Evaluating Effectiveness of the Use of an Extremity Stabilization Device for Vascular Access Procedures in Pediatrics

The purpose of this study is to evaluate the effectiveness of SafeBoard, a Food and Drug Administration–approved extremity stabilization device, as an assistive method in performing peripherally inserted central catheter procedures on children 0 to 3 years of age. This is a retrospective chart review (n = 59) of vascular access procedures where SafeBoard was utilized (n = 32) in comparison to those procedures which utilized a traditional approach to placement (n = 27). Statistical analysis demonstrated significant effect on length of procedure time, number of personnel needed for procedure, and success of placement when SafeBoard was utilized. Obtaining vascular access in pediatrics can be a challenging endeavor. Most young pediatric patients require procedural sedation and/or assistive personnel as a “holder” for successful vascular access placement to occur. An alternative option for extremity stabilization may provide improved workflow and improved placement success, which in turn may positively affect workflow.

Overcoming Lost Circulation Risks in Low Fracture Gradient Formations with a New Tailored Spacer System

In certain regions of oil and gas operations, lost circulation is a common occurrence, especially when a majority of the openhole exposed during primary cementing is carbonate-based formations. This can lead to lost circulation risks in most applications. To overcome lost circulation risks during primary cementing, a new tailored spacer system shows to improve the cement placement success. The manuscript discusses the quality assurance and performance testing with field cases demonstrating the value contributions of the spacer for achieving zonal isolation requirements as well as the top of cement objectives. The work efforts presented shows a spacer meeting and sometimes showing incremental wellbore strengthening in comparison to the published literature for existing available spacers used to overcome similar lost circulation risks.

746 Single-Centre Experience with Three Metallic Ureteric Stents (Allium URS, Memokath-051 and Resonance) for Chronic Ureteric Obstruction

Aim To evaluate efficacy of Allium URS, Memokath 051 and Resonance metallic ureteric stents as an alternative to polymer stents/nephrostomy in managing chronic ureteric obstruction (CUO). Method Retrospective analysis of consecutive patients with CUO managed with Allium URS, Memokath-051 or Resonance (September 2015/July 2020). Baseline patient variables (age, gender, underlying aetiology, ASA) and stricture characteristics (length, level, continuity) were recorded. Intra- and post-operative clinical and radiological follow-up assessments at 6 weeks, 3 months and then every 6 months, as well as any emergency attendances, were reviewed for placement success, stent complications, serum creatinine, and mortality. Outcomes included placement success rate, functional stent survival, and mean renal function. Results Overall, 129 stent insertion episodes (SIEs) (Allium URS: 23, Memokath 051: 48, Resonance: 58) occurred in 76 patients (Allium URS: 16; Memokath-051: 31; Resonance: 29). Placement success was high (Allium URS: 95.7%; Memokath-051 and Resonance: both 100%). Median functional stent survival was 11.4 months for Allium URS, 5.5 months for Memokath-051 and 11.7 months for Resonance. 47.8% of Allium URS SIEs (11/23), 64.6% of Memokath-051 SIEs (31/48) and 19% of Resonance SIEs (11/58) experienced complication (most frequently obstruction followed by migration and infection). There were no complications for Resonance SIEs for benign indication. In the first year following SIE, serum creatinine ranged from +21.3% to + 46.7% for Allium URS, -7.8% to + 8.9% for Memokath-051, and -9.4% to + 27.3% for Resonance. Conclusions Allium URS, Memokath 051 and Resonance metallic ureteric stents are all viable management options of CUO. Resonance was particularly efficacious for patients with benign aetiology.

Criterion and Construct Validity and Reliability of the Pediatric IV Difficulty Score

Highlights Abstract Background: In pediatric patients, intravenous placement success may be related to predetermined vascular access difficulty. The study purpose was to examine validity and reliability of the 6-item Pediatric Intravenous Difficulty Score. Methods: We determined if a tool that assesses pediatric intravenous difficulty was associated with clinical outcomes of peripheral attempts (criterion validity), hypotheses regarding patients’ age, race, and medical diagnosis (construct validity), and reliability of difficulty levels. Results: In 596 episodes of peripheral intravenous attempts, first-attempt success, overall success, and number of staff attempting access were associated with level of intravenous access difficulty by tool score. The tool met hypothesized construct validity criteria, and in multivariable modeling, the tool was reliable based on difficulty levels of 2 user groups. Conclusions: The 6-item Pediatric Intravenous Difficulty Score has criterion and construct validity and is reliable over time among clinicians with different levels of expertise in peripheral vascular access.

Triamcinolone acetonide injections for the treatment of recalcitrant post-radical prostatectomy vesicourethral anastomotic stenosis: A retrospective look at efficacy and safety

Introduction: We aimed to evaluate the success of bladder neck injections of triamcinolone at the time of transurethral bladder neck incision (BNI) for prevention of recurrent vesicourethral anastomotic stenosis (VUAS) following prostate cancer treatment. Methods: This is a retrospective cohort study examining patients with recurrent VUAS post-RP ± radiation treated with triamcinolone injections at the time of BNI. VUAS was diagnosed by symptoms followed by cystoscopy or urethrography. The outpatient procedures were done under general anesthesia. Cold knife incisions were made at the three, nine, and 12 o’clock BN positions, followed by triamcinolone injections (4 mg/mL) into the three and nine o’clock incision sites. Treatment outcomes were determined with cystoscopy. Results: Eighteen men underwent 25 procedures over a four-year period. Median age at diagnosis of VUAS was 65 (interquartile range [IQR] 61–68); median time to VUAS from RP was eight months (IQR 5–12). Fourteen patients (78%) had radiation treatment. The cohort had 128 unsuccessful VUAS treatments, with a median of five failed treatments per patient (IQR 3–10). Failed treatments included BN dilation, BNI, BN injection of mitomycin C, and urethral stent placement. Success rate after a mean of 16.3 months (standard deviation [SD] 8.1) from the time of triamcinolone injection was 83% (15/18). Six patients went on to have successful incontinence surgery. Five patients (28%) had treatment complications (bleeding, urinary tract infection, pain, and urinary extravasation). The three non-responders are stable and awaiting re-treatment with triamcinolone injection. Conclusions: Triamcinolone bladder neck injections for post-RP VUAS are a useful and safe treatment for recurrent stenosis.

Criterion and Construct Validity and Reliability of the Pediatric IV Difficulty Score

Highlights Abstract Background: In pediatric patients, intravenous placement success may be related to predetermined vascular access difficulty. The study purpose was to examine validity and reliability of the 6-item Pediatric Intravenous Difficulty Score. Methods: We determined if a tool that assesses pediatric intravenous difficulty was associated with clinical outcomes of peripheral attempts (criterion validity), hypotheses regarding patients’ age, race, and medical diagnosis (construct validity), and reliability of difficulty levels. Results: In 596 episodes of peripheral intravenous attempts, first-attempt success, overall success, and number of staff attempting access were associated with level of intravenous access difficulty by tool score. The tool met hypothesized construct validity criteria, and in multivariable modeling, the tool was reliable based on difficulty levels of 2 user groups. Conclusions: The 6-item Pediatric Intravenous Difficulty Score has criterion and construct validity and is reliable over time among clinicians with different levels of expertise in peripheral vascular access.