Ultrasound for Endotracheal Tube Tip Position in Term and Preterm Infants

Neonatology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Sabrina Salvadori ◽  
Daniel Nardo ◽  
Anna Chiara Frigo ◽  
Martina Oss ◽  
Irene Mercante ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Neonatal Intensive Care ◽  
Vital Signs ◽  
X Rays ◽  
Right Pulmonary Artery ◽  
Chest X Ray ◽  
Tip Position ◽  
The Right ◽  
A Prospective Study ◽  
Mean Time

<b><i>Background and Objective:</i></b> Placing an endotracheal tube (ETT) in neonates is challenging and currently requires timely radiographic confirmation of correct tip placement. The objective was to establish the reliability of ultrasound (US) for assessing ETT position in the neonatal intensive care unit (NICU), time needed to do so, and patients’ tolerance. <b><i>Methods:</i></b> A prospective study on 71 newborns admitted to our NICU whose ETT placement was evaluated with US (ETT-echo) and confirmed on chest X-rays (CXR). Data were collected by 3 operators (2 neonatologists and a resident in pediatrics). The right pulmonary artery (RPA) was used as a landmark for US. The distance between the tip of the ETT and the upper margin of the RPA was measured using US and compared with the distance between the tube’s tip and the carina on the CXR. <b><i>Results:</i></b> Seventy-one intubated newborns were included in the study (<i>n</i> = 34 &#x3c; 1,000 g, <i>n</i> = 18 1,000–2,000 g, <i>n</i> = 19 &#x3e; 2,000 g). Statistical analysis (Bland-Altman plot and Lin’s concordance correlation coefficient) showed an excellent consistency between ETT positions identified on US and chest X-ray. The 2 measures (ETT-echo and CXR) were extremely concordant both in the whole sample and in the subgroups. Minimal changes in patients’ vital signs were infrequently observed during US, confirming the tolerability of ETT-echo. The mean time to perform US was 3.2 min (range 1–13). <b><i>Conclusions:</i></b> ETT-echo seems to be a rapid, tolerable, and highly reliable method worth further investigating for future routine use in neonatology with a view to reducing radiation exposure.

scholarly journals 109 Game Changing Magnetic Experience in Rural and Urban Wirral Peninsula - Our Experience with Magseed Localisation of Impalpable Breast Tumours and Axillary Nodes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
T Arif ◽  
R Vinayagam ◽  
J M Lund ◽  
S Poonawala
Keyword(s):  
Incidental Finding ◽  
Breast Tumour ◽  
Axillary Node ◽  
Reliable Technique ◽  
Breast Tumours ◽  
Rural And Urban ◽  
Mean Size ◽  
The Right ◽  
A Prospective Study ◽  
Mean Time

Abstract Introduction Magseed is a novel localization technology in which a tiny seed is inserted to accurately mark the site of breast tumour. These can be detected intra-operatively by sentimag localization system. It aids localization of impalpable breast lesions improving margin clearance rates. Method A prospective study of first fifty Magseed localised breast tumour and axillary node excisions in Clatterbridge General Hospital. Results A total of 50 patients had 52 Magseed inserted. n = 14 was symptomatic, n = 35 was screen detected and n = 1 was an incidental finding on surveillance mammogram for a B3 lesion. 30 seeds were inserted on the right and 22 were inserted on the left (two were bilateral). 44 seeds were inserted under ultrasound guidance and the rest were targeted under stereo guidance (n = 8). Deployment of two resulted in malposition requiring wire localization. Mean age of subjects was 59.76 (range 31-81) years. Mean time to surgery after magseed insertion was 8.04 (range 1-27) days. Mean weight of the specimen was 48.57(range 10-264) gm. Mean size of the lesions was 20.32 (range 8-65) mm. Redo surgery for margin clearance was performed bringing the re-excision rate to 15.38% (n = 8). Conclusions We conclude that Magseed localization of breast tumours is a safe and reliable technique

scholarly journals Recurrent Empyema Thoracic Secondary to Pulmonary Nocardiosis in Immunocompetent Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Samshol Sukahri ◽  
Lily Diana Zainudin ◽  
Mohd Firdaus Hadi ◽  
Mohd Al-Baqlish Mohd Firdaus ◽  
Muhammad Imran Abdul Hafidz
Keyword(s):  
Vital Signs ◽  
C Reactive Protein ◽  
Nocardia Species ◽  
X Ray ◽  
Reactive Protein ◽  
Pulmonary Nocardiosis ◽  
Erythrocyte Sedimentation ◽  
Chest X Ray ◽  
The Right ◽  
Tomography Scan

Pulmonary nocardiosis is a rare disorder that mainly affects immune-compromised patients. We report a 37-year-old male who presented with persistent fever associated with productive cough. During this course of therapy, he had recurrent admissions for empyema thoracic. Clinically, his vital signs were normal. Blood investigations show leukocytosis with a significantly raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Sputum acid-fast bacilli (AFB) was scanty 1+ and sputum mycobacterium culture was negative. Chest X-ray (CXR) showed consolidative changes with mild to moderate pleural effusion on the right side. Skin biopsy was taken and showed Paecilomyces species. A computed tomography scan (CT thorax) was performed and revealed a multiloculated collection within the right hemithorax with a split pleura sign. Decortications were performed and tissue culture and sensitivity (C+S) growth of Nocardia species. And it is sensitive to sulfamethoxazole-trimethoprim and completed treatment for 4 months. This case highlights that pulmonary nocardiosis should be kept in mind in also immune-competent patients, especially in suspected cases of tuberculosis not responding to antitubercular therapy.

Bone Scintigraphic Findings of Os Trigonum: A Prospective Study of 100 Soldiers on Active Duty

2000 ◽  
Vol 21 (10) ◽  
pp. 822-824 ◽  
Author(s):  
Vladimir Sopov ◽  
Aharon Liberson ◽  
David Groshar
Keyword(s):  
Active Duty ◽  
Clinical Findings ◽  
Lower Limbs ◽  
Whole Body ◽  
X Rays ◽  
Stress Injury ◽  
Os Trigonum ◽  
Frequent Finding ◽  
The Right ◽  
A Prospective Study

PURPOSE: To determine the clinical significance of an increased uptake of 99mTc methylene-diphosphonate (Tc-MDP) in the os trigonum region seen on bone scintigrams of soldiers on active duty. PATIENTS AND METHODS: Radionuclide whole-body skeletal imaging and physical examination of the foot were carried out in 100 consecutive soldiers on active duty referred for evaluation of suspected stress-injury of the lower limbs, back pain, and different skeletal trauma. Lateral radiographs of the foot were performed in those with increased uptake of Tc-MDP at the site of os trigonum. Radiographic, scintigraphic, and clinical findings were correlated. RESULTS: Among 200 feet, 27 (13.5%) showed an increased uptake of Tc-MDP in the os trigonum region. The right side was affected in six patients, the left side in 11 and five patients had bilaterally increased uptake. On X-rays, 31 of 44 feet showed the os trigonum. Only 10 of these 27 feet (37%) had a symptomatic os trigonum. CONCLUSIONS: Our results suggest that increased uptake of Tc-MDP in the os trigonum region is a frequent finding among active soldiers and is of limited value in detecting symptomatic os trigonum.

Incidental diagnosis of situs inversus totalis: a perspective from an emergency department attendance

2021 ◽  
Vol 14 (4) ◽  
pp. e242337
Author(s):  
Umma-Kulthum Abdullahi Umar ◽  
Aysha Najim Alremeithi ◽  
Hasan Qayyum
Keyword(s):  
Emergency Department ◽  
Situs Inversus ◽  
Anatomical Variation ◽  
Vital Signs ◽  
Situs Inversus Totalis ◽  
Cardiac Complications ◽  
X Rays ◽  
Future Health ◽  
Normal Limits ◽  
Chest X Ray

A 30-year-old man of African origin presented to our emergency department (ED) with subjective fever and abdominal pain which started on the day of attendance. Vital signs and systemical examination were within normal limits. As part of his evaluation in ED, a 12-lead electrocardiogram was performed which showed features consistent with dextrocardia later confirmed on a chest X-ray as well. An ultrasound scan of the abdomen was performed which showed mirror imaging of the abdominal viscera, all of which were otherwise structurally normal. A diagnosis of situs inversus totalis was made. The patient’s symptoms resolved with analgesia and he was discharged with advice to follow-up in our hospital’s outpatient department. The diagnosis of situs inversus in the ED is a tricky one to make and most cases of this condition are discovered incidentally, as in our case. The mirror-imaged arrangement of viscera can have implications on the site of localised complaints, the physical examination, future health problems for the patient including anaesthesia risks, chronic lung conditions, cardiac complications and specialised trauma management. This anatomical variation can pose diagnostic challenges in such patients. Based on meticulous examination and readily accessible investigations including X-rays, 12-lead ECG and ultrasound, a timely diagnosis can be made.

scholarly journals Is It Time to Review Guidelines for ETT Positioning in the NICU? SCEPTIC—Survey of Challenges Encountered in Placement of Endotracheal Tubes in Canadian NICUs

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Pankaj Sakhuja ◽  
Michael Finelli ◽  
Judy Hawes ◽  
Hilary Whyte
Keyword(s):  
Nurse Practitioners ◽  
Neonatal Intensive Care ◽  
Online Survey ◽  
Tube Placement ◽  
Neonatal Intensive Care Units ◽  
Respiratory Therapists ◽  
Endotracheal Tube Placement ◽  
Wide Variability ◽  
Chest X Ray ◽  
Tip Position

Objectives. To examine current opinions and practices regarding endotracheal tube placement across several Canadian Neonatal Intensive Care Units.Design. Clinical directors from Canadian Neonatal Network affiliated NICUs and Neonatal-Perinatal Programs across Canada were invited via email to participate in and disseminate the online survey to staff neonatologists, neonatal fellows, respiratory therapists, and nurse practitioners.Result. There is wide variability in the beliefs and practices related to ETT placement. The majority use “weight +6” formula and “aim to black line” on ETT at vocal cords to estimate the depth of an oral ETT and reported estimation as challenging in ELBW infants. The majority agreed that mid-trachea is an ideal ETT tip position; however their preferred position on chest X-ray varied. Many believe that ETT positioning could be improved with more precise ETT markings.Conclusion. Further research should focus on developing more effective guidelines for ETT tip placement in the ELBW infants.

Determination of Accurate Position of Umbilical Venous Catheters in Premature Infants

2020 ◽  
Author(s):  
Selahattin Akar ◽  
Emre Dincer ◽  
Sevilay Topcuoğlu ◽  
Taner Yavuz ◽  
Hatice Akay ◽  
...  
Keyword(s):  
Intensive Care ◽  
Premature Infants ◽  
Neonatal Intensive Care ◽  
X Rays ◽  
X Ray ◽  
High Position ◽  
Umbilical Catheter ◽  
Chest X Ray ◽  
Accurate Position

Objective The aim of the study is to determine the most accurate length and position of umbilical venous catheter (UVC). Study Design This prospective study included premature infants who were admitted to the neonatal intensive care unit with inserted UVC between January 1, 2014 and December 31, 2015. The length of UVC was calculated according to the Shukla formula [(3 × birth weight + 9)/2 + 1] and the catheter was inserted under sterile conditions. After the insertion, umbilical catheter was first evaluated through chest X-ray and then with echocardiography to confirm its position. Catheters seen on the chest X-ray at the level of T9-T10 vertebrae were classified as “accurate position,” those seen above T9 vertebra as “high position,” and the catheters identified below T10 vertebra were classified as “low position.” Results A total of 68 infants smaller than 36 weeks of gestation were included in the study. In echocardiographic evaluation, 80% of the cases identified as in the “accurate position,” 100% of the cases classified as in a “high position,” and 33% of the cases defined as in a “low position” on the chest X-rays were found to be intracardiac. In our study, length of the catheter calculated according to the Shukla formula was intracardiac in 88.2% of premature infants. Conclusion Radiography alone is not sufficient for the determination of adequate position of umbilical catheter, especially in premature infants. Specialists practicing in neonatal intensive care units could improve themselves and evaluate UVC with echocardiography, making this a routine part of clinical practice. Echocardiography-guided fixation of the catheter will reduce the complications related to catheter malposition. Key Points

scholarly journals Leadless pacemakers: where is the device?

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Elrefai ◽  
C Menexi ◽  
P Roberts
Keyword(s):  
Heart Diseases ◽  
Sinus Node ◽  
X Rays ◽  
Funding Sources ◽  
Safety And Reliability ◽  
Chest X Ray ◽  
Implantation Sites ◽  
The Right ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Leadless pacemakers (LPs) were designed to avoid lead-related complications associated with transvenous pacing. To minimise the risk of complications, there is preference towards implanting LPs into the septal aspect of the right ventricle rather than the apex or free wall. The Transcatheter Pacing Study (TPS) and the international post-approval registry demonstrated the safety and reliability of the LP systems in real-world settings. The registry demonstrated that more than half of the LPs were implanted into the septum and most required &lt;2 attempts at deployment. We report a radiological method of defining LP position. Methods We reviewed the first 100 LPs implanted at our centre. Two independent observers who didn’t implant LPs reviewed the patients’ post-implant fluoroscopy images and/or post-implant CXRs when available. The reviewers assessed the devices’ positions in postero-anterior (PA) and/or right anterior oblique (RAO) views based on conventional fluoroscopic criteria for lead position. We used the proposed criteria interchangeably on fluoroscopic images and post implant CXRs (Figure). Differences in classification of device position were resolved by consensus. Results Three experienced operators implanted 100 LPs at our centre. Patients (61% male) 56.6 ± 22.2 years had normal hearts (74%), ischaemic cardiomyopathies (12%), congenital heart diseases (6%), valvular pathologies (5%) and dilated cardiomyopathies (3%). Indications for pacing were symptomatic sinus node dysfunction (36%), followed by high grade atrio-ventricular block (33%), bradyarrhythmia associated with atrial tachyarrhythmias (27%) and other indications for pacing (4%). We had a 100% successful implant rate, 88% required ≤2 attempts and 70% required one attempt. There were no major complications. We were able to classify the site of the LPs implants in a total of 90 patients who had fluoroscopic projections or chest x-rays that would allow us to classify the implant sites. A total of 32 implants were in the apex (35.6%). 28 were in mid-septum (31.1 %), 15 in the apical septum (16.7%), 14 on the septal aspect of the right ventricular inflow (15.5%) and 1 implant (1.1%) in the septum of the RV outflow tract. Conclusion Our proposed method of defining LP position demonstrated that the rate of implants into the true apex at our centre was highly comparable to that of the international registry. It also showed that we had lower rates of implants into the mid-septum in favour of apical septum. There were no pericardial effusions or cardiac perforations resulting from our implant procedures regardless of the site of the implant. We utilised widely used fluoroscopic and chest x-ray criteria for categorisation of the LPs implantation sites. However, a recognised limitation to our analysis is that our findings were not validated using other imaging modalities such as echocardiogram or cardiac computerised tomography (CT). Abstract Figure. Criteria to classify device position

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.

scholarly journals Transfer Learning with Deep Convolutional Neural Network (CNN) for Pneumonia Detection Using Chest X-ray

2020 ◽  
Vol 10 (9) ◽  
pp. 3233 ◽  
Author(s):  
Tawsifur Rahman ◽  
Muhammad E. H. Chowdhury ◽  
Amith Khandakar ◽  
Khandaker R. Islam ◽  
Khandaker F. Islam ◽  
...  
Keyword(s):  
Neural Network ◽  
Convolutional Neural Network ◽  
Transfer Learning ◽  
Viral Pneumonia ◽  
Deep Convolutional Neural Network ◽  
X Rays ◽  
X Ray ◽  
Life Threatening ◽  
Chest X Ray ◽  
The Right

Pneumonia is a life-threatening disease, which occurs in the lungs caused by either bacterial or viral infection. It can be life-endangering if not acted upon at the right time and thus the early diagnosis of pneumonia is vital. The paper aims to automatically detect bacterial and viral pneumonia using digital x-ray images. It provides a detailed report on advances in accurate detection of pneumonia and then presents the methodology adopted by the authors. Four different pre-trained deep Convolutional Neural Network (CNN): AlexNet, ResNet18, DenseNet201, and SqueezeNet were used for transfer learning. A total of 5247 chest X-ray images consisting of bacterial, viral, and normal chest x-rays images were preprocessed and trained for the transfer learning-based classification task. In this study, the authors have reported three schemes of classifications: normal vs. pneumonia, bacterial vs. viral pneumonia, and normal, bacterial, and viral pneumonia. The classification accuracy of normal and pneumonia images, bacterial and viral pneumonia images, and normal, bacterial, and viral pneumonia were 98%, 95%, and 93.3%, respectively. This is the highest accuracy, in any scheme, of the accuracies reported in the literature. Therefore, the proposed study can be useful in more quickly diagnosing pneumonia by the radiologist and can help in the fast airport screening of pneumonia patients.

Endotracheal Tube Placement Confirmation with Bedside Ultrasonography in the Pediatric Intensive Care Unit: A Validation Study

2020 ◽  
Author(s):  
Harsha K. Chandnani ◽  
Ivanna N. Maxson ◽  
Disha K. Mittal ◽  
Salem Dehom ◽  
Anthony Moretti ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Interrater Reliability ◽  
Pediatric Intensive Care ◽  
Tube Placement ◽  
X Rays ◽  
Medical Expenses ◽  
Endotracheal Tube Placement ◽  
Tube Position ◽  
Bedside Ultrasonography ◽  
A Prospective Study

AbstractCritically ill patients who are intubated undergo multiple chest X-rays (CXRs) to determine endotracheal tube position; however, other modalities can save time, medical expenses, and radiation exposure. We evaluated the validity and interrater reliability of ultrasound to confirm endotracheal tube (ETT) position in patients. A prospective study was performed on intubated patients with cuffed ETTs. The accuracy of ultrasound to confirm correct ETT placement in 92 patients was 97.8%. Sensitivity, positive predictive value, and agreement of 97.7, 93.3, and 91.3% were found on comparing ultrasound to CXR findings. Ultrasound is feasible, reliable, and has good interrater reliability in assessing correct ETT position in children.

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