scholarly journals Effect of wrist dorsiflexion on ultrasound-guided radial artery catheterisation using dynamic needle tip positioning technique in adult patients: a randomised controlled clinical trial

2021 ◽  
pp. emermed-2020-209504
Author(s):  
Qingyu Xiao ◽  
Dejiang Xu ◽  
Shaohui Zhuang
Keyword(s):  
Success Rate ◽  
Radial Artery ◽  
Adult Patients ◽  
Controlled Clinical Trial ◽  
Complication Rates ◽  
Success Rates ◽  
Time Duration ◽  
Positioning Technique ◽  
Randomised Controlled ◽  
Group D

BackgroundIt is generally recommended to keep the wrist joint mildly dorsiflexed during radial artery catheterisation. However, wrist dorsiflexion might decrease the success rate of radial artery catheterisation with dynamic needle tip positioning technique. Therefore, we assessed the success rates of two groups with or without wrist dorsiflexion by 5 cm wrist elevation in adult patients.MethodsThis randomised controlled clinical trial was performed between March and December 2018 in the First Affiliated Hospital of Shantou University Medical College, China. We recruited 120 adult patients undergoing major surgical procedures and randomly allocated them into two groups: dorsiflexion group (group D) and neutral group (group N). The primary outcome was first-attempt success rates of two groups. Secondary outcomes were overall success rates within 5 min; numbers of insertion and cannulation attempts; overall catheterisation time; duration of localisation, insertion and cannulation; and complication rates of catheterisation.ResultsFirst-attempt success rate was 88.3% in group D and 81.7% in group N (p=0.444). The overall success rate within 5 min was 93.3% in group D compared with 90.0% in group N (p=0.743). Numbers of insertion and cannulation attempts, overall catheterisation time, duration of localisation and insertion, and complication rates did not show a significant difference between the two groups. Cannulation time was longer in group N (35.68 s) than that in group D (26.19 s; p<0.05).ConclusionWrist dorsiflexion may not be a necessity for ultrasound-guided radial artery catheterisation using dynamic needle tip positioning technique in adult patients.Trial registration numberChiCTR1800015262.

scholarly journals Intrathecal dexmedetomidine improves epidural labor analgesia effects: a randomized controlled trial

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052199953
Author(s):  
Gehui Li ◽  
Hao Wang ◽  
Xiaofei Qi ◽  
Xiaolei Huang ◽  
Yuantao Li
Keyword(s):  
Local Anesthetic ◽  
Controlled Trial ◽  
Intrathecal Injection ◽  
Onset Time ◽  
Labor Analgesia ◽  
Controlled Clinical Trial ◽  
Time Duration ◽  
Clinical Registry ◽  
Randomized Controlled ◽  
Group D

Objective α2‑agonists and opioids have been used as intrathecal adjuvants to local anesthetics for several years, but the effect of intrathecal dexmedetomidine (Dex) or sufentanil combined with epidural ropivacaine in labor analgesia is not fully understood. Methods A total of 108 parturient women receiving combined spinal-epidural labor analgesia were randomly divided into three groups. Group C received l mL saline (0.9%) intrathecally, Group D received 5 µg Dex intrathecally, and Group S received 5 µg sufentanil intrathecally. All parturient women then received 0.1% epidural ropivacaine and 0.2 µg/mL sufentanil for patient-controlled epidural analgesia with standard settings. The visual analog scale score, onset time, duration of intrathecal injection, local anesthetic requirements, and side effects were recorded. Results The labor analgesia effects in Groups D and S were better than those in Group C. Groups D and S displayed significantly shorter onset times, longer durations of intrathecal injection, and reduced local anesthetic requirements compared with Group C. The incidence of shivering and pruritus in Group D was lower than that in Group S. Conclusion Intrathecal administration of 5 µg Dex could improve epidural labor analgesia effects. This randomized controlled clinical trial was registered with the Chinese Clinical Registry Center (ChiCTR-1800014943, http://www.chictr.org.cn/ ).

scholarly journals Safety and Efficacy of Bleb Needling with Antimetabolite after Trabeculectomy Failure in Glaucoma Patients: A Systemic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Xuhao Chen ◽  
Lingge Suo ◽  
Ying Hong ◽  
Chun Zhang
Keyword(s):  
Success Rate ◽  
Meta Analysis ◽  
Systemic Review ◽  
Cochrane Library ◽  
Subconjunctival Injection ◽  
Complication Rates ◽  
Safe Procedure ◽  
Success Rates ◽  
Whole Process ◽  
Before And After

Background. Bleb needling with subconjunctival injection of antimetabolites had become a widely accepted approach for trabeculectomy failure. However, IOP reduction effects, success rates, and complications occurrence for this procedure showed great inconsistency among the different studies. Methods. We conducted a literature search on PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. A random-effects model was performed on the extracted data based on the included studies. The intraocular pressure (IOP) and number of antiglaucomatous medications before and after the surgery were pooled for meta-analysis. The success and complication rates were estimated based on the results. Subgroup analysis, sensitivity analysis, and metaregression were applied to explore the origination of heterogeneity. Results. Thirty-seven studies with a total of 2182 patients were finally included in our review. For the present meta-analysis, the overall effects of bleb needling at the last visit revealed a reduction in IOP of 9.74 mmHg (95% confidence interval (CI) [8.85, 10.63]), 45.9% (95% CI [39.0%, 53.0%]) for complete success rate, and 70.4% (95% CI [63.5%, 77.0%]) for qualified success rate. Application of mitomycin C (MMC) and 5-fluorouracil (5-Fu) during the procedure were efficacious for IOP control during the follow-up. Metaregression revealed that possible origination of heterogeneity was baseline IOP before bleb needling, revealing a trend that higher baseline IOP correlated with a greater IOP reduction results p < 0.001 . For safety profile, conjunctival haemorrhage (5.7%, 95% CI [2.5%, 10.1%]), hyphema (5.5%, 95% CI [3.0%, 8.7%]), and bleb leakage (5.0%, 95% CI [3.2%, 7.3%]) had the highest estimate of incidence. An increasing number of needling was the main risk factor for needling failure. Conclusion. Bleb needling with antimetabolites could be considered an effective and safe procedure after trabeculectomy failure. After the process, patients will gain IOP control and reduce antiglaucomatous medications for at least six months with 5-Fu or MMC. Meanwhile, the overall estimates for complications were relatively low in the whole process.

scholarly journals Subureteral Injection with Small-Size Dextranomer/Hyaluronic Acid Copolymer: Is It Really Efficient?

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Iyimser Üre ◽  
Serhat Gürocak ◽  
Özgür Tan ◽  
Amirali Farahvash ◽  
Cem Senol ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Success Rate ◽  
Vesicoureteral Reflux ◽  
Low Cost ◽  
Clinical Results ◽  
Voiding Cystourethrogram ◽  
Complication Rates ◽  
Success Rates ◽  
Acid Copolymer ◽  
Urinary Infections

The aim of this study was to evaluate the clinical results of patients with vesicoureteral reflux, which were treated with subureteral injection of small-size (80–120 μm) dextranomer/hyaluronic acid copolymer (Dx/HA). Data of 75 children (105 renal units) who underwent STING procedure with small-size Dx/HA for the treatment of vesicoureteral reflux (VUR) in our clinic between 2008 and 2012 were retrospectively analyzed. Preoperative reflux grade and side, injection indication, postoperative urinary infections and urinary symptoms, voiding cystourethrogram, and renal scintigraphy results were evaluated. The success rate of the procedure was 100% in patients with grades 1 and 2 reflux, 91% in patients with grade 3 reflux, and 82.6% in patients with grade 4. Overall success rate of the treated patients was 97%. Endoscopic subureteric injection with Dx/HA procedure has become a reasonable minimally invasive alternative technique to open surgery, long-term antibiotic prophylaxis, and surveillance modalities in treatment of VUR in terms of easy application, low costs and complication rates, and high success rates. Injection material composed of small-size dextranomer microspheres seems superior to normal size Dx/HA, together with offering similar success with low cost.

scholarly journals Completion rate and impact on physician–patient relationship of video consultations in medical oncology: a randomised controlled open-label trial

ESMO Open ◽  
2020 ◽  
Vol 5 (6) ◽  
pp. e000912
Author(s):  
Thomas Walle ◽  
Erkin Erdal ◽  
Leon Mühlsteffen ◽  
Hans Martin Singh ◽  
Editha Gnutzmann ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Success Rate ◽  
Outpatient Clinics ◽  
Controlled Clinical Trial ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Open Label ◽  
Randomised Controlled ◽  
Physician Patient

BackgroundMobile phone video call applications generally did not undergo testing in randomised controlled clinical trials prior to their implementation in patient care regarding the rate of successful patient visits and impact on the physician–patient relationship.MethodsThe National Center for Tumour Diseases (NCT) MOBILE trial was a monocentric open-label randomised controlled clinical trial of patients with solid tumours undergoing systemic cancer therapy with need of a follow-up visit with their consulting physician at outpatient clinics. 66 patients were 1:1 randomised to receive either a standard in-person follow-up visit at outpatient clinics or a video call via a mobile phone application. The primary outcome was feasibility defined as the proportion of patients successfully completing the first follow-up visit. Secondary outcomes included success rate of further video calls, time spent by patient and physician, patient satisfaction and quality of physician–patient relationship.FindingsSuccess rate of the first follow-up visit in the intention-to-treat cohort was 87.9% (29 of 33) for in-person visits and 78.8% (26 of 33) for video calls (relative risk: RR 0.90, 95% CI 0.70 to 1.13, p=0.51). The most common reasons for failure were software incompatibility in the video call and no-show in the in-person visit arm. The success rate for further video visits was 91.7% (11 of 12). Standardised patient questionnaires showed significantly decreased total time spent and less direct costs for patients (Δmean −170.8 min, 95% CI −246 min to −95.5 min), p<0.0001; Δmean −€14.37, 95% CI −€23.9 to −€4.8, p<0.005) and comparable time spent for physicians in the video call arm (Δmean 0.5 min, 95% CI −5.4 min to 6.4 min, p=0.86). Physician–patient relationship quality mean scores assessed by a validated standardised questionnaire were higher in the video call arm (1.13-fold, p=0.02).InterpretationFollow-up visits with the tested mobile phone video call application were feasible but software compatibility should be critically evaluated.Trial registration numberDRKS00015788.

scholarly journals Percutaneous Treatment of Thrombosed Hemodialysis Arteriovenous Fistulas: Use of Thromboaspiration and Balloon Angioplasty

2017 ◽  
Vol 90 (1) ◽  
pp. 66-70
Author(s):  
Burak Mehmet Çildağ ◽  
Kutsi Ömer Faruk Köseoğlu
Keyword(s):  
Success Rate ◽  
Balloon Angioplasty ◽  
Mechanical Thrombectomy ◽  
Clinical Success ◽  
Percutaneous Treatment ◽  
Radiology Department ◽  
Secondary Patency ◽  
Complication Rates ◽  
Success Rates ◽  
Arteriovenous Fistulas

Background. Endovascular strategies have been used to manage patients with thrombosed vascular access for hemodialysis. We analyzed primary success rate and patency rates of balloon angioplasty following mechanical thrombectomy for the treatment of thrombosed native arteriovenous fistulas.Methods. This was a retrospective study of 24 patients with thrombosed native arteriovenous fistulas who were referred for treatment in the intervention unit of the Radiology Department. All patients had been performed percutaneous thrombo-aspiration and balloon angioplasty. Technical and clinical success rates as well as the 6th and 12th months primary and secondary patency of fistulas were evaluated .Results. Technical and clinical success was 83%. In the 6 of 20 patients, early re-thrombosis were detected. Patent AVF with primary and secondary patency rates at 6 and 12 months was 55%-40%. The secondary patency rates at 6 and 12 months were 75% and 70%.Conclusion. Mechanical thrombectomy with balloon angioplasty is a minimally invasive and effective procedure for the treatment of thrombosed native arteriovenous fistula. Advantages of this technique are minor complication rates, cost effectiveness, high techni­cal success rate.   

The use of an ostial stent does not increase the success rate of endoscopic dacryocystorhinostomy

2018 ◽  
Vol 132 (8) ◽  
pp. 718-723 ◽  
Author(s):  
M E Dinc ◽  
S Ulusoy ◽  
E Sahin ◽  
N Bozan ◽  
M O Avincsal ◽  
...  
Keyword(s):  
Success Rate ◽  
Controlled Study ◽  
Complication Rates ◽  
Success Rates ◽  
Silicone Tube ◽  
Endoscopic Dacryocystorhinostomy ◽  
Silicone Tube Intubation ◽  
The Difference ◽  
Group 2 ◽  
Prospective Controlled Study

AbstractObjectiveThis prospective, controlled study assessed how placing a stent into a newly formed ostium affects ostial patency, success and complication rates in endoscopic dacryocystorhinostomy patients.MethodsIn group 1 (40 eyes of 36 patients), both silicone tube intubation and tube stenting were performed. In group 2 (36 eyes of 34 patients), only silicone tube intubation was performed. Success, operative time and post-surgical complications were investigated two months post-operatively in each group.ResultsThe success rates were 92.5 per cent and 83.3 per cent for groups 1 and 2 respectively, but the difference was not statistically significant (p = 0.294). The complication rates also differed between the two groups, but this was again insignificant.ConclusionCompared with the use of a silicone tube alone, the addition of an ostial stent did not significantly increase the success rate of endoscopic dacryocystorhinostomy.

A Practical Training Program for Peripheral Radial Artery Catheterization in Adult Patients

2016 ◽  
Vol 125 (4) ◽  
pp. 716-723
Author(s):  
Yoshinobu Nakayama ◽  
Yuko Inagaki ◽  
Yasufumi Nakajima ◽  
Daniel I. Sessler ◽  
Nobuhiro Mukai ◽  
...  
Keyword(s):  
Training Program ◽  
Success Rate ◽  
Radial Artery ◽  
Pulse Pressure ◽  
Training Group ◽  
Adult Patients ◽  
Central Axis ◽  
Control Group ◽  
Chronic Hypertension ◽  
Radial Artery Catheterization

Abstract Background The main cause of unsuccessful peripheral radial artery catheterization using traditional palpation is imprecisely locating the arterial center. The authors evaluated factors causing disparities between the arterial centers determined by palpation versus ultrasound. The authors applied them to create and test a novel catheterization training program. Methods The arterial central axis was determined by ultrasound and palpation in 350 adults. Potential independent predictors of disparity included sex, body mass index, pulse pressure, transverse arterial diameter, subcutaneous arterial depth, chronic hypertension, and experience as an anesthesiologist (less than 3 vs. greater than or equal to 3 yr). Using the results, the authors developed a radial artery catheterization training program. It was tested by enrolling 20 first-year interns, randomized to a training or control group. The time to successful insertion was the primary outcome measure. The success rate and time required for catheterization by palpation were evaluated in 100 adult patients per group. Results Independent predictors of central axis disparity were pulse pressure, subcutaneous radial artery depth, years of experience, and chronic hypertension. Training improved the catheterization time (training group 56 ± 2 s vs. control group 109 ± 2 s; difference –53 ± 3 s; 95% CI, –70 to –36 s; P &lt; 0.0001) and total success rate (training group 83 of 100 attempts, 83%; 95% CI, 75 to 90 vs. control group 57 of 100, 57%; 95% CI, 47 to 66; odds ratio, 3.7; 95% CI, 2.7 to 5.1). Conclusions Misjudging the central axis position of the radial artery is common with a weak pulse and/or deep artery. The authors’ program, which focused on both these issues, shortened the time for palpation-guided catheterization and improved success.

scholarly journals Ultrasound assisted catheterization of internal jugular vein

2021 ◽  
pp. 48-55
Keyword(s):  
Success Rate ◽  
Internal Jugular Vein ◽  
Vascular Access ◽  
Jugular Vein ◽  
Anatomical Variations ◽  
Central Vein ◽  
Complication Rates ◽  
Success Rates ◽  
Ultrasound Assisted ◽  
Vein Catheterization

An appropriate vascular access is always needed for the success of hemodialysis. Internal jugular vein is the safest and less complicated access in between central veins. At the same time, it is the most commonly used temporary vascular access for hemodialysis. The blind method after anatomical marking for the central vascular path is the most used technique in many centers. The use of ultrasound in the placement of hemodi-alysis catheters in the central vein increases the success rate of catheterization. Ultrasound can show IJV locali-zation, anatomical variations, the presence of thrombus in the vein, and whether the vein is open. The aim of this study is to compare the success rate and complication frequency of temporary catheters placed in the IJV with and without ultrasound for hemodialysis. A total of 124 consecutive patients who required hemodialysis catheters in Haydarpaşa Numune Trai-ning and Research Hospital between February 2012 and December 2012 were randomized to the study. The patients were divided into two groups as non USG-assisted (blindly) (Group 1) and ultrasound-assisted (Group 2). The use of ultrasound significantly increased the successful catheterization rates of both experienced specialist and resident. In addition, there was no statistical difference between the success rates between the specialist and the resident. USG-assisted vein catheterization can be performed safely, easily, quickly, more painlessly and with minimal complication rates. Catheter intervention should be performed under the guidance of USG in risky patient groups who need temporary catheters. In centers that do not have USG, especially in such risky patients, blind catheter interven-tion should not be attempted after anatomical marking. USG-assisted vein catheterization can be easily perfor-med by all clinicians and residents, since the training period is short, practical and much more safe.

scholarly journals Initial experience, feasibility and safety of permanent left bundle branch pacing; a retrospective single centre study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
JLPM Van Den Broek ◽  
FALE Bracke ◽  
I Stranders ◽  
MNJ Op "T Hof ◽  
LM Rademakers
Keyword(s):  
Success Rate ◽  
Left Ventricular ◽  
Previous Experience ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Complication Rates ◽  
Success Rates ◽  
Ventricular Ejection Fraction ◽  
Delivery Sheath

Abstract Funding Acknowledgements Type of funding sources: None. Background Physiologic pacing by left bundle branch pacing (LBBP) is characterized by direct stimulation of the intrinsic His-Purkinje system and results in physiologic ventricular depolarization and repolarization. This technique has emerged as an alternative to both traditional right ventricular pacing for bradycardia and classic cardiac resynchronization therapy (CRT). High success rates and low complication rates are reported, however the majority of literature is reported by relatively few, highly experienced centres. Purpose This retrospective study aims to describe success rate, feasibility and safety of LBBP for both bradycardia and CRT indications in a high volume referral centre, performed by three physicians without previous experience with LBBP. Methods 100 patients who underwent attempted LBBP from January 2020 to September 2020 were analysed. LBBP was performed using the Medtronic SelectSecure 3830 pacing lead and the Medtronic C315HIS delivery sheath. The primary end points are acute LBBP success rates and LBBP related complications within 3-6 months from implantation. Success was defined as a paced QRS with QR or RSr’ in V1 and left ventricular activation time (LVAT) &lt;90ms. Device follow-up data was acquired at 1 month and 3-6 months after implantation. Results The mean age was 70 ± 11.4 years and 67% were men. 57% had a left ventricular ejection fraction &lt;0.50 and QRS was 146 ± 33.7ms. Pacing indication was CRT in 48, bradycardia in 42 and planned AV node ablation in 9. LBBP was successful in 83/100 patients (83%), with paced QRS of 121 ± 19.7ms and LVAT of 81 ± 13.8ms. A learning curve could not be demonstrated; the success rates in the first and latter half were 78% and 88% respectively (p = 0.183). Pacing parameters at implantation were satisfactory; R-wave 11.9 ± 5.9mV, impedance 736 ± 153Ω and capture threshold 0.7 ± 0.4V. R-wave increased to 14.6 ± 6.3mV at 1 month (p &lt; 0.001) and remained stable at 13.6 ± 5.5mV after 3-6 months (p = 0.829). Impedance decreased to 572 ± 82Ω at 1 month (p &lt; 0.001) and further decreased to 536 ± 81Ω after 3-6 months (p &lt; 0.001). Capture threshold remained stable at 1 and 3-6 months (0.7 ± 0.2V (p = 0.287) and 0.8 ± 0.2V (p = 0.055), respectively). No LBBP related complications, e.g. lead perforation or dislodgement, occurred during the follow-up of 249 ± 64 days. The main reasons for unsuccessful implantation (n = 17) were insufficient reach of the delivery sheath (n = 8) and inability to penetrate the septum due to fibrosis (n = 5). Conclusion This study shows that LBBP is a safe and feasible method for delivering physiological pacing. Without previous experience, our initial success rate is comparable to highly experienced centres. Pacing parameters remained stable after 6 months and no LBBP complications occurred. Success rate of implantation could further improve with dedicated LBBP delivery sheaths. Large randomized controlled trials are needed to further confirm safety and efficacy of LBBP.

Sign in / Sign up

Export Citation Format

Share Document