High incidence of large bore temporary hemodialysis catheter malfunction in patients with COVID-19 related kidney injury

Purpose: To evaluate the incidence of large bore hemodialysis catheter malfunction in the setting of COVID-19. Materials and methods: A retrospective review was performed of all patients who underwent placement of a temporary hemodialysis catheter after developing kidney injury after COVID-19 infection at our institution. Data collected included demographic information, procedure related information, and incidence of replacement due to lumen thrombosis. Groups were compared using students t-test for continuous variables and Fisher’s exact test for nominal variables. Results: Sixty-four patients (43M, mean age 63.2 ± 13.3) underwent placement of temporary hemodialysis catheter placement for kidney injury related to COVID 19 infection. Thirty-one (48.4%) of catheters were placed via an internal jugular vein (IJV) access and 33 (52.6%) of catheters were placed via a common femoral vein (CFV) access. Overall, 15 (23.4%) catheters required replacement due to catheter dysfunction. There were no differences in demographics in patients who required replacement to those who did not ( p > 0.05). Of the replacements, 5/31 (16%) were placed via an IJV access and 10/33 (30.3%) were placed via a CFV access ( p = 0.18). The average time to malfunction/replacement was 7.8 ± 4.8 days for catheters placed via an IJ access versus 3.4 ± 3.3 days for catheters placed via a CFV access ( p = 0.055). Conclusion: A high incidence of temporary dialysis catheter lumen dysfunction was present in patients with COVID-19 infection. Catheters placed via a femoral vein access had more frequent dysfunction with shorter indwelling time.

Definition of catheter jamming: A mechanical analysis of catheter fracture tension and fracture strain

BACKGROUND: Catheter jamming is an emerging and possibly underrated complication. OBJECTIVE: To find the criteria for determining if the catheter cannot be removed through the mechanical analysis of fracture tension and fracture strain (εf) of Peripheral Inserted Central Catheters (PICC). METHOD: We removed 30 pieces of PICC catheters from patients and recorded the indwelling time. Those with an indwelling time shorter than 12 weeks belonged to the short-term group. Those with an indwelling time longer than 12 weeks belonged to the long-term group. The first half of the same catheter is section A, and the second half is section B. The fraction tension and fracture strain of the catheter were measured, and statistical analysis was conducted. RESULTS: The fracture tension of catheter in sections A and B were 5.8917 ± 1.0095 and 6.0670 ± 0.8066 Newtons respectively (p= 0.393) and the fracture strain of catheter in sections A and B were 6.0611 ± 1.0810 and 6.2543 ± 0.7187 Newtons respectively (p= 0.343). The fracture tension of catheter in short-term and long-term group were 6.0696 ± 0.9414 and 5.9192 ± 0.8972 Newtons respectively (p= 0.535) and the fracture strain of catheter in short-term and long-term group were 6.0067 ± 0.7227 and 6.2584 ± 1.0212 respectively (p= 0.301). CONCLUSION: It is objective and consistent to take the catheter fracture tension as the standard. This standard would be able to accurately define the concept of catheter failure and reduce the risk of catheter fracture and the misdiagnosis of catheter failure. The catheter fracture tension and fracture strain was not affected by the catheter indwelling time. It is recommended to set the tensile force as 5 Newtons and carry it out at a speed of 100 mm/min for the catheter drawing of the PICC single-lumen silicone catheter (4.0F) from Budd Company.

Video-Assisted Thyroidectomy Using a Surgical Energy Device: Initial Experience in a Japanese Single-Center Cohort

<b><i>Objective:</i></b> Video-assisted thyroidectomy (VAT) was approved for coverage under the Japanese public health insurance system in 2016. In our department, we introduced VAT in 2018, and we have since been performing the procedure with the assistance of surgical energy devices. We herein summarize our cases undergoing VAT, including a review of points to consider when introducing the procedure, and characteristics of the surgical energy devices. <b><i>Methods:</i></b> We enrolled 24 patients (14 women and 10 men; age: 24–83 years; mean: 59.0 years) with thyroid/parathyroid tumors who underwent VAT between January 2018 and March 2021 at our department. The medical records of the patients were reviewed, and demographic data, clinical characteristics, histological type, treatment outcomes, and complications were analyzed. <b><i>Results:</i></b> The surgical energy devices used were LigaSure® in the first 4 cases, Acrosurg®. Scissors S17 in the next 13 cases, and Acrosurg®. Revo S15 in the latest 7 cases. The operation time (range: 72–250 min; mean: 147 min), intraoperative blood loss (range: 5–370 mL; mean: 33 mL), indwelling time of wound drain (range: 2–6 days; mean: 3.5 days), and hospitalization period (range: 3–8 days; mean: 5.5 days) were within acceptable ranges. In this study, it is suggested that Acrosurg®. Revo S15 can shorten the indwelling time and the hospitalization period. There were no serious complications, but 1 patient developed transient vocal cord paralysis, which improved 3 months after surgery. It was suggested that the microwave energy devices, Acrosurg®. Scissors S17 and Acrosurg®. Revo S15, may be more effective with respect to sealing/hemostasis/coagulation capacity and controllability than the high-frequency electrosurgical device, LigaSure®. <b><i>Conclusion:</i></b> Based on this initial experience, VAT using surgical energy devices appeared to be a safe, effective, and minimally invasive procedure for the treatment of thyroid/parathyroid tumors. Further studies confirming these early findings are needed.

Stent encrustation or fragmentation? A case report of post stent removal encrustation in postpartum woman and literature review

Background Ureteral stents are commonly used in the field of urology to relieve ureteral obstruction. However, complications relating to ureteral stent use, such as encrustation continue to occur, especially with prolonged indwell time. Case presentation Here we present a 37-year-old postpartum woman with a foreign body in her bladder after removing a ureteral stent 1 month before. She insisted that the foreign body was the fragment of stent and asked for medical malpractice indemnity payments while the surgeon of her insisted that the stent was intact during the procedure. Finally, the foreign body was confirmed as an encrustation by cystoscopy and the patient received 10,000 yuan ($ 1500) as indemnity payments after encrustation removal. Conclusion In the absence of guidelines, stent indwelling time vary with centers’ habits, stent materials and patient’s education. Early detection of stent encrustation and timely removal of the encrusted stent are still the best way to avoid stent retention. Violent stent removal is of danger and not recommended in any case.

Analysis of Risk Factors of Intracranial Infection After Traumatic Brain Injury Surgery

Background: Craniocerebral operation is the main method for the treatment of traumatic brain injury. However, it is very easy to be complicated with intracranial infection after operation, which affects the surgical efficacy and patient’s prognosis. It is also the main cause of surgical failure. It may also cause patient’s death for some patients with serious diseases. It is found that the infection after craniocerebral operation is often accompanied with abnormal changes of body-related treatment, in which the changes of serological indicators are more significant. Therefore, it is helpful to provide guidance for the prevention and judgment of patient’s postoperative infection by analyzing the patient’s serological indicators. Objective: To investigate the risk factors of intracranial infection and the levels of serum procalcitonin (PCT) and endothelin-1 (ET-1) in patients after traumatic brain injury. Methods: From January 2018 to January 2021, 58 patients with intracranial infection after traumatic brain injury (infection group) were selected, and 116 patients without intracranial infection after traumatic brain injury (non-infection group) were selected. The difference of clinical data between the two groups was analyzed. Serum PCT and ET-1 levels were measured in the two groups. Results: In the infection group, admission GCS scoring <8 points, operation time ≥4h, indwelling time of drainage tube ≥ 2d, preoperative ALB <35g/ L, mechanical ventilation and cerebrospinal fluid leakage were 63.79%, 72.41%, 43.10%, 68.97%, 32.76% and 68.97% respectively, which were obviously higher than those in the non-infection group (P<0.05). Logistic regression analysis results showed that admission GCS scoring, operation time, indwelling time of drainage tube, preoperative ALB, mechanical ventilation and cerebrospinal fluid leakage were the influencing factors of intracranial infection after traumatic brain injury (OR = 0.712,1.556,1.451,0.641,1.954 and 1.667, P<0.05); serum PCT and ET-1 in the infection group were (0.83 ± 0.20) mg/L and (0.87 ± 0.23) ng/L, respectively, which were significantly higher than those in the non-infection group (P<0.05); serum PCT and ET-1 in patients with different sex, age and pathogen had no significant difference (P>0.05); serum PCT and ET-1 area under ROC curve were 0.828 and 0.751, respectively P<0.05. Conclusion: The intracranial infection of patients with traumatic brain injury are affected by many factors including, admission GCS scoring, operation time, and so on, the levels of serum PCT and ET-1 in patients with intracranial infection are increased, which may be useful in predicting intracranial infection.

Analysis of influencing factors on the duration of pediatric peripheral intravenous catheter

Background: The application of peripheral intravenous catheter has been an effective guarantee for the success of pediatric therapy. We aimed to investigate the correlative factors that impacting the duration of pediatric peripheral intravenous catheter. Methods: From January 2017 to October 2017, 370 cases of pediatric patients in the First Hospital of Hunan University of Chinese Medicine were collected as the research object. Based on the indwelling time, the collected cases were divided into two groups, namely long time group (>72 h) and short time group (<72 h). The general data and laboratory test results of two groups were collected, and the correlation factors of indwelling time were analyzed by single factor and Logistic multiple factors. Results: As the results revealed that compared with short time group, patients in long time group had statistically significant differences in puncture site, phlebitis, extravasation of blood vessels, hemoglobin, white blood cells, platelets, and 75% ethanol sterilization ( p < 0.05). Logistic multivariate analysis indicated that scalp puncture was the independent protective factors that affecting the duration of pediatric peripheral intravenous catheter. Moreover, phlebitis represented the independent risk factor that influencing the indwelling time of pediatric peripheral intravenous catheter. And the differences were statistically significant ( p < 0.05). Conclusions: Analyze factors influencing indwelling time of pediatric peripheral intravenous catheter and enhance the management of relevant factors are of great significance to prolong the indwelling time, reduce the pain of pediatric patients, and facilitate the clinical medication.

The Improved Techniques of Holding the Lens in Endoscopic Thyroidectomy via Bilateral Areola Approach

Background: Inexperienced endoscope holder often greatly affect the time and quality of endoscopic thyroidectomy (ET) via bilateral areola approach. We summarized some techniques of holding the endoscopic lens to evaluate the value of the technique in ET.Methods: We retrospectively enrolled 200 eligible patients during two time peroids: 2015.6-2018.6 (Control group:inexperienced endoscope holder,n = 100) and 2019.9-2021.2 (Improved group:assistants who master the techniques of holding the endoscopic lens,n = 100). Surgery approach:unilateral lobectomy and isthmus resection plus ipsilateral cervical central lymph nodes dissection via bilateral areola approach of ET. Perioperative indicators included Volume of intraoperative blood loss,the time of three stages in the operation, the indwelling time of drainage tube and postoperative hospitalization time were compared. Postoperative complications were simultaneously compared involved temporary hoarseness, tetany, postoperative bleeding, postoperative infection and postoperative subcutaneous effusion.Results: The time of stage 1 (p < 0.001), stage 2 (p < 0.001) and stage 3 (p < 0.001) in the operation in improved group were significantly shorter than those in control group. The volume of intraoperative blood loss was smaller (p < 0.001), postoperative hospitalization time was shorter (p < 0.001) and the indwelling time of drainage tube was shorter (p < 0.001) for improved group. In terms of postoperative complications, the control group had more cases of temporary hoarseness (p = 0.002), tetany (p = 0.008) and postprocedure subcutaneous effusion (p = 0.009), but there was no difference in postoperative bleeding (p = 0.477) and infection (p = 1.000) between the two groups.Conclusions: The skills of holding the endoscopic lens which shorten the operation time and improve the quality of the operation are effective and suitable for novices.

Simultaneous Viscum Pleurodesis and Bullectomy in Patients With Primary Spontaneous Pneumothorax

Objectives: Although surgery is the gold standard for treatment of primary spontaneous pneumothorax (PSP), recurrence after surgery remains a concern. This study sought to evaluate the efficacy of simultaneous pleurodesis using Viscum album (VA) extract and bullectomy for the treatment of PSP.Methods: From March 2016 to November 2020, 196 patients with PSP underwent bullectomy and intraoperative pleurodesis with VA extract at a single institution. All operations were performed through video-assisted thoracic surgery by one surgeon. Upon completion of bullectomy, a polyglycolic acid sheet was used to cover the stapler lines, and 40 mg of VA extract was instilled over the entire chest wall before chest tube placement.Results: The mean operating time was 18.5±5.0 minutes (range, 10­–65) and the mean indwelling time of chest drainage was 1.8±0.5 days (range, 2–6). There were no postoperative complications over grade 3. During the median follow-up period of 36.3±18.4 months (range, 2–57), no recurrence of pneumothorax was observed.Conclusions: The results of this study demonstrated that simultaneous Viscum pleurodesis and bullectomy provides a feasible and effective treatment option for preventing postoperative pneumothorax in patients with PSP.

VISUAL OBSERVATION OF PHLEBITIS TO IDENTIFY FACTORS CONTRIBUTING TO THE DEVELOPMENT OF PHLEBITIS AMONG ADULT INPATIENT IN HCG HOSPITALS

Introduction: Peripheral intravenous catheters are used for administration of uid-electrolytes, blood and blood products, medications and parenteral nutrition. Phlebitis is the most common complication affects 75% of inpatients and is a signicant clinical problem. It negatively affects the comfort of the patient, the duration of catheter use, the hospitalization period, and treatment costs. The purpose of this study is to determine the effect of PVC duration on the development of phlebitis in infectious diseases Materials and methods: A descriptive cross-sectional study was done among 652 samples to determine the effect of peripheral venous catheter (PVC) duration on the development of phlebitis in HCG hospitals. Patients between 18-80 years of age, who were on IV parenteral therapy were included according to inclusion and exclusion criteria. Results: Development of phlebitis was observed more during night shifts (p=0.049) and it was due to the solution used for site preparation(p=0.003), material of the needle(p=0.002), indwelling time of the catheter (0.001). Further, the number of attempts made for IV insertion(p=0.001) was showing statistically signicant association with the development of phlebitis. Conclusion: The results suggest that it is very important to focus on the problems associated with the development of phlebitis especially taking care of patients during night shifts by restricting hand movements. Furthermore, it is also noted that by reducing the number of attempts while inserting IVcannulas can lower the complications related to IVcannulation.

Risk Analysis of Risk Factors for Pressure Injury Related to Tracheal Intubation in ICU Patients

Objective: This article mainly analyzes the risk factors of pressure injury related to tracheal intubation in ICU patients. Methods: This time, the investigation and research were mainly conducted on 110 patients with tracheal intubation received in the ICU of our hospital from June 2020 to June 2021, and the risk factors for related pressure injuries were analyzed. Results: According to statistics, the incidence rate of patients with tracheal intubation-related pressure injury was 23.63%, of which the lip had the highest incidence; the indwelling time of the tracheal tube, the wetness score, the movement force score, and the frictional shear score in the Braden score of the tracheal intubation These are all risk factors for pressure injury related to tracheal intubation (P<0.05). Conclusion: ICU patients have a higher incidence of related pressure injuries during tracheal intubation, so it is necessary to strengthen the care of risk factors and take reasonable and effective measures to prevent them.