Ultrasound to Localize the Peripherally Inserted Central Catheter Tip Position in Newborn Infants

2019 ◽  
Author(s):  
Xiao-Ling Ren ◽  
Hong-Lei Li ◽  
Jing Liu ◽  
Ya-Juan Chen ◽  
Man Wang ◽  
...  
Keyword(s):  
Newborn Infants ◽  
X Ray ◽  
Ultrasound Localization ◽  
The Past ◽  
Catheter Tip ◽  
Chest X Ray ◽  
Tip Position ◽  
The Right ◽  
Central Catheters ◽  
The Ideal

Objective To evaluate the application of ultrasound for the localization of the tip position of peripherally inserted central catheters (PICCs) in newborn infants. Study Design This study was a retrospective analysis on ultrasonic localization for PICC placement conducted in our department over the past 2 years. Ultrasonic localization was performed immediately after PICC placement in all neonatal patients. Successful PICC placement was confirmed if the PICC tip position was located at the inferior/superior cavoatrial junction. Chest X-ray localization was performed on 32 infants immediately after ultrasound examination to compare the accuracy of ultrasound localization. Results Of the 186 patients, 174 (93.5%) had successful PICC placement on the first attempt. In 11 (5.9%) patients, the catheter tip was placed beyond the ideal location as follows: too deep (in the right atrium) in 4 patients, too shallow in 4 patients, and malpositioned in 3 patients. Both the sensitivity and the specificity of ultrasound for identifying PICC tip localization were 100%. Complications occurred in 2.7% of this group of patients. Conclusion Ultrasonic localization of the PICC tip position is a timely, accurate, and reliable method and can identify the catheter tip with high accuracy. This method could be widely applied in neonatal wards.

The diagnostic value of intracavitary electrocardiogram for verifying tip position of peripherally inserted central catheters in cancer patients: A retrospective multicenter study

2019 ◽  
Vol 20 (6) ◽  
pp. 636-645 ◽  
Author(s):  
Ting Yu ◽  
Ligui Wu ◽  
Ling Yuan ◽  
Robert Dawson ◽  
Rongmei Li ◽  
...  
Keyword(s):  
P Wave ◽  
Wave Surface ◽  
X Ray ◽  
Catheter Tip ◽  
Chest X Ray ◽  
Tip Position ◽  
Surface Electrocardiogram ◽  
Central Catheters ◽  
Retrospective Multicenter Study

Purpose: To evaluate the feasibility and accuracy of intracavitary electrocardiogram for verifying tip position of peripherally inserted central catheters in cancer patients during follow-up period. Methods: From March 2015 to October 2015, 126 patients involved in eight hospitals who underwent peripherally inserted central catheter placement received intracavitary electrocardiogram and chest X-ray to verify position of the catheter tip during follow-up period. Their intracavitary electrocardiogram was compared with surface electrocardiogram to judge catheter tip landing zone in one of three different anatomical zones. The amplitude of intracavitary electrocardiogram P wave and the ratio of intracavitary electrocardiogram P wave/surface electrocardiogram P wave were measured and showed correlation with catheter tip position confirmed by chest X-ray. Based on chest X-ray principle, all the cases were assigned into three intracavitary electrocardiogram groups to explore the optimal cut-off values for intracavitary electrocardiogram P wave and intracavitary electrocardiogram P wave/surface electrocardiogram P wave by analyzing the receiver operating characteristic. Results: No technique-related complications or adverse events occurred in this study. The matching rate between intracavitary electrocardiogram and chest X-ray method was 93.7%. The optimal cut-off values for intracavitary electrocardiogram P wave were set from 3.15 to 3.75 mV, and intracavitary electrocardiogram P wave/surface electrocardiogram P wave from 1.65 to 3.25. Conclusions: It is demonstrated in this retrospective multicenter study that the intracavitary electrocardiogram method for verifying tip position of peripherally inserted central catheter during follow-up period is feasible and accurate in all adult patients with cancer.

scholarly journals Right Upper Lobe Shadow and Tracheobronchopathia Osteochondroplastica Confined to Right Main Bronchus: A Case Report and Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Stylianos A. Michaelides ◽  
George D. Bablekos ◽  
George Ionas ◽  
Stephanie Vgenopoulou ◽  
Maria Chorti
Keyword(s):  
Main Bronchus ◽  
Chest Ct ◽  
Cartilaginous Tissue ◽  
Bronchial Mucosa ◽  
Upper Airways ◽  
X Ray ◽  
The Past ◽  
Chest X Ray ◽  
The Right ◽  
Tracheobronchopathia Osteochondroplastica

Tracheobronchopathia osteochondroplastica (TO) is a well documented benign entity of endoscopic interest. We describe a case of 76-year-old patient who presented with fever, cough, purulent sputum during the past four days, and presence of an ovoid shadow in right upper zone of his chest X-ray. Medical history included diagnosis of colon diverticuli identified by colonoscopy 3 months ago. Chest CT revealed a compact elongated lesion containing air-bronchogram stripes. Bronchoscopy showed normal upper airways and trachea but presence of unequal sized mucosal nodules, protruding into the lumen, along the entire length of the right main bronchial mucosa. No other abnormal findings were detected. Moreover, brushing and washing smears from the apical segment of right upper lobe (RUL), where the compact lesion was located, were negative for malignancy. Biopsy from the mucosal nodules of right main bronchus showed presence of cartilaginous tissue in continuity through thin pedicles with submucosal cartilage. This finding posed the diagnosis of TO while RUL lesion was cleared by antibiotic treatment. Case is reported because, to our knowledge, it represents a unique anatomic location of TO which was confined exclusively in the right main bronchus mucosa without affecting trachea.

Contrast enhanced ultrasound as a new tool to estimate the performance of midline catheters in the single patient

2021 ◽  
pp. 112972982110346
Author(s):  
Antonio Gidaro ◽  
Francesco Casella ◽  
Francesca Lugli ◽  
Chiara Cogliati ◽  
Maria Calloni ◽  
...  
Keyword(s):  
Contrast Enhanced Ultrasound ◽  
Single Patient ◽  
Central Venous ◽  
X Ray ◽  
Chamber View ◽  
Contrast Enhanced ◽  
Chest X Ray ◽  
Vein Diameter ◽  
Tip Position ◽  
Echocardiographic Images

Background: Contrast enhanced ultrasound (CEUS) through MicroBubbles Time (MBT) (time from infusion of saline with addition of micro-bubbles of air to visualization of first bubbles in right atrium (RA), visualized by subxiphoid or apical echocardiography) is an alternative to Intracavitary ECG and chest X-ray in evaluation of tip location in central venous catheters. Objective: To evaluate feasibility and variability of CEUS in peripheral catheters (Midline-MC) in a cohort of patients and in a subgroup where tip location was also performed through chest X-ray. Secondary outcomes were verifying the correlation between MBT and distance between tip of MC and RA (anthropometric and radiological measures), body mass index (BMI), vein diameter at point of insertion. Methods: Patients with insertion of MC were enrolled in this prospective cohort. After catheter insertion, CEUS was performed recording MBT. Results: One hundred thirty-two MCs were inserted, 45 performed Chest X-ray. MBT wasn’t feasible in 7 (5%) because of low quality echocardiographic images. Subcostal view was available in 114 patients (91.2%), while 11 patients (8.8%) were examined through apical four-chamber view. Mean MBT in the whole population was 2.3 ± 0.8 s. Significant correlation between anthropometric and radiological measures, BMI and MBT was found. 32.8% of MC had a MBT ⩽2 s. Conclusions: CEUS could be useful to estimate tip position. Our study showed how 2 s is not a suitable cutoff to confirm central catheter’s tip.

Precision in Central Venous Catheter Tip Placement: A Review of the Literature

2010 ◽  
Vol 15 (3) ◽  
pp. 112-125 ◽  
Author(s):  
Russell Hostetter ◽  
Nadine Nakasawa ◽  
Kim Tompkins ◽  
Bradley Hill
Keyword(s):  
Central Venous Catheter ◽  
Selection Criteria ◽  
Weighted Average ◽  
Venous Catheter ◽  
Central Venous ◽  
Catheter Tip ◽  
Tip Position ◽  
Landmark Technique ◽  
The Ideal

Abstract Background: Long term venous catheters have been used to deliver specialized therapies since 1968. The ideal tip position of a central venous catheter provides reliable venous access with optimal therapeutic delivery, while minimizing short-and long-term complications. Ideal position limits have evolved and narrowed over time, making successful placement difficult and unreliable when depending exclusively on the landmark technique. Objective: To review and analyze contemporary literature and calculate an overall accuracy rate for first attempt placement of a PICC catheter in the ideal tip position. Methods: Key PICC placement terms were used to search the database PubMED-indexed for MEDLINE in June and October, 2009. The selection of studies required: a patient cohort without tip placement guidance technology; a documented landmark technique to place catheter tips; data documenting initial catheter placement and, that the lower third of the SVC and the cavo-atrial junction (CAJ) were included in the placement criteria. With few exceptions, articles written between 1993 and 2009 met the stated selection criteria. A composite of outcomes associated with tip placement was analyzed, and an overall percent proficiency of accurate catheter tip placement calculated. Results: Nine studies in eight articles met the selection criteria and were included for analysis. Rates of first placement success per study ranged from 39% to 75%, with the majority (7/9) being single center studies. The combined overall proficiency of these studies calculated as a weighted average was 45.87%.

Amiodarone – induced pulmonary nodules mimiking metastatic lung disease – investigation by somatostatin radio peptide scaning

2005 ◽  
Vol 4 (2) ◽  
pp. 63-65
Author(s):  
Veronica Varney ◽  
◽  
Mary Warren ◽  
M Palmer ◽  
◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Pulmonary Nodules ◽  
Alcoholic Cardiomyopathy ◽  
X Ray ◽  
The Past ◽  
Previous Diagnosis ◽  
Metastatic Lung ◽  
Chest X Ray ◽  
200Mg Daily

A 61 year old former paramedic presented to A&E complaining of palpitations. He was found to be in atrial fibrillation, which reverted spontaneously to sinus rhythm. A chest x-ray taken at that time showed multiple pulmonary nodules consistent with metastatic malignancy (Figure 1). In the past he had been treated with amiodarone 200mg daily for 6 years following a previous diagnosis of atrial fibrillation, which had been attributed to alcoholic cardiomyopathy. He had discontinued the drug 8 months earlier, after selfdiagnosing hypotension and bradycardia. A previous chest X-ray, taken before starting amiodarone, was normal.

scholarly journals CLINICAL STUDY OF PAIN IN RIGHT ILIAC FOSSA

2020 ◽  
Vol 4 (8) ◽  
Author(s):  
Saurabh Kothari ◽  
Manjula Kothari ◽  
Shree Mohan Joshi ◽  
Kalp Shandilya
Keyword(s):  
Iliac Fossa ◽  
Signs And Symptoms ◽  
Clinical History ◽  
X Ray ◽  
Pain Abdomen ◽  
Detailed Clinical History ◽  
Right Iliac Fossa Pain ◽  
Chest X Ray ◽  
The Right ◽  
Appendicular Mass

Background: A mass in the right iliac fossa is a common diagnostic problem encountered in clinical practice, requiring skill in diagnosis. Methods: 100 patients with signs and symptoms of right iliac fossa mass admitted in Hospital were identified and were studied by taking detailed clinical history, physical examination and were subjected to various investigations like x ray erect abdomen, chest x-ray, contrast x-ray . Result: In this study of out of 100 cases, 65.00% of cases were related to appendicular pathology either in the form of appendicular mass or appendicular abscess. There were 12.00% cases of ileocaecal tuberculosis. Conclusion: Appendicular lump remains the most common cause for right iliac fossa pain. Ileocaecal tuberculosis is one of the most important differential diagnoses for pain abdomen. Keywords: Appendicular Mass, Ileocaecal Tuberculosis, Carcinoma Caecum, Right Iliac Fossa Mass.

scholarly journals Subcutaneous Emphysema in Pregnancy

2011 ◽  
Vol 51 (183) ◽  
Author(s):  
A Shrestha ◽  
S Acharya
Keyword(s):  
Subcutaneous Emphysema ◽  
Late Pregnancy ◽  
X Ray ◽  
Close Observation ◽  
The Face ◽  
Normal Chest ◽  
Chest X Ray ◽  
Keywords Pregnancy ◽  
Systemic Examination ◽  
The Right

Spontaneous pneumomediastinum and subcutaneous emphysema are rare complications of labor, especially in the late pregnancy period, but they are usually self-limiting. Management includes avoidance of exacerbative factors and close observation with supportive treatment. A 19-year-old primi gravida at 36 weeks pregnancy presented with swelling over the right side of the face, neck and chest. Her general examination was normal. Systemic examination revealed swelling with palpatory crepitation over the right side of chest, neck and face, and other examination findings were normal. Chest X-ray revealed subcutaneous emphysema without pneumothorax. The patient left hospital against medical advice. Keywords: Pregnancy; subcutaneous emphysema; pneumomediastinum.

scholarly journals Nuets responsivitet – når det fremmede og det uperfekte setter premissen! Et filosofisk essay om musikalsk improvisasjon

2020 ◽  
pp. 285-299
Author(s):  
Karette Stensæth ◽  
Bjørn Kruse
Keyword(s):  
Mikhail Bakhtin ◽  
Sensory Perception ◽  
Therapeutic Practice ◽  
The Past ◽  
Random Impulses ◽  
Musical Improvisation ◽  
Philosophical Texts ◽  
The Right ◽  
Early Interaction ◽  
The Ideal

As we improvise in music and become increasingly engrossed in the activity, we are intuitively engaged in a playful negotiation of various aesthetic possibilities in the Now. We are in a state where random impulses and irrational, unintentional actions become key premise providers along with everything we have learned through knowledge and experience. This essay reflects on the responsiveness of the Now in musical improvisation. We ask: What does the experience of the Now offer? Does it come with any kind of ethics and accountability and, if so, what kind and to whom does it apply? In our elaborations we are influenced by our own experiences of, and reflections on, compositional and music therapeutic practice. We refer to the theory of musical improvisation and early interaction, and also philosophical texts, especially those by Mikhail Bakhtin. We suggest that the responsiveness of the Now in musical improvisation is a mindset that challenges us both ethically and aesthetically. It does so by seeking creative satisfaction, joy and insight, taking shape through sensory perception that is close to intuition, mimesis and imagination. Its meaning remains unfinalised and foreign to us. It is also risky and is situated on the boundary between music and performer, between performer and other performers, and between the past and future of our actions. The ideal is to strive for a Now that can be experienced as the right now but also as a Now that suits the responses we try to find room for when we improvise.

scholarly journals Radiographic aspects of acute community-acquired bacterial pneumonia and pulmonary tuberculosis in children

2021 ◽  
Author(s):  
Rivo Lova Herilanto Rakotomalala ◽  
Harimino Mireille Rakotondravelo ◽  
Andrianina Harivelo Ranivoson ◽  
Annick Lalaina Robinson
Keyword(s):  
Community Acquired Pneumonia ◽  
University Hospital ◽  
Radiographic Images ◽  
X Ray ◽  
Male Predominance ◽  
Mother And Child ◽  
Chest X Ray ◽  
The Right ◽  
The University ◽  
Tuberculosis In Children

Background: The etiological diagnosis of pneumonia is often difficult because of the impossibility of microbiological confirmation most of the time. Therefore, chest X-ray is still essential for a positive diagnosis and etiological orientation. The main objective of our study was to describe the radiographic aspects of acute community-acquired pneumonia and tubercular pneumonia in children.Methods: This was a descriptive retrospective study conducted at the university hospital mother and child of Tsaralalana from January 1st to July 31st, 2017.Results: Sixty-nine cases of pneumonia were included, including 13 cases of TB pneumonia and 46 cases of acute community-acquired pneumonia. The average age was 36.68 months with a male predominance. Clinically, respiratory functional signs predominated in both cases. Alteration in general condition was mainly observed in tubercular pneumonia (26.08%). Alveolar syndromes were present in 43.47% of TB pneumonias and 36.94% of acute community-acquired pneumonia. With regard to the radiographic images, alveolar involvement was common to both types of pneumonia; the nodular image was present in 8.69% of the tubercular pneumonias and 2.17% of the acute community-acquired pneumonia; the cavity image was present only in the tubercular pneumonia (p=0.04); the right-sided location predominated in both cases.Conclusions: X-ray images were common to both TB pneumonia and acute community-acquired pneumonia; some images were specific to TB pneumonia. However, the etiologic orientation of pneumonia is based on a combination of epidemiologic, clinical, and radiographic evidence.

scholarly journals Is Routine Chest X-ray After Ultrasound and Intracavitary Electrocardiogram Guided Peripherally Inserted Central Catheter Insertion Choosing Wisely? A Population-based Retrospective Study of 2857 Patients With Cancer

2021 ◽  
Author(s):  
Yan-Fen Shen ◽  
Jing Dong ◽  
Xin-Peng Wang ◽  
Xiao-Zheng Wang ◽  
Yuan-Yuan Zheng ◽  
...  
Keyword(s):  
Venous Access ◽  
Population Based ◽  
X Ray ◽  
Patients With Cancer ◽  
Potential Risk Factors ◽  
Catheter Tip ◽  
Chest X Ray ◽  
Clinical Records ◽  
The Cost ◽  
Routine Chest

Abstract Background: In China, routine chest X-ray (CXR) is generally required for peripherally inserted central venous catheters (PICC) to determine the position of the catheter tip. The aim of this study is to assess the value of a routine post-procedural CXR in the era of ultrasound and intracavitary electrocardiography(IC-ECG) -guided PICC insertion. Methods: A retrospective population-based cohort study was conducted to review the clinical records of all patients who had PICCs in the Venous Access Center of Beijing Cancer Hospital between January 1, 2019 and June 30, 2020. The incidence of catheter misplacement after insertion was measured. A logistic regression analysis was performed to examine potential risk factors associated with PICC-related complications and a cost analysis to assess the economic impact of the use of CXR.Results: There were 2,857 samples from 2,647 patients included. The overall incidence of intraoperative and postoperative catheter misplacement was 7.4% (n=210) and 0.67% (n=19), respectively. There was a high risk of postoperative catheter misplacement when the left-arm was chosen for placement (OR: 10.478; 95% CI: 3.467-31.670; p<0.001). The cost of performing CXR for screening of PICC-related complications was $23,808 per year, and that of using CXR to diagnose one case of catheter misplacement was $1253.Conclusion: This study confirms that misplacement of PICCs guided by ultrasound and IC-ECG is rare and that postoperative CXR is very costly. In our setting, routine postoperative CXR is unnecessary and not a wise option.

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