Search Results (18)

Lower-extremity peripherally inserted central catheters (PICCs) are used in critically ill adults when upper-extremity access is limited, yet real-world data on indications, dwell time, and device-related outcomes remain scarce. We retrospectively reviewed consecutive ultrasound-guided mid-thigh lower-extremity PICC placements performed under a standardized protocol (15 cm below the inguinal ligament; fixed 55-cm insertion depth) in an adult ICU and extracted indication patterns, catheter dwell time, removal reasons, and microbiological findings. Among 38 placements in 37 patients, difficult peripheral access was present in all cases; prolonged intravenous antibiotics were the predominant indication (34/38, 89.5%), followed by total parenteral nutrition (13/38, 34.2%) and vasopressor therapy (2/38, 5.3%). Median dwell time was 19.5 days (IQR 12–25; range 3–48). Catheters were most commonly removed due to death (15/38, 39.5%), discharge (13/38, 34.2%), or no longer being clinically indicated (8/38, 21.1%), while removal for suspected catheter infection/fever occurred in 2/38 (5.3%). A catheter-drawn culture was positive in 1/38 (2.6%; Candida albicans), whereas peripheral blood cultures were positive in 4/38 (10.5%). In this single-center retrospective descriptive cohort, standardized mid-thigh lower-extremity PICCs were used for prolonged venous access. Removals for suspected infection/fever evaluation were uncommon; however, CRBSI was not adjudicated and thrombosis surveillance was not performed. These findings describe local utilization patterns and support future comparative studies and stewardship-focused quality improvement. Full article

Background: Preoperative fasting is one of the most difficult stages of hospitalization for children and their caregivers. The popularization of preoperative oral polycarbohydrate preparations is an important element influencing the comfort of hospitalized children. The aim of the study was to assess the effect of carbohydrate administration on perioperative blood glucose (PBG), the occurrence of complications in the pre- and postoperative periods, and satisfaction in children and adolescents. Material and methods The study was a comparative-observational one, and the following research methods were used: an author’s diagnostic questionnaire, observation, and analysis of medical documentation. The research group consisted of 50 patients from the Pediatric Orthopedic Department who received an oral polycarbohydrate solution up to 2 h before anesthesia. The control group consisted of 50 patients who fasted for more than 6 h before anesthesia. The study was conducted between February and May 2024. Results: The patients were assessed using a measurement of venous blood glucose taken immediately before the administration of premedication. Parents completed a questionnaire regarding their child’s perioperative period. Conclusions: The glucose level in patients who received a polycarbohydrate preparation is higher than in children who did not. The administration of polycarbohydrate preparations influences the feeling of thirst and hunger in the postoperative period in children and adolescents. Oral administration of a polycarbohydrate preparation up to 2 h before anesthesia does not cause regurgitation in children and adolescents. Patients who received an oral polycarbohydrate preparation tolerated the waiting period before anesthesia better. Preoperative fasting is, apart from the insertion of venous access, the most stressful situation for children and adolescents during hospitalization. The supply of oral polycarbohydrate preparations has a positive effect on pediatric patients in the perioperative period. Full article

Background/Objectives: This narrative review addresses ongoing controversies and advancements concerning ultrasound-guided peripheral intravenous (IV) catheter insertion, and the impact of ultrasound guidance on success rate, procedural time, patient and staff experience, complications and costs, as well as requirements for its use. Methods: A literature review was conducted. Results: Growing evidence suggests that ultrasound-guided insertion of peripheral IV catheter represents a superior technique across various patient populations, particularly those presenting with difficult IV access (DIVA). Key findings highlight significant improvements in first-attempt success rates, reduction of procedural complications, and enhanced patient comfort. Ultrasound-guided insertion is also associated with an increase in catheter dwell time, a reduction in repeat procedures and in central line placements, leading to improved resource utilization and the potential for substantial long-term cost-effectiveness, despite the cost of initial investment and training. However, obtaining these improvements involves a critical importance for standardized training, adherence to rigorous aseptic techniques, and generalization of the transformative impact of ongoing technological advancements in ultrasound devices. Conclusions: The collective body of evidence supports the widespread adoption of ultrasound-guided peripheral IV cannulation as an evidence-based best practice in modern healthcare. Full article

Since extracorporeal membrane oxygenation (ECMO) is primarily used for patients in a high-risk state and is an invasive procedure, its unique application scenarios make it difficult to recruit suitable cases for clinical trials. Therefore, large animal models have become one of the most important models for preclinical evaluation of the safety and effectiveness of ECMO. This study aims to assess the safety and performance of a novel portable ECMO device with Small-tail Han sheep. Fifteen sheep were divided into a test group (LIFEMOTION, Chinabridge, Shenzhen, China) and control group (NOVALUNG XLUNG kit 230, Xonis, Heilbronn, Germany) with veno-venous ECMO (VV-ECMO) and veno-arterial ECMO (VA-ECMO) modes. Tracheal intubation, arteriovenous access, and ECMO support were performed. Vital signs and blood laboratory tests of the subjects were monitored and recorded. The main organs were examined pathologically at the end of day fourteen. The serum protein expression profile was analyzed by protein quantification techniques. All sheep were successfully weaned from ECMO without transfusion or cannula complications. No significant differences were observed between the two groups in terms of vital signs, oxygenation, hemodynamic stability, and physiological function (p > 0.05). According to the serum protein expression profile, no significant biomarkers associated with ECMO clinical complications were identified. The LIFEMOTION ECMO device demonstrated good safety and efficacy. Full article

Background/Objectives: Conventional blood collection can be challenging in a non-clinical or home-based setting. In response, vacuum-assisted lancing devices for capillary blood collection (typically from the upper arm) have gained popularity to broaden access to diagnostic testing. However, these devices are often costly relative to the reimbursement rate for common laboratory testing panels. This study describes the design and evaluation of Comfort Draw™, a simplified and economical vacuum-assisted capillary blood collection device. Methods: Comfort Draw™ was evaluated by 12 participants in a preliminary study and by 42 participants in a follow-up study. Metrics assessed included the following: vacuum pressure of the device, skin temperature generated by the Comfort Draw prep warmer, blood collection volume, and analytical accuracy (for 19 common serum-based analytes). Results: Acceptable blood volume (>400 µL) and serum volume (>100 µL) were collected by Comfort Draw in 85.5% and 95.1% of cases, respectively. Seventeen of the nineteen analytes examined were within CLIA acceptance limits compared to matched venous samples. Self-reported pain scores associated with Comfort Draw collection averaged 0.39 on a scale from 0 to 10. Conclusions: In this preliminary clinical study, Comfort Draw was found to be a valid and relatively painless method for collecting capillary blood specimens. The device’s simple design and lower cost could enable broader applications compared to more complex alternative capillary blood collection devices. Full article

Background: The advent of subcutaneous implantable cardioverter defibrillators (S-ICDs) marked a significant milestone in the course of cardiac rhythm devices, particularly for patients who are deemed at high risk for ventricular arrhythmias and sudden cardiac death. This extracardiac approach makes the S-ICD an especially valuable option for young patients, those with difficult venous access, or those at high risk of infection. Although the S-ICD does not provide pacing for bradycardia or heart failure, it has shown efficacy in treating ventricular arrhythmias while minimizing complications associated with transvenous systems. Methods: The purpose of this multicenter retrospective analysis was to assess the real-world efficacy and safety of the S-ICD in a heterogeneous population. Results: The GASP registry consisted of 114 patients, 68% male, aged 41 ± 15 years, with a mean LVEF of 50%. In the follow-up of 35 months, inappropriate shocks occurred in 7% while appropriate shocks occurred in 6.2%. The most common reasons for inappropriate shocks were myopotentials and atrial tachyarrhythmias. Thirty-day complication-free rates were 97.3%, with the majority of patients requiring device extraction due to infection. Over the longer term, four patients required re-intervention due to local discomfort, while one device was extracted for infection. In a multivariate analysis, complications were not significantly higher in the sicker population, such as those with diabetes, kidney disease requiring dialysis, or heart failure. Conclusions: These findings support the growing role of the S-ICD as an alternative to the TV-ICD, especially in patients without pacing indications. Full article

Background: Vascular access in emergency departments (ED) is challenging for patients with difficult venous access (DIVA), causing delays and discomfort. Ultrasound-guided techniques may offer improved outcomes, making it crucial to assess their benefits, risks, and the effectiveness of validated identification systems. Objectives: To contribute new evidence regarding the effectiveness of validated tools for identifying DIVA and to assess the clinical benefits of ultrasound-guided vascular access in emergency care, and to assess their utility in arterial puncture for arterial blood gas sampling, from now on ABG, within the ED. Methods: This study follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines for protocol development and the Consolidated Standards of Reporting Trials (CONSORT) guidelines for the conduct and reporting of the randomized clinical trial (RCT). The trial will be conducted in Spain throughout 2025. The study population will consist of 114 subjects with difficult intravenous access (DIVA), identified using the DIVA scale for individuals under 14 years of age and the A-DICAVE scale for adults, along with 80 subjects from the general surgical area (GSA). Participants will be randomly assigned, in a 1:1 ratio, to either the Control Group (CG) (traditional technique) or the Experimental Group (EG) (ultrasound-guided technique). Data collected will include sociodemographic characteristics, procedure-related variables (e.g., time required, human resources, and materials used), as well as pain levels, assessed using validated scales (EVA, FLACC, PAINAD), and overall satisfaction from both patients and healthcare professionals. Ethical approval has been obtained, and the trial will be registered as an RCT through an official clinical trial registry before recruitment begins. Results: Expected results suggest ultrasound guidance will significantly improve first-attempt success rates, reduce procedural time, enhance patient comfort, and optimize resource utilization compared to traditional techniques. Conclusions: The integration of ultrasound-guided vascular access into routine emergency protocols could enhance patient safety, satisfaction, and procedural efficiency in emergency care settings. Full article

Background: Arrhythmias in pregnancy are complex to manage due to the teratogenic effects of many antiarrhythmic drugs and the common use of ionizing radiation during catheter ablation procedures. Furthermore, pregnant women are extremely vulnerable and difficult to treat because of the progressive physical and hormonal changes that occur during the nine months of pregnancy. Case Presentation: In this case report, we describe a complex clinical case of a 34-year-old pregnant woman who was affected by an incessant right atrial tachycardia, with signs and symptoms of initial hemodynamic instability. This tachycardia was refractory to antiarrhythmic drugs, so a zero-fluoroscopy ablation was performed. The first procedure was complicated by cardiac tamponade, quickly resolved without further complications for the mother or the fetus. In the following days, a deep venous thrombosis occurred at the femoral venous access. After a few days, the patient underwent a second procedure that was successful and resulted in the restoration of a sinus rhythm. Conclusions: The management of this clinical case was complex both from a procedural and a clinical (cardiological and gynecological) point of view. Finally, the integration of the various skills led to an excellent result. Full article

Background: Implantable cardioverter-defibrillator (ICD) leads are considered a risk factor for major complications (MC) during transvenous lead extraction (TLE). Methods: We analyzed 3878 TLE procedures (including 1051 ICD lead extractions). Results: In patients with ICD lead removal, implant duration was almost half as long (69.69 vs. 114.0 months; p < 0.001), procedure complexity (duration of dilatation of all extracted leads, use of more advanced tools or additional venous access) (15.13% vs. 20.78%; p < 0.001) and MC (0.67% vs. 2.62%; p < 0.001) were significantly lower as compared to patients with pacing lead extraction. The procedural success rate was higher in these patients (98.29% vs. 94.04%; p < 0.001). Extraction of two or more ICD leads or additional superior vena cava (SVC) coil significantly prolonged procedure time, increased procedure complexity and use of auxiliary or advanced tools but did not influence the rate of MC. The type of ICD lead fixation and tip position did not affect TLE complexity, complications and clinical success although passive fixation reduces the likelihood of procedural success (OR = 0.297; p = 0.011). Multivariable regression analysis showed that ICD lead implant duration ≥120 months (OR = 2.956; p < 0.001) and the number of coils in targeted ICD lead(s) (OR = 2.123; p = 0.003) but not passive-fixation ICD leads (1.361; p = 0.149) or single coil ICD leads (OR = 1.540; p = 0.177) were predictors of higher procedure complexity, but had no influence on MC or clinical and procedural success. ICD lead implant duration was of crucial importance, similar to the number of leads. Lead dwell time >10 years is associated with a high level of procedure difficulty and complexity but not with MC and procedure-related deaths. Conclusions: The main factors affecting the transvenous removal of ICD leads are implant duration and the number of targeted ICD leads. Dual coil and passive fixation ICD leads are a bit more difficult to extract whereas fixation mechanism and tip position play a much less dominant role. Full article

Establishing intravenous (IV) access in younger patient populations via the traditional cannulation technique for procedures requiring anesthesia is often challenging. Infrared (IR) vein visualization is a modality that aids venous cannulation; however, few reports of this technique exist in the infant and toddler population. The primary aim of this study was to compare the efficacy of IR vein visualization to the standard cannulation technique for obtaining peripheral IV access in infant and toddler populations. Following Institutional Review Board (IRB) approval and written informed consent, children were randomly assigned to either a standard cannulation technique group or an IR vein visualization device group for venous cannulation. The primary outcome variable was the success rate of IV cannulation, and the secondary variables were the total number of attempts and the time to successful cannulation. No difference was noted between either group for first-attempt success rate (standard versus IR: 61.25% vs. 54.4%; p = 0.4) or time to establish IV cannulation (standard versus IR: median [interquartile range], 40 s [24–120] vs. 53 s [26–106]; p = 0.55). The anesthesiologist’s grading of the anticipated difficulty of IV cannulation was a significant predictor of cannulation success (p = 0.0016). Our study demonstrated no significant benefit in utilizing the IR vein visualization device in terms of the overall success rate, number of attempts, and time to establish successful IV cannulation when compared to the standard technique. However, in difficult IV access situations, this device proved to be a valuable rescue adjunct. Full article

Attaining venous access is a common requirement for clinical care worldwide, with a non-negligible portion of cases often being categorized as ‘difficult intravenous access’. Such complications result in far-reaching consequences affecting clinicians and patients alike. We propose a mixed-reality-based vein detection and visual guidance system that provides several key advantages, including a wider field of view, flexible operating distance, and hands-free, intuitive usage compared to existing solutions. A semi-supervised learning approach was used in model training to circumvent dataset availability limitations. Quantitative evaluation showed that the semi-supervised approach improved vein detection performance and temporal consistency. The system was also implemented and trialed in a clinical setting to assess real-world usability. Initial, preliminary assessment of HoloVein by medical professionals in a clinical setting showed improvements in detection quality using the semi-supervised approach over the baseline model. This result was deemed to be promising from a clinical perspective and could set the stage for more widespread mixed-reality venipuncture guidance tools in the future. Full article

Background: Upgrading from pacemakers to ICDs and CRTs is a difficult procedure, and often, transvenous lead extraction (TLE) is necessary for venous access. TLE is considered riskier in patients with multiple diseases. We aimed to assess the complexity, risk, and outcome of TLE among CRT and ICD candidates. Methods: We analyzed clinical data from 2408 patients undergoing TLE between 2006 and 2021. There were 138 patients upgraded to CRT-D, 33 patients upgraded to CRT-P and 89 individuals upgraded to ICD versus 2148 patients undergoing TLE for other non-infectious indications. Results: The need for an upgrade was the leading indication for TLE in only 36–66% of patients. In 42.0–57.6% of patients, the upgrade procedure could be successfully done only after reestablishing access to the occluded vein. All leads were extracted in 68.1–76.4% of patients, functional leads were retained in 20.2–31.9%, non-functional leads were left in place in 0.0–1.1%, and non-functional superfluous leads were extracted in 3.6–8.4%. The long-term survival rate of patients in the CRT-upgrade group was lower (63.8%) than in the non-upgrade group (75.2%). Conclusions: Upgrading a patient from an existing pacemaker to an ICD/CRT is feasible in 100% of cases, provided that TLE is performed for venous access. Major complications of TLE at the time of device upgrade are rare and, if present do not result in death. Full article

(1) Objective. We aimed to demonstrate that the use of the ultrasound-guided technique facilitates peripheral venous cannulation as compared to the standard technique in patients with difficult access at emergency services. (2) Method. A case–control study, randomized research. Variables were collected from a population with non-palpable or not visible veins, classified into size risk groups for 6 months. In the comparative analysis, the patients were divided into two groups: the cases group was composed of patients to whom the peripheral venous cannulation was performed with the ultrasound-guided technique (UST), while the control was composed of patients with whom the standard technique (ST) was performed. The ultrasound LOGIQ P5 750VA from General Electric Healthcare, with an 11 mHz linear probe, was utilized, along with peripheral venous catheters model Insyte^TM Autoguard^TM with gauges of 14G to 26G. (3) Results. Seventy-two cases. The use of the ultrasound decreased the time (618.34s ST, 126s UST) and the number of punctures (2.92 ST, 1.23 UST); about 25% of the patients did not have complications with the UST, as compared to 8% with the ST. The use of the ultrasound decreased the pain experienced by 1.44 points in the visual analog scale, as compared to 0.11 points with the ST. The rate of success of the first try with the UST was 76%, as compared to 16% of the ST. The gauge of the catheter increased with the UST, with successful cannulations obtained with 20G (56%) and 18G (41%) gauges. (4) Conclusions. The use of ultrasound facilitates venous cannulation according to the variables of the study. The ultrasound visualization of the vessels is associated with the selection of the catheter gauge. There was no relation between the complications and the depth of the blood vessels. Full article

(1) Background: Dural arteriovenous fistulas (DAVF) represent a rare acquired intracranial vascular malformation, with a variety of clinical signs and symptoms, which make their diagnosis difficult. Intracranial hemorrhage is one of the most serious clinical manifestations. In this paper the authors’ goal was to verify the accuracy and utility of contrast-enhanced brain CT angiography (CTA) for the identification and the characterization of dural arteriovenous fistulas (DAVFs) in patients who presented with brain hemorrhage compared to 3D digital subtraction angiography (3D DSA); (2) a retrospective study of 26 patients with DAVFs who presented with intracranial hemorrhage to our institution was performed. The information reviewed included clinical presentation, location and size of hemorrhage, brain CTA and 3D DSA findings; (3) results: 61% (16/26) of DAVFs were identified by CTA. The vast majority of patients were male (69%, 18/26) and the most common presenting symptom was sudden onset headache. All DAVFs had cortical venous drainage and about one-third were associated with a venous varix. The most common location was tentorial (73%, 19/26); (4) conclusions: CTA can represent a valid alternative diagnostic method to 3D DSA for the study of DAVF in the initial and preliminary diagnostic approach, especially in emergency situations. In fact, it represents a fast, inexpensive, non-invasive and above all, easily accessible and available diagnostic technique, unlike DSA or MRI, allowing to provide information necessary for the identification, classification and treatment planning of DAVFs. Full article

Nurses and other health students may lack the proper time for training procedural tasks, such as peripheral venous access. There is a need to develop these abilities in novices so that errors can be avoided when treating real patients. Nonetheless, from an experiential point of view, the simulation devices offered in the market do not always make sense for educators and trainees. This could make the adoption of new technology difficult. The purpose of this case study is to describe the development of an innovative simulation device and to propose concrete tactics for the involvement of the educators and trainees. We used a participative design based approach, with an ethnographic basis, where incremental cycles of user testing, development and iteration were involved. The study showcases methods from the field of design and anthropology that can be used to develop future simulation devices that resonate with students and educators to achieve a long term learning experience. Results could shed a light on new ways for the involvement of educators and students to create devices that resonate with them, making learning significant and effective. Full article