9 Arterial Line

2021 ◽  
Keyword(s):  
Arterial Line

Numerical Study of Shear-induced Hemolysis in an Arterial Line Filter

2019 ◽  
Author(s):  
Marílson Fonseca de Carvalho Almeida ◽  
Rudolf Huebner ◽  
Edna Maria de Faria Viana
Keyword(s):  
Numerical Study ◽  
Arterial Line

scholarly journals Creation of a dedicated line team for critically ill patients with COVID-19: A multidisciplinary approach to maximize resource utilization during the COVID-19 pandemic

2021 ◽  
pp. 112972982199175
Author(s):  
Pooja Nawathe ◽  
Robert Wong ◽  
Gabriel Pollock ◽  
Jack Green ◽  
Michael Kissen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Resource Utilization ◽  
Vascular Access ◽  
Medical Center ◽  
Academic Medical Center ◽  
Target Population ◽  
Primary Data ◽  
Arterial Line ◽  
Central Venous ◽  
Development Organization

Background: Pandemics create challenges for medical centers, which call for innovative adaptations to care for patients during the unusually high census, to distribute stress and work hours among providers, to reduce the likelihood of transmission to health care workers, and to maximize resource utilization. Methods: We describe a multidisciplinary vascular access team’s development to improve frontline providers’ workflow by placing central venous and arterial catheters. Herein we describe the development, organization, and processes resulting in the rapid formation and deployment of this team, reporting on notable clinical issues encountered, which might serve as a basis for future quality improvement and investigation. We describe a retrospective, single-center descriptive study in a large, quaternary academic medical center in a major city. The COVID-19 vascular access team included physicians with specialized experience in placing invasive catheters and whose usual clinical schedule had been lessened through deferment of elective cases. The target population included patients with confirmed or suspected COVID-19 in the medical ICU (MICU) needing invasive catheter placement. The line team placed all invasive catheters on patients in the MICU with suspected or confirmed COVID-19. Results and conclusions: Primary data collected were the number and type of catheters placed, time of team member exposure to potentially infected patients, and any complications over the first three weeks. Secondary outcomes pertained to workflow enhancement and quality improvement. 145 invasive catheters were placed on 67 patients. Of these 67 patients, 90% received arterial catheters, 64% central venous catheters, and 25% hemodialysis catheters. None of the central venous catheterizations or hemodialysis catheters were associated with early complications. Arterial line malfunction due to thrombosis was the most frequent complication. Division of labor through specialized expert procedural teams is feasible during a pandemic and offloads frontline providers while potentially conferring safety benefits.

Derivation of a procedural performance checklist for ultrasound-guided femoral arterial line placement using the modified Delphi method

2020 ◽  
Vol 21 (5) ◽  
pp. 715-722
Author(s):  
Jessica Baez ◽  
Elizabeth Powell ◽  
Megan Leo ◽  
Uwe Stolz ◽  
Lori Stolz
Keyword(s):  
Delphi Method ◽  
Competency Assessment ◽  
Arterial Line ◽  
Ultrasound Guided ◽  
Arterial Access ◽  
Modified Delphi Method ◽  
Modified Delphi ◽  
Item Checklist ◽  
Standard Quality ◽  
Femoral Arterial Access

Background: Many specialties utilize procedural performance checklists as an aid to teach residents and other learners. Procedural checklists ensure that the critical steps of the desired procedure are performed in a specified manner every time. Valid measures of competency are needed to evaluate learners and ensure a standard quality of care. The objective of this study was to employ the modified Delphi method to derive a procedural checklist for use during placement of ultrasound-guided femoral arterial access. Methods: A 27-item procedural checklist was provided to 14 experts from three acute care specialties. Using the modified Delphi method, the checklist was serially modified based on expert feedback. Results: Three rounds of the study were performed resulting in a final 23-item checklist. Each item on the checklist received at least 70% expert agreement on its inclusion in the final checklist. Conclusion: A procedural performance checklist was created for ultrasound-guided femoral arterial access using the modified Delphi method. This is an objective tool to assist procedural training and competency assessment in a variety of clinical and educational settings.

Arterial Line Placement Pitfalls Can Be Demonstrated and Visualized With an Inexpensive, Wearable Trainer

2022 ◽  
Author(s):  
Olivia Paradis ◽  
Lauren Bitterman ◽  
Kimberly H. Park ◽  
Stacey Ernest ◽  
Amy Russell ◽  
...  
Keyword(s):  
Arterial Line ◽  
Line Placement

Ultrasound Guided Procedures and Radiologic Imaging for Pediatric Anesthesiologists

2021 ◽  
Keyword(s):  
Lung Ultrasound ◽  
Central Line ◽  
Arterial Line ◽  
Ultrasound Guided ◽  
Pediatric Airway ◽  
Skill Sets ◽  
Additional Information ◽  
Line Placement ◽  
Extensive Training ◽  
Radiologic Imaging

Ultrasound Guided Procedures and Radiologic Imaging for Pediatric Anesthesiologists is intended as a ready resource for both experts and novices. It will be useful to those with extensive training and experience as well as beginners and those with distant experience or training. A wealth of knowledge in the human factors of procedure design and use has been applied throughout to ensure that desired information can be easily located, that steps are clearly identified and comprehensible, and that additional information of high relevance to procedure completion is co-located and salient. This book begins with the basics but quickly progresses to advanced skill sets. It is divided into four parts. Part I starts with a primer on ultrasound machine functionality as well as procedural chapters on lung ultrasound to detect a mainstem intubation or pneumothorax and gastric ultrasound to assess gastric contents in incompletely fasted patients. Part II covers ultrasound guided peripheral intravenous line placement through the incremental advancement method, ultrasound guided arterial line placement, and ultrasound guided central line placement. Part III details several ultrasound guided regional anesthesia techniques. Part IV covers radiology of the pediatric airway and mediastinum, lungs, gastrointestinal, genitourinary, musculoskeletal, and neurologic systems.

Abstract 20: Peripheral Intravenous Analysis Detects Return of Spontaneous Circulation Without Interruption of Chest Compressions in a Rat Model of Cardiopulmonary Resuscitation

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Claudius Balzer ◽  
Franz J Baudenbacher ◽  
Antonio Hernandez ◽  
Michele M Salzman ◽  
Matthias L Riess ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiopulmonary Resuscitation ◽  
Chest Compression ◽  
Venous Pressure ◽  
Fold Increase ◽  
Spontaneous Circulation ◽  
Arterial Line ◽  
Chest Compressions ◽  
Waveform Data ◽  
Return Of Spontaneous Circulation

Introduction: A higher chest compression fraction (CCF) or percentage of time providing chest compressions is associated with improved survival after cardiac arrest (CA). Pauses in chest compression duration during cardiopulmonary resuscitation (CPR) to palpate a pulse can reduce the CCF. Peripheral Intravenous Analysis (PIVA) is a novel method for determining cardiac and volume status using waveforms from a standard peripheral intravenous (IV) line. We hypothesize that PIVA will demonstrate the onset of return of spontaneous circulation (ROSC) without interruption of CPR. Methods: Eight Zucker Diabetic Fatty (ZDF) rats (4 lean, 4 diabetic) were intubated, ventilated, and cannulated with a 24g IV in the tail vein and a 22g IV in the femoral artery, each connected to a TruWave pressure transducer. Mechanical ventilation was discontinued to achieve CA. After 8 minutes, CPR began with mechanical ventilation, IV epinephrine, and chest compressions using 1.5 cm at 200 times per minute until mean arterial pressure (MAP) increased to 120 mmHg per arterial line. All waveforms were recorded and analyzed in LabChart. PIVA was measured using a Fourier transform of the peripheral venous waveform. Data are mean ± SD. Statistics: Unpaired student’s t-test (two-tailed), α = 05. Results: CA and ROSC were achieved in all 8 rats. Within 1 minute of CPR, there was a 70 ± 35 fold increase/decrease in PIVA during CPR that was temporally associated with ROSC. Within 8 ± 13 seconds of a reduction in PIVA, there was a rapid increase in end-tidal CO 2 . In all rats, ROSC occurred within 38 ± 9 seconds of the maximum PIVA value. Peripheral venous pressure decreased by 1.2 ± 0.9 mmHg during resuscitation and ROSC, which was not significant different at p=0.05. Conclusion: In this pilot study, PIVA detected ROSC without interrupting CPR. Use of PIVA may obviate the need pause CPR for pulse checks, and may result in a higher CCF and survival. Future studies will focus on PIVA and CPR efficacy.

Abstract 5: Management Of Intravenous tPA In Non-ICU Environments: Safety, Clinical Outcome, And Cost Savings

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Kisha C Coleman ◽  
Paola Palazzo ◽  
Reza B Shahripour ◽  
Amy L Brooks ◽  
Mary A Cronin ◽  
...  
Keyword(s):  
Critical Care ◽  
Stroke Unit ◽  
Cost Savings ◽  
Pressure Control ◽  
Cardiac Monitoring ◽  
Arterial Line ◽  
Systemic Hemodynamic ◽  
Stroke Units ◽  
Critical Care Admission ◽  
Iv Tpa

Background: Administration of IV tPA has traditionally necessitated admission to an ICU solely for monitoring, with relatively no need for extensive critical care services. Stroke Units that are capable of monitoring IV tPA patients have been proposed to reduce ICU use, but limited data exist that demonstrate safety. We report the largest series of non-ICU managed tPA cases in relation to safety and discharge outcomes. Methods: Consecutive cases admitted to our intermediate-level Stroke Unit spanning 2009-2011 were assembled. Unit capabilities include IV tPA management with nicardipine infusion for blood pressure control as needed, non-invasive or direct central/arterial line and cardiac monitoring, and BiPAP ventilation. Stroke Unit nurses underwent extensive orientation and participate in NET SMART Junior for continuing education. Overall sICH, and drip/ship sICH (parenchymal hemorrhage in combination with > 4 point increase on the NIHSS), systemic hemorrhage, and tPA related death rates were calculated, along with discharge mRS and total ICU cost savings per day. Results: A total of 302 Stroke Unit admissions for intravenous tPA occurred over the 3 year period, while another 31 (10%) were excluded due to critical care admission for systemic hemodynamic or pulmonary instability. Nicardipine infusions were used in 9 (10.5%) Stroke Unit tPA cases in 2009, 10 (9%) in 2010, and 14 (13%) in 2011. Overall sICH rate was 3.3% (n=10) and systemic hemorrhage rate was 2.9% (n=9) with 5 of these (56%) requiring transfusion. Estimated cost savings in total for this 3 year period was $362,400 for “avoided” ICU days. Conclusions: Intravenous tPA patients may be safely managed on non-ICU Stroke Units when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for management of tPA monitoring needs may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit.

scholarly journals Assessment of Accuracy of Continuous Noninvasive versus Invasive Method of Hemoglobin Estimation in Patients Undergoing Pituitary Surgery

2018 ◽  
Vol 05 (03) ◽  
pp. 168-172
Author(s):  
Indu Kapoor ◽  
Charu Mahajan ◽  
Ruhi Mamuliya ◽  
Hemanshu Prabhakar
Keyword(s):  
Pituitary Surgery ◽  
Poor Correlation ◽  
P Value ◽  
Arterial Line ◽  
Female Ratio ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Invasive Method ◽  
American Society ◽  
Hb Concentration

Abstract Aim Determination of hemoglobin (Hb) concentration by standard methods is time consuming, invasive, and intermittent. Noninvasive (NI) methods of Hb estimation are less time consuming, and reduce the risk of infection, number of required working personnel, and long-term costs. In this study, we aimed to find the accuracy of Hb values at various time points using noninvasive (NI) Hb monitoring and standard invasive techniques such as laboratory (LabHb) and arterial blood gas (ABG). Methods All American Society of Anesthesiologists (ASA) physical grade I and II adult patients between 18 and 65 years of either gender undergoing pituitary surgery under general anesthesia were included over a period of 1 year. Samples were collected for Hb estimation from the arterial line (aHb) using ABG analyzer machine and LabHb using automated Hb analyzer. Simultaneously, Hb reading from the NI Hb monitor was recorded using Masimo Spot Hemoglobin Check Device. Bland–Altman plot was used to find out agreement between Hb values drawn from three different techniques. A p-value < 0.05 was considered significant. Results A total of 30 patients participated in the study. The male to female ratio was 13:17. Statistical analysis showed poor correlation between the invasive and NI methods of Hb estimation. Conclusion NI method of Hb estimation may be successfully used in clinical practice, replacing estimation from ABG analysis or laboratory tests. However, NI method cannot replace the invasive methods of Hb estimation.

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