An Intravascular Catheter Bending Recognition Method for Interventional Surgical Robots

Robot-assisted interventional surgery can greatly reduce the radiation received by surgeons during the operation, but the lack of force detection and force feedback is still a risk in the operation which may harm the patient. In those robotic surgeries, the traditional force detection methods may have measurement losses and errors caused by mechanical transmission and cannot identify the direction of the force. In this paper, an interventional surgery robot system with a force detection device is designed and a new force detection method based on strain gauges is proposed to detect the force and infer the bending direction of the catheter in the vessel by using BP neural network. In addition, genetic algorithm is used to optimize the BP neural network, and the error between the calculated results and the actual results is reduced by 37%, which improves the accuracy of catheter bending recognition. Combining this new method with traditional force sensors not only reduces the error caused by the traditional mechanical transmission, but also can detect the bending direction of the catheter in the blood vessel, which greatly improves the safety of the operation.

Practices and intravascular catheter infection during on- and off-hours in critically ill patients

Background The potential relationship between intravascular catheter infections with their insertion during weekend or night-time (i.e., off-hours or not regular business hours) remains an open issue. Our primary aim was to describe differences between patients and catheters inserted during on- versus off-hours. Our secondary aim was to investigate whether insertions during off-hours influenced the intravascular catheter infectious risks. Methods We performed a post hoc analysis using the databases from four large randomized-controlled trials. Adult patients were recruited in French ICUs as soon as they required central venous catheters or peripheral arterial (AC) catheter insertion. Off-hours started at 6 P.M. until 8:30 A.M. during the week; at weekend, we defined off-hours from 1 P.M. on Saturday to 8.30 A.M. on Monday. We performed multivariable marginal Cox models to estimate the effect of off-hours (versus on-hours) on major catheter-related infections (MCRI) and catheter-related bloodstream infections (CRBSIs). Results We included 7241 patients in 25 different ICUs, and 15,208 catheters, including 7226 and 7982 catheters inserted during off- and on-hours, respectively. Catheters inserted during off-hours were removed after 4 days (IQR 2, 9) in median, whereas catheters inserted during on-hours remained in place for 6 days (IQR 3,10; p < 0.01) in median. Femoral insertion was more frequent during off-hours. Among central venous catheters and after adjusting for well-known risk factors for intravascular catheter infection, we found a similar risk between off- and on-hours for MCRI (HR 0.91, 95% CI 0.61–1.37, p = 0.65) and CRBSI (HR 1.05, 95% CI 0.65–1.68, p = 0.85). Among central venous catheters with a dwell-time > 4 or > 6 days, we found a similar risk for MCRI and CRBSI between off- and on-hours. Similar results were observed for ACs. Conclusions Off-hours did not increase the risk of intravascular catheter infections compared to on-hours. Off-hours insertion is not a sufficient reason for early catheter removal, even if femoral route has been selected.

Left Subclavian Pseudoaneurysm: A Case of Palsies in the Recurrent Laryngeal Nerve, Phrenic Nerve, and Brachial Plexus

A patient developed a subclavian pseudoaneurysm following placement of an intravascular catheter for cancer treatment. The patient presented with palsies in the phrenic nerve, brachial plexus, and recurrent laryngeal nerve. This is a rare presentation, similar to Ortner’s syndrome, which has not been previously presented in the literature. Furthermore, this case highlights the importance of early laryngoscopy in patients with persistent voice change, especially after a neck procedure.

Occurrence and incidence rate of peripheral intravascular catheter-related phlebitis and complications in critically ill patients: a prospective cohort study (AMOR-VENUS study)

Background The lack of precise information on the epidemiology of peripheral intravascular catheter (PIVC)-related phlebitis and complications in critically ill patients results in the absence of appropriate preventive measures. Therefore, we aimed to describe the epidemiology of the use of PIVCs and the incidence/occurrence of phlebitis and complications in the intensive care unit (ICU). Methods This prospective multicenter cohort study was conducted in 23 ICUs in Japan. All consecutive patients aged ≥ 18 years admitted to the ICU were enrolled. PIVCs inserted prior to ICU admission and those newly inserted after ICU admission were included in the analysis. Characteristics of the ICU, patients, and PIVCs were recorded. The primary and secondary outcomes were the occurrence and incidence rate of PIVC-related phlebitis and complications (catheter-related blood stream infection [CRBSI] and catheter failure) during the ICU stay. Results We included 2741 patients and 7118 PIVCs, of which 48.2% were inserted in the ICU. PIVC-related phlebitis occurred in 7.5% (95% confidence interval [CI] 6.9–8.2%) of catheters (3.3 cases / 100 catheter-days) and 12.9% (95% CI 11.7–14.2%) of patients (6.3 cases / 100 catheter-days). Most PIVCs were removed immediately after diagnosis of phlebitis (71.9%). Grade 1 was the most common phlebitis (72.6%), while grade 4 was the least common (1.5%). The incidence rate of CRBSI was 0.8% (95% CI 0.4–1.2%). In cases of catheter failure, the proportion and incidence rate per 100 intravenous catheter-days of catheter failure were 21% (95% CI 20.0-21.9%) and 9.1 (95% CI 8.7–10.0), respectively. Conclusion PIVC-related phlebitis and complications were common in critically ill patients. The results suggest the importance of preventing PIVC-related complications, even in critically ill patients. Trial registration UMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019, July 1, 2017).

Where Did the Midline Catheter Disappear?

Intravascular catheter break off is a rare complication during insertion or nursing care. We report the intravascular break off of a midline catheter after wound dressing change and its migration into the pulmonary artery. The broken piece of catheter was removed percutaneously using a snare kit.