Taking the Leap From PICC Placement to Tip Placement

2007 ◽  
Vol 12 (3) ◽  
pp. 148-155 ◽  
Author(s):  
Timothy Royer ◽  
Ann Earhart
Keyword(s):  
United States ◽  
Vascular Access ◽  
The United States ◽  
Scope Of Practice ◽  
X Rays ◽  
Peripherally Inserted Central Catheters ◽  
X Ray ◽  
Primary Physician ◽  
Picc Line ◽  
Central Catheters

Abstract Nurses who place peripherally inserted central catheters (PICCs) obtain x-rays after placement to determine tip placement. Radiologists read and interpret the x-ray to verify tip placement. It is then the primary physician or the radiologist who releases the PICC line for use. Until 2002, there were few institutions across the United States that empowered the vascular access nurse to take on this responsibility. This article discusses how to advance practice at the state-board-of-nursing level and discusses strategies to implement the change in scope of practice.

scholarly journals Treating Cancer With X-ray Radiation Therapy

2021 ◽  
Vol 9 ◽  
Author(s):  
Kristopher A. Lyons ◽  
Theodore H. Arsenault ◽  
Zi Ouyang
Keyword(s):  
United States ◽  
Radiation Therapy ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
The United States ◽  
X Rays ◽  
Receive Radiation Therapy ◽  
X Ray

Radiation therapy is an important cancer treatment. At least half of the cancer patients in the United States receive radiation therapy every year. X-rays are often used in radiation therapy. How are X-rays produced? How do we use X-rays to treat cancer? This article answers these questions and explains the physics behind radiation therapy.

Sensitivity and Detectability Limits for Elemental Analysis by Proton-Induced X-Ray Fluorescence with A 3 Mv Van De Graaff

1972 ◽  
Vol 16 ◽  
pp. 102-110
Author(s):  
C. J. Umbarger ◽  
R. C. Bearse ◽  
D. A. Close ◽  
J. J. Malanify
Keyword(s):  
United States ◽  
Cross Sections ◽  
Production Cross ◽  
The United States ◽  
X Rays ◽  
Biomedical Analysis ◽  
X Ray ◽  
Detector Geometry ◽  
Van De Graaff ◽  
Beam Parameters

AbstractProtons from a 3 MV Van de Graaff have been used to produce characteristic x-rays from 21 elements spanning the periodic table. Absolute Kα and Lα x-ray production cross sections have been determined, allowing one to calculate sensitivities for any given sample, detector geometry, and proton beam parameters. Elemental detectability limits are discussed assuming various backings (e.g., mylar, kapton, etc.) and matrix materials. The large number of available small proton accelerators throughout the United States promises wide applicability of this technique to environmental and biomedical analysis.

Differences in Initial Hemodialysis Vascular Access Use Among Glomerulonephritis Subtypes in the United States

2016 ◽  
Vol 67 (4) ◽  
pp. 638-647 ◽  
Author(s):  
Michelle M. O’Shaughnessy ◽  
Maria E. Montez-Rath ◽  
Yuanchao Zheng ◽  
Richard A. Lafayette ◽  
Wolfgang C. Winkelmayer
Keyword(s):  
United States ◽  
Vascular Access ◽  
The United States ◽  
Hemodialysis Vascular Access

scholarly journals Gender Disparities in Vascular Access Surgical Outcomes in Elderly Hemodialysis Patients

2018 ◽  
Vol 49 (1) ◽  
pp. 11-19 ◽  
Author(s):  
Timmy Lee ◽  
Joyce Qian ◽  
Mae Thamer ◽  
Michael Allon
Keyword(s):  
United States ◽  
Vascular Access ◽  
Surgical Outcomes ◽  
Relative Rate ◽  
Venous Catheter ◽  
The United States ◽  
Hemodialysis Patients ◽  
Elderly Male ◽  
Female Patients ◽  
Arteriovenous Fistulas

Background: Despite national vascular access guidelines promoting the use of arteriovenous fistulas (AVF) over arteriovenous grafts (AVGs) for dialysis, AVF use is substantially lower in females. We assessed clinically relevant AVF and AVG surgical outcomes in elderly male and female patients initiating hemodialysis with a central venous catheter (CVC). Methods: Using the United States Renal Data System standard analytic files linked with Medicare claims, we assessed incident hemodialysis patients in the United States, 9,458 elderly patients (≥67 years; 4,927 males and 4,531 females) initiating hemodialysis from July 2010 to June 2011 with a catheter and had an AVF or AVG placed within 6 months. We evaluated vascular access placement, successful use for dialysis, assisted use (requiring an intervention before successful use), abandonment after successful use, and rate of interventions after successful use. Results: Females were less likely than males to receive an AVF (adjusted likelihood 0.57, 95% CI 0.52–0.63). Among patients receiving an AVF, females had higher adjusted likelihoods of unsuccessful AVF use (hazard ratio [HR] 1.46, 95% CI 1.36–1.56), assisted AVF use (OR 1.34, 95% CI 1.17–1.54), and AVF abandonment (HR 1.28, 95% CI 1.10–1.50), but similar relative rate of AVF interventions after successful use (relative risk [RR] 1.01, 95% CI 0.94–1.08). Among patients receiving an AVG, females had a lower likelihood of unsuccessful AVG use (HR 0.83, 95% CI 0.73–0.94), similar rates of assisted AVG use (OR 1.05, 95% CI 0.78–1.40) and AVG abandonment, and greater relative rate of interventions after successful AVG use (RR 1.16, 95% CI 1.01–1.33). Conclusions: While AVFs should be considered the preferred vascular access in most circumstances, clinical AVF surgical outcomes are uniformly worse in females. Clinicians should also consider AVGs as a viable alternative in elderly female patients initiating hemodialysis with a CVC to avoid extended CVC dependence.

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.

scholarly journals 1184. Making Pneumonia Surveillance Easy: Automation of Pneumonia Case Detection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S424-S425
Author(s):  
Dan Ding ◽  
Anna Stachel ◽  
Eduardo Iturrate ◽  
Michael Phillips
Keyword(s):  
Language Processing ◽  
Cost Effective ◽  
The United States ◽  
Surveillance Data ◽  
X Rays ◽  
Healthcare Facilities ◽  
X Ray ◽  
Chest X Ray ◽  
Sensitivity Specificity ◽  
Time Critical

Abstract Background Pneumonia (PNU) is the second most common nosocomial infection in the United States and is associated with substantial morbidity and mortality. While definitions from CDC were developed to increase the reliability of surveillance data, reduce the burden of surveillance in healthcare facilities, and enhance the utility of surveillance data for improving patient safety - the algorithm is still laborious. We propose an implementation of a refined algorithm script which combines two CDC definitions with the use of natural language processing (NLP), a tool which relies on pattern matching to determine whether a condition of interest is reported as present or absent in a report, to automate PNU surveillance. Methods Using SAS v9.4 to write a query, we used a combination of National Healthcare Safety Network’s (NHSN) PNU and ventilator-associated event (VAE) definitions that use discrete fields found in electronic medical records (EMR) and trained an NLP tool to determine whether chest x-ray report was indicative of PNU (Fig1). To validate, we assessed sensitivity/specificity of NLP tool results compared with clinicians’ interpretations. Results The NLP tool was highly accurate in classifying the presence of PNU in chest x-rays. After training the NLP tool, there were only 4% discrepancies between NLP tool and clinicians interpretations of 223 x-ray reports - sensitivity 92.2% (81.1–97.8), specificity 97.1% (93.4–99.1), PPV 90.4% (79.0–96.8), NPV 97.7% (94.1–99.4). Combining the automated use of discrete EMR fields with NLP tool significantly reduces the time spent manually reviewing EMRs. A manual review for PNU without automation requires approximately 10 minutes each day per admission. With a monthly average of 2,350 adult admissions at our hospital and 16,170 patient-days for admissions with at least 2 days, the algorithm saves approximately 2,695 review hours. Conclusion The use of discrete EMR fields with an NLP tool proves to be a timelier, cost-effective yet accurate alternative to manual PNU surveillance review. By allowing an automated algorithm to review PNU, timely reports can be sent to units about individual cases. Compared with traditional CDC surveillance definitions, an automated tool allows real-time critical review for infection and prevention activities. Disclosures All authors: No reported disclosures.

scholarly journals Results from the 1977 coordinated observing campaign on HDE 226868 = Cygnus X-1

1979 ◽  
Vol 83 ◽  
pp. 297-298
Author(s):  
C. T. Bolton
Keyword(s):  
United States ◽  
Great Britain ◽  
Soviet Union ◽  
The United States ◽  
Radio Flux ◽  
International Astronomical Union ◽  
X Ray ◽  
The Soviet Union ◽  
International Astronomical ◽  
Flux Measurements

A coordinated campaign of radio, optical, and x-ray observations of the bright x-ray source Cygnus X-1 took place August 7–21, 1977 under sponsorship of Commission 42 of the International Astronomical Union. Radio flux measurements, optical spectra, photometry, and polarimetry were obtained during this period by ten groups from Canada, Great Britain, the Soviet Union, and the United States. The x-ray flux was monitored continuously by the SAS-3 satellite between August 11.0 and 17.0.

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