scholarly journals Time and resources of peripherally inserted central catheter insertion procedures: a comparison between blind insertion/chest X-ray and a real time tip navigation and confirmation system

2017 ◽  
Vol Volume 9 ◽  
pp. 115-125 ◽  
Author(s):  
Kenneth Tomaszewski ◽  
Nicole Ferko ◽  
Sarah Hollmann ◽  
Simona Eng ◽  
Howard Richard ◽  
...  
2018 ◽  
Vol 20 (2) ◽  
pp. 128-133 ◽  
Author(s):  
Céline Monard ◽  
Mathilde Lefèvre ◽  
Fabien Subtil ◽  
Vincent Piriou ◽  
Jean-Stephane David

Objectives: To confirm the feasibility of intracavitary electrocardiogram guidance to verify tip’s position during insertion of peripherally inserted central catheter and to identify clinical factors or intracavitary electrocardiogram patterns associated with aberrant tip’s position. Methods: A prospective study was conducted in our university hospital after authorization of the ethics committee. All patients addressed for peripherally inserted central catheter insertion were included and received the insertion using intracavitary electrocardiogram and electromagnetic guidance. Side of insertion and three electrocardiogram factors were collected: visualization of P-wave at baseline (sinusal rhythm), acquisition of the maximal P-wave and the negative deflection. All patients had a systematic post-procedural chest X-ray. One of the investigators assessed all chest X-ray, blinded to the results of intracavitary electrocardiogram, and confirmed whether the tip’s position on chest X-ray matched with the intracavitary electrocardiogram information or if the tip was malpositioned on chest X-ray (mismatch with intracavitary electrocardiogram or aberrant position). Factors associated with malposition were described. Results: From January 2015 to April 2015, 330 patients were eligible, 5 had an uninterpretable chest X-ray, and 14 were non-sinusal at baseline. Our main analysis population included 311 patients. We observed a mismatch between intracavitary electrocardiogram and chest X-ray estimate of the tip’s position in 3 cases (1%) and an aberrant tip’s position occurred in 3 cases (1%). Incidence of malposition was higher in the group of patients with non-sinusal rhythm (14%) and when the catheter was inserted on the left side (7%). Conclusion: This study confirmed the feasibility of intracavitary electrocardiogram for peripherally inserted central catheter positioning and the limits of chest X-ray. Insertion on left side may represent risk factor for aberrant position but our study lacked power to establish a statistical link.


2021 ◽  
pp. 112972982110189
Author(s):  
Alfonso Piano ◽  
Annamaria Carnicelli ◽  
Emanuele Gilardi ◽  
Nicola Bonadia ◽  
Kidane Wolde Sellasie ◽  
...  

We report a case of primary malposition of a PICC inserted by guidewire replacement in the emergency room. Intraprocedural tip location by intracavitary electrocardiography was not feasible because the patient had atrial fibrillation; intraprocedural tip location by ultrasound (using the so-called “bubble test”) showed that the tip was not in the superior vena cava or in the right atrium. A post-procedural chest X-ray confirmed the malposition but could not precise the location of the tip. A CT scan (scheduled for other purposes) finally visualized the tip in a very unusual location, the left pericardiophrenic vein.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rajit Nair ◽  
Santosh Vishwakarma ◽  
Mukesh Soni ◽  
Tejas Patel ◽  
Shubham Joshi

Purpose The latest 2019 coronavirus (COVID-2019), which first appeared in December 2019 in Wuhan's city in China, rapidly spread around the world and became a pandemic. It has had a devastating impact on daily lives, the public's health and the global economy. The positive cases must be identified as soon as possible to avoid further dissemination of this disease and swift care of patients affected. The need for supportive diagnostic instruments increased, as no specific automated toolkits are available. The latest results from radiology imaging techniques indicate that these photos provide valuable details on the virus COVID-19. User advanced artificial intelligence (AI) technologies and radiological imagery can help diagnose this condition accurately and help resolve the lack of specialist doctors in isolated areas. In this research, a new paradigm for automatic detection of COVID-19 with bare chest X-ray images is displayed. Images are presented. The proposed model DarkCovidNet is designed to provide correct binary classification diagnostics (COVID vs no detection) and multi-class (COVID vs no results vs pneumonia) classification. The implemented model computed the average precision for the binary and multi-class classification of 98.46% and 91.352%, respectively, and an average accuracy of 98.97% and 87.868%. The DarkNet model was used in this research as a classifier for a real-time object detection method only once. A total of 17 convolutionary layers and different filters on each layer have been implemented. This platform can be used by the radiologists to verify their initial application screening and can also be used for screening patients through the cloud. Design/methodology/approach This study also uses the CNN-based model named Darknet-19 model, and this model will act as a platform for the real-time object detection system. The architecture of this system is designed in such a way that they can be able to detect real-time objects. This study has developed the DarkCovidNet model based on Darknet architecture with few layers and filters. So before discussing the DarkCovidNet model, look at the concept of Darknet architecture with their functionality. Typically, the DarkNet architecture consists of 5 pool layers though the max pool and 19 convolution layers. Assume as a convolution layer, and as a pooling layer. Findings The work discussed in this paper is used to diagnose the various radiology images and to develop a model that can accurately predict or classify the disease. The data set used in this work is the images bases on COVID-19 and non-COVID-19 taken from the various sources. The deep learning model named DarkCovidNet is applied to the data set, and these have shown signification performance in the case of binary classification and multi-class classification. During the multi-class classification, the model has shown an average accuracy 98.97% for the detection of COVID-19, whereas in a multi-class classification model has achieved an average accuracy of 87.868% during the classification of COVID-19, no detection and Pneumonia. Research limitations/implications One of the significant limitations of this work is that a limited number of chest X-ray images were used. It is observed that patients related to COVID-19 are increasing rapidly. In the future, the model on the larger data set which can be generated from the local hospitals will be implemented, and how the model is performing on the same will be checked. Originality/value Deep learning technology has made significant changes in the field of AI by generating good results, especially in pattern recognition. A conventional CNN structure includes a convolution layer that extracts characteristics from the input using the filters it applies, a pooling layer that reduces calculation efficiency and the neural network's completely connected layer. A CNN model is created by integrating one or more of these layers, and its internal parameters are modified to accomplish a specific mission, such as classification or object recognition. A typical CNN structure has a convolution layer that extracts features from the input with the filters it applies, a pooling layer to reduce the size for computational performance and a fully connected layer, which is a neural network. A CNN model is created by combining one or more such layers, and its internal parameters are adjusted to accomplish a particular task, such as classification or object recognition.


2009 ◽  
Vol 28 (3) ◽  
pp. 179-183 ◽  
Author(s):  
Carol Trotter

A NUMBER OF SERIOUS COMPLICATIONS can arise from malpositioned central venous catheters (CVCs), including cardiac tamponade and perforation, pleural effusions, and infusion into the vertebral venous system anywhere along the spinal column. Figure 1 is an x-ray of a premature infant taken after insertion of a 2.0 Silastic peripherally inserted central catheter (PICC), demonstrating the catheter entering the left ascending lumbar vein (ALV). Routine contrast injection of 0.3 mL of iothalamate meglumine 60 percent (Conray, Covidien Imaging Solutions, Hazelwood, Missouri) at the time of the PICC-placement film demonstrated that the contrast material extended into the vertebral venous plexus. The catheter was immediately withdrawn before intravenous fluid was administered, and the infant experienced no complications.


2018 ◽  
Vol 19 (6) ◽  
pp. 609-614 ◽  
Author(s):  
Soshi Nakamuta ◽  
Toshihiro Nishizawa ◽  
Shiori Matsuhashi ◽  
Arata Shimizu ◽  
Toshio Uraoka ◽  
...  

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.


2021 ◽  
Vol 11 (1) ◽  
pp. 114-119
Author(s):  
Ying Wu ◽  
Guohua Huang ◽  
Qiufeng Li ◽  
Jinai He

Objective: The objective is to explore the application of computed X-ray tomography (CT) imaging technology in peripherally inserted central catheter (PICC), and to propose a more effective method for PICC catheterization. Method: In this study, 69 subjects are divided into the observation group (X-ray and CT) and the control group (X-ray). The guiding effect of CT images on PICC tube placement in complex cases is compared. In this study, CT localization of the superior vena cava–caval-atrial junction (CAJ) is used as the gold standard. The position relationship of carina-CAJ and carina-PICC catheter tip is measured and analyzed by CT image and chest radiography (CXR) image, providing scientific basis for PICC tip imaging. Results: After this study, the tip of the catheter should be 1/3 of the middle and lower part of the superior vena cava, about 3 cm above the junction of the right atrium and the superior vena cava, and in the upper part of the diaphragm of the inferior vena cava, so that it cannot enter the right ventricle or the right atrium. The best position of the tip of the catheter is near the junction of the superior vena cava and the right atrium. The average vertical distance between the tracheal carina and CAJ is 4.79 cm. Conclusion: CT and X-ray examination can effectively determine the location of the tip of PICC catheter in cancer chemotherapy patients, but the clarity of X-ray examination is missing. It is suggested to adopt CT examination, and further adopt and promote it.


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