scholarly journals AI-Enabled, Ultrasound-Guided Handheld Robotic Device for Femoral Vascular Access

Biosensors ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 522
Author(s):  
Laura J. Brattain ◽  
Theodore T. Pierce ◽  
Lars A. Gjesteby ◽  
Matthew R. Johnson ◽  
Nancy D. DeLosa ◽  
...  
Keyword(s):  
Vascular Access ◽  
Porcine Model ◽  
Performance Metrics ◽  
Femoral Vein ◽  
Hospital Setting ◽  
Needle Insertion ◽  
Seldinger Technique ◽  
Portable Ultrasound ◽  
Venous Puncture ◽  
Life Saving

Hemorrhage is a leading cause of trauma death, particularly in prehospital environments when evacuation is delayed. Obtaining central vascular access to a deep artery or vein is important for administration of emergency drugs and analgesics, and rapid replacement of blood volume, as well as invasive sensing and emerging life-saving interventions. However, central access is normally performed by highly experienced critical care physicians in a hospital setting. We developed a handheld AI-enabled interventional device, AI-GUIDE (Artificial Intelligence Guided Ultrasound Interventional Device), capable of directing users with no ultrasound or interventional expertise to catheterize a deep blood vessel, with an initial focus on the femoral vein. AI-GUIDE integrates with widely available commercial portable ultrasound systems and guides a user in ultrasound probe localization, venous puncture-point localization, and needle insertion. The system performs vascular puncture robotically and incorporates a preloaded guidewire to facilitate the Seldinger technique of catheter insertion. Results from tissue-mimicking phantom and porcine studies under normotensive and hypotensive conditions provide evidence of the technique’s robustness, with key performance metrics in a live porcine model including: a mean time to acquire femoral vein insertion point of 53 ± 36 s (5 users with varying experience, in 20 trials), a total time to insert catheter of 80 ± 30 s (1 user, in 6 trials), and a mean number of 1.1 (normotensive, 39 trials) and 1.3 (hypotensive, 55 trials) needle insertion attempts (1 user). These performance metrics in a porcine model are consistent with those for experienced medical providers performing central vascular access on humans in a hospital.

scholarly journals Development of a porcine model of emergency resternotomy at a low-volume cardiac surgery centre

2020 ◽  
Vol 31 (6) ◽  
pp. 803-805
Author(s):  
Timothy M Guenther ◽  
Sarah A Chen ◽  
Joshua D Gustafson ◽  
Curtis J Wozniak ◽  
Bob Kiaii
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Porcine Model ◽  
Comfort Level ◽  
Large Animal Model ◽  
Large Animal ◽  
Training Environment ◽  
Life Saving ◽  
Simulation Scenario ◽  
Low Volume

Abstract Emergency resternotomy in the intensive care unit (ICU) is a rarely performed, yet potentially life-saving intervention. Success relies on recognition of a deteriorating clinical condition, timely deployment of equipment/personnel and rapid execution. Given how infrequently it is performed, we sought to develop a large animal model of resternotomy to prepare ICU nurses and technicians at our low-volume cardiac surgery military centre. A porcine model of resternotomy was developed at the end of an already-scheduled trauma lab. Participants worked their way through a pre-planned simulation scenario, culminating in the need for resternotomy. Pre-simulation surveys assessing knowledge and comfort level with aspects of resternotomy were compared to post-simulation surveys. Participants improved their knowledge of resternotomy by 20.4% (P < 0.0001; 14.7% for nurses and 26.9% for technicians). Improvements were seen in all aspects assessed relating to subjective comfort/preparedness of resternotomy. The model was an effective and realistic method to augment training of ICU staff about resternotomy. Costs associated with this model can be reduced when used in conjunction with large animal labs. This model should be used together with mannequin-based methods of resternotomy training to provide a realistic training environment and assessment of skills at capable institutions.

CONTROL SYSTEM FOR NEEDLE INSERTION INTO THE PERIPHERAL VENOUS VESSEL

2021 ◽  
pp. 122-125
Author(s):  
Екатерина Александровна Витоженц ◽  
Александр Викторович Кобелев
Keyword(s):  
Experimental Studies ◽  
Needle Insertion ◽  
Tissue Type ◽  
Mixed System ◽  
Injection Needle ◽  
Recorded Signal ◽  
Venous Puncture ◽  
Complex Design ◽  
The Moment ◽  
Venous Vessel

Предложен новый способ контроля введения инъекционной иглы в просвет вены на основе измерений электрического импеданса с помощью смешанной системы электродов, состоящей из биполярного и тетраполярного звеньев. Исследованы альтернативные схемы расположения электродов при проведении контроля венозной пункции биоимпедансным методом - они имеют более сложную конструкцию, используют дорогостоящие специализированные коаксиальные иглы, не позволяют однозначно определить факт прокола стенки венозного сосуда, нуждаются в дополнительной фильтрации регистрируемого сигнала с целью корректной интерпретации результата. Эффективность предложенной методики проверялась в ходе экспериментальных исследований на 5 добровольцах. Результаты экспериментов позволили идентифицировать 4 стадии нахождения инъекционной иглы относительно верхней конечности: нет касания, касание кожного покрова, нахождение под кожей коже, попадание в просвет вены. Идентификация положений инъекционной иглы происходит в реальном времени без дополнительной фильтрации регистрируемого сигнала. Метод позволяет обнаружить момент прокола стенки венозного сосуда стандартной инъекционной иглой, что в дальнейшем позволит сэкономить на изготовлении специализированных многослойных игольчатых электродов и внедрить данный способ контроля за проведением венепункции в медицинскую практику. Дальнейшее развитие предложенного подхода предполагает идентификацию двойного прокола вены, дифференцирование типа ткани в процессе введения иглы и исследование возможности определения типа кровеносного сосуда A new method for controlling the penetration of an injection needle into the vein based on measurements of electrical impedance using a mixed system of electrodes consisting of bipolar and tetrapolar parts is proposed. Alternative schemes for the arrangement of electrodes for monitoring venous puncture using the bioimpedance method have been investigated - they have a more complex design, use expensive specialized coaxial needles, do not allow to unambiguously determine the fact of a puncture of the venous vessel wall, require additional filtering of the recorded signal in order to correctly interpret the result. The effectiveness of the proposed technique was tested in experimental studies on 5 volunteers. The results of the experiments made it possible to identify 4 stages of finding the injection needle relative to the upper limb: no touching, touching the skin, being under the skin of the skin, getting into the lumen of the vein. Identification of the positions of the injection needle occurs in real time without additional filtering of the recorded signal. The method allows detecting the moment of puncture of the wall of a venous vessel with a standard injection needle, which in the future will save on the manufacture of specialized multilayer needle electrodes and introduce this method of monitoring venipuncture into medical practice. Further development of the proposed approach involves the identification of a double vein puncture, differentiation of tissue type during needle insertion, and investigation of the possibility of determining the type of blood vessel

Vascular access for Chronic Dialysis using the Superficial Femoral Vein

2003 ◽  
Vol 4 (4) ◽  
pp. 150-153 ◽  
Author(s):  
A. Kapala ◽  
W. SzczȨsny ◽  
W. Stankiewicz ◽  
W. Hryncewicz
Keyword(s):  
Vascular Access ◽  
Femoral Vein ◽  
Chronic Dialysis ◽  
Superficial Femoral Vein

scholarly journals Development and application of a swine model for training ultrasonography-guided central venous access

2020 ◽  
Vol 47 ◽  
Author(s):  
JACKSON VINÍCIUS DE LIMA BERTUOL ◽  
NATASHA LURE BUENO CAMARGO ◽  
FERNANDO ANTONIO CAMPELO SPENCER NETTO ◽  
ANDRÉ PEREIRA WESTPHALEN
Keyword(s):  
Porcine Model ◽  
Low Cost ◽  
Central Venous Access ◽  
Training Session ◽  
Hospital Setting ◽  
Venous Access ◽  
Human Anatomy ◽  
Swine Model ◽  
Central Venous ◽  
Hands On

ABSTRACT Introduction: simulation based teaching is a powerful tool in medical education, allowing hands on practice under a controlled environment and with repeated maneuvers. Central venous access venipuncture is one of the most frequent procedures carried out in the hospital setting, due to its various clinical indications and, when performed with the help of ultrasonography, the risk of adverse events is minimized. Aim: to develop, to describe and to test a porcine model that simulates the central venous access puncture aided by ultrasonography. Method: a low cost porcine model was developed to train medical students and residents on central venous access guided by ultrasonography. Both students and medical residents underwent a theoretical training regarding the model, followed by a hands-on training session. Afterwards, the participants assessed the model by answering a questionnaire. Results: there were 51 participants. The average score regarding the similarity between the model and the human anatomy was 9.15. When the characteristics were separately assessed, the mean scores regarding the similarity of the vessels, anatomic disposition and ultrasonographic characteristics as well as the venipuncture were, respectively, 9.27; 9.31; 9.54 and 8.86. Conclusion: The model was approved and considered appropriate for the training of central venous venipuncture by all the participants. Furthermore, it is a low cost, simple and reproducible model, that presents high similarity with the human anatomy. Therefore, it may be used as an aid to train people on ultrasonography guided central venous access.

The Transposed Femoral Vein Fistula: The Native Choice in Desperate Vascular Access

2019 ◽  
Vol 54 ◽  
pp. 318-327
Author(s):  
Rebecca Lefroy ◽  
Nikesh Dattani ◽  
Mariane Reyes ◽  
Sriram Rajagopalan ◽  
Jack Fairhead ◽  
...  
Keyword(s):  
Vascular Access ◽  
Femoral Vein

Vascular access

2020 ◽  
pp. 43-69
Author(s):  
Andrew Mitchell ◽  
Giovanni Luigi De Maria ◽  
Adrian Banning
Keyword(s):  
Cardiac Catheterization ◽  
Vascular Access ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Venous Access ◽  
Seldinger Technique ◽  
Access Route ◽  
Arterial Access ◽  
Alternative Approach ◽  
Different Types

This chapter discusses different types of vascular access in cardiac catheterization. It starts by describing the Seldinger technique, then goes on to explain which arterial access route to use, including difficulties and reasons for choosing an alternative approach and trends in vascular access. The ways of obtaining arterial access (both radial and femoral) are covered, and venous access is examined for the femoral, internal jugular, and subclavian veins. Anticoagulation issues including warfarin and direct oral anticoagulants are then discussed, and the chapter ends by describing compression devices and arterial closure devices.

Out-Of-Hospital Research in the Urban Environment

1993 ◽  
Vol 8 (S1) ◽  
pp. S20-S24
Author(s):  
Paul E. Pepe
Keyword(s):  
Prehospital Care ◽  
Large Population ◽  
Hospital Setting ◽  
The United States ◽  
Trauma Resuscitation ◽  
Urban Centers ◽  
Care Research ◽  
Life Saving ◽  
Artery Disease ◽  
Patient Studies

The urban prehospital setting is one of the best venues in which to examine life-saving resuscitation interventions. When the entire catchment of the urban emergency medical services (EMS) system is used, large-population patient studies can be generated. Certain unique features give several urban centers the ability to conduct clinical trials in the out-of-hospital setting. Without resuscitation at the scene, it is rare for cardiac arrest patients to survive. In the case of trauma resuscitation, prehospital care can impact outcome significantly. Since coronary artery disease and trauma kill nearly one-million persons annually in the United States, prehospital care research is a worthwhile endeavor. This rationale for prehospital care research is strengthened by the relatively high potential for full recovery.

Prolonged Cannulation of the Femoral Vein Is a Safe Method of Temporary Vascular Access for Hemodialysis

Nephron ◽  
1998 ◽  
Vol 80 (1) ◽  
pp. 86-86 ◽  
Author(s):  
W. Weyde ◽  
I. Wikiera ◽  
M. Klinger
Keyword(s):  
Vascular Access ◽  
Femoral Vein ◽  
Safe Method

A New Method Involving Percutaneous Application in the Treatment of Deep Venous Insufficiency: An Experimental Study With Internal Compression Therapy in a Porcine Model

2020 ◽  
pp. 153857442096611
Author(s):  
Alptekin Yasim ◽  
Erdinc Eroglu ◽  
Sezen Kocarslan ◽  
Atila Yoldas ◽  
Mehmet Acipayam ◽  
...  
Keyword(s):  
Side Effects ◽  
Connective Tissue ◽  
Alcian Blue ◽  
Venous Insufficiency ◽  
Porcine Model ◽  
Femoral Vein ◽  
Compression Therapy ◽  
Collagen I ◽  
Blue Staining ◽  
Genetic Examination

Introduction: To study the efficiency of internal compression therapy (ICT), a new and promising method of treatment for deep venous insufficiency, how that efficiency is achieved, and its potential side-effects, in a porcine model. Material and Methods: The femoral vein diameters of 4 pigs were first measured. ICT was then applied such as to reduce the diameter of these veins by 50%. The femoral vein diameters of 2 pigs were re-measured after 1 month. The femoral vein and its surrounding tissue were excised for immunohistopathological and genetic examination. The same procedures were applied to the remaining 2 pigs 3 months subsequently. Collagen I and IV immunohistochemical staining and Masson’s trichrome and Alcian blue histochemical staining were applied during immunohistopathological examination. Collagen I, III, and IV and connective tissue growth factor (CTGF) mRNA expressions were examined for genetic examination. Results: The femoral vein diameters decreased by approximately 50% after ICT application. This decrease persisted after the first and third months. Histopathological examination revealed loose connective tissue around the venous tissue after the operation, particularly in the third month, together with perivascular fibrosis and increased collagen in connective tissue. No difference was observed between regions with and without ICT application in terms of mucinous degeneration, an indicator of tissue injury, during Alcian blue staining. Genetic examination revealed an increase in collagen I and IV and CTGF mRNA expression in perivascular tissue resulting from ICT application. Conclusion: ICT is effective both in terms of creating a durable tissue around the vein and of increasing collagen tissue and stimulating fibrosis, and has no deleterious side-effects on tissue.

Complications of Subclavian Catheter Hemodialysis: A 5 Year Prospective Study in 257 Consecutive Patients

1982 ◽  
Vol 5 (5) ◽  
pp. 297-303 ◽  
Author(s):  
R. Vanholder ◽  
N. Lameire ◽  
J. Verbanck ◽  
R. Van Rattinghe ◽  
M. Kunnen ◽  
...  
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Vascular Access ◽  
Vena Cava ◽  
Seldinger Technique ◽  
Access Method ◽  
Valuable Alternative ◽  
Patient Tolerance ◽  
Vena Cava Thrombosis ◽  
Subclavian Catheter

The complications related to the use of subclavian catheters for hemodialysis were prospectively studied in 257 consecutive acute and chronic renal failure patients. Using 394 catheters, 3006 single needle dialyses were performed. Indications for starting catheter dialysis were mainly the absence or disappearance of an adequate vascular access. Most hazardous complications were sepsis (9), malposition (6), hemothorax (3), bleeding (2), vena cava thrombosis (2) and pneumothorax (2). A number of mechanical problems occurred, where the obstructed catheter could easily be replaced by a modified Seldinger technique. No mortal complications occurred. Patient tolerance was excellent. It is concluded that single needle subclavian hemodialysis is a valuable alternative vascular access method in acute situations. It enables the continuation of hemodialysis on an ambulatory basis.

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