The importance of high-volume specialist centres. An audit of bilateral adrenal vein catheterization success rates

2021 ◽  
Author(s):  
Zaid Alsafi ◽  
Florian Wernig ◽  
Ali Alsafi
Keyword(s):  
High Volume ◽  
Adrenal Vein ◽  
Success Rates ◽  
Vein Catheterization

scholarly journals Outcomes of precut sphincterotomy techniques in cases of difficult biliary access

2020 ◽  
pp. flgastro-2019-101380
Author(s):  
Jared Rejeski ◽  
Marc Hines ◽  
Jason Jones ◽  
Jason Conway ◽  
Girish Mishra ◽  
...  
Keyword(s):  
High Volume ◽  
Complication Rates ◽  
Success Rates ◽  
Biliary Cannulation ◽  
Pancreatic Duct Stenting ◽  
Significant Difference ◽  
Effective Option ◽  
Needle Knife ◽  
Precut Sphincterotomy ◽  
Rectal Indomethacin

GoalsOur study aims to define success and complication rates of precut sphincterotomy with the needle-knife and transpancreatic papillary septotomy (TPS) techniques as experienced at a single, high-volume endoscopy centre.BackgroundComplication rates rise with increasing number of failed attempts at biliary cannulation; therefore, early precut sphincterotomy (PS) has been recommended. Selecting the ideal method for PS can be challenging and there is a paucity of data to help guide this decision.StudyWe performed a retrospective analysis over 37 months of endoscopic retrograde cholangiopancreatography (ERCP) experience at a single institution. We identified all ERCPs performed and stratified based on the presence of PS; if PS occurred, a thorough chart review was performed to identify success and complication rates. Patients received guideline-driven management for post-ERCP pancreatitis including rectal indomethacin and pancreatic duct stenting when appropriate.ResultsWe identified 1808 ERCP procedures performed during this time. Successful biliary cannulation was achieved in 1748 cases, yielding a success rate of 96.7% (Grades I–IV ERCP difficulty/complexity). PS was required in 232 cases (12.8%); we identified 88 TPS cases and 114 needle-knife precut sphincterotomy (NKPS) cases. Complications following PS procedures occurred in 9.1% of TPS patients and 11.4% of NKPS patients. Success rates for TPS and NKPS were 97.7% and 81.6%, respectively—a statistically significant difference (p<0.001).ConclusionThis data supports TPS as a safe and effective option for biliary access in difficult cannulation settings when performed by experienced advanced endoscopists.

Factors Influencing Successful Intubation in the Prehospital Setting

1995 ◽  
Vol 10 (4) ◽  
pp. 259-264 ◽  
Author(s):  
James V. Doran ◽  
Bartholomew J. Tortella ◽  
Walter J. Drivet ◽  
Robert F. Lavery
Keyword(s):  
Airway Management ◽  
Endotracheal Intubation ◽  
Life Support ◽  
Advanced Life Support ◽  
High Volume ◽  
Success Rates ◽  
Structured Interviews ◽  
Technical Problems ◽  
Patients Âgés ◽  
Prehospital Airway Management

AbstractObjective:To explore the determinants influencing oral/nasal endotracheal intubation (OETI/NETI) and determine which cognitive, therapeutic, and technical interventions may assist prehospital airway management.Design, Setting, and Participants:Prospective review of run reports and structured interviews of paramedics involved in OETI/NETI attempts were conducted in a high-volume, inner-city, advanced life support (ALS) system during an eight-month period (July 1991 to February 1992). Data were abstracted from run reports, and paramedics were asked in structured interviews to describe difficulties in OETI/NETI attempts.Results:Of 236 patients studied, 88% (208) were intubated successfully. Success/failure rate was not related statistically to patients' ages (p = 0. 78), medical or trauma complaint (89% vs 85%, p = 0.35), oral versus nasal route (88% vs 85%, p = 0.38), care time (scene + transport times: success, 18 minutes; failure, 20 minutes, p = 0.30), paramedic seniority (p = 0.13), or number of attempts per paramedic (p >0.05). Increased level of consciousness (LOC) was associated with decreased success rate (p = 0.04). Paramedics reported difficulties in endotracheal intubation (ETI) attempts in 110 (46.6%) of patients. Factors reported to increase ETI difficulty were: 1) technical problems (35.6%); 2) mechanical problems (15.6%); and 3) combative patients (12.7%).Conclusions:Oral endotracheal intubation and NETI success rates identified in this study are similar to those described in the literature, although innovative strategies could be used to facilitate prehospital airway management. Many of the factors found to increase ETI difficulty could be ameliorated by the administration of paralytic agents, that is, for combative patients. Focused training in cadaver and animal labs coupled with recurrence training in the operating suites should be used on a regular basis to decrease difficulties in visualization. Interventions directed at alleviating mechanical difficulties that should be explored include new-to-the-field techniques, such as retrograde intubation, fiber-optic technology, and surgical tracheal access.

scholarly journals Adrenal vein sampling using rapid cortisol assays in primary aldosteronism is useful in centers with low success rates

2011 ◽  
Vol 165 (2) ◽  
pp. 301-306 ◽  
Author(s):  
Matthias J Betz ◽  
Christoph Degenhart ◽  
Evelyn Fischer ◽  
Anna Pallauf ◽  
Volker Brand ◽  
...  
Keyword(s):  
Success Rate ◽  
Primary Aldosteronism ◽  
Femoral Vein ◽  
Tertiary Care ◽  
Control Period ◽  
Retrospective Chart Review ◽  
University Hospital ◽  
Adrenal Vein ◽  
Success Rates ◽  
Adrenal Vein Sampling

ObjectiveAdrenal vein sampling (AVS) is considered the gold standard in the differential diagnosis of primary aldosteronism (PA), but success rates vary between centers. We hypothesized that rapid (intraprocedure) cortisol measurement can improve performance in a center with initially low AVS success rate.DesignWe analyzed 46 patients with confirmed PA studied between 2008 and 2010. Forty-seven PA patients studied between 2004 and 2008 identified by retrospective chart review served as controls. All patients were treated at a single tertiary care university hospital.MethodsStarting in 2008, rapid cortisol assays (RCA) were performed in all patients during the AVS procedure. A cortisol gradient of ≥2.0 between adrenal vein and a femoral vein sample was used as success criterion. Up to two repeat samples were drawn if adrenal vein cortisol was below this threshold.ResultsDuring the control period 26 of 47 AVS were successful (55%). After introduction of RCA, 39 out of 46 AVS (85%) were successful (P=0.003). In 21 of the 46 cases (46%) a resampling was necessary. The increase in overall success was due to an increase in successful right AVS (85 vs 62% before introduction of RCA; P=0.02) and a training effect (P=0.024 for trend).ConclusionRCA during AVS are useful in centers with an initially low AVS success rate.

scholarly journals ORAL ABSTRACTS (3)EP & Ablation31LEFT ATRIAL POSTERIOR WALL ISOLATION (THE “BOX LESION PATTERN”) IN THE TREATMENT OF ATRIAL FIBRILLATION: A SINGLE CENTRE EXPERIENCE32DAY CASE CRYOBLATION (CRYO) FOR PAROXYSMAL ATRIAL FIBRILLATION (pAF) IN THE DISTRICT GENERAL HOSPITAL IS SAFE AND EFFECTIVE IF DONE IN HIGH VOLUME WITH EXPERIENCED OPERATORS33ABLATION INDEX-GUIDED PULMONARY VEIN ISOLATION FOR ATRIAL FIBRILLATION MAY IMPROVE CLINICAL OUTCOMES IN COMPARISON TO CONTACT FORCE-GUIDED ABLATION34THE PROCEDURAL COMPLICATION RATES AND SHORT-TERM SUCCESS RATES OF THORACOSCOPIC AF ABLATION DURING THE INSTITUTIONAL LEARNING CURVE35INITIAL PROCEDURAL RESULTS FROM DDRAMATIC-SVT STUDY: DD MECHANISM IDENTIFICATION AND LOCALISATION USING DIPOLE DENSITY MAPPING TO GUIDE ABLATION STRATEGY36MORBIDITY AND MORTALITY IN MIDDLE-AGED INDIVIDUALS WITH ATRIAL FIBRILLATION: UK BIOBANK DATAClinical EP37THE GM AHSN AF LANDSCAPE TOOL: A SHARED PUBLIC DATA PLATFORM TO PROMOTE QUALITY IMPROVEMENTS AND IDENTIFY OPPORTUNITIES TO PREVENT AF-RELATED STROKE IN THE DEVOLVED GREATER MANCHESTER HEALTH SYSTEM38REAL WORLD PERSISTENCE, ADHERENCE AND SWITCH-OVER ACROSS ANTICOAGULANTS IN ATRIAL FIBRILLATION-A NATIONAL POPULATION-BASED STUDY39ORTHOSTATIC HYPOTENSION AND ATRIAL FIBRILLATION40PREVALENCE OF SHORT QT AND CRITERIA OF SEVERITY IN A YOUNG ASYMPTOMATIC COHORT41SURFACE ELECTROCARDIOGRAPHIC FEATURES AND PREVALENCE OF ARRHYTHMIAS IN PAEDIATRIC FRIEDREICH'S ATAXIA42RISK STRATIFICATION OF TYPE 1 MYOTONIC DYSTROPHY: IS THE ECG ACCURATE ENOUGH TO SELECT PATIENTS AT RISK OF BRADYARRHYTHMIC EVENTS?

EP Europace ◽  
2016 ◽  
Vol 18 (suppl 2) ◽  
pp. ii13-ii17
Author(s):  
G.O. Furniss ◽  
A. Opel ◽  
A. Hussein ◽  
C.M. Pearman ◽  
A. Grace ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
High Volume ◽  
District General Hospital ◽  
Posterior Wall ◽  
Population Based ◽  
Complication Rates ◽  
Success Rates ◽  
Density Mapping ◽  
Lesion Pattern ◽  
Public Data

scholarly journals Outcomes of Balloon Angioplasty and Stenting for Symptomatic Intracranial Atherosclerotic Stenosis at a High Volume Center

2021 ◽  
pp. 63-67
Author(s):  
Toshihiro Ueda ◽  
Tatsuro Takada ◽  
Noriko Usuki ◽  
Satoshi Takaishi ◽  
Yoshiaki Tokuyama ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Balloon Angioplasty ◽  
Early Phase ◽  
Late Phase ◽  
High Volume ◽  
Success Rates ◽  
Term Outcome ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Phase Group

AbstractPurpose: This study investigated the periprocedural complication rates, long-term outcome, and restenosis of endovascular treatment for intracranial atherosclerotic stenosis (ICS) at our hospital.Methods: We retrospectively analyzed the clinical data of 217 patients comprising 256 endovascular treatments for high-grade symptomatic ICS. The lesion was located in the internal carotid artery in 77, the middle cerebral artery in 111, the basilar artery in 29, and the vertebral artery in 39. Patients were divided into two groups, before (early-phase group, 1999–2013) and after approval of Wingspan (late-phase group, 2014–2017).Results: In the early-phase group (n = 163), 157 lesions were treated by balloon angioplasty and 31 (17%) by coronary stenting. In the late-phase group (n = 54), 33 lesions were treated by balloon angioplasty and 35 (52%) by Wingspan stenting. Overall technical success rates were 96% in the balloon angioplasty and 100% in stenting groups. The 30-day rate of stroke, TIA, and death were 4.8% in the early-phase group and 4.4% in the late-phase group. There was one minor stroke and two TIAs during the follow-up period in the late-phase group.Conclusions: Endovascular treatment for symptomatic ICS in this study appeared to be safe and effective if patients are properly selected. However, future well-designed randomized trials with different techniques and modified patients selection criteria are certainly warranted.

scholarly journals Early complications of ultrasound guided central vein catheterization in children

2018 ◽  
Vol 5 (6) ◽  
pp. 2018
Author(s):  
Mehmet Surhan Arda
Keyword(s):  
Great Influence ◽  
Venous Catheter ◽  
Central Line ◽  
Central Vein ◽  
Success Rates ◽  
Early Complications ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Lower Complication ◽  
Vein Catheterization

Background: Since mid-20th century Central Venous Catheter (CVC) has been in use. Cut-down was the initial approach that was followed by Seldinger method. Thereafter, anatomic land-mark has been recommended and finally it was switched to ultrasound (USG) guidance. In adults the lower complication and higher success rates of USG guided catheterization has been reported. However, in children, although it was accepted that USG guidance lowers puncture rates, increased success and decreased complication by USG was controversial.  Methods: Between 01/07/2014 and 31/12/2017 records of patients that were younger than five years old and that were undergone USG guided CVC placing have been extracted. The early complications due to catheterization was evaluated.Results: A total 259 patients met our criteria. All of them have placed catheter successfully whereas mean puncture rate was 1.32. The 18.9% of them necessitated repetitive procedures of whom 44.9% (n= 22) of them have been catheterized from the previous central line. Thrombosis was detected in only 2.7% (n= 7) of them. Arterial puncture was noticed in four.Conclusions: USG guided central vein catheterization is safe and reliable with lower complication. It could be speculated that lower puncture rates might have great influence on patency of vessels.

scholarly journals Ultrasound assisted catheterization of internal jugular vein

2021 ◽  
pp. 48-55
Keyword(s):  
Success Rate ◽  
Internal Jugular Vein ◽  
Vascular Access ◽  
Jugular Vein ◽  
Anatomical Variations ◽  
Central Vein ◽  
Complication Rates ◽  
Success Rates ◽  
Ultrasound Assisted ◽  
Vein Catheterization

An appropriate vascular access is always needed for the success of hemodialysis. Internal jugular vein is the safest and less complicated access in between central veins. At the same time, it is the most commonly used temporary vascular access for hemodialysis. The blind method after anatomical marking for the central vascular path is the most used technique in many centers. The use of ultrasound in the placement of hemodi-alysis catheters in the central vein increases the success rate of catheterization. Ultrasound can show IJV locali-zation, anatomical variations, the presence of thrombus in the vein, and whether the vein is open. The aim of this study is to compare the success rate and complication frequency of temporary catheters placed in the IJV with and without ultrasound for hemodialysis. A total of 124 consecutive patients who required hemodialysis catheters in Haydarpaşa Numune Trai-ning and Research Hospital between February 2012 and December 2012 were randomized to the study. The patients were divided into two groups as non USG-assisted (blindly) (Group 1) and ultrasound-assisted (Group 2). The use of ultrasound significantly increased the successful catheterization rates of both experienced specialist and resident. In addition, there was no statistical difference between the success rates between the specialist and the resident. USG-assisted vein catheterization can be performed safely, easily, quickly, more painlessly and with minimal complication rates. Catheter intervention should be performed under the guidance of USG in risky patient groups who need temporary catheters. In centers that do not have USG, especially in such risky patients, blind catheter interven-tion should not be attempted after anatomical marking. USG-assisted vein catheterization can be easily perfor-med by all clinicians and residents, since the training period is short, practical and much more safe.

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