The Intraosseous Have It: A Prospective Observational Study of Vascular Access Success Rates in Patients in Extremis Using Video Review

Objective: This study aims to evaluate safety and success rates of lumbar puncture (LP) and to identify factors associated with adverse events or failure of LP in infants.Methods: This two-center prospective observational study investigated infants younger than 90 days of age who underwent LP. Need for resuscitation oxygen desaturation (SpO2 < 90%), bradycardia and intraventricular hemorrhage were considered adverse events. LP failed if cerebrospinal spinal fluid was not collected or had traces of blood. Logistic regression analysis was used to evaluate whether corrected gestational age (GA), body weight at LP, position, and any respiratory support during LP affected SpO2 desaturation or failure of LP.Results: Among 204 LPs, 134 were performed in full-term and 70 in pre-term born infants. SpO2 desaturations occurred during 45 (22.4%) LPs. At multivariate analysis, lower GA at LP (p < 0.001), non-invasive respiratory support (p 0.007) and mechanical ventilation (p 0.004) were associated with SpO2 desaturations. Transient, self-resolving bradycardia occurred in 7 (3.4%) infants. Two infants had intraventricular hemorrhage detected within 72 h of LP. No further adverse events were registered. Failure of LP occurred in 38.2% of cases and was not associated with any of the factors evaluated.Conclusions: LP was safe in most infants. Body weight or GA at LP did not affect LP failure. These data are useful to clinicians, providing information on the safety of the procedure.

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Repeated attempts at tracheal intubation by a single intubator associated with decreased success rates in emergency departments: an analysis of a multicentre prospective observational study

Emergency Medicine Journal ◽

10.1136/emermed-2013-203473 ◽

2014 ◽

Vol 32 (10) ◽

pp. 781-786 ◽

Cited By ~ 11

Author(s):

Tadahiro Goto ◽

Hiroko Watase ◽

Hiroshi Morita ◽

Hideya Nagai ◽

Calvin A Brown ◽

...

Keyword(s):

Tracheal Intubation ◽

Observational Study ◽

Emergency Departments ◽

Prospective Observational Study ◽

Success Rates

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Ultrasound-Guided Cannulation of the Brachiocephalic Vein in Neonates and Preterm Infants: A Prospective Observational Study

American Journal of Perinatology ◽

10.1055/s-0037-1608803 ◽

2017 ◽

Vol 35 (05) ◽

pp. 503-508 ◽

Cited By ~ 3

Author(s):

Paula Alonso-Quintela ◽

Sandra Terroba-Seara ◽

Aquilina Jiménez-González ◽

Silvia Rodríguez-Blanco ◽

José Vázquez-Martínez ◽

...

Keyword(s):

Observational Study ◽

Success Rate ◽

Preterm Infants ◽

Neonatal Intensive Care ◽

Prospective Observational Study ◽

Venous Catheter ◽

Late Complications ◽

Brachiocephalic Vein ◽

Success Rates ◽

Low Weight

Introduction Percutaneous central venous catheter (CVC) insertion is a challenging procedure in neonates, especially in preterm infants. Objective This study aims to describe the technical success and safety profile of ultrasound (US)-guided brachiocephalic vein (BCV) cannulation in neonates. Methods Prospective observational study. Neonates admitted to the neonatal intensive care unit (NICU) in whom US-guided cannulation of the BCV was attempted were eligible. Outcomes included first attempt success rate, the overall success rate, the number of attempts, the cannulation time, immediate mechanical complications, catheter indwelling days, and late complications. Results A total of 40 procedures in 37 patients were included. Median weight and age at the time of cannulation were 1.85 kg (0.76–4.8) and 13 days (3–31), respectively. First attempt and overall success rates were 29 (72.5%) and 38 (95%), respectively. No major complications were observed. Catheter-associated infection rate was 2.4/1,000 catheter days. There were no difference in outcomes between low weight preterm infants (<1.5 kg) and the rest of the cohort. There was no linear relationship between weight at time of insertion and the number of puncture attempts (r = 0.250; p = 0.154) or cannulation time (r = 0.257; p = 0.142). Conclusion US-guided cannulation of the BCV may be considered in acutely ill neonates, including small preterm infants, who need a large bore CVC.

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Prospective observational study of gender and ethnicity biases in respiratory protective equipment for healthcare workers in the COVID-19 pandemic

BMJ Open ◽

10.1136/bmjopen-2020-047716 ◽

2021 ◽

Vol 11 (5) ◽

pp. e047716

Author(s):

Clarissa Y M Carvalho ◽

Jan Schumacher ◽

Paul Robert Greig ◽

Danny J N Wong ◽

Kariem El-Boghdadly

Keyword(s):

Observational Study ◽

Healthcare Workers ◽

Prospective Observational Study ◽

Healthcare Facility ◽

Healthcare Services ◽

Large Female ◽

Protective Equipment ◽

Minority Ethnic Group ◽

Success Rates ◽

Fit Testing

ObjectiveTo describe success rates of respiratory protective equipment (RPE) fit testing and factors associated with achieving suitable fit.DesignProspective observational study of RPE fit testing according to health and safety, and occupational health requirements.SettingA large tertiary referral UK healthcare facility.Population1443 healthcare workers undergoing quantitative fit testing.Main outcome measuresQuantitative fit test success (pass/fail) and the count of tests each participant required before successful fit.ResultsHealthcare workers were fit tested a median (IQR) 2 (1–3) times before successful fit was obtained. Males were tested a median 1 (1–2) times, while females were tested a median 2 (1–2) times before a successful fit was found. This difference was statistically significant (p<0.001). Modelling each fit test as its own independent trial (n=2359) using multivariable logistic regression, male healthcare workers were significantly more likely to find a well-fitting respirator and achieve a successful fit on first attempt in comparison to females, after adjusting for other factors (adjusted OR=2.07, 95% CI): 1.66 to 2.60, p<0.001). Staff who described their ethnicity as White were also more likely to achieve a successful fit compared with staff who described their ethnicity as Asian (OR=0.47, 95% CI: 0.38 to 0.58, p<0.001), Black (OR=0.54, 95% CI: 0.41 to 0.71, p<0.001), mixed (OR=0.50 95% CI: 0.31 to 0.80, p=0.004) or other (OR=0.53, 95% CI: 0.29 to 0.99, p=0.043).ConclusionsMale and White ethnicity healthcare workers are more likely to achieve RPE fit test success. This has broad operational implications to healthcare services with a large female and Black, Asian and minority ethnic group population. Fit testing is imperative in ensuring RPE effectiveness in protecting healthcare workers during the COVID-19 pandemic and beyond.

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Understanding haemodialysis vascular access maturation: A prospective observational study to understand natural history and biology of AV access maturation and identify risk factors for AVF failure

http://isrctn.org/> ◽

10.1186/isrctn57422410 ◽

2014 ◽

Author(s):

Carla Barrett

Keyword(s):

Risk Factors ◽

Natural History ◽

Observational Study ◽

Vascular Access ◽

Prospective Observational Study

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Infraclavicular arterio-arterial prosthetic loop is a safe and effective vascular access technique for haemodialysis in frail patients: a prospective observational study

Pan African Medical Journal ◽

10.11604/pamj.2021.40.245.29390 ◽

2021 ◽

Vol 40 ◽

Author(s):

Ahmed Mohammed Ahmed Abdel Rahim ◽

Alexander Bush ◽

Aml Ahmed Sayed Ahmed ◽

Aml Mohammed Soliman ◽

Mohammed Ahmed Mohammed Ismail

Keyword(s):

Observational Study ◽

Vascular Access ◽

Prospective Observational Study ◽

Frail Patients ◽

Access Technique

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Impact of Succinct Training on Open Cricothyrotomy Performance: A Randomized, Prospective, Observational Study of U.S. Army First Responders

Military Medicine ◽

10.1093/milmed/usaa035 ◽

2020 ◽

Vol 185 (9-10) ◽

pp. e1779-e1786

Author(s):

Kurtis L Muller ◽

Cynthia A Facciolla ◽

Jonathan Monti ◽

Aaron Cronin

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

First Responders ◽

Training Group ◽

Success Rates ◽

Special Operations ◽

Practice Group ◽

Combat Medics ◽

Procedural Success ◽

Open Cricothyrotomy

Abstract Introduction Primary airway failure has become the second most common cause of potentially survivable battlefield fatality. Cricothyrotomy is taught to all U.S. military providers as a means of securing an airway in extremis. However, retrospective studies show that cricothyrotomy failure rates for U.S. military first responders performing the procedure in combat is 33%. Our hypothesis was that these rates could be improved. Materials and Methods We conducted a randomized, prospective, observational study to evaluate the effects of inexpensive, succinct training on open cricothyrotomy performance by studying two unique U.S. Army First Responder participant groups. One participant group consisted of regular U.S. Army Medics (68 Ws). The second group was Special Operations Combat Medics. We evaluated both groups’ baseline ability to correctly perform a cricothyrotomy and then randomly assigned individuals within each group to either a training or practice group. Results The training group had a higher proportion of success and performed the cricothyrotomy faster than the practice group with 68 Ws group appearing to benefit most from training: their procedural success rates increased by an average of 23%, and their average time-to-correct-placement decreased by 21 seconds—a 33% improvement over baseline. Conclusion With one manikin, a qualified trainer, and $35 worth of expendable supplies, 10 medics could be trained in the procedure in just 2–3 hours. Our study suggests that this simple intervention has the potential to significantly improve U.S. Army First Responders’ ability to correctly perform an open cricothyrotomy and drastically decrease the time needed to perform this lifesaving procedure correctly, possibly saving one in four potentially survivable combat casualties suffering from airway compromise.

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