ULTRASOUND GUIDED CENTRAL VENOUS CANNULATION BY ANESTHESIA TRAINEE: NEED OF THE HOUR DURING COVID PANDEMIC

2021 ◽  
pp. 33-36
Author(s):  
Binita Panigrahi ◽  
Manu Mishra ◽  
Amlan Swain ◽  
Seelora Sahu ◽  
Shashikant Shashikant
Keyword(s):  
Access Time ◽  
Categorical Variables ◽  
Venous Cannulation ◽  
Continuous Variables ◽  
Central Venous Cannulation ◽  
Central Venous ◽  
Chi Square ◽  
Group 2 ◽  
Graduate Trainees ◽  
Landmark Technique

Covid pandemic has created deciency of doctors needed to administer skilled procedures in ICUs and operating rooms. Post graduate trainees need to acquire skills fast and perform it safely on patients. Ultrasound (USG)-guided central venous cannulation (CVC) is one such. The study aimed at nding the feasibility of training USG-guided CVC cannulation to anesthesia trainee as opposed to landmark method in terms of ease, speed and safety. Patients needing CVC were divided into 2 groups of 50 each, where Group 1 was subjected to Landmark method and Group 2 to USG-guided method. Continuous variables were compared using unpaired t test and categorical variables using either the Chi square test. Access time (in seconds) was signicantly less in the USG group (258.78 ± 11.17) as opposed to Landmark technique (301.60 ± 14.03) (p 0.03). Accidental carotid artery puncture was seen in 9 patients in Landmark group as opposed to none in the USG group. No patient in any group developed pneumothorax. USG-guided technique is superior and safer than the traditional landmark technique in hands of anaesthesia trainee in terms of a shorter access time, and less incidence of arterial puncture which is desirable in COVID patients to shorten the exposure time. USG-guided method needs an assistant to focus the probe. Nonetheless, this training should be imparted to the trainee to ll the gap created by skilled doctors falling sick during COVID pandemic.

scholarly journals Ultrasound-Guided Subclavian Vein Cannulation in Neonate via Supraclavicular Approach

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Onur Balaban ◽  
Tayfun Aydın
Keyword(s):  
Subclavian Vein ◽  
Ultrasound Guidance ◽  
Jugular Vein ◽  
Venous Cannulation ◽  
Central Venous Cannulation ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Supraclavicular Approach ◽  
Vein Cannulation ◽  
Landmark Technique

Central venous cannulation of infants may be challenging. Ultrasonography is recommended and has been found superior to classic landmark technique in pediatric central venous cannulation. The cannulation of the subclavian vein using supraclavicular approach under real-time ultrasound guidance is a novel technique. It may have advantages over ultrasound-guided jugular vein cannulation in specific patients. We report a case of 3200-gram 20-day-old anencephalic neonate who had a diffuse generalized edema. The neonate was cannulated successfully via subclavian vein using supraclavicular approach under ultrasound guidance.

scholarly journals Unusual Complications of Ultrasound Guided Central Venous Cannulation

2019 ◽  
Author(s):  
Sonu Sama ◽  
Sanjay Agarwal ◽  
Vijay Adabala ◽  
Michael Leonard Anthony
Keyword(s):  
Continuous Monitoring ◽  
Ultrasound Guidance ◽  
Venous Catheter ◽  
Venous Cannulation ◽  
Central Venous Cannulation ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Common Procedure ◽  
Open Surgical Procedure ◽  
Landmark Technique

Central venous catheter (CVC) insertion is a common procedure in operation theaters and intensive care units (ICU). The procedure is performed through anatomical landmark technique, open surgical procedure, and ultrasound-assisted insertion. In the 1990s, ultrasound guidance of CVC insertion has been advocated as a means to reduce mechanical complications and placement failures compared with the landmark technique. Still CVC complications can be related to insertion, indwelling, or extraction. There is a need for continuous monitoring to avoid possible risk factors so as to minimize the morbidity and mortality.

scholarly journals Factors affecting the time lag to the second eye cataract surgery in a hospital-based population

2014 ◽  
Vol 6 (1) ◽  
pp. 31-38
Author(s):  
Charu Malik ◽  
Manjit S Bhatia ◽  
Upreet Dhaliwal
Keyword(s):  
Cataract Surgery ◽  
Time Lag ◽  
Cross Sectional Study ◽  
Analysis Of Covariance ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Cross Sectional ◽  
Group 2 ◽  
One Year

Introduction: Cataract can be treated successfully, yet patients delay surgery. Surgery in one eye may not promote surgery in the second. Objectives: To determine the time lag to the second eye cataract surgery and identify the factors that affect it. Materials and methods: This study was conducted at an ophthalmology out-patient department of a teaching hospital and was an observational, cross-sectional study. Consecutive patients of over 45 years who had had cataract surgery in one eye and had visually significant senile cataract in the other were categorized into those that requested sequential surgery (Group 1) and those that refused (Group 2). The relevant history and vision were recorded. A questionnaire was used to seek possible responsible factors that determined the refusal for the second surgery. Statistical analysis: Categorical variables were compared between groups using the chi-square test and continuous variables using the Student t-test. Factors significantly affecting the time lag were subjected to the analysis of covariance. Rresults: Of the 250 patients of the study, only 104 (41.6 %) requested the second eye surgery, less than one-fifth within one year. Thirteen patients from Group 2 presented with complications of hypermaturity in the second eye. The average time lag was 2.39 ± 2.19 years. It was significantly more in Group 2 patients (p = 0.024) who also reported more barriers (2.75 ± 1.23 versus 1.58 ± 1.10; p = 0.005). The factors that increased the time lag were older age (p = 0.028), extra-capsular surgery (p < 0.001), and being able to manage after the first surgery (p = 0.011) in Group1, and eye-camp (p = 0.021) or extra-capsular surgery (p < 0.001) in Group 2 patients. Conclusions: One-fifth of the patients reported back for sequential surgery within one year. Patients who refused surgery had more barriers; most were related to the first surgery and should be anticipated by compassionate ophthalmic professionals after surgery in the first eye. DOI: http://dx.doi.org/10.3126/nepjoph.v6i1.10761   Nepal J Ophthalmol 2014; 6 (2): 31-38

Real-time Two-dimensional Ultrasound Guidance for Central Venous Cannulation

2013 ◽  
Vol 118 (2) ◽  
pp. 361-375 ◽  
Author(s):  
Shao-yong Wu ◽  
Quan Ling ◽  
Long-hui Cao ◽  
Jian Wang ◽  
Mei-xi Xu ◽  
...  
Keyword(s):  
Real Time ◽  
Meta Analysis ◽  
Arterial Puncture ◽  
Venous Cannulation ◽  
Two Dimensional ◽  
Central Venous Cannulation ◽  
Central Venous ◽  
Random Effects Models ◽  
Randomized Studies ◽  
Landmark Technique

Abstract Background: Use of ultrasound-guided techniques to facilitate central venous cannulation (CVC) may reduce the risk of misplacement and complications. A meta-analysis was conducted to compare real-time two-dimensional ultrasound (RTUS) guidance technique with anatomical landmark technique for CVC to determine whether RTUS has any advantages. Methods: Randomized studies comparing outcomes in patients undergoing CVC with either RTUS or landmark technique were retrieved from PubMed, ISI Web of Knowledge, EMBASE, and OVID EBM Reviews from their inception to March 2012. Results: Twenty-six studies involving 4,185 CVC procedures met the inclusion criteria. Compared with landmark technique, patients with RTUS had a pooled relative risk (RR) of 0.18 (95% CI: 0.10–0.32) for cannulation failure, 0.25 (95% CI: 0.15–0.42) for arterial puncture, 0.30 (95% CI: 0.19–0.46) for hematoma, 0.21 (95% CI: 0.06–0.73) for pneumothorax, and 0.10 (95% CI: 0.02–0.54) for hemothorax from random-effects models. However, RTUS did not show a reduction in the risk of cannulation failure (RR = 0.26, 95% CI: 0.03–2.55), arterial puncture (RR = 0.34, 95% CI: 0.05–2.60), hematoma (RR = 0.13, 95% CI: 0.01–2.42), pneumothorax (RR = 0.40, 95% CI: 0.02–9.61), and hemothorax (RR = 0.40, 95% CI: 0.02–9.61) in children or infants when the limited data were analyzed. Conclusions: Among adults receiving CVC, RTUS was associated with decreased risks of cannulation failure, arterial puncture, hematoma, and hemothorax. Additional data of randomized studies are necessary to evaluate these outcomes in pediatric patients.

Abstract 15029: Atrial Arrhythmias and Pulmonary Hypertension Across Wsph Groups

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Erika B Rosenzweig ◽  
Milena Radeva ◽  
Robert Frantz ◽  
Paul M Hassoun ◽  
Anna R Hemnes ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Normal Sinus Rhythm ◽  
Volume Index ◽  
Categorical Variables ◽  
Atrial Arrhythmias ◽  
Continuous Variables ◽  
Chi Square ◽  
Normal Sinus ◽  
Chi Square Test ◽  
Group 2

Introduction: Previous reports have shown that atrial and ventricular arrhythmias (VA) are common in all forms of pulmonary hypertension (PH) with prevalence of supraventricular arrhythmias ranging from 13-25% and VA 27%. Arrhythmias are also associated with clinical worsening events. Reports have limited numbers of patients with a variety of forms of PH and limited data comparing the prevalence of atrial arrhythmias across WSPH groups and whether advancing age, WHO FC, echocardiographic, exercise capacity and hemodynamic patterns are associated with a higher prevalence of atrial arrhythmias. Methods: As part of the PVDOMICS program, we enrolled 1195 PH participants, controls and PH comparators and prospectively collected electrocardiograms (ECGs) at enrollment for 1147 of them. Comparisons across participants with and without atrial fibrillation/atrial flutter (afib/flutter) used analysis of variance (ANOVA) or Kruskal-Wallis test in continuous variables based on distribution with statistics presented as mean + SD or median [P25, P75] respectively. Pearson’s chi-square test was used for categorical variables. Results: Of 732 PH participants (467F) who had ECGs available at baseline, 527 (72.0%) were in normal sinus rhythm and 62 had afib/flutter (8.5%). Afib/flutter participants were older (75 + 8 vs 57 + 14 years; p<0.001), most commonly in WSPH group 2 (28.1%) vs. WSPH 1 (3.3%), WSPH 3(6.5%) and WSPH group 4 (3.7%), had predominantly WHO FC II/III symptoms (89.5%), higher RAP (12.6 + 5 vs.7.8 + 5mmHg; p<0.001) and PCWPm (17.8 + 5.8 vs. 12.3 + 6.2mmHg; p<0.001) and lower CO (4.3+ 1.5 vs. 5.2 +1.8L/min;p<0.001). Participants with afib/flutter had lower 6MWD 277 + 117 vs.356 + 134meters (p<0.001) than PH participants without. Echocardiography demonstrated increase in LA volume index (mL/m2), RA volume (mL) and tricuspid regurgitation severity with reduced TAPSE and LVEF (54 + 10 vs. 61 + 10%;p<0.001). ProBNP was higher in afib/flutter participants 2029 [1073, 2964] vs.268 [100, 1074]pg/ml; P<0.001) Conclusions: In this analysis of atrial arrhythmias in a large cohort of PH participants across all WSPH groups, afib/flutter was present most often in older WSPH group 2 patients who demonstrated clinical and hemodynamic features of worse heart failure.

scholarly journals Relationship of Hydroxychloroquine and Ophthalmic Complications in Patients with Type 2 Diabetes in Taiwan

2021 ◽  
Vol 18 (15) ◽  
pp. 8154
Author(s):  
Hung-Chih Chen ◽  
Hung-Yu Lin ◽  
Michael Chia-Yen Chou ◽  
Yu-Hsun Wang ◽  
Pui-Ying Leong ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Conditional Logistic Regression ◽  
Categorical Variables ◽  
Control Group ◽  
Case Group ◽  
Research Database ◽  
Continuous Variables ◽  
Chi Square ◽  
Increased Risk

The purpose of this study is to evaluate the relationship between hydroxychloroquine (HCQ) and diabetic retinopathy (DR) via the national health insurance research database (NHIRD) of Taiwan. All patients with newly diagnosed type 2 diabetes (n = 47,353) in the NHIRD (2000–2012) were enrolled in the study. The case group consists of participants with diabetic ophthalmic complications; 1:1 matching by age (±1 year old), sex, and diagnosis year of diabetes was used to provide an index date for the control group that corresponded to the case group (n = 5550). Chi-square test for categorical variables and Student’s t-test for continuous variables were used. Conditional logistic regression was performed to estimate the adjusted odds ratio (aOR) of DR. The total number of HCQ user was 99 patients (1.8%) in the case group and 93 patients (1.7%) in the control group. Patients with hypertension (aOR = 1.21, 95% CI = 1.11–1.31) and hyperlipidemia (aOR = 1.65, 95% CI = 1.52–1.79) significantly increased the risk of diabetic ophthalmic complications (p < 0.001). Conversely, the use of HCQ and the presence of rheumatoid diseases did not show any significance in increased risk of DR. HCQ prescription can improve systemic glycemic profile, but it does not decrease the risk of diabetic ophthalmic complications.

scholarly journals 350. Neurocysticercosis – Gender Differences in Clinical Presentations

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S244-S244
Author(s):  
Bharath Pendyala ◽  
Prasanth Lingamaneni ◽  
Patricia DeMarais ◽  
Lakshmi Warrior ◽  
Gregory Huhn
Keyword(s):  
Gender Differences ◽  
Categorical Variables ◽  
Public Health Issue ◽  
Diagnostic Code ◽  
Continuous Variables ◽  
Chi Square ◽  
Generalized Seizures ◽  
Icd 10 ◽  
Chi Square Test ◽  
Reported Data

Abstract Background Neurocysticercosis is a Neglected Tropical Disease and an important public health issue. Our goal was to collect and analyze data regarding clinically significant gender differences among our Neurocysticercosis patients. Methods A retrospective chart search with ICD 9/ ICD 10 diagnostic code for Neurocysticercosis and neuroimaging suggestive of Neurocysticercosis was performed for clinical encounters in the hospital or affiliated clinics between years 2013–2018. After a careful chart review, patients who were clinically diagnosed with Neurocysticercosis were included in the study. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Results Among 90 total patients included, male (49.4%) and female (50.6%) distribution were nearly identical. The mean age in females was found to be higher than males (52.5 vs 42.0, P &lt; 0.0001). Almost an equal number of males and females presented with either seizures (63.6% vs 57.8%, P= 0.85), headaches (25.0% vs 28.9%, p= 0.85), or other symptoms (11.4% vs 13.3%, p= 0.85). Males had more generalized seizures compared to females (60% vs 38%, P= 0.37), although this result was not statistically significant. Females were more likely to present with &gt; 1 lesion (82.2% vs 56.8%, P= 0.01). Males were more likely to have cystic lesions (64.7% vs 27.9%, P &lt; 0.001) compared to females who had more calcified lesions on presentation (65.1% vs 20.6%, P &lt; 0.001). Male patients were more likely to have contrast enhancement or edema surrounding the lesions (61.4% vs 33.3%, P= 0.01) and were more likely to require treatment with Albendazole/Praziquantel (75.8% vs 31.7%, P &lt; 0.001). Conclusion Although previously reported data is limited, there is a suggestion that there are gender differences in host immune response and that inflammation surrounding parenchymal lesions is more intense in females. This study suggests that men either present early in the disease phase or have different immune responses than women and require anti-parasitic therapy more frequently. More research in this aspect is needed. Disclosures All Authors: No reported disclosures

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