Search Results (45)

Background and Objectives: Vascular access in cancer patients with limited mobility remains a persistent clinical challenge, although both devices and insertion methods have improved considerably. We present our clinical experience with at-home PICC placement, supported by real-world data from routine practice, in oncology patients unable to attend hospital care, exploring its feasibility, safety, and practical applicability. Materials and Methods: All PICC insertions were performed at patients’ bedside by a trained surgeon using sterile technique. A single- or double-lumen PICC catheter was inserted under ultrasound guidance, magnetic tracking, and intracavitary ECG confirmation to secure optimal venous entry and accurate tip positioning. Results: A total of 28 PICC lines were successfully inserted in 26 oncologic patients. Two patients required catheter re-insertion, one following accidental removal and one due to infection. In 26 of 28 cases (92.9%), insertions were completed on the first attempt, while two cases required a second attempt. Insertion in the Green Zone per the ZIM classification was achieved in 26 of 28 cases (92.9%), and only two required insertions in the Yellow Zone. The basilic vein was chosen in 75% of patients. A total of 23 single-lumen and five double-lumen catheters were inserted. In terms of complications, four cases of systemic infection occurred more than 15 days after insertion and were not considered insertion-related; two patients developed localized edema requiring anticoagulation, and four catheter occlusions were managed conservatively. Conclusions: At-home PICC placement appears to be a feasible and clinically applicable approach when performed by qualified and credentialed professionals. These observations, derived from real-world clinical experience, suggest a potential role for this model in selected patient populations. Using proper sterile technique and real-time tip confirmation tools, this intervention may contribute to improved continuity of care and reduced hospital visits in selected patients. These observations suggest a potential role for expanding outpatient vascular access programs in selected patient populations. Full article

Robotic percutaneous coronary intervention (PCI) remains predominantly teleoperated, while the most demanding part of the procedure, guidewire navigation through a moving coronary tree under fluoroscopy, still depends on the continuous human interpretation of vessel anatomy, cardiac phase, guidewire position, and target location. We present a preclinical perception-to-action framework for AI-driven robotic PCI that integrates fluoroscopic perception, dynamic coronary vessel memory, vessel-coordinate state estimation, and robot-executable guidewire command generation on a robotic PCI platform. During contrast angiography, phase-indexed vessel–catheter templates and a dynamic vessel-coordinate coronary map are generated. During guidewire manipulation without contrast injection, live fluoroscopy is segmented into catheter and guidewire structures, cardiac phase is estimated by overlap between the live catheter–guidewire skeleton and stored vessel–catheter templates, the guidewire is assigned to the most likely vessel branch, and the distal tip is projected to a vessel-coordinate target representation for robotic action generation. The segmentation dataset contained 6269/1567/957 vessel images, 3857/964/537 guidewire images, and 4796/1199/667 catheter images for training/validation/test splits, respectively. Test-set Dice scores were 90.7% for vessels, 92.6% for catheters, and 89.0% for guidewires. In 623 real-time fluoroscopy frames from physician-supervised animal experiments, phase selection accuracy was 589/623 (94.6%; 95% CI, 92.5–96.1%) and vessel assignment accuracy was 575/623 (92.3%; 95% CI, 89.9–94.1%). Across 34 scenario-level episodes and their associated command-level decisions, correct-command rates ranged from 83.6% to 95.6% across target navigation and safety scenarios. These results provide preclinical evidence that live fluoroscopic perception can be converted into robot-executable coronary guidewire actions within an integrated AI-robotic PCI workflow. The study was designed to establish early system feasibility rather than to prove clinical superiority, large-scale generalization, or comparative advantages over manual or teleoperated robotic PCI. Full article

Background: Chest radiography remains central to post-procedural assessment of central venous catheter (CVC) placement in intensive care units. Multimodal large language models (MLLMs) can process medical images, but their reliability for practical radiography tasks remains uncertain. This study assessed the diagnostic performance of MLLMs and intensivists for CVC access classification, CVC tip assessment, and pneumothorax-related radiographic findings. Methods: In this retrospective diagnostic performance study, consecutive portable anteroposterior chest radiographs obtained after CVC placement in adult critically ill patients were independently evaluated by four intensivists and five MLLMs. A radiologist consensus served as the reference standard. Interobserver agreement and diagnostic performance were assessed using Fleiss’ kappa, Gwet AC1, Cohen’s kappa, accuracy, sensitivity, specificity, precision, F1 score, balanced accuracy, and Matthews correlation coefficient. Results: The final cohort included 183 unique radiographs. Intensivist reviewers showed high performance for CVC access classification but lower and more heterogeneous performance for CVC tip-position assessment. Among MLLMs, CVC access accuracy ranged from 0.339 to 0.874, whereas CVC tip assessment was dominated by almost universal classification of tips as appropriate, with near-zero specificity and chance-level balanced accuracy. For pneumothorax-related findings, all MLLMs classified every case as negative. Intensivist reviewers had higher balanced accuracy than MLLMs for CVC access classification (difference, 0.420; 95% CI, 0.349–0.490; p < 0.001) and CVC tip assessment (difference, 0.247; 95% CI, 0.205–0.290; p < 0.001). Pneumothorax analyses were exploratory because only five positive cases were present. Conclusions: The evaluated MLLMs showed unreliable diagnostic performance compared with experienced intensivists. Apparent performance was influenced by class imbalance and dominant-response behavior, supporting cautious task-specific validation and complete diagnostic performance reporting. Full article

Background/Objectives: Totally implantable venous access ports (TIVAPs) are commonly used in oncology for long-term venous access, but catheter tip malpositioning can lead to complications. Intracavitary electrocardiography (IC-ECG) provides real-time tip guidance, although data on clinical outcomes and patient satisfaction remain limited. This study evaluates postoperative complications, catheter function, and patient comfort and satisfaction after TIVAP implantation using ultrasound and IC-ECG guidance. Methods: This retrospective single-center study included adults with solid cancers who received TIVAP implants for chemotherapy from June 2021 to September 2024. Procedures used the right internal jugular vein, with ultrasound guidance and the Seldinger technique; catheter tip placement was guided by IC-ECG. Chest X-rays were obtained to assess for early complications and tip position. Primary outcomes were comfort and satisfaction; secondary outcomes included catheter tip position, catheter complications, and usability. Results: Among 213 screened patients, 192 were included (79 females, 113 males; mean age 60.83 ± 12.19 years). The catheter tip was located within the target zone in 149 patients (77.6%). Success rates were 98.44% (n = 189/192) for blood aspiration, 97.90% (n = 186/190) for port ease of use, 98.95% (n = 189/191) for overall satisfaction, and 98.43% (n = 188/191) for willingness to recommend. Discomfort occurred in 6.25% (n = 12/192) of patients. Comfort improved significantly from day1 to day7 (p < 0.001). Complication rates included hematoma (1.56%, n = 3), pneumothorax (0.52%, n = 1), venous thrombosis (1.56%, n = 3), local infection (2.08%, n = 4), systemic infection (0.52%, n = 1), and catheter occlusion (2.08%, n = 4). Catheter blood aspiration success was 93.75% (n = 180/192). Conclusions: In this retrospective cohort, TIVAP implantation via the right internal jugular vein under ultrasound and IC-ECG guidance was associated with low complication rates, favorable catheter function, and high patient satisfaction. Prospective, multicenter, and comparative studies are needed to determine whether ECG-guided tip positioning improves long-term clinical and patient-centered outcomes. Full article

In cardiovascular interventional procedures, real-time, precise monitoring of minute strain and temperature fluctuations at the catheter tip is essential to improving both the safety and efficacy of these interventions. Fiber Bragg grating (FBG)-based sensors present a promising solution owing to their diminutive size and immunity to electromagnetic interference; however, the inherent cross-sensitivity between strain and temperature remains a significant obstacle. This paper introduces a dual-FBG fiber optic sensing structure that leverages machine learning techniques. The system incorporates two FBGs: one set acts as the primary sensing element, positioned within a simulated catheter and affixed to the substrate under examination with cyanoacrylate adhesive to detect composite strain and temperature signals; the second set is spirally wound around the catheter surface to solely measure temperature, thus effectively isolating temperature interference. Additionally, a machine learning model is employed to learn the nonlinear mapping between the recorded FBG spectra and the actual strain and temperature parameters. Experimental validation was conducted within the physiologically relevant temperature range of 20 °C to 45 °C. The findings indicate that the proposed machine learning model can successfully decouple strain and temperature, achieving high-precision predictions even in situations where the sensing unit exhibits a slight nonlinear response due to adhesive bonding. This study substantiates the feasibility of utilizing machine learning-enhanced dual-FBG structures for multi-parameter sensing in complex environments. The proposed methodology presents a promising avenue for the development of next-generation smart optical fiber sensors intended for application in catheter systems. Full article

Background: Although guidelines emphasize proper insertion techniques and tip positioning, catheter-related thrombosis (CRT) remains a common and clinically significant complication of peripherally inserted central catheters (PICCs) and midline catheters (MCs). In this context, the use of pharmacological prophylaxis is still debated. This study aims to assess the incidence of CRT in patients receiving anticoagulant therapy (therapeutic or prophylactic) and antiplatelet therapy. Methods: This retrospective study was conducted at a tertiary care hospital and included adult patients from March 2021 to May 2023. Six potential confounders were analyzed: anticoagulation status (none, prophylaxis, therapeutic), antiplatelet therapy, tip position (PICCs vs. MCs), number of lumens, CRT risk factors, and drug infusion requiring central access. CRT was diagnosed in symptomatic patients using compression ultrasonography. Propensity score weighting and logistic regression were employed to estimate odds ratios (OR) and average treatment effects. Results: A total of 1431 patients were enrolled. PICCs and therapeutic anticoagulant therapy were highly protective against CRT (OR 0.068 [95% CI 0.013–0.2] and OR 0.007 [95% CI 0.001–0.046], respectively). Prophylactic anticoagulant therapy (OR 0.328 [95% CI 0.200–0.519]) and antiplatelet therapy (OR 0.342 [95% CI 0.182–0.595]) also showed protective effects. At the same time, neither the number of lumens, the presence of risk factors, nor the infusion of irritating drugs was independently associated with CRT. Conclusions: The use of anticoagulant drugs (both prophylactic and therapeutic), antiplatelet therapy, and PICC use significantly lowered the risk of CRT. The findings support personalized prevention strategies and underscore the need for a well-designed randomized controlled trial to validate these findings. Full article

Background: Cardiac tamponade (CT) is a rare but life-threatening medical emergency caused by fluid accumulation in the pericardial sac, impairing cardiac filling and reducing output. More than 20% of CT cases are iatrogenic. CT is a recognized complication of central venous catheter (CVC) placement, with mortality rates in pediatric patients reported to reach 50%. Clinical presentation is often nonspecific, and echocardiography remains the diagnostic gold standard. Case report: We present two pediatric cases of CT due to late CVC migration, managed in the pediatric intensive care unit (PICU). The first case involved a 25-day-old neonate with short bowel syndrome who received prolonged parenteral nutrition via CVC. Four days after catheter insertion, the patient developed sudden cardiocirculatory collapse. The second case featured a 2-year-old child with Leigh syndrome who required mechanical ventilation and multimodal pharmacological therapy. Six days after CVC placement, the patient developed acute hemodynamic deterioration. In both cases, echocardiography confirmed CT, while chest radiography suggested intracardiac positioning of the catheter tip. Management and outcome: Emergency pericardiocentesis and advanced cardiopulmonary resuscitation were performed. Despite transient hemodynamic stabilization, both patients developed multiorgan failure with fatal outcomes. Conclusions: CT is a critical complication in pediatric patients with CVCs. Accurate verification of catheter tip position is essential, and intracardiac placement should be avoided. Any sudden clinical deterioration in a patient with a CVC should raise suspicion of late catheter migration and requires immediate life-saving intervention. Full article

Background: Candida isolation is common in critically ill patients, but its clinical interpretation depends strongly on microbiological source, host factors, and clinical context. Bloodstream isolation, candiduria, respiratory tract isolation, surveillance cultures, catheter-tip cultures, and wound/skin cultures have different clinical implications. We aimed to evaluate clinical characteristics, microbiological sources, species distribution, antifungal treatment patterns, and outcomes among adult ICU patients with Candida-positive ICU cultures. Methods: This single-center retrospective observational cohort study was conducted in the medical intensive care unit of Marmara University Faculty of Medicine between 1 October 2022 and 5 September 2025. Adult ICU patients with at least one Candida-positive ICU culture were included. Non-Candida fungal isolates and duplicate patient-level records were excluded. The primary outcome was all-cause 28-day mortality. ICU mortality was defined as all-cause death during ICU stay. Source-stratified analyses and expanded multivariable logistic regression models were performed to evaluate factors associated with mortality. Results: A total of 349 adult ICU patients were included. Median age was 71 years [IQR, 62–82], and 185 patients were male (53.0%). Overall, 28-day mortality was 59.0% (206/349), and ICU mortality was 65.9% (230/349). Candida colonization was identified in 247 patients (70.8%), whereas Candida infection was identified in 102 patients (29.2%). The most common species were Candida albicans (48.4%), Candida glabrata (13.8%), and Candida auris (12.9%). The most frequent microbiological sources were urine (42.4%), lower respiratory tract samples (26.4%), and blood cultures (14.9%). Blood/sterile-site isolation was associated with higher ICU mortality than non-blood/non-sterile-site isolation (79.2% vs. 63.5%, p = 0.026), whereas the difference in 28-day mortality was not statistically significant (66.0% vs. 57.8%, p = 0.260). Antifungal treatment was more frequent among patients with blood/sterile-site isolation (94.3% vs. 16.9%, p < 0.001). In the expanded 28-day mortality model, lactate, NLR, and carbapenem exposure were independently associated with mortality. In the expanded ICU mortality model, lactate and CRRT/hemodialysis were independently associated with mortality. Candida score was not independently associated with either 28-day mortality or ICU mortality after broader adjustment. Conclusions:Candida-positive ICU cultures represent a heterogeneous clinical and microbiological spectrum. Source-specific interpretation is essential, particularly when distinguishing bloodstream or sterile-site isolation from non-sterile-site colonization. Candida score may reflect a higher-risk clinical phenotype, but it should not be interpreted as a stand-alone mortality prediction tool. Full article

Objective: This study aimed to compare the clinical outcomes of navigation-assisted and conventional (freehand) ventriculoperitoneal (VP) shunt placement in pediatric hydrocephalus patients. Methods: A retrospective review was conducted of 164 patients under the age of 18 who underwent VP shunt placement for hydrocephalus between 2015 and 2023 and had a minimum postoperative follow-up of 12 months. The conventional technique was used in 116 patients. The navigation-assisted technique (intraoperative ultrasonography or frameless neuronavigation) was used in 48 patients. Demographic data, hydrocephalus etiology, catheter tip position (Yim classification), revision rates, infection, complications, and length of hospital stay were recorded. Catheter tip position was assessed on postoperative imaging by two independent investigators. Results: No significant differences were found between the groups in terms of age, sex, and hydrocephalus etiology. The optimal catheter placement rate was significantly higher in the navigation-assisted group compared to the conventional technique (81.25% vs. 60.34%, p = 0.017). The revision rate was significantly lower in the navigation-assisted group (16.67% vs. 38.79%, p = 0.010). The mean hospital stay was shorter in the navigation-assisted group (7.85 ± 3.97 days vs. 10.20 ± 3.70 days, p < 0.001). The groups were similar in terms of infection (2.08% vs. 9.48%, p = 0.183) and overall complication rates (14.58% vs. 16.38%, p = 0.959). Conclusions: Navigation-assisted VP shunt placement in pediatric hydrocephalus patients is associated with a high rate of optimal catheter position, a low revision rate, and a short hospital stay. These findings support the use of navigation technology in pediatric hydrocephalus surgery, but also reveal that infection and complications are unassociated with the surgical technique. Full article

Background: Umbilical venous catheter (UVC) placement is common in neonates but carries risks of migration and infection. This study evaluates safety of a novel fixation technique using the umbilical cord clamp after a side-entry insertion. Methods: A retrospective analysis of 264 neonates was conducted at a tertiary center in order to assess safety of the novel UVC fixation method. The new technique involved side-entry catheter insertion without severing the cord, secured to the clamp with a sterile patch. Catheter tip position was confirmed and monitored every 24 h via ultrasound. Results: Catheter migration occurred in 18.9% of cases, mostly inward into the right atrium which was managed by repositioning. Migration into the ductus venosus requiring removal occurred in 0.7% of cases and unscheduled removal due to stump detachment in 1.5%. No central line-associated bloodstream infections (CLABSIs) were observed. Conclusions: The umbilical cord clamp method is a safe, single-operator alternative for UVC fixation. This technique had a low rate of catheter migration, did not increase the risk of infection, and was cost-effective and simple. Full article

Background/Objectives: Umbilical venous catheters (UVCs) and umbilical artery catheters (UACs) are essential for neonatal care, facilitating medication delivery, nutritional support, and blood pressure monitoring. However, malposition and prolonged catheter dwell time can lead to severe complications, including central line-associated bloodstream infections (CLABSIs). This study aims to evaluate the benefits of ultrasound in confirming catheter tip location, which may impact infection risk, and to assess the effectiveness of modification of the securing method. Methods: This prospective randomized controlled study was conducted from May 2022 to December 2024 at an NICU in Taiwan. Neonates requiring umbilical catheters were randomly assigned to three groups. In Group 1, the catheter length was calculated using a formula, X-ray confirmation was used, and the catheter was secured with traditional tape. In Group 2, ultrasound confirmation was used and the catheter was secured with FoamLite™ sterile dressing and transparent film. In Group 3, ultrasound confirmation was used and the catheter was secured with traditional tape. The outcomes were the rate of complications of the catheters. Results: Groups 2 and 3 demonstrated significantly lower malposition rates, microbial colonization, and CLABSI incidence compared to Group 1 (p = 0.001, 0.006, and 0.026, respectively). No significant difference was observed between Groups 2 and 3, suggesting that accurate tip positioning was more influential in reducing CLABSIs than the securing method itself. Conclusions: Ultrasound guidance improves catheter placement accuracy, minimizes malposition, lowers CLABSI risk, and reduces radiation exposure, supporting its broader implementation in NICUs. Full article

Structural heart interventions require precise navigation through tortuous and dynamic cardiac anatomies. However, current guide sheaths often lack sufficient maneuverability for positioning additional catheters. To address these limitations, this paper presents the design and evaluation of a robotic guide sheath with a dual-bendable, compressible tip. The sheath is capable of navigating complex cardiac anatomies for multiple valve interventions. The system consists of a soft continuum sheath tip driven by tendons, a laser-cut compact motorized actuation bed, and a joystick-controlled tendon actuation mechanism. A constant-curvature kinematic model maps actuation inputs to tip bending in 3D, while a custom software interface enables real-time control. Mechanical evaluation (tension, maximum bending, and contraction tests) demonstrated low actuation tension requirements (0.78 N), a wide bending range (from 80° to 90°), and promising tip compressibility (average 5 mm). Trajectory-following tests showed good accuracy, with an average error of 3.34 mm. Catheter guidance trials further validated the sheath’s ability to navigate to the right atrium and guide additional catheters effectively. This work presents a proof-of-concept robotic guide sheath with enhanced maneuverability and adaptability, establishing a foundation for future integration of sensing, automation, and clinical applications. Full article

Background/Objectives: Epidemiological surveillance of healthcare-associated infections (HAIs) and multidrug-resistant (MDR) bacteria is a key responsibility of hospital infection control committees (HICC). Active surveillance swabs facilitate the early detection of colonized patients; helping to prevent MDR pathogen transmission in intensive care units. This study aimed to describe antimicrobial resistance profiles of bacterial isolates from clinical samples in neonatal and pediatric intensive care units. Methods: A retrospective cross-sectional study was conducted at a maternal and child hospital in Rio de Janeiro, Brazil including patients aged 0–18 years admitted to neonatal (NICU), surgical (SICU), and pediatric (PICU) intensive care units between January and December 2023. A total of 286 positive cultures were analyzed from different sample types including blood, urine, tracheal aspirates, cerebrospinal fluid (CSF), and catheter tips as well as screening swabs (nasal and rectal) for colonization surveillance. Bacterial isolates were identified and tested for antimicrobial susceptibility following BrCAST (Brazilian Committee on Antimicrobial Susceptibility Testing) guidelines. Results: Of the 286 cultures, 146 (51%) originated from the NICU, 70 (24%) from the SICU, and 70 (24%) from the PICU. Coagulase-negative staphylococci (CoNS) predominated in blood cultures, especially among neonates, while MRSA was found in all nasal swabs. Among the Gram-negative bacteria; Klebsiella pneumoniae and Pseudomonas aeruginosa were the most frequent isolates, with 30–50% resistant to third-generation cephalosporins or carbapenems. ESBL-producing organisms were found in 40% of rectal swabs. Conclusions: The predominance of CoNS in neonatal ICUs and high resistance rates among Gram-negative bacteria highlight the urgent need for continuous microbiological surveillance and antimicrobial stewardship in vulnerable pediatric populations. Full article

Superselective intra-arterial chemotherapy (SSIAC) presents a promising approach for treating oral cancer by delivering high concentrations of anticancer agents directly to the tumor-feeding arteries. However, drug distribution can be unpredictable, particularly in patients with vascular variations, such as the linguofacial trunk. In this study, we conducted a patient-specific computational fluid dynamics (CFD) analysis using contrast-enhanced computed tomography data obtained from two patients with oral cancer. We created 40 catheter placement models to simulate both the conventional and SSIAC techniques. We analyzed the blood and agent flows using a zero-dimensional resistance boundary model validated in a previous study. The agent distribution ratios to the lingual artery and facial artery varied significantly, whereas the blood flow distribution remained consistent across all the models. High anticancer agent concentration gradients were observed within 2 mm of the catheter tip, indicating that local flow dynamics governed the drug delivery process. No significant correlation was observed between the bifurcation flow angles and agent distribution. This study demonstrates that agent delivery in SSIAC is highly sensitive to the catheter tip location and local blood flow, independent of the blood flow bifurcation angles. Patient-specific CFD may assist clinicians in preoperatively determining the optimal catheter positioning to improve the treatment efficacy. Full article

Infective endocarditis (IE) of the tricuspid and pulmonary valve accounts for 5 to 10% of all IE cases and, compared with left-sided IE, is often associated with intravenous (i.v.) drug use, presence of intracardiac devices, and central venous catheters (CVCs), including permanent—Hickman catheter (HC). We report a case of a 71-year-old female patient on a chronic hemodialysis (HD) program who had developed IE. Her first symptoms were fever and malaise. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) examinations were performed, revealing vegetations on the tip of HC and the anterior and posterior leaflets of the tricuspid valve (TV). Three blood culture bottles were positive for Enterococcus spp. The HC was replaced with a new CVC to continue HD. After a six-week antibiotic treatment, most clinical symptoms were resolved, and there was a decrease in vegetation size with normalization of inflammatory markers and negative follow-up blood cultures. After this initial improvement in the patient’s condition, the clinical course was complicated by the development of Citrobacter koseri bacteremia and sepsis. Despite adequate antibiotic therapy, the condition progressed to septic shock, which was soon followed by a fatal outcome. IE treatment in HD patients requires long-term broad-spectrum antibiotic therapy, and also, in patients without arteriovenous fistula (AVF), the CVC should be replaced after each HD during IE and sepsis treatment to minimize the patient’s exposure to a foreign body that is susceptible to bacterial colonization. A colonized foreign body is a focus for sustained and spreading infection, and its presence prevents adequate antibiotic treatment until the focus of infection is removed. Full article