scholarly journals Insertion of peripherally inserted central catheters with intracavitary electrocardiogram guidance: A randomized multicenter study in China

2018 ◽  
Vol 20 (5) ◽  
pp. 524-529 ◽  
Author(s):  
Yu-Xia Yin ◽  
Wei Gao ◽  
Xu-Ying Li ◽  
Wei Lu ◽  
Qian-Hong Deng ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Multicenter Study ◽  
Anatomical Landmark ◽  
Control Group ◽  
Study Group ◽  
Peripherally Inserted Central Catheters ◽  
X Ray ◽  
Ultrasound Device ◽  
Chest X Ray ◽  
Central Catheters

Introduction: Ultrasound-guided venipuncture and tip location by intracavitary electrocardiogram have many advantages during the insertion of peripherally inserted central catheters, both in terms of safety and cost-effectiveness. Recently, a new tip-conductive peripherally inserted central catheters and new Doppler ultrasound device integrated with intracavitary electrocardiogram have been introduced into clinical practice in China. A randomized multicenter study (clinical trial no. NCT03230357) was performed to verify the feasibility and accuracy of intracavitary electrocardiogram, as performed with this new peripherally inserted central catheters and device. Methods: Our study enrolled a total of 2250 adult patients in 10 different Chinese hospitals. The patients were randomly assigned to either the study group (intracavitary electrocardiogram) or the control group (anatomical landmark guidance) in a 2:1 allocation. Ultrasound was used in both groups for venipuncture and tip navigation. All patients underwent chest X-ray after the procedure to verify the position of the catheter tip. Results: No insertion-related complications were reported in either group. In the study group, first-attempt successful tip location was 91.7% (95% confidence interval: 90.3%–93.1%), significantly higher than 78.9% (95% confidence interval: 76.0%–81.9%) observed in the control group (p < 0.001). As evaluated by post-procedural chest X-ray, tip location in the study group had a sensitivity of 99.3% (95% confidence interval: 98.8%–99.7%), significantly higher than 86.8% (95% confidence interval: 84.4%–89.2%) observed in the anatomical landmark group (p < 0.001). Conclusion: These results indicated that during peripherally inserted central catheters insertion in adult patients, tip location with intracavitary electrocardiogram guidance, as carried out by a new tip-conductive peripherally inserted central catheters and intracavitary electrocardiogram integrated ultrasound device, was more effective and more accurate than tip location using anatomical landmarks.

Randomized multicenter study on long-term complications of peripherally inserted central catheters positioned by electrocardiographic technique

2020 ◽  
Vol 35 (8) ◽  
pp. 614-622
Author(s):  
Yu-Xia Yin ◽  
Wei Gao ◽  
Xu-Ying Li ◽  
Wei Lu ◽  
Qian-Hong Deng ◽  
...  
Keyword(s):  
Control Group ◽  
Exit Site ◽  
Peripherally Inserted Central Catheters ◽  
Exit Site Infection ◽  
X Ray ◽  
Length Estimation ◽  
Chest X Ray ◽  
Central Catheters

Background The intracavitary electrocardiogram (IC-ECG) method has been used for the tip location of central venous access devices for the advantage of being safe, accurate and highly cost effective. However, long-term follow-up is rare. This randomized clinical trial aimed to evaluate the long-term complications of peripherally inserted central catheters (PICCs) positioned by the IC-ECG method. Methods We randomized 2250 patients who needed PICC placement to either a landmark length estimation supplemented by IC-ECG positioned group (ECG group) or the traditional landmark length estimation alone group (control group) in a 2:1 allocation. Post-procedural chest X-rays were applied to confirm tip position. Follow-up was performed monthly to six months. Standard statistics analyses were performed with the SAS 9.13 software, and p < 0.05 was considered significant. Results As evaluated by post-procedural chest X-ray, tip location in the ECG group had a first-attempt success (catheter tip located at optimal position) of 91.7% (95% confidence interval (CI): 90.3%–93.1%), significantly higher than 78.9% (95% CI: 76.0%–81.9%) observed in the control group (p < 0.001). At six-month follow-up, in the control group, frequency of total complications was 9.5%, including the exit site infection (4.0%), phlebitis (1.3%), deep venous thrombosis (1.5%), liquid extravasation (2.9%) and mechanical failure (1.9%). The IC-ECG group had significantly lower rates of complications (6.4%, p < 0.001), including the exit site infection (2.7%, p > 0.05), phlebitis (1.1%, p > 0.05), deep venous thrombosis (1.2%, p > 0.05), liquid extravasation (2.4%, p > 0.05) and mechanical failure (1.2%, p > 0.05). In the univariable logistic regression analysis, ECG method, other diseases and upper arms were the independent protective factors, and the number of adjustment procedures (n ≥ 2) were the independent risk factors of the complications. Conclusions The intra-procedural tip location by IC-ECG is more safe and accurate than the traditional method of verifying tip location only post-procedurally, by chest X-ray.

scholarly journals Experience of Radiology Technologists Performing Peripherally Inserted Central Catheters (PICC)

2021 ◽  
Author(s):  
I. Aljediea ◽  
M. Alshehri ◽  
K. Alenazi ◽  
A. Memesh ◽  
M. Fleet
Keyword(s):  
Interventional Radiology ◽  
Success Rate ◽  
Ultrasound Guidance ◽  
Review Process ◽  
Peripherally Inserted Central Catheters ◽  
X Ray ◽  
Venous Puncture ◽  
Local Experience ◽  
Chest X Ray ◽  
Central Catheters

Abstract Purpose We conducted this study to review our local experience of performing peripherally inserted central catheters by interventional radiology technologists. Materials and Methods This is a retrospective study of peripherally inserted central catheters performed by interventional radiology technologists. These procedures were performed using ultrasound guidance for venous puncture and fluoroscopy or electrocardiography guidance followed by chest X-ray to confirm tip location. Results We reviewed all peripherally inserted central catheters performed in interventional radiology between May 2017 and July 2020. The review process included the success rate, number of venous puncture attempts, method of guidance, procedure time, fluoroscopy time, catheter duration to removal, and complications. Conclusion Interventional radiology technologists can perform peripherally inserted central catheters safely with high success rate. Extending interventional radiology technologists' role to perform peripherally inserted central catheters allow interventional radiologists to do more complex procedures. This enhances the workflow, increases the interventional radiology team efficiency, and improves the waiting time.

scholarly journals Comparison of Different Diagnostic Method for Mycobacteria Tuberculosis in Suspected Patients

1970 ◽  
Vol 7 (2) ◽  
pp. 84-88
Author(s):  
AR Khagi ◽  
S Singh ◽  
S Subba ◽  
A Bajracharya ◽  
R Tuladhar ◽  
...  
Keyword(s):  
Comparative Study ◽  
Sputum Smear ◽  
Study Group ◽  
Bacterial Cells ◽  
X Ray ◽  
Smear Examination ◽  
Group A ◽  
Chest X Ray ◽  
Group B ◽  
Sputum Smear Examination

Background: Microbial examination of smear of AFB by Z-N stain is currently the most rapid method for the detection of M. tuberculosis but its sensitivity is low i.e. required at least 10,000 bacterial cells per ml of sputum and also none specific, but auramine staining method has higher sensitivity than that of the Z-N stain but there are chances of false positive. Objective of this study was to find the correlation between chest X-ray, direct sputum smear examination by Ziehl-Neelsen stain, Auramine fluorochrome stain and sputum culture for M. tuberculosis. Methods: During that study period 250 x 3 samples were taken three each from 250 patients and divided into two groups A and B by performing Auramine fluorochrome stain in all samples . In group A, there were 150 fluorochrome stain positive samples. One each from 150 patient for comparative study of direct sputum smear examination by Ziehl-Neelsen stain, , culture on LJ medium and chest X-ray. Similarly in group B, next 100 fluorochrome stain negative specimens one each from 100 patients were taken for the comparative study of direct sputum smear examination by Ziehl-Neelsen stain, culture and chest X-ray. Results: In the study group A (n=150) all the specimens were positive in Auramine fluorochrome stain and all of them show positive in X-ray but only 134 showed positive in Ziehl-Neelsen stain and 136 showed positive in culture. In the study group B (n=100), all the specimens were negative in Auramine fluorochrome stain and all of them show negative in Ziehl-Neelsen stain but 14 of them were positive in culture and 24 were positive in chest X-ray. Conclusions: The diagnosis of PTB could be made by Auramine fluorochrome microscopy and culture. Key words: auramine fluorochrome stain; culture; mycobacterium tuberculosis; x-ray; ziehl-neelsen. DOI: 10.3126/jnhrc.v7i2.3012 Journal of Nepal Health Research Council Vol.7(2) Apr 2009 84-88

Real-time ultrasound-guided placement of peripherally inserted central venous catheter without fluoroscopy

2018 ◽  
Vol 19 (6) ◽  
pp. 609-614 ◽  
Author(s):  
Soshi Nakamuta ◽  
Toshihiro Nishizawa ◽  
Shiori Matsuhashi ◽  
Arata Shimizu ◽  
Toshio Uraoka ◽  
...  
Keyword(s):  
Success Rate ◽  
Detection Rate ◽  
Ultrasound Guidance ◽  
Catheter Placement ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Ultrasound Guided ◽  
Peripherally Inserted Central Catheters ◽  
X Ray ◽  
Central Catheters

Background and aim: Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls. Materials and methods: We retrospectively reviewed the medical case charts of 954 patients who received peripherally inserted central catheter procedure. Patient clinical data included success rate of puncture, detection rate of tip malposition with ultrasonography, adjustment rate after X-ray, and success rate of peripherally inserted central catheter placement. Results: The success rate of puncture was 100% (954/954). Detection rate of tip malposition with ultrasonography was 82.1% (78/95). The success rate of ultrasound-guided tip navigation was 98.2% (937/954). The success rate of ultrasound-guided tip location was 98.0% (935/954). Adjustment rate after X-ray was 1.79% (17/952). The final success rate of peripherally inserted central catheter placement was 99.8% (952/954). Conclusion: Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.

PECULIARITIES OF THE RADIATION PATTERN OF THE BRAIN AND INTERNAL ORGANS OF NEWBORNS WHO UNDERWENT SEVERE PERINATAL ASPHYXIA AND UNDERWENT GENERAL THERAPEUTIC HYPOTHERMIA, ACCORDING TO THE PILOT STUDY RESULTS

2021 ◽  
Vol 100 (1) ◽  
pp. 30-35
Author(s):  
N.S. Vorotyntseva ◽  
◽  
V.V. Orlova ◽  
A.N. Motina ◽  
A.D. Novikova ◽  
...  
Keyword(s):  
Therapeutic Hypothermia ◽  
Perinatal Asphyxia ◽  
Control Group ◽  
Internal Organs ◽  
X Ray ◽  
Abdominal Organs ◽  
Study Results ◽  
Negative Effect ◽  
Chest X Ray ◽  
The Brain

Objective of the research: to study the features of the radiological picture of the brain and internal organs of newborns with severe perinatal asphyxia, who underwent general therapeutic hypothermia (GTH). Materials and methods: the study included 116 newborns with severe perinatal asphyxia. GTH was performed in 72 patients (group 1), 44 children did not receive hypothermia in the 2 (control) group. In the first 6 hours of life, children of groups 1 and 2 underwent ultrasound of the brain and abdominal organs and chest x-ray. The complex ultrasound scan was repeated at 3–5, 7–10, 14–16 and 21–28 days. Repeated chest x-ray was carried out strictly according to the indications. Results: GTH reduced the incidence of organic brain lesions by 18% in children with severe perinatal asphyxia (p0,05). The study revealed a number of undesirable consequences associated with GTH. Transient effusion into the abdominal and thoracic cavities was diagnosed by ultrasound in 8 (11%) patients after hypothermia, while there were no such changes in children in the control group (p<0,05). X-ray of the chest in newborns who received GTH during the first 14 days revealed edematous-hemorrhagic changes in the lungs more often than in patients of the control group – 55 (76%) and 24 (55%), respectively (p<0,05). Conclusions: GTH effectively prevented the development of severe post-hypoxic changes in the brain. The negative effect of hypothermia on microcirculation was manifested by the development of effusion into the serous cavities and edematous-hemorrhagic syndrome.

scholarly journals Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound

2020 ◽  
Vol 180 (1) ◽  
pp. 137-146
Author(s):  
Nora Tusor ◽  
Angela De Cunto ◽  
Yousef Basma ◽  
John L. Klein ◽  
Virginie Meau-Petit
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Lung Ultrasound ◽  
Clinical Laboratory ◽  
Control Group ◽  
Ventilator Associated Pneumonia ◽  
Lung Pathology ◽  
Rater Agreement ◽  
X Ray ◽  
Chest X Ray

AbstractNo consensus exists regarding the definition of ventilator-associated pneumonia (VAP) in neonates and reliability of chest X-ray (CXR) is low. Lung ultrasound (LU) is a potential alternative diagnostic tool. The aim was to define characteristics of VAP in our patient population and propose a multiparameter score, incorporating LU, for VAP diagnosis. Between March 25, 2018, and May 25, 2019, infants with VAP were identified. Clinical, laboratory and microbiology data were collected. CXRs and LU scans were reviewed. A multiparameter VAP score, including LU, was calculated on Day 1 and Day 3 for infants with VAP and for a control group and compared with CXR. VAP incidence was 10.47 episodes/1000 ventilator days. LU and CXR were available for 31 episodes in 21 infants with VAP, and for six episodes in five patients without VAP. On Day 1, a VAP score of > 4, and on Day 3 a score of > 5 showed sensitivity of 0.94, and area under the curve of 0.91 and 0.97, respectively. AUC for clinical information only was 0.88 and for clinical and CXR 0.85.Conclusion: The multiparameter VAP score including LU could be useful in diagnosing VAP in neonates with underlying lung pathology. What is Known:• Ventilator associated pneumonia (VAP) is common in infants on the neonatal unit and is associated with increased use of antibiotics, prolonged ventilation and higher incidence of chronic lung disease.• Commonly used definitions of VAP are difficult to apply in neonates and interpretation of chest X-ray is challenging with poor inter-rater agreement in patients with underlying chronic lung disease. What is New:• The multiparameter VAP score combining clinical, microbiology and lung ultrasound (LU) data is predictive for VAP diagnosis in preterm infants with chronic lung disease.• LU findings of VAP in neonates showed high inter-rater agreement and included consolidated lung areas, dynamic bronchograms and pleural effusion.

scholarly journals Subcutaneous tunneling technique to improve outcomes for patients undergoing chemotherapy with peripherally inserted central catheters: a randomized controlled trial

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110045
Author(s):  
Mao-fang Xiao ◽  
Cai-qiong Xiao ◽  
Jia Li ◽  
Can Dai ◽  
Yu-ying Fan ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Patient Comfort ◽  
Maintenance Cost ◽  
Control Group ◽  
Peripherally Inserted Central Catheters ◽  
Catheter Dislodgement ◽  
Subcutaneous Tunneling ◽  
And Control ◽  
Experimental Group ◽  
Central Catheters

Objective To compare the value of the subcutaneous tunneling technique versus the normal technique in improving the outcomes of patients undergoing chemotherapy with peripherally inserted central catheters (PICCs). Methods One hundred thirty patients were randomly divided into an experimental group (subcutaneous tunneling technique) and control group (normal technique) according to the PICC placement technique, and clinical data were compared between the groups. Results In total, 129 PICCs were successfully inserted. Compared with the control group, the experimental group had a lower occurrence of complications after placement (especially catheter dislodgement: 3.1% vs. 15.4%, venous thrombosis: 3.1% vs. 15.4%, and wound oozing: 14.1% vs. 27.7%), lower occurrence of unscheduled PICC removal (3.1% vs. 13.8%), greater comfort during placement (14.16 ± 2.21 vs. 15.09 ± 2.49 on a scale ranging from 6 to 30 points, with higher scores indicating lower degrees of comfort), and lower costs of PICC maintenance (median (interquartile range) per-day maintenance cost: 13.90 (10.99–32.83) vs. 15.69 (10.51–57.46) Yuan). The occurrence of complications and amount of bleeding during placement were not significantly different between the two groups. Conclusions The subcutaneous tunneling technique can improve PICC placement by reducing complications and costs of maintenance with better patient comfort during placement.

scholarly journals An Artificial Intelligence–Based Chest X-ray Model on Human Nodule Detection Accuracy From a Multicenter Study

2021 ◽  
Vol 4 (12) ◽  
pp. e2141096
Author(s):  
Fatemeh Homayounieh ◽  
Subba Digumarthy ◽  
Shadi Ebrahimian ◽  
Johannes Rueckel ◽  
Boj Friedrich Hoppe ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Multicenter Study ◽  
Detection Accuracy ◽  
X Ray ◽  
Nodule Detection ◽  
Chest X Ray

scholarly journals Effectiveness of Regdanvimab in Patients With Mild-to-moderate COVID-19: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Seong Jin Choi ◽  
Sang-Won Park ◽  
Eunyoung Lee
Keyword(s):  
Statistical Significance ◽  
Supplemental Oxygen ◽  
Control Group ◽  
X Ray ◽  
Significant Difference ◽  
Lower Oxygen ◽  
Oxygen Supplement ◽  
Chest X Ray ◽  
Baseline Characteristics ◽  
Oxygen Requirements

Abstract BackgroundMonoclonal antibodies are a treatment option for patients with mild-to-moderate coronavirus disease (COVID-19). We investigated the effectiveness of regdanvimab, an anti-SARS-CoV-2 monoclonal antibody approved in South Korea, in the treatment of patients with mild-to-moderate COVID-19. MethodsMedical records of mild-to-moderate COVID-19 patients admitted to a COVID-19 designated hospital were reviewed to assess baseline characteristics (age, gender, BMI, and comorbidities) and clinical outcomes such as supplemental oxygen requirements, mortality, and length of hospitalization.ResultsFour hundred seventy-four COVID-19 patients were included in the study, and 66 of them were administered regdanvimab. The proportion of patients requiring supplemental oxygen was significantly lower in the regdanvimab group than in control group without statistical significance (6.1% vs. 22.8%, P = 0.001). There was no significant difference in mortality (0% vs 1.2%, P > 0.999) and the length of hospitalization (median: 10.5 days vs. 7.5 days, P = 0.067) between both groups. Increasing age, male sex, chest X-ray abnormality, underlying chronic kidney disease and administration of regdanvimab were found to have a significant univariate association with oxygen requirement. The multivariate analysis demonstrated that increasing age (OR: 1.03, 95% CI: 1.01-1.05, P < 0.001) and chest X-ray abnormality (OR: 4.40, 95% CI: 2.49-8.21, P < 0.001) were independently associated with higher requirement of oxygen and administration of regdanvimab was independently associated with lower oxygen supplement (OR: 0.17, 95% CI: 0.05-0.47, P < 0.002). ConclusionsRegdanvimab reduced the need for supplemental oxygen and fatalities in mild-to-moderate COVID-19 patients who matching the indications for administration of regdanvimab.

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