheter was removed. The patient was discharged from the hospital without any further complication 10 days later. PMID:26065384

  12. Retained Urethral Catheter Secondary to Placement in Proximal Ureter

    PubMed Central

    Sharda, Rajan

    2016-01-01

    We present an unusual complication secondary to indwelling urethral catheter placement. Routine catheter placement by the obstetrics team in a postpartum female leads to retention of the catheter and inability of its removal by both the obstetrics and urology teams. Although a retained urinary catheter is relatively common, inability to remove a catheter secondary to placement inadvertently into a ureter is extremely rare. In this paper we will discuss the options in removing a retained catheter and present our case of a retained catheter secondary to placement within the right proximal ureter. PMID:27144050

  13. Dialysis catheter fibrin sheath stripping: a useful technique after failed catheter exchange.

    PubMed

    Mohamad Ali, Af; Uhwut, E; Liew, Sk

    2012-01-01

    Fibrin sheath formation around long-term haemodialysis catheter is a common cause of failed dialysis access. Treatment options include pharmacological and mechanical methods. This paper reports a case of failed dialysis access due to fibrin sheath encasement. Pharmacologic thrombolysis, mechanical disruption using guide wire and catheter exchange had failed to address the issue. Eventually, fibrin sheath stripping using the loop snare technique was able to successfully restore the catheter function. PMID:22970064

  14. 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

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

    PubMed

    Lorente, Leonardo

    2016-05-01

    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

  16. Stuck suction catheter in endotracheal tube.

    PubMed

    Raut, Monish S; Joshi, Sandeep; Maheshwari, Arun

    2015-02-01

    Endotracheal tube (ETT) suction is essential to clear secretions so that airway patency can be maintained. Stuck suction catheter in ETT is an uncommon event, and it can be dangerous in patients with difficult airway cases. PMID:25722554

  17. Stuck suction catheter in endotracheal tube

    PubMed Central

    Raut, Monish S.; Joshi, Sandeep; Maheshwari, Arun

    2015-01-01

    Endotracheal tube (ETT) suction is essential to clear secretions so that airway patency can be maintained. Stuck suction catheter in ETT is an uncommon event, and it can be dangerous in patients with difficult airway cases. PMID:25722554

  18. 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

  19. Catheter Ablation of Arrhythmia During Pregnancy.

    PubMed

    Driver, Kevin; Chisholm, Christian A; Darby, Andrew E; Malhotra, Rohit; Dimarco, John P; Ferguson, John D

    2015-06-01

    Cardiac arrhythmia as a complication of pregnancy can be problematic to maternal health and fetal life and development. Catheter ablation of tachyarrhythmias during pregnancy has been successfully performed in selected patients with limited experience. Techniques to limit maternal and fetal radiation exposure, including intracardiac echo and electroanatomic mapping systems, are particularly important in this setting. Specific accommodations are necessary in the care of the gravid patient during catheter ablation. PMID:25828853

  20. Mechanical properties and imaging characteristics of remanufactured intravascular ultrasound catheters.

    PubMed

    Hoffmann, R; Haager, P; Mintz, G; Klues, H

    2000-02-01

    Intravascular ultrasound (IVUS) as a routine device in interventional cardiology is handicapped by its high price. 19 factory-made, 'remanufactured' IVUS catheters which consist of sterilized, used phased-array IVUS transducers inserted into a new catheter shaft were compared with 23 new IVUS catheters. 3 mechanical and 4 imaging characteristics were assessed on a 5 point scale (1 = unacceptable, 5 = excellent). Mechanical as well as imaging properties of 'remanufactured' IVUS catheter were comparable to new catheters with excellent ratings for each of the evaluated characteristics in 38 to 94% of 'remanufactured' catheters and 50 to 96% of new catheters. The initial failure rate for 'remanufactured' IVUS catheters was 31.6% vs. 4.3% for new catheters (P < 0.05). Overall failure rate was 47.3% for "remanufactured" catheters vs. 8.7% for new catheters (P < 0.05). The failure was due to an electronic connecting problem occurring during mechanical stress to the IVUS catheter. In conclusion, 'remanufactured' IVUS catheters offer mechanical and imaging characteristics which are comparable to new catheters. Improvements in the 'remanufacturing' process to resolve the high rate of electronic connecting problems may make this a promising approach to substantially lower the price of IVUS catheters. PMID:10832621

  1. Haemolyzed samples: responsibility of short catheters.

    PubMed

    Raisky, F; Gauthier, C; Marchal, A; Blum, D

    1994-01-01

    The haemolysis of blood samples is a source of error in the electrolytic and enzymatic determination in clinical biochemistry. This circumstance seems dependent on the material used for the venepuncture. In this study we compared three kinds of material in 350 patients who were sampled in the emergency department. This randomized study compared the haemolysis of blood samples collected with stainless steel needles and short catheters, either Teflon FEP (Cathlon Critikon) or polyurethane Vialon (Insyte Becton-Dickinson). Quantification of hemolysis was performed by assay of the optical density of plasma haemoglobin. Results were analysed, after verification of the randomization, by one-way analysis of variance by ranks. This study demonstrated a highly significant relation between occurrence of haemolysis and the sampling material, used according to its technical obligations. Haemolysis occurred frequently when short catheters were used in 42% and 55% of cases with the Teflon and Vialon catheters, respectively. Haemolysis was much less frequent with stainless steel needles (12%). This difference was even more marked for haemoglobin levels above 1.5 milligrams of plasma, where the incidence was 4.2%, 9% and 30%, respectively, for the stainless steel needles, the Teflon catheter and the Vialon catheter. This study induced our emergency department to take more blood samples with a needle, even if an infusion was to be given subsequently, or to take them using a Teflon catheter. PMID:7840428

  2. Magnetocardiographically-guided catheter ablation.

    PubMed

    Fenici, R R; Covino, M; Cellerino, C; Di Lillo, M; De Filippo, M C; Melillo, G

    1995-12-01

    After more than 30 years since the first magnetocardiographic (MCG) recording was carried out with induction coils, MCG is now approaching the threshold of clinical use. During the last 5 years, in fact, there has been a growing interest of clinicians in this new method which provides an unrivalled accuracy for noninvasive, three-dimensional localization of intracardiac source. An increasing number of laboratories are reporting data validating the use of MCG as an effective method for preoperative localization of arrhythmogenic substrates and for planning the best catheter ablation approach for different arrhythmogenic substrates. In this article, available data from literature have been reviewed. We consider the clinical use of MCG to localize arrhythmogenic substrates in patients with Wolff-Parkinson-White syndrome and in patients with ventricular tachycardia in order to assess the state-of-the-art of the method on a large number of patients. This article also addresses some suggestions for industrial development of more compact, medically oriented MCG equipments at reasonable cost. PMID:10159774

  3. 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

  4. 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. PMID:25978469

  5. Strategies for the control of catheter encrustation.

    PubMed

    Stickler, D J; Evans, A; Morris, N; Hughes, G

    2002-06-01

    Two general strategies have been adopted to develop catheter materials that resist encrustaion by bacterial biofilms: (a) the incorporation of antimicrobial agents into the polymers and (b) the production of materials with surface properties which prevent the adherence of bacterial cells. Our experience to develop non-adherent surfaces which abstracts design from nature is reported. Compounds based on 2-methacryloloxyethylphosphorylcholine co-polymerised with long-chain alkyl methacrylates have been produced which have structural and surface properties similar to those of the outer membranes of erythrocytes. These PC-coatings have been applied onto catheter base materials where they produce polar surfaces that are extremely hydrophilic. In experiments using a laboratory model of the catheterised bladder we found that the PC-coatings did not reduce colonisation of latex or silicone catheters by crystalline Proteus mirabilis biofilm. There were no significant difference between the amounts of calcium and magnesium salts deposited on coated and non-coated catheters. In a further set of experiments the PC-coatings did not significantly increase the mean times for which catheters drained freely. In a parallel clinical study, the performance of PC-coated ureteral stents was investigated. Scanning electron microscopy and bacteriological analysis on 44 PC-coated stents that had been implanted in patients for 12-week periods and 28 control stents suggested that the PC-coated devices were less vulnerable to encrustation and colonisation by bacterial biofilm than normal stents. It was of interest that in contrast to encrusted catheters, urease producing species such as P. mirabilis were rarely isolated from the stents. The main organisms colonising the stents were enterococci and coagulase-negative staphylococci. These results suggest that the mechanisms of catheter and stent encrustation may be different and require different strategies for control. PMID:12135840

  6. Conversion of Non-Tunneled to Tunneled Hemodialysis Catheters

    SciTech Connect

    Ha, Thuong G. Van Fimmen, Derek; Han, Laura; Funaki, Brian S.; Santeler, Scott; Lorenz, Jonathan

    2007-04-15

    Purpose. To determine the safety and efficacy of conversion of non-tunneled (temporary) catheters to tunneled catheters in hemodialysis patients. Methods. A retrospective review of 112 consecutive conversions in 111 patients was performed over a period of 4 years. Fourteen patients were lost to follow-up. The remaining 97 patients had clinical follow-up. Temporary catheters were converted to tunneled catheters utilizing the same internal jugular venotomy sites and a modified over-the-wire technique with use of a peel-away sheath . Follow-up clinical data were reviewed. Results. Technical success was achieved in all 112 procedures. None of the 97 patients with follow-up suffered early infection within 30 days. The total number of follow-up catheter days was 13,659 (range 2-790). Cases of confirmed and suspected bacteremia requiring catheter removal occurred at a frequency of 0.10 per 100 catheter days. Suspected catheter infection treated with antibiotics but not requiring catheter intervention occurred at a frequency of 0.04 per 100 catheter days. Frequency of all suspected or confirmed infections was 0.14 per 100 catheter days. Catheter interventions as a result of poor blood flow, inadvertent removal, catheter fracture, or kinking occurred at a rate of 0.18 per 100 catheter days. Life table analysis revealed primary patency rates of 86%, 64%, and 39% at 30 days, 90 days, and 180 days, respectively. Conclusion. Conversion of temporary catheters to tunneled catheters using the pre-existing venotomy sites is safe and has low rates of infection and malfunction. These rates are comparable to previously published rates for tunneled catheters placed de novo and tunneled catheter exchanges.

  7. [Swan Ganz catheter. Experts opinion].

    PubMed

    Cohen Arazi, Hernán; Nani, Sebastián; Giorgi, Mariano; Guardiani, Fernando; Caturla, Nicolás; Benzadón, Mariano

    2014-01-01

    Investigators have raised doubts as to the safety of the Swan Ganz catheter (SGC). In order to define the point of view of cardiologists in our country, the Argentine Society of Cardiology's Emergency Council organized a meeting to analyze their views in different settings (non-cardiac surgery, cardiac surgery, acute coronary syndromes and heart failure) using the RAND-UCLA appropriateness method. A detailed review with the scientific evidence was sent to the experts in cardiology prior to the meeting in the SAC auditorium where the panellists selected the clinical variables create the specific situations. These hypothetic situations were resent to the panellists at a second stage for their individual evaluation, rating the benefit-to-harm ratio of the procedure on a scale of 1 to 9 (1 meant that the expected harms greatly outweighed the expected benefits, and 9 that the expected benefits greatly outweighed the expected harms, 5 could mean either that the harms and benefits were roughly equal). Two experts analyzed the results, describing the agreement/disagreement ratio. Finally, each indication was classified as "appropriate" "uncertain" or "inappropriate" ,for the procedure in accordance with the panelists' median score: median scores in the 1-3 range were classified as inappropriate, those in the 4-6 range as uncertain, and those in the 7-9 range as appropriate. We observed high disagreement rates in SGC indications between cardiologists. However, the panelists were in favor of SGC use when situations included shock and myocardial dysfunction, especially in the presence of organic dysfunction. There were some situations when panelists considered SGC not useful, in patients without organ failure. PMID:25188663

  8. Electromyography analysis of the rectus abdominis and external oblique muscles of children 8 to 10 years old.

    PubMed

    Moraes, A C; Bankoff, A D; Pellegrinotti, L L; Moreira, Z W; Galdi, E H

    1995-11-01

    The objective of this work was to study through in the electromyography the upper and lower umbilical rectus abdominis and the anterior and posterior parts of the external oblique muscles of children 8 to 10 years old. The children studied practice artistic and rhythmical gymnastic sports at the training and learning level and the study was made during abdominal exercise in the dorsal decubitus position on the ground and on a board. The children were divided into 2 groups: Group I - ten already trained children; Group II - nineteen learners. The participants in Group I practiced an average of 5 times a week and those in Group II practiced 2 times a week. The exercises analyzed were: on the ground, lifting the legs 30, 20 and 10 cm high with the knees flexed 90 degrees; flexing the trunk while maintaining the legs elevated and the knees flexed; flexing the trunk with homo and heterolateral rotation of the trunk while maintaining the legs elevated and the knees flexed. On the board, flexing the trunk with the knees flexed 90 degrees on top of the board inclined 30, 20 and 10 cm; flexing the trunk with rotation of the trunk homo and heterolateral with the knees flexed on the board inclined 30, 20 and 10 cm. The results showed that the superior umbilical part of the rectus abdominis muscle presented more intense action potential than the inferior-umbilical part; the more intense action potential occurred at the flexing of the trunk and at the flexing of the trunk with homo and heterolateral rotation. The anterior part of the external oblique muscle presented more intense action potential than the posterior part; the more intense action potential occurred at the flexing of the trunk and at the flexing of the trunk with heterolateral rotation. In both of the muscles the more intense action potential occurred between 45 and 60 degrees of flexing the trunk; the children in Group I presented more intense action potential than those in Group II; the exercise of lifting the

  9. How to manage an arterial catheter.

    PubMed

    Parry, Andrew; Higginson, Ray

    2016-03-16

    Rationale and key points This article provides nurses with information on the safe and effective use and management of arterial catheters, the gold standard for accurate blood pressure measurement and routine serial blood gas sampling in critical care. Arterial catheters are used when real-time blood pressure monitoring is required, such as when there is a risk of significant blood loss. ▶ Arterial catheters provide real-time blood pressure monitoring, enabling rapid identification of changes in blood pressure and guiding fluid resuscitation. ▶ Arterial catheters can be used to take blood samples without having to perform multiple arterial or venous punctures. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article will change your practice when managing a patient with an arterial catheter. 2. Any further learning needs you have identified. Subscribers can upload their reflective accounts at: rcni.com/portfolio . PMID:26982866

  10. Catheter-associated urinary tract infections.

    PubMed

    Liedl, B

    2001-01-01

    In the past few years it has been clearly demonstrated that the concept of bacterial biofilm production permits an understanding and provides some explanation of the pathogenesis, diagnosis and treatment of catheter-associated urinary tract infections. This concept describes the colonization of catheter surfaces and the movement of bacteria against the urinary flow. It explains the antibacterial resistance of these matrix-enclosed sessile populations of bacteria. The catheter encrustation can be observed as mineralizing bacterial biofilm. The differentiation in swarming cells exposing a much higher activity of the enzyme urease is responsible for the predominant role of Proteus mirabilis in obstructing encrustations. The guidelines for the prevention of catheter-associated urinary tract infections were developed over the past decades by clinicians and are still valid. They can now be better understood taking into consideration these new theories. As overuse of urethral catheters and non-compliance of their recommended use are still apparent, educational and surveillance programmes are needed to help maintain good standards of care. PMID:11148750

  11. 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.

  12. Stereotactic catheter placement for Ommaya reservoirs.

    PubMed

    Kennedy, Benjamin C; Brown, Lauren T; Komotar, Ricardo J; McKhann, Guy M

    2016-05-01

    Ommaya reservoirs are an important surgical therapy for the chronic intrathecal administration of chemotherapy for patients with leptomeningeal carcinomatosis. Surgical accuracy is paramount in these patients with typically normal sized ventricles, and may be improved with stereotactic guidance. This paper aimed to review a large series of stereotactic Ommaya catheter placements, examining accuracy and complications. We conducted a retrospective review of 109 consecutive adult patients who underwent stereotactic Ommaya catheter placement for leptomeningeal carcinomatosis or central nervous system lymphoma at Columbia University Medical Center, USA, from 1998-2013. The rate of accurate placement in the ventricular system was 99%, with the only poor catheter position due to post-placement migration. The rate of peri-operative complications was 6.4%. Hemorrhagic complications occurred in patients with thrombocytopenia or therapeutic anti-coagulation pre-operatively or during the post-operative period. Use of stereotaxy for catheter placement of Ommaya reservoirs is safe and effective, and should be considered when placing a catheter into non-hydrocephalic ventricles. PMID:26778516

  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. 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.

  15. Left Atrial Anatomy Relevant to Catheter Ablation

    PubMed Central

    Sánchez-Quintana, Damián; Cabrera, José Angel; Saremi, Farhood

    2014-01-01

    The rapid development of interventional procedures for the treatment of arrhythmias in humans, especially the use of catheter ablation techniques, has renewed interest in cardiac anatomy. Although the substrates of atrial fibrillation (AF), its initiation and maintenance, remain to be fully elucidated, catheter ablation in the left atrium (LA) has become a common therapeutic option for patients with this arrhythmia. Using ablation catheters, various isolation lines and focal targets are created, the majority of which are based on gross anatomical, electroanatomical, and myoarchitectual patterns of the left atrial wall. Our aim was therefore to review the gross morphological and architectural features of the LA and their relations to extracardiac structures. The latter have also become relevant because extracardiac complications of AF ablation can occur, due to injuries to the phrenic and vagal plexus nerves, adjacent coronary arteries, or the esophageal wall causing devastating consequences. PMID:25057427

  16. The importance of effective catheter securement.

    PubMed

    Fisher, Jayne

    This article examines the importance of securing/fixing indwelling urinary catheters. The Oxford English dictionary interlinks the two words-'secure' and 'fix'-as having the same meaning. To secure the catheter should not be confused with 'support', whereby the weight of the urine drainage bag is supported with the use of velcro straps or a sleeve. The author introduces the need for the concept of this practice to be at the forefront of nurses' minds in all settings, and this is demonstrated through the use of case studies. Current guidance in this area is reviewed, as well as the problems that can arise when catheters are not secured properly and the available products for health professionals to use. PMID:20948482

  17. Everting (toposcopic) catheter for broad clinical application.

    PubMed

    Shook, D R; Doppman, J L; Cattau, E L; Goldstein, S R

    1986-05-01

    The advanced development of the clinical everting (toposcopic) catheter is described. A detailed discussion of the design and outline of the fabrication techniques are followed by a thorough performance evaluation and summary of the first two clinical applications. The everting element is a low-durometer thermoplastic polyurethane elastomer. Surface treatments include the bonding of a hydrophilic polymeric coating, optimized for lubricity, to the sliding internal surfaces of the catheter. Eversion pressures and infusion/aspiration flow rates have been measured under various conditions and the infusate-in-blood mixing potential investigated. A preliminary assessment is given of the clinical performance of the catheter in the vascular delivery of chemotherapy and standard endoscopic retrograde cholangiopancreatography. PMID:3724105

  18. Catheter-related bacteremia by Cupriavidus metallidurans.

    PubMed

    D'Inzeo, Tiziana; Santangelo, Rosaria; Fiori, Barbara; De Angelis, Giulia; Conte, Viola; Giaquinto, Alessia; Palucci, Ivana; Scoppettuolo, Giancarlo; Di Florio, Viviana; Giani, Tommaso; Sanguinetti, Maurizio; Rossolini, Gian Maria; Spanu, Teresa

    2015-01-01

    Cupriavidus bacteremia is a rare infection and identification of the pathogen is difficult. We present four cases of bacteremia by Cupriavidus metallidurans that were initially identified to the genus level by both Bruker and Vitek matrix-assisted laser desorption ionization-time of flight mass spectrometry and later identified to the species level by 16S rRNA gene sequencing. To our knowledge, these are the first cases of C. metallidurans catheter-related infections. Patients were successfully treated with antibiotic therapy and catheter removal. PMID:25446890

  19. [Phlebitogenicity of venous catheters of Vialon].

    PubMed

    Fassolt, A

    1985-12-01

    During three days 132 surgical patients with postoperative infusion treatment were checked on the frequency of venous reactions in the arms when catheters/cannulas of 4 different materials were used and the outcome compared. A significant result was obtained in connection with the I-cath catheter made of vialon (a polyurethanelike resin polymer) and the L-cath of polyurethane. Phlebitis was decreased to 27.3% resp. 24.2% - approximately half of its usual frequency - when I-cath of polyvinyl-chloride and FEP-teflon vasofix cannulas were applied (both 51.5%). The different predisposing factors of infusion phlebitis are under discussion. PMID:4093198

  20. Ventriculoperitoneal Shunt Peritoneal Catheter Knot Formation

    PubMed Central

    Ul-Haq, Anwar; Al-Otaibi, Faisal; Alshanafey, Saud; Sabbagh, Mohamed Diya; Al Shail, Essam

    2013-01-01

    The ventriculoperitoneal (VP) shunt is a common procedure in pediatric neurosurgery that carries a risk of complications at cranial and abdominal sites. We report on the case of a child with shunt infection and malfunction. The peritoneal catheter was tethered within the abdominal cavity, precluding its removal. Subsequently, laparoscopic exploration identified a knot at the distal end of the peritoneal catheter around the omentum. A new VP shunt was inserted after the infection was healed. This type of complication occurs rarely, so there are a limited number of case reports in the literature. This report is complemented by a literature review. PMID:24109528

  1. Catheter ablation of inappropriate sinus tachycardia.

    PubMed

    Gianni, Carola; Di Biase, Luigi; Mohanty, Sanghamitra; Gökoğlan, Yalçın; Güneş, Mahmut F; Horton, Rodney; Hranitzky, Patrick M; Burkhardt, J David; Natale, Andrea

    2016-06-01

    Catheter ablation for inappropriate sinus tachycardia (IST) is recommended for patients symptomatic for palpitations and refractory to other treatments. The current approach consists in sinus node modification (SNM), achieved by ablation of the cranial part of the sinus node to eliminate faster sinus rates while trying to preserve chronotropic competence. This approach has a limited efficacy, with a very modest long-term clinical success. To overcome this, proper patient selection is crucial and an epicardial approach should always be considered. This brief review will discuss the current role and limitations of catheter ablation in the management of patients with IST. PMID:26310299

  2. Central Venous Access Catheters (CVAC) and Gastrostomy (Feeding) Tubes

    MedlinePlus

    ... Membership Directory (SIR login) Interventional Radiology Central Venous Access Catheters (CVAC) and Gastrostomy (Feeding) Tubes People with ... without surgery by an interventional radiologist. Central Venous Access Catheters (CVAC) A CVAC is a tube that ...

  3. Proteus mirabilis biofilms and the encrustation of urethral catheters.

    PubMed

    Stickler, D; Ganderton, L; King, J; Nettleton, J; Winters, C

    1993-01-01

    Bacterial biofilms were observed on 69 of 75 catheters taken from patients undergoing long-term bladder management. Ten catheters were colonized by pure cultures of Proteus mirabilis. In each of these cases the bacteria formed layers on the catheter surface, underlying encrustations of struvite and hydroxyapatite which partially or completely occluded the catheter lumen. Encrustation was also apparent on catheters colonized by P. mirabilis plus other species, but was rarely seen on catheters colonized by non-urease-producing species. These observations support the hypothesis that catheter encrustation is brought about by the activity of urease-producing biofilms and confirms that the main target in the control of catheter encrustation should be P. mirabilis. PMID:8171763

  4. Reduced intravascular catheter-related infection by routine use of antibiotic-bonded catheters in a surgical intensive care unit.

    PubMed

    Kamal, G D; Divishek, D; Kumar, G C; Porter, B R; Tatman, D J; Adams, J R

    1998-03-01

    We report a comparative analysis of intravascular catheter-related infection before and after routine use of antibiotic-bonded catheters in an intensive care unit. Cefazolin-bonded catheters were placed in patients requiring catheterization for at least 3 days, or with remote infection, standard catheters at other times. One thousand forty-five catheters (259 patients) over 6 months were compared with 801 (236 antibiotic-bonded, 565 standard) catheters (239 patients) the next 6 months. After use of antibiotic-bonded catheters, we found: 1.7% catheters infected versus 3.7% (p = 0.01); catheter-associated bacteremia 0.1% versus 1.3% (p < 0.005); catheter-related infection rate 4.39 versus 10.73 per 1000 patient days (p < 0.005), and 5.06 versus 11.47 per 1000 catheter days (p < 0.01); and cumulative risk of infection decreased (p < 0.005). Antibiotic-bonded catheters were used with more remote infections (52% versus 27%, p < 0.001), had longer indwelling time (4.4 versus 3.1 days, p = 0.0001), and more were inserted over a guide wire (66% vs. 28%, p < 0.001). In conclusion routine use of antibiotic-bonded catheters was associated with a significant reduction in infectious complications. PMID:9572020

  5. Small Bowel Obstruction Due to Suprapubic Catheter Placement.

    PubMed

    Bonasso, Patrick C; Lucke-Wold, Brandon; Khan, Uzer

    2016-07-01

    Suprapubic catheter placement has associated complications such as bowel injury, bladder injury, or bleeding. This case describes the management of an elderly patient who had suprapubic catheter placement complicated by small bowel obstruction. The catheter had continued production of urine. Further patient treatment required abdominal exploration and bowel resection. PMID:27335801

  6. 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...

  7. 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...

  8. 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...

  9. 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...

  10. 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...

  11. 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...

  12. 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...

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 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...

  1. 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...

  2. 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...

  3. Activity of sparfloxacin on Staphylococcus epidermidis attached to plastic catheters.

    PubMed

    Pascual, A; García, I; Ramirez de Arellano, E; Perea, E J

    1995-08-01

    The activity of sparfloxacin on Staphylococcus epidermidis biofilms on different plastic catheters was evaluated. Sparfloxacin showed high bactericidal activity against S. epidermidis biofilms on Vialon and polyvinylchloride catheters. The combination of sparfloxacin with amikacin or rifampicin significantly increased its activity against bacterial biofilms on polyurethane and Teflon catheters. PMID:8522473

  4. 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... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1290 Steerable catheter control system. (a) Identification. A steerable catheter control system is a device that...

  5. 21 CFR 870.1290 - Steerable catheter control system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Steerable catheter control system. 870.1290... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1290 Steerable catheter control system. (a) Identification. A steerable catheter control system is a device that...

  6. 21 CFR 870.1290 - Steerable catheter control system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Steerable catheter control system. 870.1290... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1290 Steerable catheter control system. (a) Identification. A steerable catheter control system is a device that...

  7. 21 CFR 870.1290 - Steerable catheter control system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Steerable catheter control system. 870.1290... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1290 Steerable catheter control system. (a) Identification. A steerable catheter control system is a device that...

  8. 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... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Diagnostic Devices § 870.1290 Steerable catheter control system. (a) Identification. A steerable catheter control system is a device that...

  9. 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...

  10. 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...

  11. 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...

  12. Ultrasound assessment of caudal catheter position in infants.

    PubMed

    Roberts, Stephen A; Galvez, Ignacio

    2005-05-01

    The positioning of caudally inserted epidural catheters is crucial to their effectiveness. However, level assessment can be difficult and time consuming. We report the use of ultrasound to assess the catheter position in three patients aged between 1 and 10 months. The advantages and disadvantages of this technique are discussed in relation to other methods of assessing caudal catheter placement. PMID:15828997

  13. 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...

  14. A comparison of the priming properties of two central venous catheters and one pulmonary artery catheter.

    PubMed

    Sanderson, P M

    1995-01-01

    The time taken to prime the individual lumina of two multilumen central venous catheters (Viggo-Spectramed 14G 20 cm Hydrocath and Vialon 14G 20 cm Deltacath) and one pulmonary artery catheter (Viggo-Spectramed 110 cm 7.5F Pentacath) at flows between 5 ml.h-1 and 99 ml.h-1 is reported. The catheters supplied by different manufacturers but of identical length and gauge have significantly different priming times (p < 0.001). A protocol which may be used to prime the individual lumina of the three catheters studied is described. By means of an in vitro test the accuracy of this protocol is validated. PMID:7702147

  15. 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.

  16. [Drug administration through enteral feeding catheters].

    PubMed

    Goñi Viguria, R; Sánchez Sanz, L; Asiain Erro, M; Baztán Indave, A

    2001-01-01

    Because of easiness and accessibility, the oral route of administration is usually the route of choice for medication delivery, as long as the oral drug form is available and the patients' circumstances allow it.In patients admitted to the intensive care unit this route is frequently altered. This provokes difficulties in swallowing and consequently an enteral feeding catheter must be inserted to supply the patient's nutritional requirements. This catheter is also used for the drug administration, which necessitates opening capsules or crushing pills before dilution. When added to drug-nutrient interactions, this process alters the drug's properties and modifies its pharmacokinetic profile, its pharmacological effect and the intensity of side effects. It can also provoke catheter obstruction. The aim of this study was to establish guidelines for drug administration through enteral feeding catheters. We provide a thorough review of the literature, describe oral drug forms, present a protocol for correct drug administration and provide a guide to the most commonly used drugs in our unit. For each of these drugs we include recommendations on administration and possible alternatives. PMID:11459545

  17. 21 CFR 870.1340 - Catheter introducer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Catheter introducer. 870.1340 Section 870.1340 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... the skin into a vein or artery. (b) Classification. Class II (performance standards)....

  18. 21 CFR 870.1250 - Percutaneous catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Percutaneous catheter. 870.1250 Section 870.1250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... through the skin using a dilator and a sheath (introducer) or guide wire. (b) Classification. Class...

  19. A new catheter system for coronary angioplasty.

    PubMed

    Simpson, J B; Baim, D S; Robert, E W; Harrison, D C

    1982-04-01

    A new catheter system has been designed for percutaneous transluminal coronary angioplasty. An independently movable, flexible-tipped guide wire within the balloon dilation catheter facilitates selection of the involved vessel. This guide wire can be passed slowly and carefully beyond the coronary stenosis, permitting safe advancement of the balloon catheter. After testing in animal and cadaver hearts, this system was used in 53 patients (56 stenoses) with single vessel coronary artery disease, with an overall primary success rate of 64 percent. In the last 41 of these 56 cases, use of a balloon catheter with a smaller deflated diameter increased the success rate to 73 percent. In patients with lesions of the left anterior descending coronary artery, the success rate was 89 percent. Three (6 percent) of the 53 patients had complications during coronary arterial dilation that necessitated emergency coronary arterial bypass graft surgery. There were no procedure-related or late cardiac deaths. During the mean follow-up period of 8 months (range 1 to 21), there were one late death (of noncardiac causes) and no late myocardial infarctions. Clinical status was persistently improved in 31 of the 36 patients who had successful dilation. The remaining five patients experienced restenosis at the angioplasty site and return of angina pectoris within 3 months of dilation. Two of these patients had repeat coronary angioplasty with restoration of asymptomatic status, and three had elective coronary bypass graft surgery. PMID:6461241

  20. 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.

  1. [Candida catheter related-blood stream infection].

    PubMed

    Kadowaki, Masako; Shimono, Nobuyuki

    2014-02-01

    Candida catheter-related bloodstream infection (CRBSI) is a biofilm-related disease, which is usually refractory because antifungals show limited effect. With medical development and increase in number of compromised hosts, CRBSI became more frequent. Candida, which is one of the opportunistic pathogens, ranks the fourth causative organism of bacteremia. The onset of bacteremia is greatly associated with the presence of catheter. Repeated blood cultures and the central venous catheter (CVC) tip culture are done for the definitive diagnosis of Candida CRBSI. Additionally serological examinations such as (1 --> 3)-beta-D-glucan and mannan antigen are also useful for early diagnosis. It is important for the appropriate treatment to remove CVC, which is an artificial contaminated material, and administer antifungals promptly. As to the choice of antifungals, we should also take into account the ability of antibiofilm effect of antifungals as well as immunological state of host including neutropenia, prior administration of azoles, isolated or estimated Candida species, sensitivity against antifungals, administration route, pharmacokinetics (bioavailability, metabolic and excretion pathway, distribution) and drug interaction. As to complication of Candida bacteremia, first we should check endophthalmitis, which occurs frequently and leads to the loss of eyesight, as well as infective endocarditis, arthritis, metastatic infections such as embolic pneumonia and suppurative thrombotic phlebitis of catheter insertion site. Lastly we emphasize that the appropriate treatment based on the character of Candida bacteremia and biofilm leads to favorable prognosis. PMID:24809204

  2. The risks and benefits of suprapubic catheters.

    PubMed

    Yates, Ann

    Suprapubic catheterisation can improve some patients' quality of life but the insertion procedure, as well as changing and managing the catheter, carry risks of infection and other negative patient outcomes. This article highlights the advantages and disadvantages, indications and contraindications, and the potential benefits, so health professionals can understand the relevant issues and assess and inform patients accordingly. PMID:27017651

  3. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) 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...

  4. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) 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...

  5. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) 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...

  6. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) 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...

  7. 21 CFR 882.4100 - Ventricular catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) 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...

  8. Urethral catheters: can we reduce use?

    PubMed Central

    2011-01-01

    Background Indwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection. Methods The efficacy of an intervention programme to improve adherence to recommendations to reduce the use of urethral catheters was studied in a before-after comparison in ten Dutch hospitals. The programme detected barriers and facilitators and each individual facility was supported with developing their own intervention strategy. Outcome was evaluated by the prevalence of catheters, alternatives such as diapers, numbers of urinary tract infections, the percentage of correct indications and the duration of catheterization. The costs of the implementation as well as the catheterization were evaluated. Results Of a population of 16,495 hospitalized patients 3335 patients of whom 2943 were evaluable for the study, had a urethral catheter. The prevalence of urethral catheters decreased insignificantly in neurology (OR 0.93; 95% CI 0.77 - 1.13) and internal medicine wards (OR 0.97; 95% CI 0.83 - 1.13), decreased significantly in surgical wards (OR 0.84; 95% CI 0.75 - 0.96), but increased significantly in intensive care (IC) and coronary care (CC) units (OR 1.48; 95% CI 1.01 - 2.17). The use of alternatives was limited and remained so after the intervention. Duration of catheterization decreased insignificantly in IC/CC units (ratio after/before 0.95; 95% CI 0.78 - 1.16) and neurology (ratio 0.97; 95% CI 0.80 - 1.18) and significantly in internal medicine (ratio 0.81; 95% CI 0.69 - 0.96) and surgery wards (ratio 0.80; 95% CI 0.71 - 0.90). The percentage of correct indications on the day of inclusion increased from 50 to 67% (p < 0.0001). The prevalence of urinary tract infections in catheterized patients did not change. The mean cost saved per 100 patients was € 537. Conclusion Targeted implementation of recommendations from an

  9. Azygos catheter placement as a cause of failure of dialysis.

    PubMed

    Stewart, G D; Jackson, A; Beards, S C

    1993-11-01

    Common complications of venous dialysis catheters include sepsis and accidental removal. Angiographic demonstration of dialysis lines is only rarely requested usually to confirm the presence of clot or stenosis as a cause for poor dialysis flow. Poor flow can also be due to inadvertent placement of the catheter in the azygos system. The use of dialysis catheters with a long venous limb which extends beyond the arterial port may predispose to such placement as their lumen is lateral to the central axis of the catheter. In those patients with poor venous access catheter placement under angiographic control may be helpful. PMID:8258225

  10. 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. PMID:27005500

  11. Prevention of urinary catheter incrustations by acetohydroxamic acid.

    PubMed

    Burns, J R; Gauthier, J F

    1984-09-01

    Acetohydroxamic acid was administered in 5 patients to determine its effect in reducing urinary catheter incrustations. All patients had chronic indwelling catheters that required frequent changes because of severe incrustations and catheter occlusion. Incrustations were analyzed chemically for calcium, magnesium, ammonia nitrogen and phosphorus. The degree of incrustation before and during acetohydroxamic acid therapy was compared in each patient and was decreased significantly (average 81 per cent) during therapy (p less than 0.05). Catheter changes were required less frequently during therapy in all patients. Acetohydroxamic acid is effective in preventing catheter incrustations and should be considered in patients with this problem. PMID:6381758

  12. 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

  13. Interrelationships between meat quality traits, texture measurements and physicochemical characteristics of M. rectus abdominis from Charolais heifers.

    PubMed

    Oury, M P; Picard, B; Briand, M; Blanquet, J P; Dumont, R

    2009-10-01

    Ninety-nine Charolais heifers were used to study the variability of meat quality traits in relation to the physicochemical characteristics of M. rectus abdominis. The heifers of the same trade class were slaughtered at 33months of age (±4months) and 381kg carcass weight (±31kg). Muscle and bone development scores were evaluated before slaughter. Carcass weight, slaughter age and life average daily gain were recorded. Shear force measurements and meat quality traits were evaluated after 14days of aging. Some physicochemical characteristics were measured 24h post-slaughter. Tenderness was correlated with slaughter age (r=-0.31), bone development (r=-0.22) and life average daily gain (r=+0.37). Tenderness was significantly related to total collagen content (r=-0.24), lipid content (r=+0.27) and I myosin heavy chain proportion (r=+0.24). Juiciness was positively correlated with lipid content (r=+0.31) and I myosin heavy chain proportion (r=+0.20). Flavor intensity was correlated with lipid content (r=+0.26) and mean fiber area (r=+0.24). Shear force was correlated with total collagen, lipid and 27K proteasome sub-unit contents. Taking animal characteristics and muscle properties together in a multiple regression analysis increased the explained tenderness variability to 33%. The independent variables listed in order of importance were life average daily gain, total collagen content, bone development, lipid content, I myosin heavy chain isoform proportion, shear force of broiled meat and slaughter age. PMID:20416732

  14. Cutaneous reinnervation of the rectus abdominis musculocutaneous flap after chest wall reconstruction: development of herpes zoster in the transplanted musculocutaneous flap.

    PubMed

    Tomita, K; Inoue, K

    1998-08-01

    We report a patient in whom herpes zoster developed in the transplanted rectus abdominis musculocutaneous flap 14 months after a chest wall reconstruction for recurrent breast cancer. Based on the distribution of the varicella zoster virus spreading along the sensory nerve fibers, we concluded that the virus spread along the reinnervated sensory nerves from the dorsal ganglia, through the intercostal nerves, and into the flap skin. It is suggested that this finding demonstrates the pathway of reinnervation into the transferred musculocutaneous flap on the chest wall. PMID:9718154

  15. Chronic peritoneal dialysis catheters: challenges and design solutions.

    PubMed

    Ash, S R

    2006-01-01

    Although highly successful as transcutaneous access devices, today's peritoneal dialysis catheters still have imperfect hydraulic function, biocompatibility and resistance to infection. Success of Tenckhoff catheters is greatly improved by the proper positioning of deep and subcutaneous cuffs and intraperitoneal segment. Newer peritoneal catheter designs are intended to improve hydraulic function, avoid outflow failure, and diminish exit site infection. These catheter designs serve as excellent alternatives for patients with various types of failure of Tenckhoff catheters. Catheters have been designed for Continuous Flow Peritoneal Dialysis, and have generally been successful in providing high peritoneal dialysis flow rate, but not always successful in optimally distributing flow of peritoneal fluid. Improvements in catheter design may expand the use of peritoneal dialysis as a successful home dialysis therapy. PMID:16485243

  16. Experiments with Planing Surfaces

    NASA Technical Reports Server (NTRS)

    Sottorf, W

    1934-01-01

    A previous report discusses the experimental program of a systematic exploration of all questions connected with the planing problem as well as the first fundamental results of the investigation of a flat planing surface. The present report is limited to the conversion of the model test data to full scale.

  17. 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.

  18. Bowel Perforation During Peritoneal Dialysis Catheter Placement.

    PubMed

    Abreo, Kenneth; Sequeira, Adrian

    2016-08-01

    Interventional nephrologists and radiologists place peritoneal dialysis catheters using the percutaneous fluoroscopic technique in both the inpatient and outpatient setting. Nephrologists caring for such patients may have to diagnose and manage the complications resulting from these procedures. Abdominal pain can occur following peritoneal dialysis catheter placement when the local and systemic analgesia wears off. However, abdominal pain with hypotension is suggestive of a serious complication. Bleeding into the abdomen and perforation of the colon or bladder should be considered in the differential diagnosis. In the case reported here, the peritoneogram showed contrast in the bowel, and correct interpretation by the interventionist would have prevented this complication. The characteristic pattern of peritoneogram images in this case will guide interventionists to avoid this complication, and the discussion of the differential diagnosis and management will assist nephrologists in taking care of such patients. PMID:26857647

  19. Retrograde Epidural Catheter Relieves Intractable Sacral Pain.

    PubMed

    Gupta, Ruchir; Shodhan, Shivam; Hosny, Amr

    2016-01-01

    Pain caused by tumor infiltration of the sacral area remains a major clinical challenge. Patients with poor pain control despite comprehensive medical management may be treated with neuraxial techniques such as continuous epidural or spinal anesthetic. We report a case in which a patient with metastatic breast cancer experienced inadequate pain relief after multiple intravenous pain management regimens as well as intrathecal (IT) drug delivery. The concentration of local anesthetics delivered via the IT catheter was limited due to the patient's baseline motor weakness which would be exacerbated with higher concentrations of local anesthetics. Thus, a decision was made to insert an epidural catheter via a retrograde technique to provide the patient with a "band of anesthesia" which would provide profound sensory blockade without concomitant motor weakness. Pain refractory to other modalities of pain control was successfully treated with the epidural technique. PMID:27162431

  20. Distributed pressure sensors for a urethral catheter.

    PubMed

    Ahmadi, Mahdi; Rajamani, Rajesh; Timm, Gerald; Sezen, A S

    2015-08-01

    A flexible strip that incorporates multiple pressure sensors and is capable of being fixed to a urethral catheter is developed. The urethral catheter thus instrumented will be useful for measurement of pressure in a human urethra during urodynamic testing in a clinic. This would help diagnose the causes of urinary incontinence in patients. Capacitive pressure sensors are fabricated on a flexible polyimide-copper substrate using surface micromachining processes and alignment/assembly of the top and bottom portions of the sensor strip. The developed sensor strip is experimentally evaluated in an in vitro test rig using a pressure chamber. The sensor strip is shown to have adequate sensitivity and repeatability. While the calibration factors for the sensors on the strip vary from one sensor to another, even the least sensitive sensor has a resolution better than 0.1 psi. PMID:26738054

  1. Live volumetric imaging (LVI) intracardiac ultrasound catheter.

    PubMed

    Dausch, David E; Castellucci, John B; Gilchrist, Kristin H; Carlson, James B; Hall, Stephen D; von Ramm, Olaf T

    2013-01-01

    The Live Volumetric Imaging (LVI) catheter is capable of real-time 3D intracardiac echo (ICE) imaging, uniquely providing full volume sectors with deep penetration depth and high volume frame rate. The key enabling technology in this catheter is an integrated piezoelectric micromachined ultrasound transducer (pMUT), a novel matrix phased array transducer fabricated using semiconductor microelectromechanical systems (MEMS) manufacturing techniques. This technology innovation may enable better image guidance to improve accuracy, reduce risk, and reduce procedure time for transcatheter intracardiac therapies which are currently done with limited direct visualization of the endocardial tissue. Envisioned applications for LVI include intraprocedural image guidance of cardiac ablation therapies as well as transcatheter mitral and aortic valve repair. PMID:23773496

  2. Retrograde Epidural Catheter Relieves Intractable Sacral Pain

    PubMed Central

    Gupta, Ruchir; Shodhan, Shivam; Hosny, Amr

    2016-01-01

    Pain caused by tumor infiltration of the sacral area remains a major clinical challenge. Patients with poor pain control despite comprehensive medical management may be treated with neuraxial techniques such as continuous epidural or spinal anesthetic. We report a case in which a patient with metastatic breast cancer experienced inadequate pain relief after multiple intravenous pain management regimens as well as intrathecal (IT) drug delivery. The concentration of local anesthetics delivered via the IT catheter was limited due to the patient's baseline motor weakness which would be exacerbated with higher concentrations of local anesthetics. Thus, a decision was made to insert an epidural catheter via a retrograde technique to provide the patient with a “band of anesthesia” which would provide profound sensory blockade without concomitant motor weakness. Pain refractory to other modalities of pain control was successfully treated with the epidural technique. PMID:27162431

  3. 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. PMID:24668920

  4. 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

  5. Soft Robotic Concepts in Catheter Design: an On-demand Fouling-release Urinary Catheter

    PubMed Central

    Leveri, Vrad; Wang, Qiming; Shivapooja, Phanindhar; Zhao, Xuanhe; L00F3;pez, Gabriel P.

    2014-01-01

    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 was 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 were 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. PMID:24668920

  6. Ultrasound catheters for circumferential cardiac ablation

    NASA Astrophysics Data System (ADS)

    Diederich, Chris J.; Nau, William H.; Taylor, Kevin; Maguire, Mark T.; Picazo, Guillermo; Gangu, Madhuri; Lesh, Michael D.

    1999-05-01

    The purpose of this study was to investigate performance characteristics of a catheter-based ultrasound applicator intended for circumferential ablation of cardiac tissue. The catheter design integrates a cylindrical ultrasound transducer within a distendable water filled balloon in order to produce circumferential lesions at sites in the atria (i.e., pulmonary vein ostia), intended for treatment of certain atrial arrhythmias. Biothermal simulations were used to investigate thermal lesion depths corresponding to variations in applied power, duration, balloon diameter, and acoustic efficiency. Prototype applicators of varying frequency (7 - 12 MHz) and balloon diameter were constructed and characterized using measurements of acoustic efficiency and rotational beam plots. In vitro studies were performed in freshly excised beef hearts to characterize the radial penetration, axial length, and angular uniformity of thermal lesions produced by these applicators. Selected applicators were tested in vivo within pulmonary veins, coronary sinus, and atrial appendage of canine and porcine hearts. These preliminary efforts have indicated that circumferential ablation of cardiac tissue using ultrasound balloon catheters is feasible, and devices between 7 - 12 MHz with balloon diameters of 1.5 - 2.0 cm are capable of producing uniform lesions between 1 - 5 mm depth or greater for treatment durations of 120 seconds or less.

  7. Permcath Catheter Embolization: a Case Report

    PubMed Central

    Yousefshahi, Hadi; Bina, Payvand; Yousefshahi, Fardin

    2015-01-01

    Introduction: Nowadays, many types of intravascular devices and catheters are used in order to diagnose and treat diseases. Complications related to these instruments are the costs that doctors and patients have to pay to benefit from their advantages. Catheter embolization is one of these side effects. Patients with devices in their cardiopulmonary system are at risk for severe complications such as arrhythmias, pulmonary embolism, myocardial injuries, hemoptysis, thrombosis and perforation. Case Presentation: A 50-years-old woman, with a history of breast cancer, had a PermCath emplacement in right subclavian vein for a course of chemotherapy. The treatment for cancer seemed to be successful and the PermCath had remained in its position without complication, for a couple of years however, the catheter was founded broken and embolized to the right ventricle and the main left pulmonary artery, diagnosed by a chest X-ray study incidentally. Conclusions: It is better to remove the unused devices safely to prevent and decrease their possible complications. PMID:25964881

  8. Catheter-related mortality among ESRD patients.

    PubMed

    Wasse, Haimanot

    2008-01-01

    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

  9. The Effects of Bridge Exercise on an Unstable Base of Support on Lumbar Stability and the Thickness of the Transversus Abdominis

    PubMed Central

    Cho, Misuk; Jeon, Hyewon

    2013-01-01

    [Purpose] We examined the effects of an abdominal drawing-in bridge exercise using a pressure biofeedback unit on different bases on the thickness of trunk and abdominal muscles, and lumbar stability. [Subjects] Thirty healthy young adults (2 males, 28 females) took part in this study. The subjects were randomly and equally assigned to a stable bridge exercise group and an unstable bridge exercise group. [Methods] The subjects performed bridge exercises using an abdominal drawing-in method on a stable base and on an unstable base, and changes in their abdominal muscle thickness and on the stable and on unstable bases lumbar stability were evaluated. [Results] After the intervention, the stable bridge exercise group showed a statistically significantly increased muscle thickness in the transversus abdominis, and the unstable bridge exercise group showed significantly increased muscle thicknesses of the transversus abdominis and internal obliques in static and dynamic lumbar stability. The unstable bridge exercise group showed significant increase after performing the exercise. [Conclusion] Lumbar stability exercise, with the compensation of the lumbar spine minimized, using an abdominal drawing-in method on an unstable support of base is effective and efforts to prevent the compensation may induce a greater exercise effect. PMID:24259841

  10. 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. PMID:27374014

  11. 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.

  12. 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

  13. 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

  14. 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. PMID:24847039

  15. [Catheter ablation of atrial flutter and paroxysmal atrial fibrillation].

    PubMed

    Márquez, Manlio F

    2003-01-01

    Radiofrequency catheter ablation has emerged as a curative therapy for atrial flutter based on studies demonstrating the role of the cavotricuspid isthmus. With a high rate of success and minimal complications, catheter ablation is the therapy of choice for patients with the common type of atrial flutter. Left atrial flutter, non-cavotricuspid isthmus dependent, and those associated with heart disease have a worst outcome with catheter ablation. Radiofrequency catheter ablation has also emerged as a curative therapy for paroxysmal atrial fibrillation based on studies demonstrating the role of triggering foci in the pulmonary veins for the initiation of atrial fibrillation. Catheter ablation is performed by a transseptal approach using radiofrequency energy at the ostium of each pulmonary vein. Mapping is guided by special catheters. Sequential radiofrequency applications eliminates or dissociates pulmonary vein muscle activity. Although complications exists, this is the only curative method for these patients. PMID:12966653

  16. Radiographically guided percutaneous catheter drainage of pleural fluid collections.

    PubMed

    Merriam, M A; Cronan, J J; Dorfman, G S; Lambiase, R E; Haas, R A

    1988-12-01

    We reviewed the outcome of guided percutaneous catheter drainage of pleural fluid collections in 18 patients over a 5-year period. Catheter positioning was guided by fluoroscopy in 10 (56%) cases, CT in seven (39%), and sonography in one (6%). Included were 16 patients with empyemas and one each with a sterile hematoma and transudate. In nine of the patients, previous surgical chest tube drainage had been unsuccessful. The majority of collections were treated with a 12- or 14-French catheter and closed underwater seal drainage. Twelve (80%) of the 15 patients who had an adequate trial of guided drainage were cured. Propyliodone oil suspension contrast sinography after catheter placement showed two clinically unsuspected bronchopleural fistulas. Although an extensive multilocular pleural collection was a contraindication to percutaneous catheter drainage, the thick fibrous peel of a chronic empyema was not. Drainage of pleural fluid collections with radiographic guidance ensures proper catheter placement and is successful in a high percentage of cases. PMID:3055887

  17. 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

  18. 2. VIEW SOUTH, INCLINE PLANE CAR, INCLINE PLANE TRACK, UPPER ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. VIEW SOUTH, INCLINE PLANE CAR, INCLINE PLANE TRACK, UPPER STATION. - Monongahela Incline Plane, Connecting North side of Grandview Avenue at Wyoming Street with West Carson Street near Smithfield Street, Pittsburgh, Allegheny County, PA

  19. Epidural catheter with integrated light guides for spectroscopic tissue characterization

    PubMed Central

    Soto-Astorga, R. P.; West, S.; Putnis, S.; Hebden, J. C.; Desjardins, A. E.

    2013-01-01

    Epidural catheters are used to deliver anesthetics and opioids for managing pain in many clinical scenarios. Currently, epidural catheter insertion is performed without information about the tissues that are directly ahead of the catheter. As a result, the catheter can be incorrectly positioned within a blood vessel, which can cause toxicity. Recent studies have shown that optical reflectance spectroscopy could be beneficial for guiding needles that are used to insert catheters. In this study, we investigate the whether this technique could benefit the placement of catheters within the epidural space. We present a novel optical epidural catheter with integrated polymer light guides that allows for optical spectra to be acquired from tissues at the distal tip. To obtain an initial indication of the information that could be obtained, reflectance values and photon penetration depth were estimated using Monte Carlo simulations, and optical reflectance spectra were acquired during a laminectomy of a swine ex vivo. Large differences between the spectra acquired from epidural adipose tissue and from venous blood were observed. The optical catheter has the potential to provide real-time detection of intravascular catheter placement that could reduce the risk of complications. PMID:24298420

  20. Use of tunnelled catheters in haematological malignancy patients with neutropenia.

    PubMed

    Sariosmanoglu, N; Uğurlu, B; Turgut, N H; Demirkan, F; Ozsan, H; Ergor, G; Gulay, Z; Hazan, E; Oto, O

    2008-01-01

    This prospective study analysed 83 patients (age 45 +/- 17 years) with haematological neoplasms, implanted with 93 tunnelled catheters, who were neutropenic or developed neutropenia during treatment. Catheters were implanted in the right (n = 82) or left (n = 11) jugular vein by the same surgical team using the same technique. They remained in place for 124 +/- 88 days: 29% were removed due to infection; 18% due to treatment termination and 2% due to mechanical problems. Seventeen patients died with catheters in place. At 30, 60, 90, 120 and 200 days mean catheter duration rates were 82%, 75%, 65%, 60% and 35%, respectively, and freedom from catheter removal due to infection was 92%, 88%, 80%, 77% and 67%, respectively. Patient diagnosis and history of previous catheter infection did not increase catheter infection risk, but patients undergoing stem cell transplantation had an increased infection risk. Tunnelled catheters can be used in high-risk patients with neutropenia. Systemic infections can be managed in most patients without catheter removal. PMID:18831907

  1. [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. PMID:11811006

  2. Encrusted and incarcerated urinary bladder catheter: what are the options?

    PubMed Central

    Ho, Christopher C.K.; Khandasamy, Yugasaravanan; Singam, Praveen; Hong Goh, Eng; Zainuddin, Zulkifli M.

    2010-01-01

    Urinary bladder catheter encrustations are known complications of long-term urinary catheterisation, which is commonly seen in clinical practice. These encrustations can impede deflation of the balloon and therefore cause problems in the removal of the catheter. The options in managing an encrusted and incarcerated urinary bladder catheter include extracorporeal shock wave lithotripsy and lithoclast. We describe here another technique of dealing with a stuck and encrustated catheter, via direct crushing of the encrustations with a rigid cystoscope inserted through a suprapubic cystostomy tract. PMID:21483557

  3. 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

  4. Influence of catheter orientation on lesion formation in bovine myocardium by using an open-irrigated laser ablation catheter.

    PubMed

    Sagerer-Gerhardt, Michaela; Weber, Helmut P

    2016-09-01

    Lesion sizes and quality are crucial for successful catheter ablation procedures. We sought to test the influence of catheter orientation towards the endocardial surface on lesion formation in bovine myocardium by using an open-irrigated laser ablation catheter. Continuous wave 1064-nm laser catheter applications at 15 W (4.5 W/mm²)/30 s, (135 J/mm²), irrigation flow 30 mL/min, were aimed at the left ventricular endocardial surface of bovine myocardium. The catheter was kept in vertical, in slanting (67.5°, 45°, 22.5°), and in flat positions; in flat position, also 60 s of radiation times were applied (n = 10, each). Lesions were evaluated morphometrically. Maximum depth of lesion was achieved with the catheter in a vertical orientation. Catheter inclination of <22.5 showed a highly significant decrease of lesion depth from 5.6 ± 1.1 to 3.7 ± 0.5 mm (p = 0.0001). In a flat catheter position, laser radiation of 30 s achieved the smallest lesions. However, after 60 s of radiation, the flat lesions were similar in depth (p = 087) and were larger in width (p = 0.0004) and in volumes (p = 0.0025) as compared to the lesions achieved with the catheter in vertical position after 30 s of radiation. Steam-pop with intramural cavitation or tissue vaporization with crater formation did not occur. Longer radiation times can achieve larger lesions regardless of catheter orientation. Catheter orientation is not a major determinant for laser ablation lesion size and quality, and a steerable support may not be needed when using the open-irrigated electrode-laser mapping and ablation (ELMA) catheter RytmoLas. PMID:27286865

  5. Advancement of epidural catheter from lumbar to thoracic space in children: Comparison between 18G and 23G catheters

    PubMed Central

    Baidya, Dalim Kumar; Pawar, Dilip Kumar; Dehran, Maya; Gupta, Arun Kumar

    2012-01-01

    Backgrounds and Objectives: Lumbar-to-thoracic advancement of epidural catheter is a safe alternative to direct thoracic placement in children. In this prospective randomized study, success rate of advancement of two different types and gauges of catheter from lumbar-to-thoracic space were studied. Materials and Methods: Forty ASA I and II children (up to 6 years) undergoing thoracic or upper-abdominal surgery were allocated to either Group I (18G catheter) or Group II (23G catheter). After induction of general anesthesia a pre-determined length of catheter was inserted. Successful catheter placement was defined as the catheter tip within two segment of surgical incision in radio-contrast study. Intra-operative analgesia was provided by epidural bupivacaine and intravenous morphine. Post-operative analgesia was provided with epidural infusion of 0.1% bupivacaine+1mcg/ml fentanyl. Observations and Results: Catheter advancement was successful in 3 cases in Group I and 2 cases in Group II. Five different types of catheter positions were found on X-ray. Negative correlation was found between age and catheter advancement [significance (2-tailed) =0.03]. However, satisfactory post-operative analgesia was obtained in 35 cases. Positive correlation was found between infusion rate, the number of segment of gap between desired level and the level reached [significance (2-tailed) =0.00]. 23G catheter use was associated with more technical complications. Conclusion: Advancement of epidural catheter from lumbar to thoracic level was successful in only 10-15% cases but satisfactory analgesia could be provided by increasing the infusion rates. PMID:22345940

  6. [The role of the interventional radiologist in central venous catheter dysfunction (pictorial essay)].

    PubMed

    Altunel, Ekrem; Oran, Ismail; Parildar, Mustafa; Memiş, Ahmet

    2004-03-01

    Failure to aspirate blood from the lumen of venous catheters, inadequate blood flow and/or high resistance pressures during hemodialysis were accepted as catheter dysfunction. Other correctable problems such as residual lumen thrombus, external fibrin catheter sheath or malpositioned catheter tip were identified by contrast injection. Catheter malpositions were corrected by snare-mediated catheter repositioning or by exchange of the catheter over a guidewire. Catheters of inadequate length were exchanged over a guidewire to the appropriate position or replaced. Treatment of fibrin sheath formation included fibrin sheath stripping, guidewire catheter exchange, and urokinase infusion. Early catheter dysfunction is frequently due to mechanical problems such as inadequate positioning, kinking, or constriction. Delayed dysfunction usually results from thrombus formation, either within the lumen, around the catheter ("fibrin sleeve"), or in the host vein. In the management of catheter malfunctions and complications, interventional radiological techniques are safe and effective alternatives to standard surgical techniques. PMID:15054708

  7. 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. PMID:25547257

  8. 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.

  9. Comparison of Standard Catheters Versus Radial Artery-Specific Catheter in Patients Who Underwent Coronary Angiography Through Transradial Access.

    PubMed

    Chen, On; Goel, Sunny; Acholonu, Michael; Kulbak, Guy; Verma, Shivani; Travlos, Efstratios; Casazza, Richard; Borgen, Elliot; Malik, Bilal; Friedman, Michael; Moskovits, Norbert; Frankel, Robert; Shani, Jacob; Ayzenberg, Sergey

    2016-08-01

    In this prospective, randomized controlled study, we aim to compare the performance outcomes of standard catheters with the radial artery-specific catheter. Over the past decade, transradial cardiac catheterization has gained widespread popularity because of its low complication rates compared with transfemoral access. Operators have the choice of using either standard catheters (used for both transfemoral and transradial approach, with need for separate catheter use for either right or left coronary artery engagement) or a dedicated radial artery catheter, which is specifically designed to engage both coronary arteries through radial artery access. A total of 110 consecutive patients who underwent coronary angiography at our institution from March 2015 to April 2015 were prospectively randomized to either radial artery-specific Tiger catheter (5Fr; Terumo Interventional Systems, Somerset, New Jersey) versus standard Judkins left and right catheters (5Fr R4, L4; Cordis Corporation, Miami, Florida). The end points of the study included fluoroscopy time, dose-area product, contrast volume used, and total procedure time for the coronary angiography. A total of 57 patients (52%) were randomized to radial artery-specific catheter and 53 (48%) to the standard catheter. Tiger catheter was associated with significantly lower fluoroscopy time (184 ± 91 vs 238 ± 131 seconds, p = 0.015), which was statistically significant. Other outcome measures such as dose-area product (2,882.4 ± 1,471.2 vs 3,524.6 ± 2,111.7 Gy·cm(2), p = 0.07), total contrast volume (48.1 ± 16.1 vs 53.4 ± 18.5 ml, p = 0.114), and total procedure time (337 ± 382 vs 434 ± 137 seconds, p = 0.085) were also lower in single-catheter group, but it did not reach statistical significance. A total of 8 patients (14%) were crossed over from radial-specific catheter arm to standard catheter arm because of substandard image quality and difficulty in coronary engagement. Six patients had to be

  10. 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.

  11. Engineering Considerations Of Catheters For Intravascular Ultrasonic Measurements

    NASA Astrophysics Data System (ADS)

    Martin, Roy W.; Johnson, Christopher C.

    1989-08-01

    The mechanical properties of commonly used fluid transfusion or pressure monitoring catheters are similar to the properties required of catheters which include sensing devices. Consequently, bending and torsional stiffness of commercial catheters and tubes were measured at both room and body temperature. Five of these usually placed with the aid of fluoroscopy had an average Young's modulus of 5714x101 dyne/cm at 21°C which decreased 29% at body temperature; a shear modulus of 70.5x101 dyne/cm 4 at 21°C which decreased 13% at body temperature, and plastic deformation of 8% when loaded for 1 minute at 37°. Four of these were composed of a composite material. Catheters which are balloon directed during insertion had moduli values approximately 1/3 of these or less. The drag forces produced on balloons used on such catheters were measured for fluid velocities ranging from 10-50 cm/sec. Using this information the average force applied to a balloon throughout a cardiac cycle was calculated; values of 1280 dynes for a .6 ml balloon and 2490 dynes for a 1 ml balloon were found. The maximum wall thicknesses to catheter radii for single lumen catheters were determined for various material moduli which would allow the catheter tip to be directed by a balloon during its passage into the right heart.

  12. 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

  13. 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...

  14. 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...

  15. 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...

  16. Delayed Onset of Subdural Hematoma following Epidural Catheter Breakage

    PubMed Central

    Ishikawa, Yoshimoto; Imagama, Shiro; Ito, Zenya; Ando, Kei; Gotoh, Momokazu; Nishiwaki, Kimitoshi; Nagao, Yoshimasa; Ishiguro, Naoki

    2015-01-01

    Study Design Case report. Objectives To describe a case of delayed-onset spinal hematoma following the breakage of a spinal epidural catheter. Methods The authors describe the clinical case review. Results A 64-year-old woman had undergone epidural anesthesia 18 years before she was referred to our hospital because of lower-back pain and lower neurologic deficit with leg pain. The clinical examination showed the presence of a fragment of an epidural catheter in the thoracolumbar canal, as assessed by computed tomography, and a spinal hematoma that compressed the spinal cord at the same spinal level, as assessed by magnetic resonance imaging. Surgical removal of the epidural catheter and decompression surgery were performed. The patient exhibited substantial clinical improvement 1 month after surgery; she achieved a steady gait without the need for a cane and had no leg pain. Conclusion This is the first report of delayed onset of spinal hematoma following the breakage of an epidural catheter. Generally, when the breakage of an epidural catheter occurs without symptoms, follow-up alone is recommended. However, because spinal hematoma might exhibit a late onset, the possibility of this complication should be considered when deciding whether to remove the catheter fragment. We believe that in our patient, there could be a relationship between the catheter fragment and subdural hematoma, and catheter breakage could have been a risk factor for the spinal hematoma. PMID:26835209

  17. 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

  18. Diagnosis and Rescue of a Kinked Pulmonary Artery Catheter

    PubMed Central

    Mouawad, Nicolas J.; Stein, Erica J.; Moran, Kenneth R.; Go, Michael R.; Papadimos, Thomas J.

    2015-01-01

    Invasive hemodynamic monitoring with a pulmonary catheter has been relatively routine in cardiovascular and complex surgical operations as well as in the management of critical illnesses. However, due to multiple potential complications and its invasive nature, its use has decreased over the years and less invasive methods such as transesophageal echocardiography and hemodynamic sensors have gained widespread favor. Unlike these less invasive forms of hemodynamic monitoring, pulmonary artery catheters require an advanced understanding of cardiopulmonary physiology, anatomy, and the potential for complications in order to properly place, manage, and interpret the device. We describe a case wherein significant resistance was encountered during multiple unsuccessful attempts at removing a patient's catheter secondary to kinking and twisting of the catheter tip. These attempts to remove the catheter serve to demonstrate potential rescue options for such a situation. Ultimately, successful removal of the catheter was accomplished by simultaneous catheter retraction and sheath advancement while gently pulling both objects from the cannulation site. In addition to being skilled in catheter placement, it is imperative that providers comprehend the risks and complications of this invasive monitoring tool. PMID:26075106

  19. Intrapleural migration of a percutaneous transhepatic hemodialysis catheter.

    PubMed

    Kwan, Sharon W; Kerlan, Robert K

    2012-01-01

    Percutaneous transhepatic catheters are a form of nonconventional access for patients requiring hemodialysis. We report a complication of these catheters which has not been previously described in the literature. The mechanism for intrapleural migration and a way to avoid this potential complication are discussed. PMID:21786242

  20. 21 CFR 870.2870 - Catheter tip pressure transducer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... change in relation to changes in blood pressure. These changes are transmitted to accessory equipment for... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Catheter tip pressure transducer. 870.2870 Section... pressure transducer. (a) Identification. A catheter tip pressure transducer is a device incorporated...

  1. 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. PMID:26383168

  2. Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

    SciTech Connect

    Oh, Jung Suk Lee, Hae Giu Chun, Ho Jong; Choi, Byung Gil; Lee, Sang Hoon; Hahn, Seong Tai; Ohm, Joon Young

    2013-10-15

    Purpose: This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. Methods: Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6-20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6-38) after the percutaneous drainage. Results: Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5-14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10-58 days (median, 28) after the Foley catheter placement. Conclusions: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites.

  3. Endovascular Removal of Long-Term Hemodialysis Catheters

    SciTech Connect

    Foley, Peter T.; Carter, Ranjana M.; Uberoi, Raman

    2007-09-15

    Central venous catheters that have been in place for a long time can become fixed to the vein wall, making them impossible to pull out. Leaving them in situ is undesirable because of the risk that they could act as a nidus for thrombosis. Moreover, inserting new catheters alongside the old ones might compromise flow in the superior vena cava, further predisposing to thrombosis. Surgical removal is likewise undesirable, as this would necessitate thoracotomy with the attendant risks. We describe a novel technique, which we were able to use to remove retained long-term hemodialysis catheters in a patient who needed new catheters and who would have been a high-risk candidate for surgery. The right internal jugular vein was punctured adjacent to the site of insertion and a guide wire was used to form a snare, which was passed around the catheters and used to saw through the fibrous attachments to the vein wall. The midsection of one catheter could not be freed but the snare was used to cut off the proximal and distal ends, which could then be removed, the latter via the femoral vein. New catheters were then inserted via the left internal jugular vein. This technique enabled successful catheter extraction and replacement in a patient who would have been a poor candidate for cardiothoracic surgery.

  4. 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

  5. New technical approach for the repair of an abdominal wall defect after a transverse rectus abdominis myocutaneous flap: a case report

    PubMed Central

    Kaemmer, Daniel A; Conze, Joachim; Otto, Jens; Schumpelick, Volker

    2008-01-01

    Introduction Breast reconstruction with autologous tissue transfer is now a standard operation, but abnormalities of the abdominal wall contour represent a complication which has led surgeons to invent techniques to minimize the morbidity of the donor site. Case presentation We report the case of a woman who had bilateral transverse rectus abdominis myocutaneous flap (TRAM-flap) breast reconstruction. The surgery led to the patient developing an enormous abdominal bulge that caused her disability in terms of abdominal wall and bowel function, pain and contour. In the absence of rectus muscle, the large defect was repaired using a combination of the abdominal wall component separation technique of Ramirez et al and additional mesh augmentation with a lightweight, large-pore polypropylene mesh (Ultrapro®). Conclusion The procedure of Ramirez et al is helpful in achieving a tension-free closure of large defects in the anterior abdominal wall. The additional mesh augmentation allows reinforcement of the thinned lateral abdominal wall. PMID:18416835

  6. The preferential contraction ratios of transversus abdominis on the variations of knee angles during abdominal drawing-in maneuver in wall support standing

    PubMed Central

    Hwang, Young-In; Kim, Jwa-Jun; Park, Du-Jin

    2014-01-01

    The objective of this study was to determine appropriate knee angles for the abdominal drawing-in maneuver (ADIM) through evaluation of changes in contraction ratios of the abdominal muscles and activity of quadriceps muscle in relation to changes in knee angles occurring while the ADIM is performed in the wall support standing (WSS). 20 subjects performed the ADIM at different knee angles (0°, 20°, 40°, 60°) in random order, standing at a point 6 inches away from the wall with the spine maintained in the neutral position. The WSS with knee flexion at 20° showed significantly higher preferential contraction ratio (PCR) of transversus abdominis (TrA) compared to other positions (0°, 40°, 60°). Therefore, performing the ADIM in the WSS with knee flexion at 20° appears to be the most appropriate position for TrA PCR. PMID:24877045

  7. Beamlet focal plane diagnostic

    SciTech Connect

    Caird, J.A.; Nielsen, N.D.; Patton, H.G.; Seppala, L.G.; Thompson, C.E.; Wegner, P.J.

    1996-12-01

    This paper describes the major optical and mechanical design features of the Beamlet Focal Plane Diagnostic system as well as measurements of the system performance, and typical data obtained to date. We also discuss the NIF requirements on the focal spot that we are interested in measuring, and some of our plans for future work using this system.

  8. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain.

    PubMed

    Fernandes da Mota, Patrícia Gonçalves; Pascoal, Augusto Gil Brites Andrade; Carita, Ana Isabel Andrade Dinis; Bø, Kari

    2015-02-01

    Diastasis recti abdominis (DRA) is an impairment characterized by a midline separation of the rectus abdominis muscles along the linea alba. It has its onset during pregnancy and the first weeks following childbirth. There is scant knowledge on both prevalence and risk factors for development of the condition. The aim of this study was to investigate the prevalence of DRA at gestational week 35 and three timepoints postpartum, possible risk factors, and the relationship between DRA and lumbo-pelvic pain. Ultrasound images of inter rectus distance (IRD) were recorded in 84 healthy primiparous women, at three locations on the linea alba. The IRD was measured at: gestational week 35 and 6-8, 12-14, and 24-26 weeks postpartum. Diagnosis of DRA was defined as 16 mm at 2 cm below the umbilicus. Independent sample t-test and binary logistic regression was used to assess differences and risk factors in women with and without DRA and women with and without lumbo-pelvic pain. P < 0.05 was considered statistically significant. The prevalence of DRA decreased from 100% at gestational week 35-39% at 6 months postpartum. No statistically significant differences were found in prepregnancy body mass index (BMI), weight gain, baby's birth weight or abdominal circumference between women with and without DRA at 6 months postpartum. Women with DRA at 6 months postpartum were not more likely to report lumbo-pelvic pain than women without DRA. DRA is prevalent at 6 months postpartum, but is not linked with lumbo-pelvic pain. PMID:25282439

  9. Timing of catheter drainage in infected necrotizing pancreatitis.

    PubMed

    van Grinsven, Janneke; van Santvoort, Hjalmar C; Boermeester, Marja A; Dejong, Cornelis H; van Eijck, Casper H; Fockens, Paul; Besselink, Marc G

    2016-05-01

    Acute pancreatitis is the most common gastrointestinal indication for hospital admission, and infected pancreatic and/or extrapancreatic necrosis is a potentially lethal complication. Current standard treatment of infected necrosis is a step-up approach, consisting of catheter drainage followed, if necessary, by minimally invasive necrosectomy. International guidelines recommend postponing catheter drainage until the stage of 'walled-off necrosis' has been reached, a process that typically takes 4 weeks after onset of acute pancreatitis. This recommendation stems from the era of primary surgical necrosectomy. However, postponement of catheter drainage might not be necessary, and earlier detection and subsequent earlier drainage of infected necrosis could improve outcome. Strong data and consensus among international expert pancreatologists are lacking. Future clinical, preferably randomized, studies should focus on timing of catheter drainage in patients with infected necrotizing pancreatitis. In this Perspectives, we discuss challenges in the invasive treatment of patients with infected necrotizing pancreatitis, focusing on timing of catheter drainage. PMID:26956064

  10. In vivo method for the evaluation of catheter thrombogenicity

    SciTech Connect

    Solomon, D.D.; Arnold, W.L.; Martin, N.D.; Lentz, D.J.

    1987-01-01

    A new method has been developed to evaluate the relative thrombogenicity of vascular catheters. The technique provides a means to quantitatively differentiate between catheters made from different polymeric materials. Autologous In-111 labeled platelets were infused into a dog model and catheters were then inserted into the external jugular vein of the dog. The neck region was scanned using gamma camera imaging. Comparisons between catheter materials were made using computer generated uptake slopes during the first 40 min of the scan. In addition to scintigraphy, visual assessment of thrombus deposition, thrombus weight, platelet deposition, and scanning electron microscopy were used to validate the technique. Poly(vinyl chloride), polyurethane, heparinized polyurethane, and silicone catheter materials were tested. It was found that heparinized polyurethane was the least thrombogenic of all materials evaluated.

  11. Catheter Obstruction of Intrathecal Drug Administration System -A Case Report-

    PubMed Central

    Rhee, Seok Myeon; Choi, Eun Joo; Lee, Pyung Bok

    2012-01-01

    Intrathecal drug administration system (ITDAS) can reduce the side effects while increasing the effectiveness of opioids compared to systemic opioid administration. Therefore, the use of ITDAS has increased in the management of cancer pain and chronic intractable pain. Catheter obstruction is a serious complication of ITDAS. Here, we present a case of catheter obstruction by a mass formed at the side hole and in the lumen. A 37-year-old man suffering from failed back surgery syndrome received an ITDAS implantation, and the ITDAS was refilled with morphine every 3 months. When the patient visited the hospital 18 months after ITDAS implantation for a refill, the amount of delivered morphine sulfate was much less than expected. Movement of the pump rotor was examined with fluoroscopy; however, it was normal. CSF aspiration through the catheter access port was impossible. When the intrathecal catheter was removed, we observed that the side hole and lumen of the catheter was plugged. PMID:22259717

  12. 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.

  13. 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.

  14. 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

  15. Efficacy of preventing hemodialysis catheter infections with citrate lock.

    PubMed

    Silva, Jorge; Antunes, Jorge; Carvalho, Telmo; Ponce, Pedro

    2012-10-01

    Prevalent use of tunneled dialysis catheters can reach 30%. Infection remains the most serious catheter-related problem. Catheter locks are increasingly used for prevention, but are not yet recommended either by the Food and Drug Association or European Medicines Agency, on the basis of increasing bacterial resistance or lock toxicity. The aim was to test safety and effectiveness of citrate. A prospective, interventional study was conducted to assess the safety and efficacy of a 30% citrate lock in preventing catheter-related bacteremia (CRB). A total of 157 prevalent tunneled catheters were locked with citrate and prospectively followed during a 1-year period. The primary endpoint was first CRB diagnosed according to two of the diagnostic criteria for Catheter Infection of Centers for Disease Control and Prevention (CDC), namely definite and probable infection. The CDC criterion of possible but not proved infection was not considered. This citrate lock cohort (n = 157) had 10 episodes of CRB. We observed 0.49 CRB episodes/1000 patient-days and the mean infection-free catheter day was 130.6 ± 100.9. No clinically relevant adverse events were observed. No proved tunnel or exit site infection was observed and no patients died because of CRB. Catheter obstruction episodes were reported on 69 occasions out of 14 catheters. These results were compared with an historical cohort from a previous study of catheter locking with low-dose gentamicin and did not show significant difference in efficacy. Citrate lock is effective in preventing CRB. No toxicity was observed. The use of citrate lock may have advantages over antibiotic locks: no reported bacterial resistance, lower industrial cost, and less manipulation. PMID:22515732

  16. 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.

  17. The tail plane

    NASA Technical Reports Server (NTRS)

    Munk, Max M

    1923-01-01

    This report deals with the calculation of the equilibrium, statistical stability, and damping of the tail plane. The author has simplified the present theory of longitudinal stability for the particular purpose of obtaining one definite coefficient characteristics of the effect of the tail plane. This coefficient is obtained by substituting certain aerodynamic characteristics and some dimensions of the airplane in a comparatively simple mathematical expression. Care has been taken to confine all aerodynamical information necessary for the calculation of the coefficient to the well-known curves representing the qualities of the wing section. This is done by making use of the present results of modern aerodynamics. All formulas and relations necessary for the calculation are contained in the paper. They give in some cases only an approximation of the real values. An example of calculation is added in order to illustrate the application of the method. The coefficient indicates not only whether the effect of the tail plane is great enough, but also whether it is not too great. It appears that the designer has to avoid a certain critical length of the fuselage, which inevitably gives rise to periodical oscillations of the airplane. The discussion also shows the way and in what direction to carry out experimental work.

  18. 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. PMID:22256282

  19. Modified multipurpose catheter enhances clinical utility for cardiac catheterizations.

    PubMed

    Mannino, S C; Scavina, M; Palmer, S

    1994-10-01

    The Multipurpose technique for coronary arteriography employs a single catheter. The benefits are a reduction in the cost of the procedure and a shorter procedural time by experienced operators. To enhance the performance of these catheters, a modification was made in the materials and tip design, and these modifications were clinically evaluated in a small study. Compared to the control group of patients (n = 41), patients catheterized with the Multipurpose-SM (n = 43) were shown to have a shorter procedural time as measured by a reduced fluoroscopy time (7.08 min vs. 9.52 min, P = .007). This difference is statistically significant at a 95% confidence level and resulted in less radiation exposure to the operator and cath lab staff. The procedural time was significantly reduced by fewer catheter exchanges (19% study vs. 46% control; P = .006), which were needed to successfully complete the procedure. The new Multipurpose-SM catheter also demonstrated enhanced flexibility for cannulating coronary arteries with superior or anterior takeoffs. This study concludes that the utilization of a modified Multipurpose-SM catheter is safe and effective in cannulating both the left and right coronary arteries, bypass grafts, and performing left ventriculography. The primary benefits of using this modified catheter are reduced fluoroscopy time and the need for fewer catheter exchanges. PMID:7834732

  20. Bacteria on Catheters in Patients Undergoing Peritoneal Dialysis

    PubMed Central

    Pihl, Maria; Davies, Julia R.; Johansson, Ann-Cathrine; Svensäter, Gunnel

    2013-01-01

    ♦ Background: Peritonitis is the leading cause of morbidity for peritoneal dialysis (PD) patients, and microbial biofilms have previously been identified on catheters from infected patients. However, few studies of catheters from patients without clinical signs of infection have been undertaken. The aim of the present study was to investigate the extent to which bacteria are present on catheters from PD patients with no symptoms of infection. ♦ Methods: Microbiologic culturing under aerobic and anaerobic conditions and confocal laser scanning microscopy were used to determine the distribution of bacteria on PD catheters from 15 patients without clinical signs of infection and on catheters from 2 infected patients. The 16S rRNA gene sequencing technique was used to identify cultured bacteria. ♦ Results: Bacteria were detected on 12 of the 15 catheters from patients without signs of infection and on the 2 catheters from infected patients. Single-species and mixed-microbial communities containing up to 5 species were present on both the inside and the outside along the whole length of the colonized catheters. The bacterial species most commonly found were the skin commensals Staphylococcus epidermidis and Propionibacterium acnes, followed by S. warneri and S. lugdunensis. The strains of these micro-organisms, particularly those of S. epidermidis, varied in phenotype with respect to their tolerance of the major classes of antibiotics. ♦ Conclusions: Bacteria were common on catheters from patients without symptoms of infection. Up to 4 different bacterial species were found in close association and may represent a risk factor for the future development of peritonitis in patients hosting such micro-organisms. PMID:22855889

  1. Videolaparoscopic Catheter Placement Reduces Contraindications to Peritoneal Dialysis

    PubMed Central

    Santarelli, Stefano; Zeiler, Matthias; Monteburini, Tania; Agostinelli, Rosa Maria; Marinelli, Rita; Degano, Giorgio; Ceraudo, Emilio

    2013-01-01

    ♦ Background: Videolaparoscopy is considered the reference method for peritoneal catheter placement in patients with previous abdominal surgery. The placement procedure is usually performed with at least two access sites: one for the catheter and the second for the laparoscope. Here, we describe a new one-port laparoscopic procedure that uses only one abdominal access site in patients not eligible for laparotomic catheter placement. ♦ Method: We carried out one-port laparoscopic placement in 21 patients presenting contraindications to blind surgical procedures because of prior abdominal surgery. This technique consists in the creation of a single mini-laparotomy access through which laparoscopic procedures and placement are performed. The catheter, rectified by an introducer, is inserted inside the port. Subsequently, the port is removed, leaving the catheter in pelvic position. The port is reintroduced laterally to the catheter, confirming or correcting its position. Laparotomic placement was performed in a contemporary group of 32 patients without contraindications to blind placement. Complications and long-term catheter outcome in the two groups were evaluated. ♦ Results: Additional interventions during placement were necessary in 12 patients of the laparoscopy group compared with 5 patients of the laparotomy group (p = 0.002). Laparoscopy documented adhesions in 13 patients, with need for adhesiolysis in 6 patients. Each group had 1 intraoperative complication: leakage in the laparoscopy group, and intestinal perforation in the laparotomy group. During the 2-year follow-up period, laparoscopic revisions had to be performed in 6 patients of the laparoscopy group and in 5 patients of the laparotomy group (p = 0.26). The 1-year catheter survival was similar in both groups. Laparoscopy increased by 40% the number of patients eligible to receive peritoneal dialysis. ♦ Conclusions: Videolaparoscopy placement in patients not eligible for blind surgical

  2. 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

  3. Thromboresistance Characterization of Extruded Nitric Oxide-Releasing Silicone Catheters

    PubMed Central

    Amoako, Kagya A.; Archangeli, Christopher; Handa, Hitesh; Major, Terry; Meyerhoff, Mark E.; Annich, Gail M.; Bartlett, Robert H.

    2013-01-01

    Intravascular catheters used in clinical practice can activate platelets, leading to thrombus formation and stagnation of blood flow. Nitric oxide (NO)-releasing polymers have been shown previously to reduce clot formation on a number of blood contacting devices. In this work, trilaminar NO-releasing silicone catheters were fabricated and tested for their thrombogenicity. All catheters had specifications of L = 6 cm, inner diameter = 21 gauge (0.0723 cm), outer diameter = 12 gauge (0.2052 cm), and NO-releasing layer thickness = 200 ± 11 μm. Control and NO-releasing catheters were characterized in vitro for their NO flux and NO release duration by gas phase chemiluminescence measurements. The catheters were then implanted in the right and left internal jugular veins of (N = 6 and average weight = 3 kg) adult male rabbits for 4 hours thrombogenicity testing. Platelet counts and function, methemoglobin (metHb), hemoglobin (Hb), and white cell counts and functional time (defined as patency time of catheter) were monitored as measured outcomes. Nitric oxide-releasing catheters (N = 6) maintained an average flux above (2 ± 0.5) × 10−10 mol/min/cm2 for more than 24 hours, whereas controls showed no NO release. Methemoglobin, Hb, white cell, and platelet counts and platelet function at 4 hours were not significantly different from baseline (α = 0.05). However, clots on controls were visibly larger and prevented blood draws at a significantly (p < 0.05) earlier time (2.3 ± 0.7 hours) into the experiment, whereas all NO-releasing catheters survived the entire 4 hours test period. Results indicate that catheter NO flux levels attenuated thrombus formation in a short-term animal model. PMID:22395119

  4. 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.

  5. Catheter Related Escherichia hermannii Sepsis in a Haemodialysis Patient

    PubMed Central

    Rank, Cecilie Utke; Lommer Kristensen, Peter; Schrøder Hansen, Dennis; Brandi, Lisbet

    2016-01-01

    Escherichia hermannii is an extremely rare etiological agent of invasive infection, and thus, the bacterium was initially considered non-pathogenic. However, in five previously reported case reports E. hermannii has been implicated as the sole pathogen. Our case report describes blood stream infection with E. hermannii in a haemodialysis patient with persisting symptoms, high fever and inflammatory markers despite appropriate antibiotic treatment until replacement of the dialysis catheter. We suspect biofilm formation to be a crucial pathogenic feature for E. hermannii in the maintenance of an infection, which stresses the necessity of antibiotic treatment along with catheter replacement in bloodstream- and catheter-related infection with E. hermannii. PMID:27006723

  6. 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.

  7. Management of catheter-associated upper extremity deep venous thrombosis.

    PubMed

    Crawford, Jeffrey D; Liem, Timothy K; Moneta, Gregory L

    2016-07-01

    Central venous catheters or peripherally inserted central catheters are major risk factors for upper extremity deep venous thrombosis (UEDVT). The body and quality of literature evaluating catheter-associated (CA) UEDVT have increased, yet strong evidence on screening, diagnosis, prevention, and optimal treatment is limited. We herein review the current evidence of CA UEDVT that can be applied clinically. Principally, we review the anatomy and definition of CA UEDVT, identification of risk factors, utility of duplex ultrasound as the preferred diagnostic modality, preventive strategies, and an algorithm for management of CA UEDVT. PMID:27318061

  8. Malposition of Subclavian Venous Catheter Leading to Chest Complications

    PubMed Central

    Singh, Amarjit; Sidhu, Kuldeep Singh; Kaur, Avleen

    2016-01-01

    Although Central Venous Catheter (CVC) placement is a relatively simple procedure but its insertion and maintenance are associated with significant risks. Malposition (defined as any CVC tip position outside the superior vena cava) may be associated with catheter insertion and may require immediate intervention. It may result in complications like haemothorax, pleural effusions, pneumothorax, sepsis, thrombosis and cardiac tamponade. This case report presents timely detection of the complication after placement of CVC. Everyone should be aware of the complications and monitor consistently appropriate position of catheter tips.

  9. Spiculated Bladder Calculi: The Culprit for Repeated Catheter Failure

    PubMed Central

    Wek, C.; Fox, T. P.; Muir, G. H.

    2013-01-01

    We report on the case of a frustrated 90-year-old gentleman who was seen in the Accident and Emergency department for the third time in four days with failure of his long-term urethral catheter. He reported that the catheter simply “fell out” with the balloon deflated. On each occasion previously, the catheter had been reinserted in A&E and the patient discharged home. These repeated visits to A&E were understandably a source of much frustration for the patient and his family. On the third presentation, plain abdominal radiography demonstrated a large spiculated bladder calculus. PMID:23984173

  10. Catheterization in the community: converting to the Foley catheter tray.

    PubMed

    Yates, Ann

    2011-11-01

    With the aim of minimizing clinical incidents and improving clinical practice, the Cardiff and Vale University Health Board carried out a trial of a Foley catheter tray to be carried by district nurses as emergency boot stock. As part of the trial all nurses had to undergo training on the Foley catheter tray prior to use. The district nurses using the tray reported improvement in confidence, efficiency, convenience and patient experience. Owing to the success of the initiative, use of the Foley catheter tray as emergency boot stock is now standard practice for District Nursing/Acute Response and out-of-hours care in the Cardiff and Vale area. PMID:22067568

  11. Hemiballismus as a complication of an intratumoral chemotherapy catheter.

    PubMed

    Zuccarelli, Britton; Aalbers, Brian; Grabb, Paul

    2016-08-01

    We report an unusual case of delayed bilateral, right greater than left hemiballismus in a 15-year-old female patient with a history of a craniopharyngioma 2years following the insertion of a right intratumoral chemotherapy catheter. Following cyst decompression, the catheter was found to have changed position, traversing the basal ganglia structures, namely the right subthalamic nucleus. Her movement disorder near-completely resolved immediately following removal of the catheter. A review of the current literature and proposed pathophysiological mechanisms are discussed. PMID:26964474

  12. 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.

  13. 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.

  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. 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.

  16. 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.

  17. Mosaic Focal Plane Development

    NASA Astrophysics Data System (ADS)

    Mason, David L.; Horner, Scott D.; Aamodt, Earl K.

    2002-12-01

    Advances in systems engineering, applied sciences, and manufacturing technologies have enabled the development of large ground based and spaced based astronomical instruments having a large Field of View (FOV) to capture a large portion of the universe in a single image. A larger FOV can be accomplished using light weighted optical elements, improved support structures, and the development of mosaic Focal Plane Assemblies (mFPA). A mFPA designed for astronomy can use multiple Charged Coupled Devices (CCD) mounted onto a single camera baseplate integrated at the instrument plane of focus. Examples of current, or proposed, missions utilizing mFPA technology include FAME, GEST, Kepler, GAIA, LSST, and SNAP. The development of a mFPA mandates tighter control on the design trades, component development, CCD characterization, component integration, and performance verification testing. This paper addresses the capability Lockheed Martin Space Systems Company's (LMSSC) Advanced Technology Center (ATC) has developed to perform CCD characterization, mFPA assembly and alignment, and mFPA system level testing.

  18. Mosaic Focal Plane Development

    NASA Astrophysics Data System (ADS)

    Mason, D.; Horner, S.; Aamodt, E.

    Advances in manufacturing and applied sciences have enabled the development of large ground and spaced based astronomical instruments having a Field of View (FOV) large enough to capture a large portion of the universe in a single image. A large FOV can be accomplished using light weighted optics, improved structures, and the development of mosaic Focal Plane Assemblies (mFPAs). A mFPA comprises multiple Charged Coupled Devices (CCD) mounted onto a single baseplate integrated at the focus plane of the instrument. Examples of current, or proposed, missions utilizing mFPA technology include FAME, GEST, Kepler, GAIA, LSST, and SNAP. The development of a mFPA mandates tight control on the design trades of component development, CCD definition and characterization, component integration, and performance verification testing. This paper addresses the results of the Lockheed Martin Space Systems Company (LMSSC), Advanced Technology Center (ATC) developed mFPA. The design trades and performance characterization are services provided by the LMSSC ATC but not detailed in this paper.

  19. 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

  20. FAQs about Catheter-Associated Urinary Tract Infection

    MedlinePlus

    ... Tract Infection” What is “catheter-associated urinary tract infection”? A urinary tract infection (also called “UTI”) is an infection in the urinary system, which includes the bladder (which stores the ...

  1. 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

  2. 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. PMID:25328804

  3. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    .... Class III (premarket approval). (c) Date PMA or notice of completion of a PDP is required. A PMA or a... intravascular occluding catheter shall have an approved PMA or a declared completed PDP in effect before...

  4. 21 CFR 882.5150 - Intravascular occluding catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    .... Class III (premarket approval). (c) Date PMA or notice of completion of a PDP is required. A PMA or a... intravascular occluding catheter shall have an approved PMA or a declared completed PDP in effect before...

  5. [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. PMID:24929256

  6. The use of radiofrequency catheter ablation to cure dilated cardiomyopathy.

    PubMed

    Schmidt, S B; Lobban, J H; Reddy, S; Hoelper, M; Palmer, D L

    1997-01-01

    Incessant supraventricular tachycardia can cause a dilated cardiomyopathy. This article discusses the case of a 55-year-old woman whose cardiomyopathy was reversed when she underwent successful radiofrequency catheter ablation of a unifocal atrial tachycardia. PMID:9197188

  7. Right atrial indwelling catheter for patients requiring long-term intravenous therapy.

    PubMed

    Ivey, M F; Adam, S M; Hickman, R O; Gibson, D L

    1978-12-01

    The use of a central venous catheter for long-term intravenous therapy is described. The catheter's history, physical description, and uses are discussed. Also reviewed are complications from use of the catheter, the pharmacist's role in patient teaching, and the procedure for administering medications through the catheter. A listing of drugs administered through the catheter, incompatibility data and patient teaching instructions are also included. PMID:717409

  8. 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

  9. The Three Planes of Language.

    ERIC Educational Resources Information Center

    Sampson, Gloria

    1999-01-01

    Currently, the language sciences place together four different forms of mental activity on one plane of language, which results in confusion. This paper presents arguments from metaphysics, hermeneutics, and semiotics to demonstrate that there are actually three planes of language (a biologically-based information processing plane, a literal…

  10. Urinary catheter with polyurethane coating modified by ion implantation

    NASA Astrophysics Data System (ADS)

    Kondyurina, I.; Nechitailo, G. S.; Svistkov, A. L.; Kondyurin, A.; Bilek, M.

    2015-01-01

    A low friction urinary catheter that could be used without a lubricant is proposed in this work. A polyurethane coating was synthesised on the surface of a metal guide wire catheter. Ion implantation was applied to surface modify the polyurethane coating. FTIR ATR, wetting angle, AFM and friction tests were used for analysis. Low friction was found to be provided by the formation of a hard carbonised layer on the polyurethane surface.

  11. 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. PMID:21096567

  12. Peripherally Inserted Central Catheters Complicated by Vascular Erosion in Neonates.

    PubMed

    Blackwood, Brian P; Farrow, Kathryn N; Kim, Stan; Hunter, Catherine J

    2016-08-01

    Peripherally inserted central catheters (PICCs) are widely used in the pediatric population, and their use continues to grow in popularity. These catheters provide a reliable source of venous access to neonatal patients but can also be the cause of life-threatening complications. There are several well-documented complications such as infections, catheter thrombosis, vascular extravasations, and fractured catheters. However, the complication of vascular erosion into the pleural space using both small and silicone-based catheters is rarely described. After obtaining institutional review board approval, we identified 4 cases to review of PICCs complicated by vascular erosions in the past 2 years. Herein, we also review the current literature of PICC complications. Getting the catheter tip as close to the atrial-caval junction as possible and confirmation of this placement are of the utmost importance. The thick wall of the vena cava near the atrium seems to be less likely to perforate; in addition, this position provides increased volume and turbulence to help dilute the hyperosmolar fluid, which seems to also be a factor in this complication. A daily screening chest x-ray in patients with upper extremity PICCs and ongoing parenteral nutrition (PN) are not necessary at this time given the overall low rate of vascular erosion and concerns regarding excessive radiation exposure in pediatric populations. However, a low threshold for chest x-ray imaging in patients with even mild respiratory symptoms in the setting of upper extremity PN is recommended. PMID:25700180

  13. Continuous shoulder analgesia via an indwelling axillary brachial plexus catheter.

    PubMed

    Reuben, S S; Steinberg, R B

    2000-09-01

    Continuous interscalene brachial plexus blockade can provide anesthesia and analgesia in the shoulder region. Difficulty accessing the interscalene space and premature displacement of interscalene catheters may preclude their use in certain situations. We present two case reports in which a catheter was advanced from the axilla along the brachial plexus sheath to the interscalene space to provide continuous cervicobrachial plexus analgesia. In the first case report, previous neck surgery made the anatomic landmarks for performing an interscalene block very difficult. An epidural catheter was advanced from the axillary brachial plexus sheath to the interscalene space under fluoroscopic guidance. This technique provided both intraoperative analgesia for shoulder surgery as well as 24-hour postoperative analgesia by an infusion of 0.125% bupivacaine. In the second case report, a catheter was inserted in a similar fashion from the axillary to the interscalene space to provide 14 days of continuous analgesia in the management of complex regional pain syndrome. We have found that this technique allows us to secure the catheter more easily than with the traditional interscalene approach and thus prevents premature dislodgment. This approach may be a suitable alternative when either an interscalene or an infraclavicular catheter may not be inserted. PMID:11090734

  14. 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

  15. Active catheter driven by a thermo-hydraulic actuation.

    PubMed

    Horovitz, Yonatan; Kosa, Gabor

    2015-01-01

    Catheters and flexible endoscopes are usually steered by mechanical wires that are driven from their base. Due to friction and buckling there is a need to place the driving actuator of the catheter at the catheter's tip. Such active catheter's manoeuvrability is much higher than wire-driven ones. A problem with active catheters is the difficulty to create high enough bending using micro-actuators placed at the catheter's tip. Our actuation method is an attempt to overcome this difficulty by using a novel thermo-hydraulic actuation method. The magnitude of the bending torque of our actuator is created by internal hydraulic pressure in the tube and the steering direction is controlled by the thermal micro-actuator embedded in the wall of the tube. In this paper we present the modelling, optimization, design and testing of an initial prototype of such an actuator. We found that a 4 mm OD actuator made of TPU can bend to ±12°. PMID:26738094

  16. 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.

  17. Migration of Central Venous Catheters in Neonates: A Radiographic Assessment.

    PubMed

    Gupta, Ruby; Drendel, Amy L; Hoffmann, Raymond G; Quijano, Carla V; Uhing, Michael R

    2016-05-01

    Objective This study aims to determine the frequency that umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs) migrate into the cardiothymic silhouette after initial verification of correct placement. Study Design This is a single-center, retrospective study in neonates in whom a PICC or UVC was placed. The frequency of catheter tip migration into the cardiothymic silhouette requiring catheter manipulation was determined radiographically at 1 and 24 hours, respectively, after insertion. Results At 1 and 24 hours, 36 and 23% of UVCs (n = 41) migrated into the cardiothymic silhouette, respectively. At 1 and 24 hours, 23 and 11% of PICCs (n = 63) migrated into the cardiothymic silhouette, respectively. Migration was not associated with birth weight, weight at insertion, or postnatal age at insertion. Conclusion UVCs and PICCs frequently migrate into the cardiothymic silhouette increase the risk for development of a pericardial effusion. Serial radiographic assessment of catheter tip location is needed to assess catheter migration within the first 24 hours of line placement. PMID:26731179

  18. Important aspects of the colonization of central venous catheter.

    PubMed

    Andreoli-Pinto, T J; Graziano, K U

    1999-01-01

    This study comprises five different kind of venous central catheters, 103 in total, made of Polyurethane Tecoflex, Polyurethane Vialon, PTFE and PVC, and the influence of their raw material on the microbial colonization. Patients age and sex, besides their clinical conditions, were taken into account, and neither considered as a sample vicious, nor associated with colonization. When the tips of the catheters were asseptically inoculated in Tryptic Soy Broth and Tioglicolate, colonization was detected in 15.5% of the catheters. Coagulase negative Staphylococcus, some of which with biofilm, were the predominant organisms found, although some bacillus have also been detected: Enterobacter aerogenes, Hafnia alvei, Pseudomonas cepacia, Xanthomonas maltophilia and Aeromonas sobria. It was not possible to notice any association between the colonization of the catheters and their raw material, probably due to the influence of a previous contact and linking with blood components. This contact causes a thin coating on the surface of the cathether, which makes all the catheters similar in respect of the attachment of a bacterial cell. So, the colonization depends on the virulence of the organism, much more then on the nature of the catheter. PMID:10326311

  19. Bacterial biofilms in patients with indwelling urinary catheters.

    PubMed

    Stickler, David J

    2008-11-01

    Bacteria have a basic survival strategy: to colonize surfaces and grow as biofilm communities embedded in a gel-like polysaccharide matrix. The catheterized urinary tract provides ideal conditions for the development of enormous biofilm populations. Many bacterial species colonize indwelling catheters as biofilms, inducing complications in patients' care. The most troublesome complications are the crystalline biofilms that can occlude the catheter lumen and trigger episodes of pyelonephritis and septicemia. The crystalline biofilms result from infection by urease-producing bacteria, particularly Proteus mirabilis. Urease raises the urinary pH and drives the formation of calcium phosphate and magnesium phosphate crystals in the biofilm. All types of catheter are vulnerable to encrustation by these biofilms, and clinical prevention strategies are clearly needed, as bacteria growing in the biofilm mode are resistant to antibiotics. Evidence indicates that treatment of symptomatic, catheter-associated urinary tract infection is more effective if biofilm-laden catheters are changed before antibiotic treatment is initiated. Infection with P. mirabilis exposes the many faults of currently available catheters, and plenty of scope exists for improvement in both their design and production; manufacturers should take up the challenge to improve patient outcomes. PMID:18852707

  20. Migrating lumbar intrathecal catheter fragment associated with intracranial subarachnoid hemorrhage.

    PubMed

    Hnenny, Luke; Sabry, Hatem A; Raskin, Jeffrey S; Liu, Jesse J; Roundy, Neil E; Dogan, Aclan

    2015-01-01

    Intrathecal catheter placement into the lumbar cistern has varied indications, including drug delivery and CSF diversion. These Silastic catheters are elastic and durable; however, catheter-associated malfunctions are well reported in the literature. Fractured catheters are managed with some variability, but entirely intradural retained fragments are often managed conservatively with observation. The authors describe a case of a 70-year-old man with an implanted intrathecal morphine pump for failed back surgery syndrome who presented to an outside hospital with a history of headache, neck pain, nausea, and photophobia of 3 days' duration. He also described mild weakness and intermittent numbness of both legs. Unenhanced head CT demonstrated subarachnoid hemorrhage (SAH). A right C-5 hemilaminectomy was performed. This case is unique in that there was no indication that the lumbar intrathecal catheter had fractured prior to the patient's presentation with SAH. This case demonstrates that intrathecal catheter fragments are mobile and can precipitate intracranial morbidity. Extrication of known fragments is safe and should be attempted to prevent further neurosurgical morbidity. PMID:25360531

  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. 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.

  3. Catheter ablation of atrial fibrillation: Radiofrequency catheter ablation for redo procedures after cryoablation

    PubMed Central

    Kettering, Klaus; Gramley, Felix

    2013-01-01

    AIM: To evaluate the effectiveness of two different strategies using radiofrequency catheter ablation for redo procedures after cryoablation of atrial fibrillation. METHODS: Thirty patients (paroxysmal atrial fibrillation: 22 patients, persistent atrial fibrillation: 8 patients) had to undergo a redo procedure after initially successful circumferential pulmonary vein (PV) isolation with the cryoballoon technique (Arctic Front Balloon, CryoCath Technologies/Medtronic). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (CARTO; Biosense Webster) depending on the intra-procedural findings. After discharge, patients were scheduled for repeated visits at the arrhythmia clinic. A 7-day Holter monitoring was performed at 3, 12 and 24 mo after the ablation procedure. RESULTS: During the redo procedure, a mean number of 2.9 re-conducting pulmonary veins (SD ± 1.0 PVs) were detected (using a circular mapping catheter). In 20 patients, a segmental approach was sufficient to eliminate the residual pulmonary vein conduction because there were only a few recovered pulmonary vein fibres. In the remaining 10 patients, a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction. All recovered pulmonary veins could be isolated successfully again. At 2-year follow-up, 73.3% of all patients were free from an arrhythmia recurrence (22/30). There were no major complications. CONCLUSION: In patients with an initial circumferential pulmonary vein isolation using the cryoballoon technique, a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation. PMID:24009817

  4. The Tego™ needleless connector for hemodialysis catheters may protect against catheter colonization.

    PubMed

    Guembe, M; Pérez-Granda, M J; Cruces, R; Alcalá, L; Bouza, E

    2016-08-01

    Catheter connectors used in hemodialysis patients are those with open caps to manage high blood flows. However, current guidelines for the prevention of catheter infections recommend closed connectors. Tego™ is a closed connector designed to enable high blood flows. We used an in vitro model to compare the efficacy of Tego™ against contamination with that of standard caps in a real-life practice scenario. The model consisted of 200 blood culture bottles (BCB) with an inserted cannula closed either with Tego™ (100) or with open caps (100). BCB were manipulated using two different methods: under aseptic conditions and with gloves contaminated with a 0.05 McFarland Staphylococcus aureus solution. The BCB were incubated at 37 °C under continuous shaking for up to 7 days or until positive. When a BCB turned positive, 100 μL of the fluid was cultured. The positivity rate and time to positivity of the BCB in each method were compared. Overall, 4.0 % of BCB with Tego™ and 52.0 % of BCB with open caps were positive in the sterile model (p < 0.001), whereas all BCB in the contamination model were positive. We did not find differences regarding the median time (hours) to positivity between Tego™ and the standard cap in the contamination model (19.04 vs. 17.87, p = 0.465). In our model, Tego™ proved to be better than the standard cap for the prevention of contamination when the device was handled under optimal conditions. Moreover, it was as efficient as the standard catheter cap in the contamination model. PMID:27189077

  5. NASA Connect: 'Plane Weather'

    NASA Technical Reports Server (NTRS)

    1999-01-01

    Excerpt from the NASA Connect show 'Plane Weather' This clip explains how our weather occurs, and why Solar radiation is responsible. 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.

  6. 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.

  7. 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.

  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. 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.

  10. Fiber optic pressure catheter for cardiovascular applications

    NASA Astrophysics Data System (ADS)

    Lin, Yuping; Sawatari, Takeo; Hartley, Craig J.

    1998-07-01

    We developed a fiber optic pressure catheter which has the potential to exceed the performance and cost-effectiveness of any currently available pressure measurement system in cardiovascular applications. Our design is based on a movable metallic ribbon, which works as a reflector, to transform the pressure into a light signal. The sensor has a diameter of 0.8 mm and is covered by medical grade polyurethane. In the laboratory tests, our sensors consistently showed high sensitivity and low noise (about 1 mmHg) over the pressure range of 0 to 300 mmHg. The time constant of the sensor, which is limited by the current software is about 20 mseconds (50 Hz). Using a mechanical heart simulator to generate pressure pulses, the pressure reading was independent of temperature change over a 30 degree Celsius range, and the drift was minimal during the 72-hour pressure pulse tests. A preliminary animal test was carried out with our sensors inserted into the artery of a dog. The comparison with an external reference sensor showed basic sensor performance. The sensor can also be used in brain, lung, and bladder pressure measurement applications.

  11. Reliability of Ultrasound Imaging of the Transversus Deep Abdominial, Internal Oblique and External Oblique Muscles of Patients with Low Back Pain Performing the Drawing-in Maneuver

    PubMed Central

    Park, Sung doo

    2013-01-01

    [Purpose] The purpose of this study was to investigate the reliability of ultrasound imaging (USI) measurements of muscle thicknesses of patients with low back pain (LBP) performing the abdominal drawing-in maneuver (ADIM) [Subjects] Twenty patients with LBP were the subjects. [Methods] Muscle thickness measurements of transversus abdominis (Tra), internal obliques (IO), and external obliques (EO) muscles were measured using ultrasound imaging at rest and during performance of the ADIM. [Results] The intra-examiner reliability estimates ranged from 0.55 to 0.97 in the rest position, and from 0.82 to 0.95 during ADIM. The inter-examiner reliability estimates ranged from 0.77 to 0.98 in the rest position, and from 0.86 to 0.98 during ADIM. [Conclusion] ADIM thickness measurements of the TrA, IO, and EO muscles in patients with LBP based on the mean of 2 measures are highly reliable when taken by a single examiner and adequately reliable when taken by different examiners. PMID:24259867

  12. Ultrasound Evaluation of Muscle Thickness Changes in the External Oblique, Internal Oblique, and Transversus Abdominis Muscles Considering the Influence of Posture and Muscle Contraction

    PubMed Central

    Sugaya, Tomoaki; Abe, Yota; Sakamoto, Masaaki

    2014-01-01

    [Purpose] The aim of this study was to investigate muscle thickness changes in the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) muscles between the neutral position and trunk rotation, under a state of rest without voluntary contractions, and isometric contractions to both sides with resistance of 50% of the maximum trunk rotation strength. [Subjects] The subjects of this study were 21 healthy young men. [Methods] Muscle thickness changes in the EO, IO, and TrA in each position and state were evaluated by ultrasound. The range of motion at maximum trunk rotation and the maximum strength of trunk rotation were measured using a hand-held dynamometer. [Results] In the neutral position and at 50% trunk rotation to the right side, the thicknesses of the IO and TrA significantly increased with resistance. In both states, the thicknesses of the IO and TrA significantly increased at 50% trunk rotation to the right side. [Conclusion] The muscular contractions of the IO and TrA were stronger during ipsilateral rotation than in the neutral position and with resistance than at rest. Moreover, the muscular contraction was strongest in the resistive state during ipsilateral rotation. PMID:25276022

  13. A prospective randomized controlled trial of Wallace and Rocket embryo transfer catheters.

    PubMed

    El-Shawarby, Salem A; Ravhon, Amir; Skull, Jonathan; Ellenbogen, Adrian; Trew, Geoffrey; Lavery, Stuart

    2008-10-01

    The aim of this study was to compare the efficacy of two embryo transfer catheters: Wallace and Rocket Embryon in an IVF programme of a tertiary referral university centre. A total of 308 patients undergoing embryo transfer were prospectively randomized to either a transfer with the Wallace catheter or a transfer with the Rocket catheter. The main outcome measure in this study was the clinical pregnancy rate, and secondary outcome measures included implantation rate, visibility of the catheter under ultrasound, number of retained embryos post transfer, and whether change of catheter was required. In addition, patient discomfort during the procedure was recorded. Pregnancy and implantation rates were similar when Wallace or Rocket catheters were used. However, for the Rocket catheter, the tip was more often clearly seen on ultrasound and it had a lower rate of retained embryos in the catheter after transfer (P < 0.05). Experience with different transfer catheters is recommended for difficult cases. PMID:18854110

  14. A comparison of epidural catheters with or without subcutaneous injection ports for treatment of cancer pain.

    PubMed

    de Jong, P C; Kansen, P J

    1994-01-01

    The aim of this study was to compare the incidence of technical complications of epidural catheters with subcutaneous injection ports to percutaneous epidural catheters without ports, fixed only by adhesive dressing. We reviewed 149 patients who received 250 epidural catheters for treatment of cancer pain during a 3 1/2-yr period from January 1, 1989, to June 30, 1992. Of the 250 catheters, 52 were provided with subcutaneous injection ports and 198 were percutaneous catheters. Of the 198 percutaneous catheters, 41 were tunneled for a short distance; the remainder entered the skin at the dorsal midline. In the percutaneous group 21% of the catheters became dislodged. In the injection port group, there were no catheter dislodgements. The overall incidence of infections was similar in both groups (13.6%). When we indexed the infection rate to catheter-days, the number of infections per 1000 catheter-days in the injection port group was half that of the percutaneous group (2.86 infections versus 5.97 for percutaneous catheters). No injection port became infected during the first 70 days of treatment, whereas in the percutaneous group infections occurred as early as the first week. Within the percutaneous group the complication rate in the tunneled epidural catheters was as high as in the nontunneled. We conclude that injection ports reduce the complication rate of epidural catheters, particularly catheter dislodgement and early infections. PMID:8267188

  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. Epidural catheter fixation. A comparison of subcutaneous tunneling versus device fixation technique

    PubMed Central

    Sharma, Ashima; Parasa, Sujay Kumar; Tejvath, Kiran; Ramachandran, Gopinath

    2016-01-01

    Background and Aims: The technique of securing the epidural catheter has a major bearing on the efficacy of epidural analgesia. Specific fixator devices, for e.g., Lockit epidural catheter clamp, which successfully prevents catheter migration, are available. The possibility of catheter snapping and surgical retrieval has been reported with tunneling of catheters. These techniques have not been compared for safety, efficacy and appropriateness of achieving secure epidural catheter fixation in the postoperative period. Material and Methods: A total of 200 patients who required postoperative epidural analgesia were included. They were randomized into two groups: Group I (n = 100) in whom epidural catheters were tunneled vertically in the paravertebral subcutaneous tissue and group II (n = 100) wherein a Lockit device was used to fix the catheter. Likert score was used to quantify patient's comfort during procedure. The techniques were compared for migration, catheter dislodgement, local trauma, catheter snapping and catheter obstruction. Results: 12% of tunneled catheters had migrated significantly outward. 22% of patients had erythema and 77% had significant procedural discomfort in group I. In group II, 3% catheters had kinked and 14% had erythema from device adhesive. Conclusion: Our results support the use of Lockit device as a safe and comfortable fixation device compared to subcutaneous tunneling of catheters. PMID:27006544

  17. Non-infected hemodialysis catheters are associated with increased inflammation compared to arteriovenous fistulas.

    PubMed

    Goldstein, Stuart L; Ikizler, T Alp; Zappitelli, Michael; Silverstein, Douglas M; Ayus, Juan C

    2009-11-01

    Although hemodialysis catheters predispose to infection which, in turn, causes inflammation, we studied whether they induce inflammation independent of infection. We compared the level of the inflammatory marker C-reactive protein (CRP) in maintenance hemodialysis patients, comparing those dialyzed using a non-infected catheter to those using arteriovenous fistulas. All incident patients had catheters and fistula placement at dialysis initiation. In 35 patients the fistulas matured, the catheters were removed and the patients were evaluated at 6 months (catheter-fistula). These results were compared to 15 patients in whom the fistula did not mature and catheter use persisted for 6 months (catheter-catheter). There was a significant 82% reduction in the CRP level in the catheter-fistula group but a 16% increase in the catheter-catheter group at 6 months. The changes in CRP did not differ by gender, diabetes status, or by race, and was not correlated with a change in phosphorus, age, or urea reduction ratio at 1 month following hemodialysis initiation. Decreased CRP was associated with increased hemoglobin and albumin. Patients with persistent fistula use from dialysis initiation through 6 months had consistently low CRP levels over that time period. Our study shows that catheters might contribute to increased inflammation independent of infection, and supports avoidance of catheters and a timely conversion to fistulas with catheter removal. PMID:19675528

  18. Intracranial ventricular catheter placement with a smartphone assisted instrument.

    PubMed

    Thomale, Ulrich-W

    2015-01-01

    Mobile technology has recently been introduced for blood pressure measurements or glucose level controls. In surgical disciplines the use of smartphone applications is mostly restricted as training tools or knowledge resources. Simple surgical procedures which are performed often in certain disciplines may be performed with limited accuracy since routine and overwork of medical staff lead to less awareness to possible mistakes. In these cases simple and effective means are necessary to achieve better patient safety.In this context, a surgical instrument for ventricular catheter placement in neurosurgical patients was designed which is assisted by measurements undertaken in a smartphone software application specifically visualizing the use of this instrument and achieving better accuracy for catheter positioning. On theoretical ground, the angulation of the catheter trajectory towards the surface of the skull in a coronal reconstructed CT or MR image is determined as the simplified but the most relevant individual parameter for correct ventricular catheter placement. Transfer of a CT/MRI image onto the smartphone can be performed via mail as anonymous file. Using this image, the trajectory measurement can be performed individually in a few steps by calibration of the image size, definition of the frontal entry point, and virtual placement of the instrument on the surface of the skull. Then the angulation can be adjusted and measured to place the catheter's trajectory towards the ipsilateral ventricle and the catheter length is determined. The parameters are now given by the app and visualized on the image in order to be applied to the surgical site of the patient.The tool represents a widely available and cost-effective solution as navigation technique which is simple to apply in order to achieve better accuracy in ventricular catheter placement for higher safety in a large cohort of neurosurgical patients. PMID:25626554

  19. 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.

  20. 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.'.

  1. 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

  2. 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. PMID:26501916

  3. Effect of plastic catheter material on bacterial adherence and viability.

    PubMed

    Lopez-Lopez, G; Pascual, A; Perea, E J

    1991-06-01

    The kinetics of adherence of single isolates of Staphylococcus aureus, S. epidermidis, Pseudomonas aeruginosa and Escherichia coli to catheters made of polyvinyl chloride (PVC), Teflon, siliconised latex, polyurethane and Vialon was evaluated by a radiometric assay. Radiolabelled bacteria (10(8) cfu/ml) were incubated in vials containing 1-cm lengths of catheter for up to 3 days. The peak of maximal adherence to each biomaterial was reached after 24 h for P. aeruginosa and after 72 h for the other strains. Bacterial adherence to PVC and siliconised latex was significantly higher (2-6 times; p less than 0.05) than to the other biomaterials for all the strains. The lowest values of adherence were observed with polyurethane and Vialon for the staphylococci but with Teflon for E. coli and P. aeruginosa. Bacterial viability and growth was evaluated in eluates obtained from incubation of segments of each catheter in buffer for 24 h. None of the eluates affected the viability of the staphylococci. However, all of them, significantly increased the growth of E. coli and P. aeruginosa with the exception of the eluate from siliconised latex, in which the inoculum count was reduced to an undetectable level for E. coli. We conclude that bacterial adherence to catheters may depend in part on the nature of the biomaterial and that certain substances eluted from the catheters may affect the viability and growth of different micro-organisms. PMID:1905357

  4. How to deal with dialysis catheters in the ICU setting

    PubMed Central

    2012-01-01

    Acute kidney insufficiency (AKI) occurs frequently in intensive care units (ICU). In the management of vascular access for renal replacement therapy (RRT), several factors need to be taken into consideration to achieve an optimal RRT dose and to limit complications. In the medium and long term, some individuals may become chronic dialysis patients and so preserving the vascular network is of major importance. Few studies have focused on the use of dialysis catheters (DC) in ICUs, and clinical practice is driven by the knowledge and management of long-term dialysis catheter in chronic dialysis patients and of central venous catheter in ICU patients. This review describes the appropriate use and management of DCs required to obtain an accurate RRT dose and to reduce mechanical and infectious complications in the ICU setting. To deliver the best RRT dose, the length and diameter of the catheter need to be sufficient. In patients on intermittent hemodialysis, the right internal jugular insertion is associated with a higher delivered dialysis dose if the prescribed extracorporeal blood flow is higher than 200 ml/min. To prevent DC colonization, the physician has to be vigilant for the jugular position when BMI < 24 and the femoral position when BMI > 28. Subclavian sites should be excluded. Ultrasound guidance should be used especially in jugular sites. Antibiotic-impregnated dialysis catheters and antibiotic locks are not recommended in routine practice. The efficacy of ethanol and citrate locks has yet to be demonstrated. Hygiene procedures must be respected during DC insertion and manipulation. PMID:23174157

  5. Radiofrequency catheter ablation of accessory pathways in infants.

    PubMed Central

    Benito, F.; Sánchez, C.

    1997-01-01

    OBJECTIVE: To evaluate the indications, results and complications of radiofrequency catheter ablation in small infants with supraventricular tachycardia due to an accessory atrioventricular pathway. METHODS: Five infants less than 9 months old underwent radiofrequency catheter ablation of accessory pathways. Ablation was done for medically refractory tachyarrhythmia associated with aborted sudden death in two patients, left ventricular dysfunction in one, failure of antiarrhythmic drugs in one, and planned cardiac surgery in one. All five patients underwent a single successful procedure. Three left free wall pathways were ablated by transseptal approach, a right posteroseptal pathway was ablated from the inferior vena cava, and a left posteroseptal pathway was approached from the inferior vena cava into the coronary sinus. A deflectable 5F bipolar electrode catheter with a 3 mm tip was used. RESULTS: A sudden increment in impedance indicative of coagulum formation was observed in two procedures. One patient developed a transient ischaemic complication after ablation of a left lateral accessory pathway by transseptal approach. This patient had mild pericardial effusion after the procedure. Moderate pericardial effusion was also noted in another patient. After a mean follow up of 18.4 months all patients are symptom free without treatment. CONCLUSIONS: Radiofrequency catheter ablation can be performed successfully in infants. Temperature monitoring in 5F ablation catheters would be desirable to prevent the development of coagulum. Echocardiography must be performed after the ablation procedure to investigate pericardial effusion. Images PMID:9326990

  6. 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.

  7. Plane Mercury librations

    NASA Astrophysics Data System (ADS)

    Barkin, Yu. V.; Ferrandiz, J. M.

    2009-04-01

    theory of Mercury librations in longitude by using three characteristics of Mercury rotation determined in the paper [3]. Two from these parameters are values of angle of librations in longitude and angular velocity in moment of passage of perihelion of Mercury orbit on 17 April 2002: (^g)0 = 0007 ± 0001, (^?•? )0 = (2.10± 0.06)•? ars/d. Third parameter determined in [3] is a dynamical coefficient: K = (B -A)•(4Cm ) = (5.08± 0.30) × 10-5. B > A are principal moment of inertia, corresponding to equatorial axes of inertia; Cm is a polar moment of inertia of the mantle of Mercury. 1 Analytical theory of plane Mercury librations. This theory describes forced and free librations of Mercury in longitude in the frame of plane problem about resonant librations of Mercury considered or as non-spherical rigid body, or as system of rigid non-spherical mantle and liquid ellipsoidal core. Saving the main terms for the perturbations of angle of librations ^g and angular velocity ^? in both mentioned cases we will have formulae [6]: ^g = K(E sin M + E sin2M + E sin 3M + E sin4M + E sin5M ) 1 2 3 4 5+K0 sin(E šKM- - φ) (A)

  8. Use of heparin-coated central venous lines to prevent catheter-related bloodstream infection.

    PubMed

    Abdelkefi, Abderrahman; Achour, Wafa; Ben Othman, Tarek; Ladeb, Saloua; Torjman, Lamia; Lakhal, Amel; Ben Hassen, Assia; Hsairi, Mohamed; Ben Abdeladhim, Abdeladhim

    2007-06-01

    Bloodstream infections related to the use of central venous catheters are an important cause of patient morbidity, mortality, and increased health care costs. Catheter-related infection may be due to fibrin deposition associated with catheters. Interventions designed to decrease fibrin deposition have the potential to reduce catheter-related infections. This study was a randomized, controlled trial in which 246 patients with nontunneled central venous catheters were randomly assigned to receive a heparin-coated catheter with 50 mL/d of normal saline solution as a continuous infusion (heparin-coated group) or a noncoated catheter with a continuous infusion of low-dose unfractionated heparin (control group: continuous infusion of 100 U/kg/d). Catheter-related bloodstream infection occurred in 2.5% (3/120 catheters) in the heparin-coated group (0.9 events per 1,000 days) and in 9.1% (11/120 catheters) in the control group (3.5 events per 1,000 days; P = 0.027). No other risk factors were found for the development of catheter-related bloodstream infection. Six and seven patients experienced severe bleeding in the heparin-coated and control groups, respectively (P = 1.00). We did not observe heparin-induced thrombocytopenia. The use of heparin-coated catheters can be a safe and effective approach to the prevention of catheter-related bloodstream infection in patients with hematooncologic disease. PMID:17624052

  9. 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. PMID:17099302

  10. Comparison of outcomes between surgically placed and percutaneously placed peritoneal dialysis catheters: A retrospective study

    PubMed Central

    Sivaramakrishnan, R.; Gupta, S.; Agarwal, S. K.; Bhowmik, D.; Mahajan, S.

    2016-01-01

    There is lack of adequate data on comparison of outcomes between percutaneously placed peritoneal dialysis (PD) catheters inserted by nephrologists and PD catheters placed by surgeons. The aim of this study is to retrospectively analyze the outcomes of PD catheters inserted by surgeons (by open surgical or laparoscopic technique) and compare them with those inserted by nephrologists among ESRD patients who underwent elective PD catheter insertions between January 2009 and December 2012. The primary outcome measure was the proportion of catheters removed because of primary nonfunction. The secondary outcome measures were catheter survival, patient survival, and incidence of complications of catheter insertion. A total of 143 PD catheter insertions (88 by surgeons and 55 by nephrologists) performed in 132 patients were considered for the analysis. The primary nonfunction rate of PD catheter insertions in both groups was comparable (18.2% and 7.3%, P = 0.08). Break-in period was shorter in Group N (p = <0.001). No differences were noted in patient or catheter survival. Percutaneously placed PD catheters performed by nephrologists have comparable outcomes with surgically placed PD catheters among selected cases and have the advantage of lower costs, avoidance of operation theater scheduling issues, smaller incision length, and shorter break-in period. Therefore, more nephrologists should acquire the expertise on percutaneous PD catheter placement as it leads to lesser waiting times and better utilization of PD. PMID:27512299

  11. Comparison of outcomes between surgically placed and percutaneously placed peritoneal dialysis catheters: A retrospective study.

    PubMed

    Sivaramakrishnan, R; Gupta, S; Agarwal, S K; Bhowmik, D; Mahajan, S

    2016-01-01

    There is lack of adequate data on comparison of outcomes between percutaneously placed peritoneal dialysis (PD) catheters inserted by nephrologists and PD catheters placed by surgeons. The aim of this study is to retrospectively analyze the outcomes of PD catheters inserted by surgeons (by open surgical or laparoscopic technique) and compare them with those inserted by nephrologists among ESRD patients who underwent elective PD catheter insertions between January 2009 and December 2012. The primary outcome measure was the proportion of catheters removed because of primary nonfunction. The secondary outcome measures were catheter survival, patient survival, and incidence of complications of catheter insertion. A total of 143 PD catheter insertions (88 by surgeons and 55 by nephrologists) performed in 132 patients were considered for the analysis. The primary nonfunction rate of PD catheter insertions in both groups was comparable (18.2% and 7.3%, P = 0.08). Break-in period was shorter in Group N (p = <0.001). No differences were noted in patient or catheter survival. Percutaneously placed PD catheters performed by nephrologists have comparable outcomes with surgically placed PD catheters among selected cases and have the advantage of lower costs, avoidance of operation theater scheduling issues, smaller incision length, and shorter break-in period. Therefore, more nephrologists should acquire the expertise on percutaneous PD catheter placement as it leads to lesser waiting times and better utilization of PD. PMID:27512299

  12. Severe hypernatremia associated catheter malposition in an intensive care patient.

    PubMed

    Silahli, Musa; Gökdemir, Mahmut; Duman, Enes; Gökmen, Zeynel

    2016-09-01

    We present a catheter related severe hypernatremia in a 2-month-old baby who was admitted to the pediatric intensive care. Imbalance of plasma sodium is commonly seen in pediatric intensive care patients. The water and sodium balance is a complex process. Especially, brain and kidneys are the most important organs that affect the water and sodium balance. Other mechanisms of the cellular structure include osmoreceptors, Na-K ATPase systems, and vasopressin. Hypernatremia is usually an iatrogenic condition in hospitalized patients due to mismanagement of water electrolyte imbalance. Central venous catheterization is frequently used in pediatric intensive care patients. Complications of central venous catheter placement still continue despite the usage of ultrasound guidance. Malposition of central venous catheter in the brain veins should be kept in mind as a rare cause of iatrogenic hypernatremia. PMID:27555161

  13. The use of multiple intraosseous catheters in combat casualty resuscitation.

    PubMed

    Sarkar, Debjeet; Philbeck, Thomas

    2009-02-01

    During the current military engagements in Iraq and Afghanistan, establishing intravenous (IV) access for resuscitation of critically injured casualties remains a persistent challenge. Intraosseous (IO) access has emerged as a viable alternative in resuscitation. In this case report, a 19 year-old male soldier was severely wounded by a roadside bomb in Iraq. Given the heavy initial blood loss, anatomic location of the injuries and gross wound contamination, peripheral IV access could not be established. Instead, multiple IO catheters were used to initiate fluid resuscitation prior to transfer to a combat support hospital. To our knowledge, this is the first report of such extensive usage of IO catheters. Multiple IO catheters can be placed rapidly and safely and may help solve the challenge of establishing vascular access for resuscitation of critically injured casualties. PMID:19317188

  14. Best practice for indwelling catheter in the home setting.

    PubMed

    Emr, Kathleen; Ryan, Rosemary

    2004-12-01

    Although there is ample research-based evidence regarding indwelling urinary catheter management in acute and long-term care settings, there is limited home care information. This article describes how a home health agency, using available research and then extrapolating and applying it to home care, implemented a successful catheter management program.Hackensack University Medical Center Home Health Agency (HUMC) is among the largest certified home health agencies in New Jersey, providing community-based services to more than 10,000 patients annually. The present climate of limited fiscal and human resources necessitate an efficient and cost-effective use of all services to remain viable, including initiatives in urinary catheter management. PMID:15597002

  15. Novel catheter enabling simultaneous radiofrequency ablation and optical coherence reflectometry

    PubMed Central

    Herranz, D.; Lloret, Juan; Jiménez-Valero, Santiago; Rubio-Guivernau, J. L.; Margallo-Balbás, Eduardo

    2015-01-01

    A novel radiofrequency ablation catheter has been developed with integrated custom designed optics, enabling real-time monitoring of radiofrequency ablation procedures through polarization-sensitive optical coherence reflectometry. The optics allow for proper tissue illumination through a view-port machined in the catheter tip, thus providing lesion depth control over the RF ablation treatment. The system was verified in an in-vitro model of swine myocardium. Optical performance and thermal stability was confirmed after more than 25 procedures, without any damage to the optical assembly induced by thermal stress or material degradation. The use of this catheter in RF ablation treatments may make possible to assess lesion depth during therapy, thus translating into a reduction of potential complications on the procedure. PMID:26417499

  16. 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.

  17. Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction

    PubMed Central

    Roldan, Carlos J.; Paniagua, Linda

    2015-01-01

    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. PMID:26587087

  18. 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

  19. Nosocomial sepsis in neonates with single lumen vascular catheters.

    PubMed

    Bhandari, V; Eisenfeld, L; Lerer, T; Holman, M; Rowe, J

    1997-01-01

    Catheter-related sepsis is commonly encountered in the neonatal intensive care unit. We retrospectively studied infants with vascular catheters at 2 NICUs. Data were obtained from the computerised admission records available at both the hospitals. Our aims were to describe the clinical and microbial profile of nosocomial sepsis in infants with vascular catheters [umbilical artery (UA), umbilical venous (UV), central venous Broviac (CV), percutaneously placed central venous (PC), peripheral artery (PA)], and to determine the association between catheter type, duration and sepsis in a subset of the population. Nosocomial sepsis (positive blood culture after the 3rd postnatal day) occurred in 217 of 2091 (10.4%) infants. Infected infants, in contrast to non-infected, had a significantly (P < 0.001) greater number of multiple catheters (2.3 vs 1.4) had lower birth weights (1.2 vs 2.1 kg), were younger (28 vs 33 weeks) and had lower 1 and 5 minute Apgar scores (4.3 and 6.7 vs 5.5 and 7.4). The most common organism was coagulase negative Staphylococcus. In a subset population as analyses revealed, longer duration of UA use was associated with higher infection rates [13.6% with UA use for > or = 8 days vs 1.3% for < or = 7 days (P < 0.0001)]. PC use had a lower rate of sepsis than CV use (5.1% vs 15.2%; P < 0.05). Use of intravascular catheters should be balanced between the need for vascular access and the risk of sepsis. PMID:10771883

  20. [Catheter-related thrombosis during intravascular temperature management].

    PubMed

    Kerz, T; Beyer, C; Oswald, S; Moringlane, R

    2016-07-01

    We report on a case of catheter-related thrombosis after 7‑day catheter placement during intravascular temperature management (IVTM), in spite of the use of prophylactic anticoagulants. There were no clinical sequelae. According to the literature, occult thrombosis during ITVM could be more frequent than previously reported and dedicated monitoring for potential thrombosis may be indicated. However, a study comparing IVTM with surface cooling found no differences in clinical outcome. Therefore, n either of the methods can be recommended over the other. Further studies should evaluate the rate of occult thrombosis during the use of both cooling methods. PMID:27316589

  1. A retrospective study of central venous catheters GCRI experience

    PubMed Central

    Jain, Sachin A.; Shukla, Shilin N.; Talati, Shailesh S.; Parikh, Sonia K.; Bhatt, Shivani J.; Maka, Vinayak

    2013-01-01

    Background: The use of central venous catheters (CVCs) has greatly improved the quality-of-care in cancer patients, yet these catheters may cause serious infectious and thrombotic complications. The aim of this retrospective study was to study the various types of CVCs and their complications. Materials and Methods: We studied retrospectively 213 cases of CVCs in our institute with their indications, type and complications from August 2010 to July 2011. Results: A total of 213 CVCs were inserted in patients with hematological (62%) and solid organ malignancies (38%). Ninety-eight patients (46%) had peripheral inserted central catheter (PICC), 90 (42%) patients had Hickman catheters and 25 (12%) had a port. The median duration of retention of Hickman catheters was 104 days (3-365 days), for the peripherally inserted central catheters was 59 days (3-100 days) and for the port it was 280 days (45-365 days). Non-infective complications were more than infective (12% vs. 7%). The most common complication was non-infective occlusion and thrombophlebitis. In one patient with PICC thrombosis occurred in the cephalic, radial and ulnar vein and in one patient with port thrombosis occurred in the superior vena cava. Organisms were isolated in 60% (12 out of 20) of cultures. Common organisms isolated were Pseudomonas aeruginosa in 5 (42%), Staphylococcus aureus in 2 (16%), Escherichia coli in 2 (16%) and Aspergillus in 3 (25%) patients. 7 out of 12 infected patients had negative blood cultures within 7 days of antibiotic treatment, 5 patients remained positive for more than 7 days with antibiotics. In 155 patients (73%), the desired treatment protocol was completed and at present there are still 28 patients (13%) with catheters. 5 patients (2.3%) died of febrile neutropenia and septicemia with multi-organ failure. In 5 patients (2.3%), the catheters (1 Port, 1 Hickman and 3 PICC) were prematurely removed because of thrombosis. Conclusion: CVCs are better options to facilitate

  2. Conservative Management of Left Atrial Intramural Hematoma after Catheter Ablation

    PubMed Central

    Oraii, Saeed; Roshanali, Farideh; Ghorbanisharif, Alireza; Mikaeili, Javad; Tahraei, Mahmood

    2016-01-01

    Left atrial intramural hematoma is a very rare complication of radiofrequency ablation procedures. A patient with tachyarrhythmia underwent radiofrequency catheter ablation. Echocardiography performed the following morning showed a large mass in the left atrium, suggestive of intramural hematoma formation. The patient was in a stable condition; therefore, it was decided that follow-up should be conservative and her anticoagulation therapy was continued. The size of the hematoma decreased significantly over the following 50 days. This case highlights a rare complication of a complex catheter ablation procedure in the left atrium that was managed via a noninvasive approach, with which all interventionists should be familiar. PMID:27482270

  3. Sagittal vein thrombosis caused by central vein catheter.

    PubMed

    Sabzi, Feridoun; Karim, Hosein; Heydar Pour, Behzad; Faraji, Reza

    2015-01-01

    Cerebral venous thrombosis, including thrombosis of cerebral veins and major dural sinuses, is an uncommon disorder in the general population. However, it has a higher frequency among patients younger than 40 years of age, patients with thrombophilia, pregnant patients or those receiving hormonal contraceptive therapy or has foreign body such as catheter in their veins or arterial system. In this case report, we described clinical and radiological findings in a patient with protein C-S deficiency and malposition of central vein catheter. PMID:25796028

  4. Central Venous Catheter-related Fungemia Caused by Rhodotorula glutinis.

    PubMed

    Miglietta, Fabio; Letizia Faneschi, Maria; Braione, Adele; Palumbo, Claudio; Rizzo, Adriana; Lobreglio, Giambattista; Pizzolante, Maria

    2015-01-01

    Bloodstream infection due to Rhodotorula glutinis is extremely rare and mostly associated with underlying immunosuppression or cancer. Vascular access devices provide the necessary surfaces for biofilm formation and are currently responsible for a significant percentage of human infections. In this work, we describe a rare case of central venous catheter-related Rhodotorula glutinis fungemia in a female patient with acute myelogenous leukemia in remission. The timely removal of central venous catheter was an essential element for overcoming this CVC-related Rhodotorula fungemia. PMID:26329371

  5. [Indications and complications of central venous catheters in hematologic oncology: report of 81 cases].

    PubMed

    Abdelkefi, A; Ladeb, S; Ben Othman, T; Torjman, L; Jeddi, R; Ben Hassen, A; Ben Abdeladhim, A

    2000-11-01

    From february 1998 to july 1999, 81 central venous catheters were placed in 41 patients 28 years old (5 to 51 years). We used the subclavicular anatomic way (Aubaniac) in all cases. The total duration of catheter placement was 2905 days (median of 31 days, range 1 to 165 days). We observed 1 pneumothorax (1.2%), 3 venous thrombosis (3.7%) and 1 arterial puncture (1.2%). Catheter-related infections were seen in 8 catheters (2.7 per 1000 catheter-days). Candida was encountered in 4 cases (50%), Gram-positive cocci in 2 cases (25%), and Gram-negative bacilli in 2 cases (25%). The improvement of preventive ways, diagnosis techniques (simultaneous quantitative cultures, differential positivity time), and therapeutic methods (treatment without removal of the catheter, antibiotic lock technique, catheter exchange by guidewire) should allow a better treatment of catheter-related infections. PMID:11155387

  6. Central venous catheters for chemotherapy of solid tumors--our results in the last 5 years.

    PubMed

    Zganjer, Mirko; Cizmić, Ante; Butković, Diana; Matolić, Martina; Karaman-Ilić, Maja; Stepan, Jasminka

    2008-09-01

    Central venous catheters provide an easy access for intravenous medications. Having a central line in place will relieve a child from the discomfort and danger of multiple regular intravenous lines for chemotherapy. The use of indwelling central venous catheters has become commonplace in the management of children undergoing oncological treatment. There are two types of central lines commonly used. There are Broviac catheters and Port-A-Cath (PAC) catheters. In the last 5 years we inserted 194 catheters in 175 children. We inserted 121 Broviac catheters and 73 PAC catheters. During the follow up of 39382 catheter days 44 complications were observed. In Broviac group the median follow up was 155 days and in PAC group was 230 days. We observed differences in the incidence between two devices. In Broviac group infections were more frequent and in PAC group other complications were more frequent than infections. PMID:18982750

  7. Effect of plastic catheters on the phagocytic activity of human polymorphonuclear leukocytes.

    PubMed

    López-López, G; Pascual, A; Perea, E J

    1990-05-01

    The effect of five kinds of plastic catheters (polyvinyl chloride, Teflon, polyurethane, Vialon and siliconized latex) on the phagocytic and bactericidal function of human polymorphonuclear leukocytes was evaluated. In the presence of the polyvinyl chloride, Teflon and siliconized latex catheters, superoxide radical production by polymorphonuclear leukocytes was significantly inhibited. The effect of the siliconized latex catheter was presumably mediated by products eluted from the catheter into the medium, since the incubation of polymorphonuclear leukocytes in eluates obtained from the incubation of this catheter in buffer induced a similar inhibitory effect. This phenomenon was not observed with polyurethane or Vialon catheters. Neither the catheters evaluated nor their eluates affected the uptake of opsonized Staphylococcus aureus by human polymorphonuclear leukocytes. It is concluded that the polyvinyl chloride, Teflon and siliconized latex catheters used in this study could impair the respiratory burst of human polymorphonuclear leukocytes. PMID:2164932

  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. PMID:22059378

  9. Balloon Dilatation for Removal of an Irretrievable Permanent Hemodialysis Catheter: The Safest Approach.

    PubMed

    Garcarek, Jerzy; Gołębiowski, Tomasz; Letachowicz, Krzysztof; Kusztal, Mariusz; Szymczak, Maciej; Madziarska, Katarzyna; Jakuszko, Katarzyna; Zmonarski, Sławomir; Guziński, Maciej; Weyde, Wacław; Klinger, Marian

    2016-05-01

    Long-term hemodialysis catheter dwell time in the central vein predisposes to fibrin sheath development, which subsequently causes catheter malfunction or occlusion. In very rare cases, the catheter can be overgrown with fibrin and rigidly connected with the vein or heart structures. This makes its removal almost impossible and dangerous because of the possibility of serious complications, namely vein and heart wall perforation, bleeding, or catheter abruption in deep tissues. We describe two cases in which standard retrieval of long-term catheters was not possible. Balloon dilatation of catheter lumens was successfully used to increase the catheter diameter with simultaneous tearing of the fibrin sheath surrounding it. This allowed the catheter to be set free safely. Based on this experience, we present recent literature and our point of view. PMID:26684390

  10. Disconnection of chamber and catheter as a complication of central venous catheter type port-a-cath.

    PubMed

    Kostic, S; Kovcin, V; Granić, M; Jevdic, D; Stanisavljevic, N

    2011-12-01

    The use of a central vein catheter (CVC) type port-a-cath (VPS), apart from the comfort it provides to the patient undergoing chemotherapy, also carries certain complications. In this study, our patient was subjected to chemotherapy after a radical breast cancer operation and was given a CVC type VPS. After further care, a rare complication was verified--disconnection of the chamber and catheter, which one was visually identified in the right heart chamber. As the patient was vitally endangered, she was immediately hospitalized and the catheter was removed by catheterization of the right femoral vein, with scopic imaging. Early diagnosis and localization of the problem prevented more severe complications and mortality. PMID:20607455

  11. Postmastectomy reconstruction: comparative analysis of the psychosocial, functional, and cosmetic effects of transverse rectus abdominis musculocutaneous flap versus breast implant reconstruction.

    PubMed

    Cederna, P S; Yates, W R; Chang, P; Cram, A E; Ricciardelli, E J

    1995-11-01

    Over 40,000 postmastectomy breast reconstructions are performed annually. In this study, we investigated the psychosocial, functional, and cosmetic effects of transverse rectus abdominis musculocutaneous (TRAM) flap versus breast implant reconstruction. Thirty-three women who had undergone postmastectomy breast reconstruction were contacted by telephone and agreed to participate in the study. Twenty-two women completed the self-assessment questionnaires regarding their quality of life, psychological symptoms, functional status, body image, and global satisfaction. The TRAM and implant groups contained 8 and 14 patients, respectively. The groups were well matched for age, employment status, marital status, race, religion, and severity of medical and surgical illnesses. The average follow-up was 36 months. Statistical analysis of the responses revealed that women who had undergone TRAM flap reconstruction were more satisfied with how their reconstructed breast felt to the touch (p = .01), and there was a trend toward greater satisfaction with the appearance of their reconstructed breast (p = .08). However, these same patients identified more difficulties as far as functioning at work or school, performing vigorous physical activities, participating in community or religious activities, visiting with relatives, and interacting with male friends (p < .04). There were no statistically significant differences in body image or overall satisfaction. In this small cohort study, both the TRAM flap group and the implant group were satisfied with the results of their breast reconstruction, but the TRAM flap group was more satisfied with how their breast felt and tended to be more satisfied with the cosmetic result. The TRAM flap group reported greater psychological, social, and physical impairments as a result of their reconstruction. PMID:8579262

  12. Neonatal PICC: one unit's six-year experience with limiting catheter complications.

    PubMed

    Corzine, Marie; Willett, Lynne D

    2010-01-01

    Safe dressing techniques for neonatal peripherally inserted central catheters (PICCs) remain controversial in the literature. This article describes one unit's experience with the placement and management of 491 PICCs during a six-year period with more than 5,600 catheter days. The dressing technique described in this article differs from that seen in the literature with the addition of a protective base layer. Catheter complication rates are low, and catheter dressing changes are minimized with this dressing technique. PMID:20472533

  13. 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

  14. Thrombolytic Therapy Using Urokinase for Management of Central Venous Catheter Thrombosis

    PubMed Central

    Son, Jung Tack; Min, Sun Young; Kim, Jae Il; Choi, Pyong Wha; Heo, Tae Gil; Lee, Myung Soo; Kim, Chul-Nam; Kim, Hong-Yong; Yi, Seong Yoon; Lee, Hye Ran; Roh, Young-Nam

    2014-01-01

    Purpose: The management of central venous catheters (CVCs) and catheter thrombosis vary among centers, and the efficacy of the methods of management of catheter thrombosis in CVCs is rarely reported. We investigated the efficacy of bedside thrombolysis with urokinase for the management of catheter thrombosis. Materials and Methods: We retrospectively reviewed data from patients who had undergone CVC insertion by a single surgeon in a single center between April 2012 and June 2014. We used a protocol for the management of CVCs and when catheter thrombosis was confirmed, 5,000 U urokinase was infused into the catheter. Results: A total of 137 CVCs were inserted in 126 patients. The most common catheter-related complication was thrombosis (12, 8.8%) followed by infection (8, 5.8%). Nine of the 12 patients (75%) with catheter thrombosis were recanalized successfully with urokinase. The rate of CVC recanalization was higher in the peripherally inserted central catheter (PICC) group (87.5%) than the chemoport group (50%). Reintervention for catheter-related thrombosis was needed in only 2.2% of patients when thrombolytic therapy using urokinase was applied. Age <60 years (P=0.035), PICC group (P=0.037) and location of the catheter tip above the superior vena cava (P=0.044) were confirmed as independent risk factors for catheter thrombosis. Conclusion: Thrombolysis therapy using urokinase could successfully manage CVC thrombosis. Reintervention was rarely needed when a protocol using urokinase was applied for the management of CVC thromboses. PMID:26217634

  15. Clinical biodurability of aliphatic polyether based polyurethanes as peritoneal dialysis catheters.

    PubMed

    Crabtree, John H

    2003-01-01

    Thermoplastic polyurethane elastomers are the most important implantable grade polyurethanes in medical applications. An aliphatic polyether based polyurethane, Tecoflex (TF; Thermedics, Inc., Woburn, MA), is used in the construction of a proprietary peritoneal dialysis (PD) catheter. Information is limited regarding the biostability of the TF polymer in the clinical environment as a PD catheter. This report presents the clinical experience regarding the biodurability of 104 catheter implants. The extracorporeal tubing segments of all TF catheters eventually developed aesthetically offensive discoloration, opaqueness, and surface tackiness. Catheter breaks in the external segment occurred in 27% of devices that survived longer than 28 months. Mupirocin ointment at the catheter skin exit site caused swelling and deformity of the TF in one case. Three catheters extruded as a result of Dacron cuffs separating from the tubing wall. Catheters removed for other reasons were frequently found to have loose cuffs, especially if the devices were implanted for several years. Causes and possible mechanisms for observed failures are discussed. The durability of biomaterials used in construction of PD catheters is of vital importance for successful long-term functioning. The TF polymer embodied as a PD catheter represents a mismatch of the material and its mission. Fabrication of PD catheters from higher grade polyurethanes possessing greater biostability should be explored. Silicone rubber appears to remain the most durable material to date for PD catheter construction. PMID:12790378

  16. Use of an alteplase algorithm for the management of hemodialysis catheter dysfunction.

    PubMed

    Abdelmoneim, Ahmed S; Miller, Lisa M; Armstrong, Sean; Sood, Manish M; Wazny, Lori; Chateau, Dan; Vercaigne, Lavern M

    2012-04-01

    Hemodialysis (HD) catheter dysfunction compromises HD adequacy and increases the cost of patient care. Repeated administration of alteplase in HD catheters typically produces only short-term benefits. The purpose of this study was to design, implement, and evaluate the efficacy of an experimental alteplase algorithm to manage HD catheter dysfunction. This was a two-part prospective nonrandomized study. Baseline data of alteplase use and catheter exchange were collected during part 1 of the study. Part 2 consisted of the alteplase algorithm implementation and repeat collection of catheter data. Rates of alteplase use and catheter exchange per 1000 catheter-days were the primary and secondary outcomes of the study. One hundred and seventy-two catheters in 131 patients were followed prospectively during the course of the study. The adjusted relative rate (RR) of alteplase use showed no significant difference between both parts of the study, adjusted RR: 1.10, 95% confidence interval (CI) (0.73-1.65). Similarly, catheter exchange rates were not significantly different over the duration of the study (1.12 vs. 1.03 per 1000 catheter-days). However, waiting time for catheter exchange increased from 20.36 ± 14 days in part 1 to 38.42 ± 28 days in part 2 (P < 0.05). The alteplase algorithm did not significantly reduce alteplase use. This may be partially explained by repeated use of alteplase in part 2, due to longer waiting times for catheter exchange procedures. PMID:22098698

  17. Successful Management of Atrio-Esophageal Fistula after Cardiac Radiofrequency Catheter Ablation

    PubMed Central

    Shim, Hun Bo; Kim, Chilsung; Kim, Hong-Kwan

    2013-01-01

    An increase in cardiac radiofrequency catheter ablation for treating refractory atrial fibrillation has resulted in an increased prevalence of complications. Among numerous complications of radiofrequency catheter ablation, atrio-esophageal fistula, although rare, is known to have fatal results. We report a case of successful management of an atrio-esophageal fistula as a complication of cardiac radiofrequency catheter ablation. PMID:23614102

  18. Efficacy of dicloxacillin-coated polyurethane catheters in preventing subcutaneous Staphylococcus aureus infection in mice.

    PubMed Central

    Sherertz, R J; Forman, D M; Solomon, D D

    1989-01-01

    In a mouse model, dicloxacillin-coated polyurethane catheters or control (uncoated) catheters were placed subcutaneously and then Staphylococcus aureus was inoculated at the time of insertion, 24 or 48 h later. The in vivo half-life of the antibiotic was 11 to 16 h. When 10(5) CFU of S. aureus were inoculated at the time of catheter insertion, dicloxacillin-coated catheters kept the number of S. aureus removed from catheters by sonication below 10(2) CFU at 12, 24, 48, and 96 h after inoculation compared with titers greater than 10(3.5) CFU for control catheters (P less than 0.05). When S. aureus was inoculated 24 h after catheter insertion, control catheters averaged greater than 10(2) CFU of S. aureus removed compared with less than 10(1.5) CFU for the dicloxacillin-coated catheters (P less than 0.05). No difference was found between coated and control catheters when S. aureus was inoculated 48 h after catheter insertion, but S. aureus titers averaged less than 10(2) CFU for all experimental groups. Our data suggest that in mice, regional prophylaxis of S. aureus subcutaneous space infection is feasible with catheters coated with dicloxacillin and that the presence of antibiotic is only necessary for the first 24 to 48 h. PMID:2802545

  19. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) initiative: A summary and review of peripherally inserted central catheter and venous catheter appropriate use.

    PubMed

    Woller, Scott C; Stevens, Scott M; Evans, R Scott

    2016-04-01

    Peripherally inserted central catheters (PICCs) are being selected for venous access more frequently today than ever before. Often the choice of a PICC, when compared with other vascular access devices (VADs), is attractive because of perceived safety, availability, and ease of insertion. However, complications associated with PICCs exist, and there is a paucity of evidence to guide clinician choice for PICC selection and valid use. An international panel with expertise in the arena of venous access and populations associated with these devices was convened to clarify approaches for the optimal use of PICCs and VADs. Here we present for the busy hospital-based practitioner the methodology, key outcomes, and recommendations of the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) panelists for the appropriate use of VADs. Journal of Hospital Medicine 2016;11:306-310. © 2015 Society of Hospital Medicine. PMID:26662622

  20. Excimer laser lead extraction catheter with increased laser parameters

    NASA Astrophysics Data System (ADS)

    Coe, M. Sean; Taylor, Kevin D.; Lippincott, Rebecca A.; Sorokoumov, Oleg; Papaioannou, Thanassis

    2001-05-01

    A fiber optic catheter connected to a pulsed excimer laser (308 nm) is currently used to extract chronically implanted pacemaker and defibrillator leads at Fluence of 60 mJ/mm2 and repetition rate of 40 Hz. The object of this study was to determine the effect of higher repetition rates (80 Hz) in the catheter's cutting performance. The penetration rate (micrometers /sec), and the associated mechanical and thermal effects were measured in soft (porcine myocardium) and hard tissue (bovine tendon) at 60 mJ/mm2-80 Hz, and were compared to the corresponding values at commercially available laser parameters (60 mJ/mm2-40 Hz). Ablation rates were measured with perforation experiments and the extent of thermal and mechanical damage was measured under polarized light microscopy. For hard (soft) tissue, the laser catheter demonstrated penetration speed of 106 +/- 32 (302 +/- 101) micrometers /sec at 40 Hz and 343 +/- 120 (830 +/- 364) micrometers /sec at 80 Hz. Maximum extent of thermal effects at 40 Hz and 80 Hz was 114 +/- 35 micrometers (72 +/- 18) and 233 +/- 63 micrometers (71 +/- 16) respectively. Maximum extent of mechanical effects at 40 Hz and 80 Hz was 188 +/- 63 micrometers (590 +/- 237) and 386 +/- 100 micrometers (767 +/- 160) respectively. In vitro testing of the laser catheter with 80 Hz laser parameters has demonstrated increased penetration speed in both soft and hard fibrous tissue, while maintaining associated thermal and mechanical effects within limited ranges.

  1. Multifiber excimer laser catheter design strategies for various medical applications

    NASA Astrophysics Data System (ADS)

    Verdaasdonck, Rudolf M.; van Swol, Christiaan F. P.; van Leeuwen, Ton G. J. M.; Tulleken, Cees A. F.; Boon, Tom A.

    1994-07-01

    For the XeCl Excimer laser (308 nm, 115 ns), special design multifiber laser catheters were developed and theoretically as well as experimentally evaluated. Monte Carlo simulations showed that the penetration depth of 308 nm XeCl excimer light varied from 50 to 200 micrometers for fiber diameters from 50 to 550 micrometers and larger. Tissue ablation is expected to be restricted to this irradiated area. In order to ablate larger tissue areas, a flexible bundle of fibers is used introducing gaps in the irradiance distribution due to dead space in between the individual fibers. Multifiber catheters were developed for a unique neurosurgery bypass procedure and for urethra stricture surgery. Real-time, close-up, high speed video imaging showed that tissue ablation mechanism of these catheters is predominately governed by explosive short-life vapor bubbles fragmenting the tissue to small particles. In order to temper the ablation process, laser energy was delivered in 8 pulses divided over 8 sectors of a multifiber catheter (multiplexing), keeping the same fluence instead of one pulse addressing all the fibers at once.

  2. Technique of pulmonary vein isolation by catheter ablation

    PubMed Central

    Wittkampf, F.H.M.; Derksen, R.; Wever, E.F.D.; Simmers, T.A.; Boersma, L.V.A.; Vonken, E.P.A.; Velthuis, B.K.; Sreeram, N.; Rensing, B.J.; Cramer, M.J.

    2002-01-01

    In selected patients with atrial fibrillation, the fibrillation episodes may be initiated by single or short bursts of ectopy often originating from one or more pulmonary veins (PVs). Therefore, electrical isolation of these veins by catheter ablation is currently being explored as a treatment modality for patients with paroxysmal and even more permanent types of atrial fibrillation. At present, two different techniques are used: 1) selective ablation of electrical connections between left atrium and myocardial sleeves inside the PVs; and 2) contiguous encircling lesions around and outside the PV ostia. With both techniques, moderate to high success rates have been reported with a limited follow-up duration. Both types of procedure are very complex and require a highly skilful team. With the variable anatomy of the PVs, non-invasively acquired angiographic images may serve as a roadmap for catheter manipulation. Modern three-dimensional catheter navigation techniques can be applied to facilitate accurate catheter positioning with limited fluoroscopic exposure. Experimental and clinical research is needed to define patient selection criteria. ImagesFigure 2Figures 3 and 4Figure 5 PMID:25696100

  3. 21 CFR 870.1350 - Catheter balloon repair kit.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... effect the repair or replacement. (b) Classification. Class III (premarket approval). (c) Date PMA or notice of completion of a PDP is required. A PMA or notice of completion of a PDP is required to be filed... distribution before May 28, 1976. Any other catheter balloon repair kit shall have an approved PMA or...

  4. 21 CFR 870.1350 - Catheter balloon repair kit.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... effect the repair or replacement. (b) Classification. Class III (premarket approval). (c) Date PMA or notice of completion of a PDP is required. A PMA or notice of completion of a PDP is required to be filed... distribution before May 28, 1976. Any other catheter balloon repair kit shall have an approved PMA or...

  5. Pneumothorax as a complication of central venous catheter insertion

    PubMed Central

    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

    2015-01-01

    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. PMID:25815301

  6. 21 CFR 870.1230 - Fiberoptic oximeter catheter.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ....1230 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... saturation of the blood. It consists of two fiberoptic bundles that conduct light at a desired wavelength through blood and detect the reflected and scattered light at the distal end of the catheter....

  7. 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 Section 876.4020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4020 Fiberoptic...

  8. 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. PMID:25815301

  9. Enhanced photocoagulation with catheter-based diffusing optical device

    NASA Astrophysics Data System (ADS)

    Kang, Hyun Wook; Kim, Jeehyun; Oh, Jungwhan

    2012-11-01

    A novel balloon catheter-based diffusing optical device was designed and evaluated to assist in treating excessive menstrual bleeding. A synthetic fused-silica fiber was micro-machined precisely to create scattering segments on a 25 mm long fiber tip for uniform light distribution. A visible wavelength (λ=532 nm) was used to specifically target the endometrium due to the high vascularity of the uterine wall. Optical simulation presented 30% wider distribution of photons along with approximately 40% higher irradiance induced by addition of a glass cap to the diffuser tip. Incorporation of the optical diffuser with a polyurethane balloon catheter considerably enhanced coagulation depth and area (i.e., 3.5 mm and 18.9 cm2 at 1 min irradiation) in tissue in vitro. The prototype device demonstrated the coagulation necrosis of 2.8±1.2 mm (n=18) and no thermal damage to myometrium in in vivo caprine models. A prototype 5 cm long balloon catheter-assisted optical diffuser was also evaluated with a cadaveric human uterus to confirm the coagulative response of the uterine tissue as well as to identify the further design improvement and clinical applicability. The proposed catheter-based diffusing optical device can be a feasible therapeutic tool to photocoagulate endometrial cell layers in an efficient and safe manner.

  10. 21 CFR 876.5030 - Continent ileostomy catheter.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Continent ileostomy catheter. 876.5030 Section 876.5030 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5030 Continent...

  11. 21 CFR 876.5010 - Biliary catheter and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Biliary catheter and accessories. 876.5010 Section 876.5010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5010 Biliary...

  12. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Urological catheter and accessories. 876.5130 Section 876.5130 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5130...

  13. Complications of indwelling pleural catheter use and their management

    PubMed Central

    Lui, Macy M S; Thomas, Rajesh; Lee, Y C Gary

    2016-01-01

    The growing utilisation of indwelling pleural catheters (IPCs) has put forward a new era in the management of recurrent symptomatic pleural effusions. IPC use is safe compared to talc pleurodesis, though complications can occur. Pleural infection affects <5% of patients, and is usually responsive to antibiotic treatment without requiring catheter removal or surgery. Pleural loculations develop over time, limiting drainage in 10% of patients, which can be improved with intrapleural fibrinolytic therapy. Catheter tract metastasis can occur with most tumours but is more common in mesothelioma. The metastases usually respond to analgaesics and/or external radiotherapy. Long-term intermittent drainage of exudative effusions or chylothorax can potentially lead to loss of nutrients, though no data exist on any clinical impact. Fibrin clots within the catheter lumen can result in blockage. Chest pain following IPC insertion is often mild, and adjustments in analgaesics and drainage practice are usually all that are required. As clinical experience with the use of IPC accumulates, the profile and natural course of complications are increasingly described. We aim to summarise the available literature on IPC-related complications and the evidence to support specific strategies. PMID:26870384

  14. 6DoF catheter detection, application to intracardiac echocardiography.

    PubMed

    Ralovich, Kristóf; John, Matthias; Camus, Estelle; Navab, Nassir; Heimann, Tobias

    2014-01-01

    Hybrid imaging systems, consisting of fluoroscopy and echocardiography, are increasingly selected for intra-operative support of minimally invasive cardiac interventions. Intracardiac echocardiograpy (ICE) is an emerging modality with the promise of removing sedation or general anesthesia associated with transesophageal echocardiography (TEE). We introduce a novel 6 degrees of freedom (DoF) pose estimation approach for catheters (equipped with radiopaque ball markers) in single X-Ray fluoroscopy projection and investigate the method's application to a prototype ICE catheter. Machine learning based catheter detection is implemented in a Bayesian hypothesis fusion framework, followed by refinement of ball marker locations through template matching. Marker correspondence and 3D pose estimation are solved through iterative optimization. The method registers the ICE volume to the C-arm coordinate system. Experiments are performed on synthetic and porcine in-vivo data. Target registration error (TRE), defined in the echo cone, is the basis of our preliminary evaluation. The method reached 8.06 ± 7.2 mm TRE on 703 cases. Potential uses of our hybrid system include structural heart disease interventions and electrophysiologycal mapping or catheter ablation procedures. PMID:25485433

  15. Peritoneo-vulvar catheter extrusion after shunt operation.

    PubMed

    Nagulic, M; Djordjevic, M; Samardzic, M

    1996-04-01

    We report an unusual case of catheter extrusion through the external genitalia. between the labium majus and the labium minus, in a 6-month-old hydrocephalic baby. The event occurred 5 months after placement of a ventriculoperitoneal shunt. PMID:8739410

  16. Catheter-tip force transducer for cardiovascular research

    NASA Technical Reports Server (NTRS)

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

    1975-01-01

    Sensor can be installed in left ventricle by means of procedures available for inserting catheter into an artery at body's extremities and manipulating it through vessel and past aortic valve. Metallic tines of device can be used as internal electrode for electrocardiogram.

  17. Central venous catheter-related Corynebacterium minutissimum bacteremia.

    PubMed

    Rupp, M E; Stiles, K G; Tarantolo, S; Goering, R V

    1998-10-01

    Although Corynebacterium minutissimum is well-known as the cause of erythrasma, it is noted as the etiologic agent of nondermatologic disease only rarely. We document this organism as a cause of central venous catheter-associated bacteremia and report the use of pulsed-field gel electrophoresis to characterize its molecular epidemiology. PMID:9801290

  18. 21 CFR 876.5010 - Biliary catheter and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Biliary catheter and accessories. 876.5010 Section 876.5010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5010 Biliary...

  19. 21 CFR 876.5130 - Urological catheter and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Urological catheter and accessories. 876.5130 Section 876.5130 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5130...

  20. 21 CFR 876.5030 - Continent ileostomy catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Continent ileostomy catheter. 876.5030 Section 876.5030 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Therapeutic Devices § 876.5030 Continent...

  1. Intraperitoneal catheter placement for pharmacological imaging studies in conscious mice

    PubMed Central

    Boudreau, Eilis; Chen, Gang; Li, Xin; Buck, Kari; Hitzemann, Robert; Hickman, Debra

    2016-01-01

    Imaging studies that use rodents sometimes involve intraperitoneal administration of pharmacological compounds. To facilitate such studies, the authors developed a simple and easily mastered technique for placing an intraperitoneal catheter in a conscious mouse. This technique eliminates the need to remove the animal from the scanner to administer a drug through the intraperitoneal route. PMID:20023678

  2. 21 CFR 870.1230 - Fiberoptic oximeter catheter.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ....1230 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... saturation of the blood. It consists of two fiberoptic bundles that conduct light at a desired wavelength through blood and detect the reflected and scattered light at the distal end of the catheter....

  3. Fiber photo-catheters for laser treatment of atrial fibrillation

    NASA Astrophysics Data System (ADS)

    Peshko, Igor; Rubtsov, Vladimir; Vesselov, Leonid; Sigal, Gennady; Laks, Hillel

    2007-04-01

    A fiber photo-catheter has been developed for surgical treatment of atrial fibrillation with laser radiation. Atrial fibrillation (AF) is a heart rhythm abnormality, which 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.

  4. 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.

  5. Steam-deformed Judkins-left guiding catheter with use of the GuideLiner® catheter to deliver stents for anomalous right coronary artery

    PubMed Central

    Kuno, Toshiki; Fujisawa, Taishi; Yamazaki, Hiroyuki; Motoda, Hiroyuki; Kodaira, Masaki; Numasawa, Yohei

    2015-01-01

    Objective: Percutaneous coronary intervention for anomalous right coronary artery (RCA) originating from the left coronary cusp is challenging because of our current inability to coaxially engage the guiding catheter. Methods: We report a case of an 88-year-old woman with non-ST segment elevation myocardial infarction, with an anomalous RCA origin. Using either the Judkins-Left catheter or Amplatz-Left catheter was difficult because of RCA ostium tortuosity. Thus, we used steam to deform the Judkins-Left catheter, but back-up support was insufficient to deliver the stent. Results: We used GuideLiner®, a novel pediatric catheter with rapid exchange/monorail systems, to enhance back-up support. Conclusions: We were able to successfully stent with both the deformed Judkins-Left guiding catheter and GuideLiner® for an anomalous RCA origin. PMID:27489700

  6. Microbiology of Non-Tunnelled Catheter-Related Infections

    PubMed Central

    Mallya, Shrikara P.; Bhat, Ashok; Baliga, Shrikala

    2016-01-01

    Introduction Aerobic bacterial infections often complicate vascular access in patients receiving haemodialysis, leading to Catheter-Related Blood Stream Infections (CRBSI). Various studies report Gram - positive bacteria, Staphylococcus aureus (S. aureus) in particular, as the most common aetiologic agent. Studies on microbiological analysis in this subset of population from India are very few. Aim To examine clinical and bacteriological profiles of haemodialysis patients developing CRBSI, the antibiotic susceptibility of the bacteria isolated from these patients and determine nasal carriage of S. aureus in the study subjects. Materials and Methods Using a prospective observational design 127 patients receiving haemodialysis (84 males; 43 females) from October 2011 to March 2013 were enrolled in this study. At each dialysis session, catheters were examined for any evidence of infection. In case of suspicion for infection, pus swab, blood culture and the catheter tips were sent to microbiology laboratory for site specific investigations. Vancomycin injection was empirically administered to these patients pending culture results. Data obtained was examined for relationship of CRBSI with clinical and socio-demographic risk factors. Results Out of 127 patients, 19 developed CRBSI, 10 developed exit-site infections and 33 patients were noted to have colonization of their catheters. The most common organisms included S. aureus in 24 (45.2%) catheter tips, followed by Pseudomonas aeruginosa in 9 (17%), Acinetobacter spp. in 5 (9%), Enterobacter spp. in 4 (7.5%) and Klebsiella pneumoniae in 3 (5.6%) catheter tips. Bacteraemia was found in 19 (20.7%) patients and P. aeruginosa was the most commonly isolated organism amongst them (38.8%). Staphylococcal nasal carriage was seen in 60 (69%) patients and 36 (41.4%) of these isolates were methicillin-resistant. Significant factors associated with CRBSI included history of bacteraemia, presence of diabetes mellitus, long duration

  7. 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.

  8. Gamma radiation-sterilized, triple-lumen catheters coated with a low concentration of chlorhexidine were not efficacious at preventing catheter infections in intensive care unit patients.

    PubMed Central

    Sherertz, R J; Heard, S O; Raad, I I; Gentry, L; Bowton, D; Scuderi, P; Hu, J; Carruth, W; Satishchandra, B; Pepe, J; Mosenthal, A; Burke, T; Dupuis, J

    1996-01-01

    In a randomized, double-blind trial, gamma radiation-sterilized, chlorhexidine-coated triple-lumen catheters were compared with uncoated control catheters for their ability to prevent catheter infection in 254 intensive care unit patients. The chlorhexidine coating was not efficacious, and a rabbit model demonstrated that reduction of chlorhexidine activity by gamma radiation sterilization was the likely explanation for the failure. PMID:8878569

  9. Modulation of crystalline Proteus mirabilis biofilm development on urinary catheters.

    PubMed

    Stickler, David J; Morgan, Sheridan D

    2006-05-01

    The crystalline biofilms formed by Proteus mirabilis can seriously complicate the care of patients undergoing long-term bladder catheterization. The generation of alkaline urine by the bacterial urease causes calcium and magnesium phosphates to precipitate from urine and accumulate in the catheter biofilm, blocking the flow of urine from the bladder. The pH at which these salts crystallize from a urine sample, the nucleation pH (pH(n)), can be elevated by diluting the urine and by increasing its citrate content. The aim of this study was to examine whether manipulation of pH(n) in these ways modulated the rate at which crystalline biofilm developed. Experiments in laboratory models of the catheterized bladder infected with P. mirabilis showed that when the bladder was supplied with a concentrated urine (pH(n) 6.7) at a low fluid output (720 ml per 24 h), catheters blocked at 19-31 h. Diluting this urine 1:4 increased the pH(n) to 7.5 and models supplied with this urine at 2880 ml per 24 h took 110-137 h to block. When models were supplied with urine containing citrate at 1.5 mg ml(-1) or above (pH(n) 8.3-9.1), the catheters drained freely for the full 7 day experimental period. Scanning electron microscopy revealed that the catheter biofilms that developed in urine with high pH(n) values were devoid of crystalline formations. These observations should encourage a clinical trial to examine the effect of increasing a patient's fluid intake with citrate-containing drinks on the encrustation and blockage of catheters. PMID:16585633

  10. Catheter selection for ablation of the cavotricuspid isthmus for treatment of typical atrial flutter.

    PubMed

    Da Costa, Antoine; Jamon, Yann; Romeyer-Bouchard, Cécile; Thévenin, Jérôme; Messier, Marc; Isaaz, Karl

    2006-11-01

    Radiofrequency catheter ablation (RFA) represents the first line therapy of the cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) with a high efficacy and low secondary effects. RFA of CTI-dependent AFL can be performed by using various types of ablation catheters. Recent evaluations comparing externally cooled tip RFA (ecRFA) catheters and large-tip (8 mm) catheters have revealed that these catheters have a higher efficacy for CTI-AFL ablation compared to 4-mm catheters. The reliability of RFA catheters for AFL is variable and an optimal catheter selection may enhance the RFA effectiveness. The main goal of this article is to review the elements that improve the management of CTI RFA. Preliminary examinations of histopathologic and anatomical elements that may interfere with conventional CTI RFA are presented. Experimental studies concerning the electrobiology of large-tip and cooled-tip catheters are compared. The different catheter designs between cooled-tip and 8-mm-tip catheters are examined (size of the deflectable curve, rotation stability, and size of the distal nonsteerable catheter part) because of their critical role in CTI RFA results. A thorough review of clinical trials of each catheter is presented, and comparison of both catheters in this clinical setting is analyzed. In addition, the role of CTI morphology on AFL RF duration is underlined such as the value of right atrial angiography as an adjunct tool for CTI RFA catheter selection. Based on randomized studies, 8-mm-tip catheters seem to be more effective for ablation in case of straight angiographic isthmus morphology. On the other hand, ecRFA catheters appear to be more effective in cases of complex CTI anatomy or difficult CTI RFA. To reduce X-ray exposition and RFA application time, few studies report that CTI angiographic evaluation before RFA allows a catheter selection based on both CTI morphology and length. Moreover, preliminary data of randomized studies showed that an

  11. Controlled trial of a continuous irrigation suction catheter vs conventional intermittent suction catheter in clearing bronchial secretions from ventilated patients.

    PubMed

    Isea, J O; Poyant, D; O'Donnell, C; Faling, L J; Karlinsky, J; Celli, B R

    1993-04-01

    Continuous irrigation-suction catheter (Irri-cath) is a double-lumen device that allows for simultaneous saline solution infusion and aspiration. This system may theoretically be more effective than conventional dry intermittent suction due to its vortex principle. To test this hypothesis, we performed 200 suction maneuvers in 20 ventilated patients. Identically shaped catheters were used in a randomized sequence. For the same individual, we used equal instilled saline solution volume (40 ml), vacuum pressure (-180 cm H2O), and ventilatory parameters. Effectiveness of suction was determined by measuring the total aspirated volume, the dry lyophilized weight of secretion, the corrected dry weight (dry weight-weight of instilled salt), and protein concentration. No difference in heart rate, respiratory frequency, O2 saturation, systemic blood pressure, peak inspiratory pressure, or patient discomfort was found when the two modalities were compared; however, the total volume of secretions collected, the dry weight, the corrected dry weight, and the protein concentration were significantly higher with continuous irrigation suction catheter when compared with the conventional method (p < 0.05). The suction time was shorter with the Irri-cath (p < 0.05). We conclude that the Irri-Cath is more effective than conventional intermittent suction catheter in clearing bronchial secretions in patients on mechanical ventilation. PMID:8131470

  12. The solar system's invariable plane

    NASA Astrophysics Data System (ADS)

    Souami, D.; Souchay, J.

    2012-07-01

    Context. The dynamics of solar system objects, such as dwarf planets and asteroids, has become a well-established field of celestial mechanics in the past thirty years, owing to the improvements that have been made in observational techniques and numerical studies. In general, the ecliptic is taken as the reference plane in these studies, although there is no dynamical reason for doing so. In contrast, the invariable plane as originally defined by Laplace, seems to be a far more natural choice. In this context, the latest study of this plane dates back to Burkhardt. Aims: We define and determine the orientation of the invariable plane of the solar system with respect to both the ICRF and the equinox-ecliptic of J2000.0, and evaluate the accuracy of our determination. Methods: Using the long-term numerical ephemerides DE405, DE406, and INPOP10a over their entire available time span, we computed the total angular momentum of the solar system, as well as the individual contribution to it made by each of the planets, the dwarf planets Pluto and Ceres, and the two asteroids Pallas and Vesta. We then deduced the orientation of the invariable plane from these ephemerides. Results: We update the previous results on the determination of the orientation of the invariable plane with more accurate data, and a more complete analysis of the problem, taking into account the effect of the dwarf planet (1) Ceres as well as two of the biggest asteroids, (4) Vesta and (2) Pallas. We show that the inclusion of these last three bodies significantly improves the accuracy of determination of the invariable plane, whose orientation over a 100 y interval does not vary more than 0.1 mas in inclination, and 0.3 mas in longitude of the ascending node. Moreover, we determine the individual contributions of each body to the total angular momentum of the solar system, as well as the inclination and longitude of the node with respect to this latter plane. Conclusions: Owing to the high accuracy

  13. Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit

    PubMed Central

    2015-01-01

    Flushing and locking of intravenous catheters are thought to be essential in the prevention of occlusion. The clinical sign of an occlusion is catheter malfunction and flushing is strongly recommended to ensure a well-functioning catheter. Therefore fluid dynamics, flushing techniques, and sufficient flushing volumes are important matters in adequate flushing in all catheter types. If a catheter is not in use, it is locked. For years, it has been thought that the catheter has to be filled with an anticoagulant to prevent catheter occlusion. Heparin has played a key role in locking venous catheters. However, the high number of risks associated with heparin forces us to look for alternatives. A long time ago, 0.9% sodium chloride was already introduced as locking solution in peripheral cannulas. More recently, a 0.9% sodium chloride lock has also been investigated in other types of catheters. Thrombolytic agents have also been studied as a locking solution because their antithrombotic effect was suggested as superior to heparin. Other catheter lock solutions focus on the anti-infective properties of the locks such as antibiotics and chelating agents. Still, the most effective locking solution will depend on the catheter type and the patient's condition. PMID:26075094

  14. Minimally invasive catheter implantation for regional chemotherapy of the liver: A new percutaneous transsubclavian approach

    SciTech Connect

    Wacker, Frank K.; Boese-Landgraf, Jochen; Wagner, Armin; Albrecht, Dirk; Wolf, Karl-Juergen; Fobbe, Franz

    1997-03-15

    Purpose. Development of a percutaneously implantable catheter system for regional chemotherapy of liver metastases and its application in patients with surgically implanted but dislocated catheters. Methods. Thirty-three patients with liver metastases of colorectal tumors were submitted to percutaneous puncture of the subclavian artery and insertion of a catheter whose tip was placed in the proper hepatic artery and whose end was subcutaneously connected with an infusion pump. Results. The mean duration of therapy via the percutaneously inserted catheter was 27 weeks ({+-}14 weeks). The most frequent complication was disconnection of the therapy catheter from the tube of the infusion pump. Eighty percent of all complications were corrected by reintervention. The therapy drop-out rate due to catheter-associated complications was 9%. Conclusion. Percutaneous insertion of a catheter for regional chemotherapy of the liver is a relatively uncomplicated method with high patient acceptance and simple access for reintervention.

  15. Development of Active Catheter,Active Guide Wire and Micro Sensor Systems

    PubMed Central

    Haga, Y.; Mineta, T.; Totsu, K.; Makishi, W.; Esashi, M.

    2001-01-01

    Summary Active catheters and active guide wires which move like a snake have been developed for catheter-based minimally invasive diagnosis and therapy. Communication and control IC chips in the active catheter reduce the number of lead wires for control. The active catheter can be not only bent but also torsioned and extended. An ultra minature fiber-optic pressure sensor; a forward-looking ultrasonic probe and a magnetic position and orientation sensor have been developed for catheters and guide wires. These moving mechanisms and several sensors which are fitted near the tip of the catheter and the guide wire will provide detailed information near the tip and enable delicate and effective catheter intervention. PMID:20663389

  16. Neonatal peripherally inserted central catheters: recommendations for prevention of insertion and postinsertion complications.

    PubMed

    Paulson, Pamela R; Miller, Kellee M

    2008-01-01

    Peripherally inserted central catheters (PICCs) continue to be necessary in neonatal care. They benefit many premature infants and those needing long-term intravenous access. An experienced inserter, early recognition of PICC candidates, early PICC placement, knowledge of anatomy, and correct choice of vein all increase placement success. As with any invasive procedure, there are risks. These include pain, difficulty advancing the catheter, damage to vessels, catheter malposition, and bleeding. Utilizing assessment skills, following the product manufacturer's instructions, and carefully placing the catheter should minimize most of these risks. Additional risks include postinsertion complications such as occlusions, thrombosis, catheter failure, infection, and catheter malposition. Proper nursing care--which includes controlling infection, properly securing the catheter, and changing the dressing as needed--is key to preventing complications and maintaining the PICC until treatment has been completed. PMID:18697655

  17. Experience of on table modified standard catheters for directed arterial and venous thrombolysis.

    PubMed

    Ram, Bhavin; Baliga, Kapil; Rajesh, S; George, Robbie K

    2016-07-01

    To describe an on-table modification of standard angiography catheters for use in directed arterial and venous thrombolysis. An angiogram is performed and the length of thrombosed vessel (artery or vein) is measured. A 5 or 6 Fr catheter (preferably straight/multi- purpose/vertebral catheter) is modified on table for use by making multiple holes with 23 G needle. After testing ex vivo with saline injection, the on table modified catheter is placed over a wire into the thrombosed segment of the vessel and thrombolytic agent infusion is commenced utilizing a syringe driver after giving a bolus dose of thrombolytic agent. Median duration of thrombolysis was 24 h in our study. We have utilized this method in twenty thrombosed vessels, without any catheter related complications. In our experience, this modification of a standard catheter as a multi-hole catheter is a readily available, simple, cheap, versatile and effective device for directed thrombolysis. PMID:26719163

  18. Plane waves as tractor beams

    NASA Astrophysics Data System (ADS)

    Forgács, Péter; Lukács, Árpád; Romańczukiewicz, Tomasz

    2013-12-01

    It is shown that in a large class of systems, plane waves act as tractor beams: i.e., an incident plane wave can exert a pulling force on the scatterer. The underlying physical mechanism for the pulling force is due to the sufficiently strong scattering of the incoming wave into another mode carrying more momentum, in which case excess momentum is created behind the scatterer. This tractor beam or negative radiation pressure (NRP) effect, is found to be generic in systems with multiple scattering channels. In a birefringent medium, electromagnetic plane waves incident on a thin plate exert NRP of the same order of magnitude as optical radiation pressure, while in artificial dielectrics (metamaterials), the magnitude of NRP can even be macroscopic. In two dimensions, we study various scattering situations on vortices, and NRP is shown to occur by the scattering of heavy baryons into light leptons off cosmic strings, and by neutron scattering off vortices in the XY model.

  19. 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.

  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, 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.

  2. 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.

  3. Plane waves in noncommutative fluids

    NASA Astrophysics Data System (ADS)

    Abdalla, M. C. B.; Holender, L.; Santos, M. A.; Vancea, I. V.

    2013-08-01

    We study the dynamics of the noncommutative fluid in the Snyder space perturbatively at the first order in powers of the noncommutative parameter. The linearized noncommutative fluid dynamics is described by a system of coupled linear partial differential equations in which the variables are the fluid density and the fluid potentials. We show that these equations admit a set of solutions that are monochromatic plane waves for the fluid density and two of the potentials and a linear function for the third potential. The energy-momentum tensor of the plane waves is calculated.

  4. 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.

  5. Irrigated Tip Catheters for Radiofrequency Ablation in Ventricular Tachycardia

    PubMed Central

    Grothoff, Matthias; Dinov, Borislav; Kosiuk, Jedrzej; Richter, Sergio; Sommer, Philipp; Breithardt, Ole A.; Bollmann, Andreas; Arya, Arash; Hindricks, Gerhard

    2015-01-01

    Radiofrequency (RF) ablation with irrigated tip catheters decreases the likelihood of thrombus and char formation and enables the creation of larger lesions. Due to the potential dramatic consequences, the prevention of thromboembolic events is of particular importance for left-sided procedures. Although acute success rates of ventricular tachycardia (VT) ablation are satisfactory, recurrence rate is high. Apart from the progress of the underlying disease, reconduction and the lack of effective transmural lesions play a major role for VT recurrences. This paper reviews principles of lesion formation with radiofrequency and the effect of tip irrigation as well as recent advances in new technology. Potential areas of further development of catheter technology might be the improvement of mapping by better substrate definition and resolution, the introduction of bipolar and multipolar ablation techniques into clinical routine, and the use of alternative sources of energy. PMID:25705659

  6. Development of a Novel Shock Wave Catheter Ablation System

    NASA Astrophysics Data System (ADS)

    Yamamoto, H.; Hasebe, Yuhi; Kondo, Masateru; Fukuda, Koji; Takayama, Kazuyoshi; Shimokawa, Hiroaki

    Although radio-frequency catheter ablation (RFCA) is quite effective for the treatment tachyarrhythmias, it possesses two fundamental limitations, including limited efficacy for the treatment of ventricular tachyarrhythmias of epicardial origin and the risk of thromboembolism. Consequently, new method is required, which can eradicate arrhythmia source in deep part of cardiac muscle without heating. On the other hand, for a medical application of shock waves, extracorporeal shock wave lithotripter (ESWL) has been established [1]. It was demonstrated that the underwater shock focusing is one of most efficient method to generate a controlled high pressure in a small region [2]. In order to overcome limitations of existing methods, we aimed to develop a new catheter ablation system with underwater shock waves that can treat myocardium at arbitrary depth without causing heat.

  7. Irrigated tip catheters for radiofrequency ablation in ventricular tachycardia.

    PubMed

    Müssigbrodt, Andreas; Grothoff, Matthias; Dinov, Borislav; Kosiuk, Jedrzej; Richter, Sergio; Sommer, Philipp; Breithardt, Ole A; Rolf, Sascha; Bollmann, Andreas; Arya, Arash; Hindricks, Gerhard

    2015-01-01

    Radiofrequency (RF) ablation with irrigated tip catheters decreases the likelihood of thrombus and char formation and enables the creation of larger lesions. Due to the potential dramatic consequences, the prevention of thromboembolic events is of particular importance for left-sided procedures. Although acute success rates of ventricular tachycardia (VT) ablation are satisfactory, recurrence rate is high. Apart from the progress of the underlying disease, reconduction and the lack of effective transmural lesions play a major role for VT recurrences. This paper reviews principles of lesion formation with radiofrequency and the effect of tip irrigation as well as recent advances in new technology. Potential areas of further development of catheter technology might be the improvement of mapping by better substrate definition and resolution, the introduction of bipolar and multipolar ablation techniques into clinical routine, and the use of alternative sources of energy. PMID:25705659

  8. S-Nitroso-N-acetylpenicillamine (SNAP) Impregnated Silicone Foley Catheters: A Potential Biomaterial/Device To Prevent Catheter-Associated Urinary Tract Infections

    PubMed Central

    2016-01-01

    Urinary Foley catheters are utilized for management of hospitalized patients and are associated with high rates of urinary tract infections (UTIs). Nitric oxide (NO) potently inhibits microbial biofilm formation, which is the primary cause of catheter associated UTIs (CAUTIs). Herein, commercial silicone Foley catheters are impregnated via a solvent swelling method with S-nitroso-N-acetyl-D-penicillamine (SNAP), a synthetic NO donor that exhibits long-term NO release and stability when incorporated into low water-uptake polymers. The proposed catheters generate NO surface-fluxes >0.7 × 10–10 mol min–1 cm–2 for over one month under physiological conditions, with minimal SNAP leaching. These biomedical devices are demonstrated to significantly decrease formation of biofilm on the surface of the catheter tubings over 3, 7, and 14 day periods by microbial species (Staphylococcus epidermidis and Proteus mirabilis) commonly causing CAUTIs. Toxicity assessment demonstrates that the SNAP-impregnated catheters are fully biocompatible, as extracts of the catheter tubings score 0 on a 3-point grading scale using an accepted mouse fibroblast cell-line toxicity model. Consequently, SNAP-impregnated silicone Foley catheters can likely provide an efficient strategy to greatly reduce the occurrence of nosocomial CAUTIs. PMID:26462294

  9. Percutaneous Catheter Drainage in Infected Pancreatitis Necrosis: a Systematic Review.

    PubMed

    Ke, Lichi; Li, Junhua; Hu, Peihong; Wang, Lianqun; Chen, Haiming; Zhu, Yaping

    2016-06-01

    The primary aim of this study was to present the outcomes of percutaneous catheter drainage (PCD) in patients with infected pancreatitis necrosis. A second aim was to focus on disease severity, catheter size, and additional surgical intervention. A literature search of the PubMed/MEDLINE/Cochrane Library (January 1998 to February 2015) databases was conducted. All randomized, non-randomized, and retrospective studies with data on PCD techniques and outcomes in patients with infected pancreatitis necrosis were included. Studies that reported data on PCD along with other interventions without the possibility to discriminate results specific to PCD were excluded. The main outcomes were mortality, major complications, and definitive successful treatment with percutaneous catheter drainage alone. Fifteen studies of 577 patients were included. There was only one randomized, controlled trial, and most others were retrospective case series. Organ failure before PCD occurred in 55.3 % of patients. With PCD alone, definitive successful treatment was 56.2 % of patients. Additional surgical intervention was required after PCD in 38.5 % of patients. The overall mortality rate was 18 % (104 of 577 patients). Complications occurred in 25.1 % of patients, and fistula was the most common complication. PCD is an efficient tool for treatment in the majority of patients with infected pancreatitis necrosis as the only intervention. Multiple organ failures before PCD are negative parameters for the outcome of the disease. Large catheters fail to prove to be more effective for draining necrotic tissue. However, in the extent of multi-morbid patients, to determine one single prognostic factor seems to be difficult. PMID:27358518

  10. Catheter-related blood stream infection caused by Raoultella ornithinolytica.

    PubMed

    Sękowska, Alicja; Dylewska, Katarzyna; Gospodarek, Eugenia; Bogiel, Tomasz

    2015-11-01

    Raoultella spp. representatives are Gram-negative capsulated, nonmotile rods. These bacteria are found in the natural environment: plants, water, soil and insects. R. ornithinolytica is one of the three species of Raoultella. R. ornithinolytica is the only species within the genus which has the ability to produce ornithine decarboxylase. Human infections related to R. ornithinolytica are exceedingly rare. The present case report describes catheter-related blood stream infection caused by R. ornithinolytica and successfully treated with antibiotic therapy. PMID:25894520

  11. Determination of lesion size by ultrasound during radiofrequency catheter ablation.

    PubMed

    Awad, S; Eick, O

    2003-01-01

    The catheter tip temperature that is used to control the radiofrequency generator output poorly correlates to lesion size. We, therefore, evaluated lesions created in vitro using a B-mode ultrasound imaging device as a potential means to assess lesion generation during RF applications non-invasively. Porcine ventricular tissue was immersed in saline solution at 37 degrees C. The catheter was fixed in a holder and positioned in a parallel orientation to the tissue with an array transducer (7.5 MHz) app. 3 cm above the tissue. Lesions were produced either in a temperature controlled mode with a 4-mm tip catheter with different target temperatures (50, 60, 70 and 80 degrees C, 80 W maximum output) or in a power controlled mode (25, 50 and 75 W, 20 ml/min irrigation flow) using an irrigated tip catheter. Different contact forces (0.5 N, 1.0 N) were tested, and RF was delivered for 60 s. A total of 138 lesions was produced. Out of these, 128 could be identified on the ultrasound image. The lesion depth and volume was on average 4.1 +/- 1.6 mm and 52 +/- 53 mm3 as determined by ultrasound and 3.9 +/- 1.7 mm and 52 +/- 55 mm3 as measured thereafter, respectively. A linear correlation between the lesion size determined by ultrasound and that measured thereafter was demonstrated with a correlation coefficient of r = 0.87 for lesion depth and r = 0.93 for lesion volume. We conclude that lesions can be assessed by B-mode ultrasound imaging. PMID:12910859

  12. Catheter-related infections in pediatric patients with cancer.

    PubMed

    Cecinati, V; Brescia, L; Tagliaferri, L; Giordano, P; Esposito, S

    2012-11-01

    Central venous catheters (CVCs) are essential in the management of pediatric patients receiving antineoplastic therapy or bone marrow transplants, and have significantly improved their quality of life, but CVC-related infectious complications are a major source of morbidity. It has been estimated that 14-51 % of the CVCs implanted in children with malignancies may be complicated by bacteremia, and that the incidence of infections is 1.4-1.9 episodes per 1,000 CVC days. However, there are few recent data concerning the epidemiology of CVC-related infections, the prevalence of antimicrobial resistance in their etiology, or the main factors associated with an increased risk of infection by type of catheter, patient age, the type of cancer, or the presence of neutropenia. Moreover, although various new strategies have been proposed in an attempt to reduce the risk of CVC-related infections, such as catheters impregnated with antiseptics/antibiotics, lock antibiotic prophylaxis, the use of ointments at the exit site, and antithrombotic prophylaxis, their real efficacy in children has not yet been demonstrated. The management of CVC-related infections remains difficult, mainly because of the number of still open questions (including the choice of optimal antimicrobial therapy because of the increasing isolation of multiresistant bacterial strains, treatment duration, whether catheters should be removed or not, the feasibility of guidewire exchange, and the usefulness of antibiotic lock therapy) and the lack of studies of children with cancer. Only well-designed, prospective clinical trials involving pediatric cancer patients can clarify optimal prevention and treatment strategies for CVC-related infections in this population. PMID:22661169

  13. Cohort Study: Central Venous Catheter-Related Complications in Children with Hematologic Diseases at a Single Center

    PubMed Central

    Pektaş, Ayhan; Kara, Ateş; Gurgey, Aytemiz

    2015-01-01

    Objective: This study aims to document and analyze the central venous catheter (CVC)-related complications in children with hematological diseases who were treated within a single institution. Materials and Methods: A retrospective investigation was conducted in 106 pediatric patients in whom 203 CVCs were inserted. A total of 175 catheter-related complications occurred in 5 years. Results: The rates of clinical catheter infections, local catheter infections, venous thromboembolism, bleeding, and mechanical complications were 2.6, 1.1, 0.2, 0.2, and 0.2 per 1000 catheter days. Methicillin-resistant Staphylococcus epidermidis was the predominant infectious organism in blood and catheter cultures. The children with leukemia had a significantly higher frequency of clinical catheter infections (p=0.046). The children who underwent bone marrow transplantation had a significantly lower frequency of clinical catheter infections (p=0.043) and higher frequency of local catheter infections (p=0.003). The children with implanted catheters had a significantly lower frequency of clinical catheter infections (p=0.048). The children with thrombocytopenia had significantly fewer local catheter infections and significantly more clinical catheter infections and catheter-related bleeding (respectively p=0.001, p=0.042, and p=0.024). Conclusion: Leukemia, bone marrow transplantation, and thrombocytopenia are risk factors for CVC-associated complications. The relatively higher number of interventions performed via permanent catheters may be responsible for the significantly increased incidence of systemic infections and mechanical injury. PMID:26316482

  14. Impact of Hemodialysis Catheter Dysfunction on Dialysis and Other Medical Services: An Observational Cohort Study

    PubMed Central

    Griffiths, Robert I.; Newsome, Britt B.; Leung, Grace; Block, Geoffrey A.; Herbert, Robert J.; Danese, Mark D.

    2012-01-01

    Practice guidelines define hemodialysis catheter dysfunction as blood flow rate (BFR) <300 mL/min. We conducted a study using data from DaVita and the United States Renal Data System to evaluate the impact of catheter dysfunction on dialysis and other medical services. Patients were included if they had ≥8 consecutive weeks of catheter dialysis between 8/2004 and 12/2006. Actual BFR <300 mL/min despite planned BFR ≥300 mL/min was used to define catheter dysfunction during each dialysis session. Among 9,707 patients, the average age was 62,53% were female, and 40% were black. The median duration of catheter dialysis was 190 days, and the cohort accounted for 1,075,701 catheter dialysis sessions. There were 70,361 sessions with catheter dysfunction, and 6,33 1 (65.2%) patients had at least one session with catheter dysfunction. In multivariate repeated measures analysis, catheter dysfunction was associated with increased odds of missing a dialysis session due to access problems (Odds ratio [OR] 2.50; P < 0.001), having an access-related procedure (OR 2.10; P < 0.001), and being hospitalized (OR 1.10; P = 0.001). Catheter dysfunction defined according to NKF vascular access guidelines results in disruptions of dialysis treatment and increased use of other medical services. PMID:22518313

  15. Response characteristics of esophageal balloon catheters handmade using latex and nonlatex materials

    PubMed Central

    Cross, Troy J; Lalande, Sophie; Hyatt, Robert E; Johnson, Bruce D

    2015-01-01

    The measurement of esophageal pressure allows for the calculation of several important and clinically useful parameters of respiratory mechanics. Esophageal pressure is often measured with balloon-tipped catheters. These catheters may be handmade from natural latex condoms and polyethylene tubing. Given the potential of natural latex to cause allergic reaction, it is important to determine whether esophageal catheter balloons can be fabricated, by hand, using nonlatex condoms as construction materials. To determine the static and dynamic response characteristics of esophageal balloon catheters handmade from latex and nonlatex materials, six esophageal catheter balloons were constructed from each of the following condom materials: natural latex, synthetic polyisoprene, and polyurethane (18 total). Static compliance and working volume range of each balloon catheter was obtained from their pressure-volume characteristics in water. The dynamic response of balloon catheters were measured via a pressure “step” test, from which a third-order underdamped transfer function was modeled. The dynamic ranges of balloon catheters were characterized by the frequencies corresponding to ±5% amplitude- and phase-distortion (fA5% and fφ5%). Balloon catheters handmade from polyurethane condoms displayed the smallest working volume range and lowest static balloon compliance. Despite this lower compliance, fA5% and fφ5% were remarkably similar between all balloon materials. Our findings suggest that polyisoprene condoms are an ideal nonlatex construction material to use when fabricating esophageal catheter balloons by hand. PMID:26077619

  16. Occurrence and Management Strategies for Catheter Entrapment with Onyx Liquid Embolization

    PubMed Central

    Qureshi, Adnan I.; Mian, Nidaullah; Siddiqi, Harris; Qureshi, Mushtaq H.; Malik, Adil M; Rauf Afzal, Mohammad; Khan, Asif A.; Suri, M. Fareed K.

    2015-01-01

    In June 2012, Food and Drug Administration (FDA) issued a warning about the risk of catheter entrapment associated with Onyx embolization. We used our experience, literature review, and FDA Manufacturer and User Facility Device Experience (MAUDE) data review to identify five strategies to address catheter entrapment: 1/. Surgical resection of vessel at point of entrapment of catheter and retraction from exterior portion at the femoral region; 2/. Advancing and closing the loop of snare over the entrapped catheter followed by retraction; 3/. Advancing the distal access catheter over the entrapped catheter and retraction with forward movement of the distal access catheters; 4/. Inflation of balloon catheter coaxial to the entrapped catheter with subsequent retraction; and 5/. Intravascular retention and internalization of microcatheter. In the MAUDE data, there were 77 reports of catheter entrapment with Onyx embolization; microcatheter was retracted by surgical excision in 15, endovascular snare or other retriever devices in 5, deliberately entrapped inside the vessel using stent in 1, and left without intervention within intravascular compartment in 27 patients. PMID:26301030

  17. A clever technique for placement of a urinary catheter over a wire

    PubMed Central

    Abbott, Joel E.; Heinemann, Adam; Badalament, Robert; Davalos, Julio G.

    2015-01-01

    Objective: The objective was to present a straightforward, step-by-step reproducible technique for placement of a guide-wire into any type of urethral catheter, thereby offering a means of access similar to that of a council-tip in a situation that may require a different type of catheter guided over a wire. Materials and Methods: Using a shielded intravenous catheter inserted into the eyelet of a urinary catheter and through the distal tip, a “counsel-tip” can be created in any size or type of catheter. Once transurethral bladder access has been achieved with a hydrophilic guide-wire, this technique will allow unrestricted use of catheters placed over a wire facilitating guided catheterization. Results: Urethral catheters of different types and sizes are easily advanced into the bladder with wire-guidance; catheterization is improved in the setting of difficult urethral catheterization (DUC). Cost analysis demonstrates benefit overuse of traditional council-tip catheter. Conclusion: Placing urinary catheters over a wire is standard practice for urologists, however, use of this technique gives the freedom of performing wire-guided catheterization in more situations than a council-tip allows. This technique facilitates successful transurethral catheterization over wire in the setting of DUC for all catheter types and styles aiding in urologic management of patients at a cost benefit to the health care system. PMID:26229328

  18. Effect of two different short peripheral catheter materials on phlebitis development.

    PubMed

    Karadağ, A; Görgülü, S

    2000-01-01

    One of the most common causes of phlebitis in hospitalized patients is intravenous catheters. The material of the catheter is a determining factor in the development of phlebitis, as are factors such as age, gender, and medical diagnosis of the patient. The aim of this study, conducted in the coronary care unit of a 384-bed hospital in Ankara, Turkey, was to determine the effect of two different short peripheral catheters on phlebitis development caused by i.v. treatment. Overall, 255 patients constituted the study sample (130 with Teflon, 125 with Vialon catheters). Both groups were followed up for phlebitis development for 6 days. The total phlebitis rate was 36.8%, with almost half of the patients (49.2%) in the Teflon catheter group and 24.0% of patients in the Vialon catheter group. A significant statistical relationship was found between phlebitis rate and variables such as gender, catheter material, and indwelling time. The results of the study demonstrate that Vialon catheters are associated with less risk of catheter-induced phlebitis than are Teflon catheters. PMID:11272972

  19. Complications Encountered with a Transfemorally Placed Port-Catheter System for Hepatic Artery Chemotherapy Infusion

    SciTech Connect

    Kuroiwa, Toshiro; Honda, Hiroshi; Yoshimitsu, Kengo; Irie, Hiroyuki; Aibe, Hitoshi; Tajima, Tsuyoshi; Shinozaki, Kenji; Masuda, Kouji

    2001-03-15

    A port-catheter system was implanted via femoral artery access for hepatic artery chemotherapy infusion. Implantation was attempted in 90 patients and was successful in 88. Blood flow redistribution was performed using embolization coils. In the first ten patients a soft heparin-coated infusion catheter was used. For the following 78 patients we used a stiffer catheter coated with fluorine-acryl-styrene-urethane-silicone (FASUS) copolymer. The catheter was connected to a port implanted subcutaneously below the level of the inguinal ligament. Complications during the procedure and after placement were observed in 7 of 90 patients and 24 of 88 patients, respectively. These included catheter obstruction (11%), dislocation of the catheter tip (10%), drug toxicity (5.7%), and catheter infection (3.4%). In 6 of 10 patients with catheter obstruction, recanalization of the port system was achieved. In 7 of 9 patients with dislocation of the indwelling catheter tip, replacement of the port system was successful. Our complications appear to be comparable with those encountered with the subclavian/brachial approach when the new catheter coating is used. Notable is the avoidance of cerebral infarcts.

  20. A novel method for measuring catheter lock spillage: an in vitro study.

    PubMed

    Polaschegg, Hans-Dietrich

    2012-09-01

    Catheters are widely used for blood purification, parenteral nutrition, and for the infusion of drugs. Previous work on catheter lock spillage has focused on the theory and in vitro demonstration of catheter lock spillage caused by the laminar flow profile and by fluid exchange caused by density differences. This work describes an in vitro test with a method that potentially allows measurement of catheter lock spillage in vivo without sampling. The method is based on the change of the electrical resistance of the catheter when the lock solution is injected. This method was tested in vitro with human blood at 36°C using 46.7% trisodium citrate as catheter lock solution. The catheter tip was placed in a beaker filled with whole blood. A stainless steel rod in the beaker served as one electrode and an Arrow-Johans ECG adapter, which was placed on the distal end of the catheter, served as a second electrode. Conductivity was measured with a 5V (rms) 310 Hz sinus voltage and a 10 kOhm resistor in series to the catheter. The driving voltage and the voltage drop at the catheter was continuously measured with a program written under LabView (National Instruments), and the results were converted into mean trisodium citrate concentrations. Within 20 min, the mean trisodium citrate concentration in the catheter decreased to less than 5%. Unlike the previous methods used for catheter lock spillage measurement, this principle can be employed to measure the time course of catheter lock spillage in vivo. PMID:22639886

  1. Monitoring Central Venous Catheter Resistance to Predict Imminent Occlusion: A Prospective Pilot Study

    PubMed Central

    Wolf, Joshua; Tang, Li; Rubnitz, Jeffrey E.; Brennan, Rachel C.; Shook, David R.; Stokes, Dennis C.; Monagle, Paul; Curtis, Nigel; Worth, Leon J.; Allison, Kim; Sun, Yilun; Flynn, Patricia M.

    2015-01-01

    Background Long-term central venous catheters are essential for the management of chronic medical conditions, including childhood cancer. Catheter occlusion is associated with an increased risk of subsequent complications, including bloodstream infection, venous thrombosis, and catheter fracture. Therefore, predicting and pre-emptively treating occlusions should prevent complications, but no method for predicting such occlusions has been developed. Methods We conducted a prospective trial to determine the feasibility, acceptability, and efficacy of catheter-resistance monitoring, a novel approach to predicting central venous catheter occlusion in pediatric patients. Participants who had tunneled catheters and were receiving treatment for cancer or undergoing hematopoietic stem cell transplantation underwent weekly catheter-resistance monitoring for up to 12 weeks. Resistance was assessed by measuring the inline pressure at multiple flow-rates via a syringe pump system fitted with a pressure-sensing transducer. When turbulent flow through the device was evident, resistance was not estimated, and the result was noted as “non-laminar.” Results Ten patients attended 113 catheter-resistance monitoring visits. Elevated catheter resistance (>8.8% increase) was strongly associated with the subsequent development of acute catheter occlusion within 10 days (odds ratio = 6.2; 95% confidence interval, 1.8–21.5; p <0.01; sensitivity, 75%; specificity, 67%). A combined prediction model comprising either change in resistance greater than 8.8% or a non-laminar result predicted subsequent occlusion (odds ratio = 6.8; 95% confidence interval, 2.0–22.8; p = 0.002; sensitivity, 80%; specificity, 63%). Participants rated catheter-resistance monitoring as highly acceptable. Conclusions In this pediatric hematology and oncology population, catheter-resistance monitoring is feasible, acceptable, and predicts imminent catheter occlusion. Larger studies are required to validate

  2. Development of A MEMS Based Manometric Catheter for Diagnosis of Functional Swallowing Disorders.

    NASA Astrophysics Data System (ADS)

    Hsu, H. Y.; Hariz, A. J.; Omari, T.; Teng, M. F.; Sii, D.; Chan, S.; Lau, L.; Tan, S.; Lin, G.; Haskard, M.; Mulcahy, D.; Bakewell, M.

    2006-04-01

    Silicon pressure sensors based on micro-electro-mechanical-systems (MEMS) technologies are gaining popularity for applications in bio-medical devices. In this study, a silicon piezo-resistive pressure sensor die is used in a feasibility study of developing a manometric catheter for functional swallowing disorders diagnosis. The function of a manometric catheter is to measure the peak and intrabolus pressures along the esophageal segment during the swallowing action. Previous manometric catheters used the water perfusion technique to measure the pressure changes. This type of catheter is reusable, large in size and the pressure reading is recorded by an external transducer. Current manometric catheters use a solid state pressure sensor on the catheter itself to measure the pressure changes. This type of catheter reduces the discomfort to the patient but it is reusable and is very expensive. We carried out several studies and experiments on the MEMS-based pressure sensor die, and the results show the MEMS-based pressure sensors have a good stability and a good linearity output response, together with the advantage of low excitation biasing voltage and extremely small size. The MEMS-based sensor is the best device to use in the new generation of manometric catheters. The concept of the new MEMS-based manometric catheter consists of a pressure sensing sensor, supporting ring, the catheter tube and a data connector. Laboratory testing shows that the new calibrated catheter is capable of measuring pressure in the range from 0 to 100mmHg and maintaining stable condition on the zero baseline setting when no pressure is applied. In-vivo tests are carried out to compare the new MEMS based catheter with the current version of catheters used in the hospital.

  3. Effect of imaging and catheter characteristics on clinical outcome for patients in the PRECISE study

    PubMed Central

    Polley, Mei-Yin; Lee, Benjamin; Kunwar, Sandeep; Pedain, Christoph; Wembacher-Schröder, Eva; Mittermeyer, Stephan; Westphal, Manfred; Sampson, John H.; Vogelbaum, Michael A.; Croteau, David; Chang, Susan M.

    2010-01-01

    The PRECISE study used convection enhanced delivery (CED) to infuse IL13-PE38QQR in patients with recurrent glioblastoma multiforme (GBM) and compared survival to Gliadel Wafers (GW). The objectives of this retrospective evaluation were to assess: (1) catheter positioning in relation to imaging features and (2) to examine the potential impact of catheter positioning, overall catheter placement and imaging features on long term clinical outcome in the PRECISE study. Catheter positioning and overall catheter placement were scored and used as a surrogate of adequate placement. Imaging studies obtained on day 43 and day 71 after resection were each retrospectively reviewed. Catheter positioning scores, catheter overall placement scores, local tumor control and imaging change scores were reviewed and correlated using Generalized Linear Mixed Models. Cox PH regression analysis was used to examine whether these imaging based variables predicted overall survival (OS) and progression free survival (PFS) after adjusting for age and KPS. Of 180 patients in the CED group, 20 patients did not undergo gross total resection. Of the remaining 160 patients only 53% of patients had fully conforming catheters in respect to overall placement and 51% had adequate catheter positioning scores. Better catheter positioning scores were not correlated with local tumor control (P = 0.61) or imaging change score (P = 0.86). OS and PFS were not correlated with catheter positioning score (OS: P = 0.53; PFS: P = 0.72 respectively), overall placement score (OS: P = 0.55; PFS: P = 0.35) or imaging changes on day 43 MRI (P = 0.88). Catheter positioning scores and overall catheter placement scores were not associated with clinical outcome in this large prospective trial. PMID:20563833

  4. Central venous catheter vascular erosions. Diagnosis and clinical course.

    PubMed Central

    Ellis, L M; Vogel, S B; Copeland, E M

    1989-01-01

    Central venous catheter (CVC) vascular erosions are difficult to diagnose, and they cause serious complications. From 1985 to 1987, ten patients receiving the surgical services at the University of Florida suffered CVC vascular erosions. By chest roentgenogram, nine CVC tips were in the superior vena cava (SVC), although three catheter tips abutted the lateral wall of the SVC. One catheter tip was in the right atrium. All patients had sudden onset of symptoms, the most common of which was shortness of breath. Initial diagnosis was respiratory insufficiency in five patients, cardiac failure in three patients, pulmonary embolism in one, and sepsis in one. Four patients required intensive care. Two patients suffered pericardial tamponade, and pleural effusions developed in eight patients. One patient died of cardiac arrest. The average time interval from CVC placement to onset of symptoms was 60.2 hours, and from the onset of symptoms to the time of diagnosis, the interval was 16.7 hours. The mean volume obtained at thoracentesis was 1324 ml and at pericardiocentesis was 250 ml. Images Fig. 1. PMID:2930292

  5. [Septic pulmonary emboli caused by parenteral nutrition catheter infection].

    PubMed

    Kuwabara, M; Itoi, K; Ariyasu, T; Yanagihara, K; Nasu, T

    1990-09-01

    A case of septic pulmonary emboli due to parenteral nutrition catheter infection was reported. Characteristic radiologic features were recognized. A 50-year-old man, who was receiving parenteral nutrition after total gastrectomy, consulted our department with complaints of fever and general malaise. A chest radiograph showed scattered ill-defined small peripheral nodules, which were not present before parenteral nutrition, and these nodules were quickly formed cavities + in 2nd day. He was suffering from high fever, hemo-sputum and dyspnea after removal of the parenteral nutrition catheter. Pseudomonas aeruginosa was isolated from the tip of parenteral nutrition catheter and sputum cultures. Septic pulmonary emboli were diagnosed and antibiotic therapy was performed. Bacterial endocarditis and septic thrombophlebitis were ruled out. The multiple cavity nodules extended to involve the peripheral areas of the lung and invasive shadows appeared on the chest radiograph in 8th day. Then, the invasive shadows disappeared and the walls of the cavitary lesions became thinner. After 2 months, all cavitary lesions disappeared with only linear shadows remaining. PMID:2125088

  6. The Malposition of Central Venous Catheters in Children

    PubMed Central

    Dzierzega, Maria; Ossowska, Magdalena; Chmiel, Dariusz; Wieczorek, Aleksandra; Balwierz, Walentyna

    2014-01-01

    Summary Background Contemporary medical care, especially in the field of pediatrics often requires central venous line (CVC – Central Venous Catheter) implantation for carrying out treatment. Some conditions are treated intravenously for several months, other require long-term venous access due to periodical administration of medications or daily nutritional supplementation. Material/Methods A total number of 309 CVCs were implanted at Children’s University Hospital in Cracow between January 2011 and December 2012 (24 months). Malposition of the CVC is not common. The target of our article was to present two rare cases of malposition of catheters and two displacements of catheter due to chest tumors, and to enhance the importance of differential diagnostic imaging when difficulties occur. Results CVC malposition was detected with different imaging modalities followed by appropriate medical procedures. Conclusions In case of any difficulties with central lines, it is necessary to investigate the underlying cause. The central line team at hospital cooperating with other specialists is needed to detect complications and to prevent them. PMID:25177409

  7. [Pulmonary complications during parenteral feeding via percutaneous silicon catheters].

    PubMed

    Closa, R M; Coroleu, W; Natal, A; Gómez-Papí, A; Ainsa Abos, E; Sánchez Galiana, A

    1998-07-01

    Percutaneous fine bore silicone central catheters are frequently used in sick full term newborns and in low birth weight premature infants; although their use has some risks. We report two cases of pleural effusion in two prematures of 34 and 33 weeks gestation and birth weight of 1,510 and 1,650 g, respectively; and one case neumonitis in a newborn of a 38 weeks gestation and 2,730 g birth weight. All of them have in common same initial clinical sign: increase mucus secretion of the upper airway a few hours after the beginning of parenteral nutrition using the type of catheter mentioned with the tip abnormally located in pulmonary artery. These complications are probably related to endothelial injury of very slow flow vessels due to the high osmolarity and low pH of the parenteral solutions used; which probably, in turn, produce thrombosis and vascular perforation, and/or extravasation. We suggest to suspect a pulmonary artery abnormally located catheter in patients receiving parenteral nutrition who increase upper airway mucus secretion. The rapid correction of the position would prevent major complications. PMID:12602026

  8. Ventriculoperitoneal shunt malfunction caused by proximal catheter fat obstruction.

    PubMed

    Mizrahi, Cezar José; Spektor, Sergey; Margolin, Emil; Shoshan, Yigal; Ben-David, Eliel; Cohen, José E; Moscovici, Samuel

    2016-08-01

    Ventriculoperitoneal (VP) shunt placement is the mainstay of treatment for hydrocephalus, yet shunts remain vulnerable to a variety of complications. Although fat droplet migration into the subarachnoid space and cerebrospinal fluid pathways following craniotomy has been observed, a VP shunt obstruction with fat droplets has never been reported to our knowledge. We present the first reported case of VP shunt catheter obstruction by migratory fat droplets in a 55-year-old woman who underwent suboccipital craniotomy for removal of a metastatic tumor of the left medullocerebellar region, without fat harvesting. A VP shunt was inserted 1month later due to communicating hydrocephalus. The patient presented with gait disturbance, intermittent confusion, and pseudomeningocele 21days after shunt insertion. MRI revealed retrograde fat deposition in the ventricular system and VP shunt catheter, apparently following migration of fat droplets from the fatty soft tissue of the craniotomy site. Spinal tap revealed signs of aseptic meningitis. Steroid treatment for aseptic "lipoid" meningitis provided symptom relief. MRI 2months later revealed partial fat resorption and resolution of the pseudomeningocele. VP shunt malfunction caused by fat obstruction of the ventricular catheter should be acknowledged as a possible complication in VP shunts after craniotomy, even in the absence of fat harvesting. PMID:27010421

  9. Side-viewing fiberoptic catheter for biospectroscopy applications.

    PubMed

    de Lima, C J; Sathaiah, S; Pacheco, M T T; Zângaro, R A; Manoharan, R

    2004-01-01

    Utilization of fiberoptic catheters can turn the Raman and fluorescence spectroscopy systems into powerful bio-medical diagnostic probes. An in vivo bio-chemical diagnosis of some important organs like the esophagus, intestine, lung branches, artery, etc., can be possible by developing fiber-probes with good signal collection capabilities, a good flexibility to scan different spatial regions of the sample and less background signals generated in the probes themselves. An in vivo diagnosis of endoluminal inner walls utilizing front-viewing catheters (FVC) is very difficult because the internal diameter of these organs do not allow (excitation and collection) flexibility to access the different spatial regions of the sample. In this work we have developed, different side-viewing catheter (SVC) probes with a very small distal tip (semi sphere, phi approximately 1.5 mm) and micro mirrors allow beam steering of the excitation and collected radiation at a 90 degree angle. Preliminary results of spectroscopic applications have been presented. Reflectance, fluorescence and Raman scattering measurements have been used to compare the efficiency of SVC with traditional FVC probes. The results demonstrate that the SVC probes not only exhibit more flexibility but also similar spectral characteristics and signal collection efficiencies in comparison with conventional FVC probes. PMID:15316854

  10. Bioelectromagnetic localization of a pacing catheter in the heart

    NASA Astrophysics Data System (ADS)

    Pesola, K.; Nenonen, J.; Fenici, R.; Lötjönen, J.; Mäkijärvi, M.; Fenici, P.; Korhonen, P.; Lauerma, K.; Valkonen, M.; Toivonen, L.; Katila, T.

    1999-10-01

    The accuracy of localizing source currents within the human heart by non-invasive magneto- and electrocardiographic methods was investigated in 10 patients. A non-magnetic stimulation catheter inside the heart served as a reference current source. Biplane fluoroscopic imaging with lead ball markers was used to record the catheter position. Simultaneous multichannel magnetocardiographic (MCG) and body surface potential mapping (BSPM) recordings were performed during catheter pacing. Equivalent current dipole localizations were computed from MCG and BSPM data, employing standard and patient-specific boundary element torso models. Using individual models with the lungs included, the average MCG localization error was 7±3 mm, whereas the average BSPM localization error was 25±4 mm. In the simplified case of a single homogeneous standard torso model, an average error of 9±3 mm was obtained from MCG recordings. The MCG localization accuracies obtained in this study imply that the capability of multichannel MCG to locate dipolar sources is sufficient for clinical purposes, even without constructing individual torso models from x-ray or from magnetic resonance images.

  11. Assessment of a new hub design and the semiquantitative catheter culture method using an in vivo experimental model of catheter sepsis.

    PubMed Central

    Segura, M; Alía, C; Valverde, J; Franch, G; Torres Rodríguez, J M; Sitges-Serra, A

    1990-01-01

    An in vivo model of hub-related catheter sepsis in rabbits is reported. The model was used to investigate the protection offered by a new hub design against external contamination by Pseudomonas aeruginosa or Staphylococcus epidermidis and to reassess the diagnostic value of the semiquantitative culture method in bacteremia of endoluminal origin. Contamination of conventional Luer-Lock connectors was followed by clinical sepsis, positive catheter segment cultures, or both, whereas contamination of the new hub was followed by complete protection. Clinical and bacteriological discrepancies observed between contamination with P. aeruginosa and S. epidermidis suggest that the virulence of microorganisms may account for differences in the natural history of hub-originated catheter sepsis. The semiquantitative extraluminal method for catheter culture yielded less than 15 CFU in three animals with proven bacteremia and should not be used as the "gold standard" to define catheter-related bacteremia. PMID:2254430

  12. 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.…

  13. Optimization of starshades: focal plane versus pupil plane

    NASA Astrophysics Data System (ADS)

    Flamary, R.; Aime, C.

    2014-09-01

    We search for the best possible transmission for an external occulter coronagraph that is dedicated to the direct observation of terrestrial exoplanets. We show that better observation conditions are obtained when the flux in the focal plane is minimized in the zone in which the exoplanet is observed, instead of for the total flux received by the telescope. We describe the transmission of the occulter as a sum of basis functions. For each element of the basis, we numerically computed the Fresnel diffraction at the aperture of the telescope and the complex amplitude at its focus. The basis functions are circular disks that are linearly apodized over a few centimeters (truncated cones). We complemented the numerical calculation of the Fresnel diffraction for these functions by a comparison with pure circular disks (cylinder) for which an analytical expression, based on a decomposition in Lommel series, is available. The technique of deriving the optimal transmission for a given spectral bandwidth is a classical regularized quadratic minimization of intensities, but linear optimizations can be used as well. Minimizing the integrated intensity on the aperture of the telescope or for selected regions of the focal plane leads to slightly different transmissions for the occulter. For the focal plane optimization, the resulting residual intensity is concentrated behind the geometrical image of the occulter, in a blind region for the observation of an exoplanet, and the level of background residual starlight becomes very low outside this image. Finally, we provide a tolerance analysis for the alignment of the occulter to the telescope, which also favors the focal plane optimization. This means that telescope offsets of a few decimeters do not strongly reduce the efficiency of the occulter.

  14. Robust catheter identification and tracking in X-ray angiographic sequences.

    PubMed

    Fazlali, H R; Karimi, N; Soroushmehr, S M R; Samavi, S; Nallamothu, B; Derksen, H; Najarian, K

    2015-08-01

    Coronary artery disease (CAD) is one of the major causes of death worldwide. Today X-ray angiography is a standard method for CAD diagnosis. Usually, the quality of these images is not good enough. Noise, camera and heart motions, non-uniform illumination and even the presence of catheter are sources of quality degradation. The existence of catheter can produce difficulties in vessel extraction methods because catheter is structurally similar to arteries. In this paper we propose a fully automatic method for catheter detection and tracking during the whole angiography sequence. In this method with a vesselness map, we smooth each frame using guided filter. The catheter is detected in the first frame using Hough transform. We then fit a second order polynomial on the catheter and accurately track it throughout the sequence. Our method is tested on 25 X-ray angiography sequences where a precision of 0.9597 is achieved. PMID:26738124

  15. High-sensitivity intravascular photoacoustic imaging of lipid–laden plaque with a collinear catheter design

    PubMed Central

    Cao, Yingchun; Hui, Jie; Kole, Ayeeshik; Wang, Pu; Yu, Qianhuan; Chen, Weibiao; Sturek, Michael; Cheng, Ji-Xin

    2016-01-01

    A highly sensitive catheter probe is critical to catheter-based intravascular photoacoustic imaging. Here, we present a photoacoustic catheter probe design on the basis of collinear alignment of the incident optical wave and the photoacoustically generated sound wave within a miniature catheter housing for the first time. Such collinear catheter design with an outer diameter of 1.6 mm provided highly efficient overlap between optical and acoustic waves over an imaging depth of >6 mm in D2O medium. Intravascular photoacoustic imaging of lipid-laden atherosclerotic plaque and perivascular fat was demonstrated, where a lab-built 500 Hz optical parametric oscillator outputting nanosecond optical pulses at a wavelength of 1.7 μm was used for overtone excitation of C-H bonds. In addition to intravascular imaging, the presented catheter design will benefit other photoacoustic applications such as needle-based intramuscular imaging. PMID:27121894

  16. Experience with a triple-lumen catheter for autologous stem-cell transplantation.

    PubMed

    Verity, Ryan; Burbridge, Brent

    2016-06-01

    We relate our experience with the Cook (Cook Medial Inc., Bloomington, IN, USA), triple-lumen hyperalimentation (HAS) catheter for treatment related to autologous stem-cell transplant. Nineteen HAS catheters were implanted in the right jugular vein, and tunneled to the right anterior chest wall, under imaging guidance. Retrospectively, we reviewed each catheter. Three patient's experienced "ballooning" of the middle (white) lumen of the HAS catheter during routine use. We assessed, time in situ, follow-up imaging, chemotherapy regimen, possibility of systemic or device infection, tissue pathology of the patient's malignancy, and other factors to attempt to determine if there were any associations that could explain the catheter lumen failure. After this pilot study of the HAS-catheter in these 19 patients, we discontinued use of this device at our facility due to mechanical problems of ballooned and obstructed middle lumens. There was no obvious cause, or association, detected to explain the ballooning identified. PMID:27257462

  17. High-sensitivity intravascular photoacoustic imaging of lipid-laden plaque with a collinear catheter design.

    PubMed

    Cao, Yingchun; Hui, Jie; Kole, Ayeeshik; Wang, Pu; Yu, Qianhuan; Chen, Weibiao; Sturek, Michael; Cheng, Ji-Xin

    2016-01-01

    A highly sensitive catheter probe is critical to catheter-based intravascular photoacoustic imaging. Here, we present a photoacoustic catheter probe design on the basis of collinear alignment of the incident optical wave and the photoacoustically generated sound wave within a miniature catheter housing for the first time. Such collinear catheter design with an outer diameter of 1.6 mm provided highly efficient overlap between optical and acoustic waves over an imaging depth of >6 mm in D2O medium. Intravascular photoacoustic imaging of lipid-laden atherosclerotic plaque and perivascular fat was demonstrated, where a lab-built 500 Hz optical parametric oscillator outputting nanosecond optical pulses at a wavelength of 1.7 μm was used for overtone excitation of C-H bonds. In addition to intravascular imaging, the presented catheter design will benefit other photoacoustic applications such as needle-based intramuscular imaging. PMID:27121894

  18. Management Of Fever And Suspected Infection In Pediatric Patients With Central Venous Catheters.

    PubMed

    Brennan, Courtney; Wang, Vincent J

    2015-12-01

    The use of indwelling central venous catheters is essential for pediatric patients who require hemodialysis, parenteral nutrition, chemotherapy, or other medications. Fever is a common chief complaint in the emergency department, and fever in a patient with a central venous catheter may be related to a common cause of fever, or it may be due to a catheter-associated bloodstream infection. Catheter-associated bloodstream infections may also lead to additional complications such as sepsis, septic shock, or septic complications including suppurative thrombophlebitis, endocarditis, osteomyelitis, septic emboli, and abscesses. Early resuscitation as well as timely and appropriate antibiotic therapy have been shown to improve outcomes. This issue focuses on the approach to fever in pediatric patients with central venous catheters and the management and disposition of patients with possible catheter-associated bloodstream infections. PMID:26569627

  19. Mobility therapy and central or peripheral catheter-related adverse events in an ICU in Brazil*

    PubMed Central

    Lima, Natália Pontes; da Silva, Gregório Marques Cardim; Park, Marcelo; Pires-Neto, Ruy Camargo

    2015-01-01

    OBJECTIVE: To determine whether mobility therapy is associated with central or peripheral catheter-related adverse events in critically ill patients in an ICU in Brazil. METHODS: A retrospective analysis of the daily medical records of patients admitted to the Clinical Emergency ICU of the University of São Paulo School of Medicine Hospital das Clínicas Central Institute between December of 2009 and April of 2011. In addition to the demographic and clinical characteristics of the patients, we collected data related to central venous catheters (CVCs), hemodialysis (HD) catheters and indwelling arterial catheters (IACs): insertion site; number of catheter days; and types of adverse events. We also characterized the mobility therapy provided. RESULTS: Among the 275 patients evaluated, CVCs were used in 49%, HD catheters were used in 26%, and IACs were used in 29%. A total of 1,268 mobility therapy sessions were provided to patients while they had a catheter in place. Catheter-related adverse events occurred in 20 patients (a total of 22 adverse events): 32%, infection; 32%, obstruction; and 32%, accidental dislodgement. We found that mobility therapy was not significantly associated with any catheter-related adverse event, regardless of the type of catheter employed: CVC-OR = 0.8; 95% CI: 0.7-1.0; p = 0.14; HD catheter-OR = 1.04; 95% CI: 0.89-1.21; p = 0.56; or IAC-OR = 1.74; 95% CI: 0.94-3.23; p = 0.07. CONCLUSIONS: In critically ill patients, mobility therapy is not associated with the incidence of adverse events involving CVCs, HD catheters, or IACs. PMID:26176520

  20. Pigtail assisted tracking of guide catheter for navigating the difficult radial: Overcoming the "razor effect".

    PubMed

    Garg, Naveen; Sahoo, Dhabaleswar; Goel, Praveen Kumar

    2016-01-01

    During transradial procedures, sharp edge of the guide catheter tip may act like a "razor-blade" and can prevent the catheter navigation. It is especially common with radial artery loop, tortuous radial artery and radial artery spasm. We describe a cost effective and easy technique which overcomes this "razor-blade" effect and helps in tracking the guide catheter in complex radial anatomy for the easy and successful completion of procedure. PMID:27316490

  1. Improved antibiotic-impregnated catheters with extended-spectrum activity against resistant bacteria and fungi.

    PubMed

    Raad, Issam; Mohamed, Jamal A; Reitzel, Ruth A; Jiang, Ying; Raad, Sammy; Al Shuaibi, Munirah; Chaftari, Anne-Marie; Hachem, Ray Y

    2012-02-01

    Minocycline-rifampin-impregnated central venous catheters (M/R CVCs) have been shown to be efficacious in reducing catheter-related bloodstream infections (CRBSI) and inhibiting the biofilm adherence of resistant Gram-positive and Gram-negative pathogens, with the exception of Pseudomonas aeruginosa and Candida spp. To expand the spectrum of antimicrobial activity, a novel second-generation M/R catheter was developed by adding chlorhexidine (CHX-M/R). CVCs and peripherally inserted central catheters (PICCs) were impregnated with CHX-M/R and compared with first-generation M/R catheters, CHX-silver sulfadiazine-treated CVCs (CHX/SS-CVCs), chlorhexidine-treated PICCs, and uncoated catheters. A biofilm catheter colonization model was used to assess the efficacy of catheters against methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium (VRE), P. aeruginosa, Candida albicans, and Candida glabrata. CHX-M/R-impregnated CVCs were the only antimicrobial catheters that completely inhibited the biofilm colonization of all resistant bacterial and fungal organisms tested at all time intervals, and they were significantly superior to uncoated catheters (all P values were ≤0.003). Furthermore, CHX-M/R-coated CVCs had a significantly more effective and prolonged (up to 3 weeks) antimicrobial activity against MRSA and P. aeruginosa than M/R, CHX/SS, and uncoated CVCs (P < 0.0001). Similarly, CHX-M/R-coated PICCs were also superior to M/R-coated and CHX-coated PICCs in preventing biofilms of MRSA, VRE, P. aeruginosa, and Candida species (P value = 0.003 for all). Our study shows that novel CHX-M/R-coated catheters have unique properties in completely inhibiting biofilm colonization of MRSA, VRE, P. aeruginosa, and fungi in a manner superior to that of M/R- and chlorhexidine-treated catheters. PMID:22123686

  2. Emergent Right Coronary Artery Thrombectomy with a Jet Aspiration Thrombectomy Catheter

    SciTech Connect

    Yamauchi, Teiyu; Furui, Shigeru; Isshiki, Takaaki; Toyoizumi, Hideki; Kohtake, Hiroshi; Takeshita, Kohji; Suzuki, Shigeru; Harasawa, Arimi; Sasaki, Yasushi

    1999-07-15

    A saline-jet aspiration thrombectomy (JAT) catheter was used in a patient with acute myocardial infarction. A right coronary arteriogram showed complete thrombotic occlusion at the proximal segment. With this catheter the thrombus was removed without complications in 5 sec. The patient underwent percutaneous transluminal coronary angioplasty and placement of a Palmaz-Schatz stent after successful thrombectomy. Thrombectomy with a JAT catheter was very useful in this patient.0.

  3. Risk factor analysis for long-term tunneled dialysis catheter-related bacteremias.

    PubMed

    Jean, G; Charra, B; Chazot, C; Vanel, T; Terrat, J C; Hurot, J M; Laurent, G

    2002-07-01

    Infection, mainly related to vascular access, is one of the main causes of morbidity and a preventable cause of death in hemodialysis patients. From January 1994 to April 1998 we conducted a prospective study to assess the incidence and risk factors of catheter-related bacteremia. One hundred and twenty-nine tunneled dual-lumen hemodialysis catheters were inserted percutaneously into the internal jugular vein in 89 patients. Bacteremia (n = 56) occurred at least once with 37 (29%) of the catheters (an incidence of 1.1/1,000 catheter-days); local infection (n = 45, 1/1,000 catheter-days) was associated with bacteremia in 18 cases. Death in 1 case was directly related to Staphylococcus aureus (SA) septic shock, and septicemia contributed to deaths in 2 additional cases. Catheters were removed in 48% of the bacteremic episodes. Treatment comprised intravenous double antimicrobial therapy for 15-20 days. Bacteriological data of bacteremia showed 55% involvement of SA. Nasal carriage of SA was observed in 35% of the patients with catheters. Bacteremic catheters were more frequently observed in patients with diabetes mellitus (p = 0.03), peripheral atherosclerosis (p = 0.001), a previous history of bacteremia (p = 0.05), nasal carriage of SA (p = 0.0001), longer catheter survival time (p = 0.001), higher total intravenous iron dose (p = 0.001), more frequent urokinase catheter infusion (p < 0.01), and local infection (p < 0.001) compared with non-bacteremic catheters. Monovariate survival analysis showed that significant initial risk factors for bacteremia were nasal carriage of SA (p = 0.00001), previous bacteremia (p = 0.0001), peripheral atherosclerosis (p = 0.005), and diabetes (p = 0.04). This study confirms the relatively high incidence of bacteremia with tunneled double-lumen silicone catheters and its potential complications. Possible preventive actions are discussed according to the risk factors. PMID:12119469

  4. Entanglement of a Pigtail Catheter by the Chordae Tendineae of the Tricuspid Valve During Pulmonary Angiography

    SciTech Connect

    Winrow, Dana; Beckmann, Carl F.; Lacomis, Joan M.; Dedrick, Carolyn G.

    1996-04-15

    Two cases are presented in which a pigtail catheter was entrapped by the chordae tendineae of the tricuspid valve during pulmonary arteriography. A technique for removal of the catheter from its entanglement by the chordae tendineae is described. Caution must be taken when advancing through the right ventricle a catheter that appears to be entrapped by the chordae tendineae. When such an entanglement occurs, measures to reduce the risk of rupturing a papillary muscle must be taken.

  5. Continuous Femoral Nerve Analgesia after Unilateral Total Knee Arthroplasty: Stimulating versus Non-Stimulating Catheters

    PubMed Central

    Hayek, Salim M.; Ritchey, R. Michael; Sessler, Daniel; Helfand, Robert; Samuel, Samuel; Xu, Meng; Beven, Michael; Bourdakos, Demetrios; Barsoum, Wael; Brooks, Peter

    2006-01-01

    Continuous femoral analgesia provides extended pain relief and improved functional recovery for total knee arthroplasty (TKA). Successful continuous peripheral nerve analgesia depends on the catheter proximity to the target nerve. If the catheter is not close to the nerve, high infusion rates may be required to provide analgesia or analgesia may be sub-optimal. Stimulating catheters may allow more accurate placement of catheters in close proximity to the nerve. This randomized prospective study examined the use stimulating catheters versus non-stimulating catheters in 41 patients undergoing TKA. All patients had intravenous patient controlled anesthesia (IVPCA) for supplementary pain relief. The principal aim of the trial was to examine whether the use of a stimulating catheter allowed the use of lesser amounts of local anesthetics than a non-stimulating catheter. Additional parameters examined included post-operative pain scores, opioid use, side effects and acute functional orthopedic outcomes. Analgesia was good in both groups, but there were no statistically significant differences in the amount of ropivacaine administered; the median amount of ropivacaine given to patients in the stimulating catheter group was 8.2 ml/h vs. 8.8 ml/h for patients with non-stimulating catheters, P = 0.26 (median difference -0.6; 95% confidence interval, -2.3 to 0.6). No significant differences between the treatment groups were noted for the amount of fentanyl dispensed by the IVPCA, numeric pain rating scale scores, acute functional orthopedic outcomes, side effects or amounts of oral opioids consumed. Implications: For total knee arthroplasty, there seems to be no significant advantage for the use of stimulating catheters over traditional non-stimulating catheters in continuous femoral nerve blocks. PMID:17122240

  6. Catheter fracture and embolization from totally implanted venous access ports--case reports.

    PubMed

    Vadlamani, P; Dawn, B; Perry, M C

    1998-12-01

    Totally implanted venous access ports are excellent devices for delivering chemotherapeutic agents and prolonged intravenous infusions in patients with cancer. Catheter fracture and embolization are rare and potentially serious complications of these widely used devices. Retrieval of the embolized fragment is generally indicated but may not be possible. The authors report three cases of catheter embolization in their center over a period of 9 years. Catheter "pinch-off," fracture, embolization, and retrieval are discussed. PMID:9855376

  7. Plane Wave and Coulomb Asymptotics

    NASA Astrophysics Data System (ADS)

    Mulligan, P. G.; Crothers, D. S. F.

    2004-01-01

    A simple plane wave solution of the Schrödinger Helmholtz equation is a quantum eigenfunction obeying both energy and linear momentum correspondence principles. Inclusion of the outgoing wave with scattering amplitude f obeys unitarity and the optical theorem. By closely considering the standard asymptotic development of the plane wave, we show that there is a problem with angular momentum when we consider forward scattering at the point of closest approach and at large impact parameter given semiclassically by (l + 1/2)/k where l is the azimuthal quantum number and may be large (J Leech et al, Phys. Rev. Lett. 88 257901 (2002)). The problem is resolved via non-uniform, non-standard analysis involving the Heaviside step function, unifying classical, semiclassical and quantum mechanics, and the treatment is extended to the case of pure Coulomb scattering.

  8. 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

  9. Multiple Coaxial Catheter System for Reliable Access in Interventional Stroke Therapy

    SciTech Connect

    Kulcsar, Zsolt Yilmaz, Hasan; Bonvin, Christophe; Lovblad, Karl O.; Ruefenacht, Daniel A.

    2010-12-15

    In some patients with acute cerebral vessel occlusion, navigating mechanical thrombectomy systems is difficult due to tortuous anatomy of the aortic arch, carotid arteries, or vertebral arteries. Our purpose was to describe a multiple coaxial catheter system used for mechanical revascularization that helps navigation and manipulations in tortuous vessels. A triple or quadruple coaxial catheter system was built in 28 consecutive cases presenting with acute ischemic stroke. All cases were treated by mechanical thrombectomy with the Penumbra System. In cases of unsuccessful thrombo-aspiration, additional thrombolysis or angioplasty with stent placement was used for improving recanalization. The catheter system consisted of an outermost 8-Fr and an intermediate 6-Fr guiding catheter, containing the inner Penumbra reperfusion catheters. The largest, 4.1-Fr, reperfusion catheter was navigated over a Prowler Select Plus microcatheter. The catheter system provided access to reach the cerebral lesions and provided stability for the mechanically demanding manipulations of thromboaspiration and stent navigation in all cases. Apart from their mechanical role, the specific parts of the system could also provide access to different types of interventions, like carotid stenting through the 8-Fr guiding catheter and intracranial stenting and thrombolysis through the Prowler Select Plus microcatheter. In this series, there were no complications related to the catheter system. In conclusion, building up a triple or quadruple coaxial system proved to be safe and efficient in our experience for the mechanical thrombectomy treatment of acute ischemic stroke.

  10. A rare instructive complication of balloon catheter fracture during percutaneous coronary intervention.

    PubMed

    Nomura, Tetsuya; Higuchi, Yusuke; Kato, Taku; Keira, Natsuya; Tatsumi, Tetsuya

    2016-01-01

    The entrapment, fracture, and dislodgement of catheterization devices during percutaneous coronary intervention (PCI) are rare complications, for which cardiac surgery is sometimes required. Here, we encountered a rare but instructive case of balloon catheter fracture during PCI. Although there have been some reports of guidewire fracture in PCI, reports on balloon catheter fracture are very rare to our knowledge. A simulation test to examine the mechanism of balloon catheter fracture revealed that overuse of the balloon catheter, both for kissing balloon inflation and balloon anchor, was highly likely to have been the cause of the fracture. PMID:25708708

  11. Impact of bloodstream infections on catheter colonization during extracorporeal membrane oxygenation.

    PubMed

    Kim, Dong Wan; Yeo, Hye Ju; Yoon, Seong Hoon; Lee, Seung Eun; Lee, Su Jin; Cho, Woo Hyun; Jeon, Doo Soo; Kim, Yun Seong; Son, Bong Soo; Kim, Do Hyung

    2016-06-01

    There are concerns about secondary extracorporeal membrane oxygenation (ECMO) catheter infections in bacteremic patients. We investigated the association between blood stream infection (BSI) and ECMO catheter colonization. From January 2012 to August 2014, 47 adults who received ECMO support were enrolled. The ECMO catheter tip was cultured at the end of the ECMO procedure. The enrolled patients were classified into two groups according to the presence of BSI during ECMO support and analyzed with respect to ECMO catheter colonization. Of 47 cases, BSI during ECMO was identified in 13 patients (27.7 %). ECMO catheter colonization was identified in 6 (46.2 %) patients in the BSI group and 3 (8.8 %) in the non-BSI group. BSI during ECMO support was independently associated with ECMO catheter colonization [odds ratio (OR) 5.55; 95 % confidence interval (CI) 1.00-30.73; p = 0.049]. The organisms colonizing ECMO catheters in the setting of primary BSI were predominantly Gram-positive cocci and Candida species. Acinetobacter baumannii was the most common colonizing pathogen in the setting of secondary BSI. All the organisms colonizing ECMO catheters were multi-drug resistant organisms, including methicillin-resistant S. aureus, Candida glabrata, and carbapenem-resistant A. baumannii. ECMO catheters may become contaminated with multi-drug resistant pathogens in the presence of BSI. Therefore, ECMO should be applied cautiously in septic patients with bacteremia caused by multi-drug resistant pathogens. PMID:26721824

  12. [Infections related to central venous catheters in children affected from malignant diseases].

    PubMed

    Handrup, Mette Møller; Møller, Jens Kjølseth; Schrøder, Henrik

    2011-06-27

    Central venous catheters (CVC) are an essential part of the treatment of children with haematological and oncological diseases. Unfortunately, CVC also represent a major risk factor of bloodstream infections. Catheter-related bloodstream infections (CRBSI) in children are often diagnosed based on blood cultures from the CVC only. Most CRBSI can be treated without catheter removal. On suspicion of CRBSI empirical antibiotic treatment with piperacillin-tazobactam, meropenem or ampicillin in combination with gentamicin is recommended. The systemic treatment can be combined with catheter-lock therapy. PMID:21712011

  13. [Experience in the use of Broviac catheters in children with hematologic neoplastic diseases].

    PubMed

    Swiatkiewicz, V; Molski, S; Wysocki, M; Jundziłł, W; Hryncewicz, W; Pilecki, O

    1996-08-01

    Between 1990 and 1994, 61 Broviac catheters were implanted in 53 children with haematological neoplastic diseases. The mean duration of catheter function was 206 days (range 14-615 days). The total observation time was 12544 days, during which 84 catheter-related complications were recorded, i.e. 6.7 per 1000 catheter use days. Infections occurred with a frequency of 3.8 episodes/1000 cath, days, the majority of which were bacteriemias (2.6/1000 cath, days). Gram-positive and Gram-negative strains were the isolated etiologic agents with equal frequency. Most of infectious episodes (85%) responded well to initial empiric antibiotics treatment without removal of the catheters. Mechanica complications (occlusion, displacement or catheter leakage) occurred significant less frequently and were managed by repairing or replacing the device or clearing the block. No deaths were related to catheter complications. In conclusion indwelling Broviac catheters offer a safe and effective method of long-term venous access. Infections are the most frequent catheter-related complications. PMID:8927470

  14. Innovation in catheter securement devices: minimising risk of infection, trauma and pain.

    PubMed

    Holroyd, Sharon

    2016-05-01

    Urinary catheters are one of the most common invasive devices used in the NHS. The risks are well-documented and the practice of catheterisation of the bladder has been around for years. Traditionally catheter fixation devices have not been widely used, despite many best practice guidelines advising on their use as a standard within catheter care and maintenance. This article considers some of the evidence around urinary catheterisation and the benefits and limitations of fixation devices. There will be a product focus on the Optimum Medical Ugo Fix Gentle catheter fixation device, with case histories to demonstrate patient satisfaction with the product. PMID:27170410

  15. Semi-automated location identification of catheters in digital chest radiographs

    NASA Astrophysics Data System (ADS)

    Keller, Brad M.; Reeves, Anthony P.; Cham, Matthew D.; Henschke, Claudia I.; Yankelevitz, David F.

    2007-03-01

    Localization of catheter tips is the most common task in intensive care unit imaging. In this work, catheters appearing in digital chest radiographs acquired by portable chest x-rays were tracked using a semi-automatic method. Due to the fact that catheters are synthetic objects, its profile does not vary drastically over its length. Therefore, we use forward looking registration with normalized cross-correlation in order to take advantage of a priori information of the catheter profile. The registration is accomplished with a two-dimensional template representative of the catheter to be tracked generated using two seed points given by the user. To validate catheter tracking with this method, we look at two metrics: accuracy and precision. The algorithms results are compared to a ground truth established by catheter midlines marked by expert radiologists. Using 12 objects of interest comprised of naso-gastric, endo-tracheal tubes, and chest tubes, and PICC and central venous catheters, we find that our algorithm can fully track 75% of the objects of interest, with a average tracking accuracy and precision of 85.0%, 93.6% respectively using the above metrics. Such a technique would be useful for physicians wishing to verify the positioning of catheter tips using chest radiographs.

  16. Virulence factors in Proteus bacteria from biofilm communities of catheter-associated urinary tract infections.

    PubMed

    Hola, Veronika; Peroutkova, Tereza; Ruzicka, Filip

    2012-07-01

    More than 40% of nosocomial infections are those of the urinary tract, most of these occurring in catheterized patients. Bacterial colonization of the urinary tract and catheters results not only in infection, but also various complications, such as blockage of catheters with crystalline deposits of bacterial origin, generation of gravels and pyelonephritis. The diversity of the biofilm microbial community increases with duration of catheter emplacement. One of the most important pathogens in this regard is Proteus mirabilis. The aims of this study were to identify and assess particular virulence factors present in catheter-associated urinary tract infection (CAUTI) isolates, their correlation and linkages: three types of motility (swarming, swimming and twitching), the ability to swarm over urinary catheters, biofilm production in two types of media, urease production and adherence of bacterial cells to various types of urinary tract catheters. We examined 102 CAUTI isolates and 50 isolates taken from stool samples of healthy people. Among the microorganisms isolated from urinary catheters, significant differences were found in biofilm-forming ability and the swarming motility. In comparison with the control group, the microorganisms isolated from urinary catheters showed a wider spectrum of virulence factors. The virulence factors (twitching motility, swimming motility, swarming over various types of catheters and biofilm formation) were also more intensively expressed. PMID:22533980

  17. Few Outflow Problems With a Self-locating Catheter for Peritoneal Dialysis

    PubMed Central

    Stegmayr, Bernd G.; Sperker, Wolfgang; Nilsson, Christina H.; Degerman, Christina; Persson, Sven-Erik; Stenbaek, Jan; Arnerlöv, Conny

    2015-01-01

    Abstract We developed a technique for direct start of peritoneal dialysis. Using a coiled or straight Tenckhoff catheter often results in obstruction of flow. A self-locating Wolfram catheter is on the market. It is not clarified if this results in a benefit. The primary aim of this study was to perform a randomized investigation to clarify if the use of a self-locating peritoneal dialysis (PD) catheter would result in different flow problems than a straight Tenckhoff catheter. A total of 61 insertions were made who were randomized and received either a straight Tenckhoff (n = 32) or a self-locating Wolfram catheter (n = 29). A previously described operation technique allowed immediate postoperative start of dialysis. Seven straight Tenckhoff catheters had to be changed into self-locating catheters, and none vice versa, due to flow problems (P = 0.011). An early leakage resulted in temporarily postponed PD in 4 patients. This study showed that using the present operation technique the self-locating PD-catheter causes fewer obstruction episodes than a straight Tenckhoff catheter. This facilitates immediate postoperative start of PD. PMID:26632891

  18. Repositioning of Misplaced Central Venous Catheter with Saline Injection Under C-Arm Imaging

    PubMed Central

    Gautam, Parshotam Lal; Jain, Krishan; Monga, Hitika

    2015-01-01

    Malposition of central venous catheter is a well known technical complication. Misplaced catheter often requires reinsertion for proper placement of the catheter in the superior vena cava (SVC) to support safe delivery of care and minimize complications. But reinsertion exposes the patient once again to risks of complications related to the procedure including potential of misplacement. Literature describes only a few techniques for repositioning a misplaced central venous catheter (CVC). We tried old simple method of saline injection with force under image intensifier using hydrostatic force of intravenous fluid to straighten the CVC. We could successfully reposition two misplaced CVC’s using this method. PMID:26816974

  19. Orbital Space Plane (OSP) Program

    NASA Technical Reports Server (NTRS)

    McKenzie, Patrick M.

    2003-01-01

    Lockheed Martin has been an active participant in NASA's Space Launch Initiative (SLI) programs over the past several years. SLI, part of NASA's Integrated Space Transportation Plan (ISTP), was restructured in November of 2002 to focus the overall theme of safer, more afford-able space transportation along two paths - the Orbital Space Plane Program and the Next Generation Launch Technology programs. The Orbital Space Plane Program has the goal of providing rescue capability from the International Space Station by 2008 and transfer capability for crew (and limited cargo) by 2012. The Next Generation Launch Technology program is combining research and development efforts from the 2nd Generation Reusable Launch Vehicle (2GRLV) program with cutting-edge, advanced space transportation programs (previously designated 3rd Generation) into one program aimed at enabling safe, reliable, cost-effective reusable launch systems by the middle of the next decade. Lockheed Martin is one of three prime contractors working to bring Orbital Space Plane system concepts to a system definition level of maturity by December of 2003. This paper and presentation will update the international community on the progress of the' OSP program, from an industry perspective, and provide insights into Lockheed Martin's role in enabling the vision of a safer, more affordable means of taking people to and from space.

  20. Symmetry in finite phase plane

    NASA Astrophysics Data System (ADS)

    Zak, J.

    2010-03-01

    The known symmetries in one-dimensional systems are inversion and translations. These symmetries persist in finite phase plane, but a novel symmetry arises in view of the discrete nature of the coordinate xi and the momentum pi : xi and pi can undergo permutations. Thus, if xi assumes M discrete values, i = 0, 1,2,..., M - 1, a permutation will change the order of the set x0,x1,..., xM-1 into a new ordered set. Such a symmetry element does not exist for a continuous x-coordinate in an infinite phase plane. Thus, in a finite phase plane, translations can be replaced by permutations. This is also true for the inversion operator. The new permutation symmetry has been used for the construction of conjugate representations and for the splitting of the M-dimensional vector space into independent subspaces. This splitting is exhaustive in the sense that if M = iMi with Mi being prime numbers, the M-dimensional space splits into M1,M2,...Mn-dimensional independent subspaces. It is shown that following this splitting one can design new potentials with appropriate constants of motion. A related problem is the Weyl-Heisenberg group in the M-dimensional space which turns into a direct product of its subgroups in the Mi-dimensional subspaces. As an example we consider the case of M = 8.