Interclavicularis anticus digastricus muscle in a female body donor: a case report

Background and objectives Muscular variations of the ventral thoracic wall are generally common and of great clinical interest. Materials and methods An unusual muscular variation of the ventral thoracic wall was observed and dissected in a West-European female body donor. Results An interclavicularis anticus digastricus muscle was observed and studied. It originated from the manubrium sterni and inserted bilaterally to the clavicles. Both muscle bellies were interconnected by a tendon on the ventral surface of the manubrium sterni. The muscle was innervated by branches of the lateral pectoral nerve. Conclusions The interclavicularis anticus digastricus muscle is a muscular variation of the ventral thoracic wall of unknown prevalence. This variation might be of clinical interest in orthopaedics and thoracic surgery. It is also a vulnerable structure during infraclavicular insertion of a subclavian vein catheter or fractures of the clavicle.

Chryseobacterium indologenes Infection in an Immunocompromised Patient - A Rare Case Report

A 63-year-old male patient with diabetes mellitus, hypertension and chronic kidney disease who has been undergoing haemodialysis thrice weekly developed fever and shivering during haemodialysis for one week. He was doing haemodialysis from elsewhere and presented to nephrology department of our hospital with the same complaints. The patient had an intravenous catheter over left internal jugular vein, which was placed one month back from elsewhere for doing haemodialysis. He is a known case of diabetes mellitus and hypertension for the past ten years and on regular medications. On examination, the patient was moderately built and nourished, pallor was present and icterus, cyanosis, clubbing, lymphadenopathy, oedema were absent. His respiratory, cardiovascular, central nervous and gastro intestinal system examinations were within normal limit. The patient was febrile (101̊ F). pulse rate - 98/min, blood pressure – 150/80 mmHg, respiratory rate - 20 cycles per minute, fasting blood sugar - 140 mg/dl, Hb – 9 mg%, WBC count - 5600/μL. On local examination, mild erythema was noted over his neck on intravenous catheter site of left internal jugular vein. Other investigations were within normal limit. Human immunodeficiency virus (HIV), HBsAg and hepatitis C virus (HCV) antibodies were negative. The urine and sputum cultures were done to rule out any genitourinary or respiratory system involvement. Both cultures yielded no pathogens. The patient was treated with removal of internal jugular vein catheter, and a femoral vein catheter was placed. Blood and tip of intravenous catheter were sent to microbiology laboratory for culture and sensitivity testing. The patient was empirically started on intravenous antibiotic vancomycin.

Ultrasound evaluation of dialysis access-related distal ischaemia

Dialysis access-related distal ischaemia is a rare yet potentially rather risky complication of haemodialysis angioaccess. Timely diagnosis is crucial to target both the goals of the access team: first of all to preserve the function of the hand ideally along with angioaccess patency. Unfortunately for some patients, urgent access ligation and central vein catheter insertion would be needed to save the hand. After a first clinical examination to determine the diagnostic suspicion, the ultrasound evaluation would provide nearly all the needed information to confirm the diagnosis and to determine the most appropriate procedure to rescue the patient from distal ischaemia. In some cases, photoplethysmography would help in the differential diagnosis of other non-ischaemic causes of similar signs and symptoms. Angiography would complete the preoperative evaluation for some. Dialysis access-related distal ischaemia would be briefly reviewed, and a deep description of the ultrasound examination tools and findings would be provided for a tailored therapeutic approach.

Education in the placement of ultrasound-guided peripheral venous catheters: a systematic review

Background Placing a peripheral vein catheter can be challenging due to several factors, but using ultrasound as guidance increases the success rate. The purpose of this review is to investigate the knowledge already existing within the field of education in ultrasound-guided peripheral vein catheter placement and explore the efficacy and clinical impact of different types of education. Methods In accordance with PRISMA-guidelines, a systematic search was performed using three databases (PubMed, EMBASE, CINAHL). Two reviewers screened titles and abstracts, subsequently full-text of the relevant articles. The risk of bias was assessed using the Cochrane Collaboration risk of bias assessment tool and the New Ottawa scale. Results Of 3409 identified publications, 64 were included. The studies were different in target learners, study design, assessment tools, and outcome measures, which made direct comparison difficult. The studies addressed a possible effect of mastery learning and found e-learning and didactic classroom teaching to be equally effective. Conclusion Current studies suggest a potential benefit of ultrasound guided USG-PVC training on success rate, procedure time, cannulation attempts, and reducing the need for subsequent CVC or PICC in adult patients. An assessment tool with proven validity of evidence to ensure competence exists and education strategies like mastery learning, e-learning, and the usage of color Doppler show promising results, but an evidence-based USG-PVC-placement training program using these strategies combined is still warranted.

Amino Acid Absorption Profiles in Growing Pigs Fed Different Protein Sources

The aim of the present study was to determine postprandial amino acid (AA) appearance in the blood of growing pigs as influenced by protein source. Seven growing pigs (average body weight 18 kg), in a 7 × 5 Youden square design, were fitted with a jugular vein catheter and fed seven diets containing wheat, soybean meal, enzyme-treated soybean meal, hydrothermally-treated rapeseed meal, casein, hydrolyzed casein, and a crystalline AA blend with the same AA profile as casein. The latter was not eaten by the pigs, therefore being excluded. Blood samples were collected at −30, 30, 60, 90, 120, 180, and 360 min after a meal and analyzed for free AA. Overall, plasma AA concentrations were highest 60 min after feeding. There were no differences in plasma AA concentration between casein and hydrolyzed casein, but soybean meal resulted in lower AA plasma concentrations compared with enzyme-treated soybean meal at 60 and 120 min after feeding. There were no differences between hydrothermally-treated rapeseed meal and soybean meal. In conclusion, the ingredients could not clearly be categorized as being slow or fast protein with regard to protein digestion and absorption of AA, but soybean meal resulted in a prolonged appearance of plasma AA compared to casein and hydrolyzed casein.

Tunneling technique of PICCs and Midline catheters

Background: The tunneling technique is currently widely used for placement of CVC. Recently, some clinicians have used this technique for peripherally inserted central catheters (PICC), or Midline catheters (MCs). Objective: To describe a safe antegrade tunneling technique for PICCs and MCs insertion with a blunt tunneler. Methods: This retrospective monocentric survey collected ASST Lodi hospital data from January 1st to December 31st, 2019. The indication for PICCs and MCs tunneled implant was to respect the correct vein/catheter ratio or special clinical situation (children, burns, wounds, and wider catheter 5/6 fr). Contraindications included the operator’s low skills and severe risk of bleeding (INR > 3; Platelet count <50’000). Results: About 390 PICCs (327 4 fr and 63 5 fr) and 183 MCs were placed. One hundred and sixty-five PICCs (42%) and 110 MCs (60%) were tunneled. Five fr PICCs were more present among tunneled catheters (54/165 [32.7%] vs 9/225 [4%] p < 0.0001). In the majority tunneling was necessary to respect the correct catheter/vein ratio. The exit site was shifted only for four special clinical situations: skin infections (one PICC and two MCs); burns (one MC). No early complication (intraprocedural, major bleeding), catheter related thrombosis, or device fractures occurred. Two catheter-related bloodstream infections (one PICC, one MC), nine dislocations (four PICCs, five MCs), one MC occlusion were recorded. Conclusions: The antegrade tunneling technique with blunt tunneler of PICCs and MCs is simple, rapid and is regarded as a safe maneuver. More in-depth and future prospective studies are needed to evaluate the impact of tunneling on early and late complications.