Intra-aortic balloon pumps in cardiogenic shock: an overview

The intra-aortic balloon pump was first introduced for the treatment of cardiogenic shock. It is now the most commonly used form of circulatory support, despite disappointing findings from the intra-aortic balloon pump SHOCK II trial ( Thiele et al, 2012 ). Common placement is via the femoral artery into the aorta, with the tip of the balloon sitting below the left subclavian artery and the distal end above the renal arteries. The balloon is timed to inflate at the beginning of diastole augmenting coronary perfusion and deflate on the R wave just before systole, reducing the afterload. Patients who may be considered for intra-aortic balloon pump insertion are those experiencing ST elevation myocardial infarction or complex ischaemic disease and cardiogenic shock. Despite advances in catheter size and technology, potential complications include bleeding from the insertion site, limb ischaemia and compartment syndrome. Cardiovascular nurses require specialist knowledge and skills concerning balloon console technology, nursing care and potential complications.

Abstract 1122‐000101: First‐in‐Human Experience Using the Millipede 088 Aspiration Catheter in Stroke Thrombectomy

Introduction : Studies have suggested that closely matching the catheter size to the vessel size may improve the effectiveness of clot aspiration in stroke thrombectomy. A new category of “super‐bore” aspiration catheters with 8Fr OD and 0.088in ID has recently been developed to further improve reperfusion success. In this work we report on early clinical experience using a CE Marked device called Millipede 088 developed by Perfuze (Galway, Ireland). Methods : The clinical, procedural, and radiological data were reviewed for consecutive cases in which Millipede 088 was used. Millipede 088 was navigated to the target vessel over a 6F intermediate catheter with or without a microcatheter and microwire, at the discretion of the physician. Performance was evaluated in terms of successful intracranial navigation and reperfusion measured using the mTICI scale. Results : Ten patients (age 55–89 years, 50% male) with intracranial large vessel occlusions (LVOs) were treated ‐ 4 ICA and 6 M1 LVOs. In two cases, the patients had concomitant tandem lesions requiring additional treatment. Millipede 088 was delivered intracranially in all cases, and to the target vessel in 8 cases. In two cases in which Millipede 088 was not advanced to the target vessel, it was placed intracranially for distal flow control, and an intermediate catheter was used for clot aspiration. In one case, following mTICI 2b reperfusion after aspiration, a stentriever was deployed via Millipede 088 to retrieve a distal M2 clot. Excellent reperfusion (mTICI 2c‐3) at the end of the procedure, was achieved in all (100%) of patients. First‐pass mTICI 2c‐3 was achieved in 5 patients (50%). No sICH or other complications were reported. Conclusions : In this first in man experience, aspiration thrombectomy using the Millipede 088 proved to be technically feasible and safe. Excellent reperfusion was achieved in all patients. The Millipede 088 represents a promising option for stroke thrombectomy.

FAKTOR RISIKO EKSTERNAL KEJADIAN PHLEBITIS PADA PEMASANGAN KATETER INTRAVENA PERIFER: STUDI DOKUMENTASI

Intravenous insertion therapy given for a long time can cause complications such as phlebitis. Phlebitis is an inflammatory reaction in the veins along with signs of pain, redness, swelling, heat, and hardening at the puncture site and along the vein. One main factor that influence the incidence of phlebitis are external factors such as inappropriate intravenous (IV) catheters, length of catheter insertion, location of the catheter, pH and fluid osmolarity and internal factors include age, sex and comorbidities. External factors are factors that can be modified according to the authority of the nurse, so that the modification can reduce the incidence of phlebitis in the hospital. The aim of this study was to identify the external risk factors for phlebitis on peripheral intravenous catheter insertion in the inpatient room of a private Indonesian hospital. This research method was descriptive quantitative. Samples based on population, obtained from the Slovin formula were 95 medical records of inpatients with purposive sampling technique. Data collection obtained from medical record documents, included in the observation sheet. This study showed that more than half of the patients with intravenous catheters had the incidence of phlebitis (53%). Patients who experienced the incidence of phlebitis used an intravenous catheter size of 24G (88,89%), the location was in the metacarpal (56,33%), used hipotonic fluid (81,25%) and had an intravenous catheter inserted for more or equal to three days (63,41%). It is important to be able to increase the knowledge and skills of nurses, especially regarding the standard procedure for infusion and treatment as well as external factors that influence the occurrence of phlebitis. Keywords: Intravenous therap;, Phlebitis; Eksternal factors AbstrakTerapi pemasangan intravena yang diberikan dalam jangka waktu yang lama dapat menimbulkan komplikasi seperti adanya kejadian phlebitis. Phlebitis adalah reaksi peradangan pada pembuluh darah vena beserta dengan tanda-tanda nyeri, kemerahan, bengkak, panas, serta pengerasan pada daerah tusukan dan sepanjang pembuluh darah vena. Salah satu faktor utama yang memengaruhi kejadian phlebitis adalah faktor eksternal seperti ukuran kateter intravena/IV yang tidak sesuai, lama pemasangan kateter IV, lokasi pemasangan kateter IV, pH dan osmolaritas cairan. Faktor lainnya yaitu faktor internal seperti usia, jenis kelamin dan penyakit penyerta. Faktor eksternal merupakan faktor yang dapat di modifikasi sesuai kewenangan perawat, sehingga dapat menurunkan angka kejadia phlebitis di rumah sakit. Tujuan penelitian ini untuk mengidentifikasi faktor risiko eksternal kejadian phlebitis pada pemasangan kateter intravena perifer di ruang rawat inap di satu rumah sakit swasta Indonesia. Metode penelitian ini adalah deskriptif kuantitatif. Sampel berdasarkan populasi, yang didapatkan dari rumus Slovin adalah 95 rekam medis pasien rawat inap dengan teknik purposive sampling. Pengumpulan data yang didapatkan dari dokumen rekam medis di masukkan dalam lembar observasi. Penelitian ini menunjukkan bahwa lebih separuh pasien yang terpasang kateter intravena mengalami kejadian phlebitis (53%). Pasien yang mengalami kejadian phlebitis tersebut menggunakan ukuran kateter intravena 24G (88,89%), lokasi pada metacarpal (56,33%), menggunakan jenis cairan hipotonik (81,25%) serta terpasang kateter intravena lebih atau sama dengan tiga hari (63,41%). Penting untuk dapat meningkatkan pengetahuan dan keterampilan perawat khususnya tentang standar prosedur pemasangan infus dan perawatannya serta faktor eksternal yang memengaruhi terjadinya phlebitis.

530 An Audit of Appropriate Documentation Following Urethral Catheterisation

Introduction Urethral catheterisation is a procedure frequently done in the hospital by medical personnel. Appropriate documentation is necessary to ensure safe clinical care and to reduce the risk of litigation. Method We randomly reviewed electronic notes of patients seen by the on-call urology team who had a urethral catheter inserted in September 2020. Reviewing the trust’s guidelines, we considered that appropriate documentation should include reference to the following 10 items; indication, chaperone present, consent obtained, groin examination, catheter size, catheter type, insertion process, urine colour, water in balloon and residual volume were reviewed. Results A total of 50 patients were included. 72%(36/50) were inserted by a member of the urology team. Only 28%(14/50) had all 10 items documented. Indication for catheterisation was best documented at 94%(47/50) while presence of a chaperone and groin examination (i.e. presence of a foreskin and its replacement post-catheterisation) were the lowest at 44%(22/50). Conclusions This study shows there is low compliance to adequate documentation of urethral catheterisation. A ‘smart phrase’ has been developed for use with our Trusts electronic medical records system to assist clinicians with appropriate documentation. Clinicians that use the phrase ‘.icat’ are prompted to document all 10 requisite items. This uses the mnemonic i-CATHETAR [indication, Chaperone and consent, groin Assessment, Tube (catheter size and type), insertion process (Hard/Easy), urine Tint, Aqua in balloon, Residual volume]. A second audit cycle is currently being done to review the effectiveness of this intervention.

Neuroendovascular Management of Acute Ischemic Basilar Strokes: 2-Dimensional Operative Video

Basilar artery occlusions (BAOs) are devastating ischemic strokes that account for 1% of all strokes with high morbidity and mortality; however, neuroendovascular techniques such as ADAPT have recently revolutionized the clinical outcomes of these patients.1-3 Common underlying pathology in patients with BAO include intracranial atherosclerotic disease (ICAD) as well as thromboembolic origin.4 Basilar artery ICAD in a setting of acute stroke portends a poor prognosis and post-thrombectomy residual critical flow limiting stenosis treatment options, including balloon angioplasty with or without stent placement.5-7 We present a video illustration of neuroendovascular technique and challenges encountered when managing this pathology. Image at 5:42 reprinted with permission from Alawieh et al, Lessons learned over more than 500 stroke thrombectomies using ADAPT with increasing aspiration catheter size, Neurosurgery, 86(1), 2020, pp. 61-70, with permission from the Congress of Neurological Surgeons.1

A prospective sonographic evaluation of peripheral intravenous catheter associated thrombophlebitis

Objective: Thrombophlebitis associated with peripheral intravenous catheters (PIVCs) is a poorly described complication in the literature. Given limited accuracy of current assessment tools and poor documentation in the medical record, the true incidence and relevance of this complication is misrepresented. We aimed to identify risk factors in the development of thrombophlebitis using an objective methodology coupling serial diagnostic ultrasound and clinical assessment. Methods: We conducted a single-site, prospective observational cohort study. Adult patients presenting to the emergency department that underwent traditionally placed PIVC insertion and were being hospitalized with an anticipated length of stay greater than 2 days were eligible participants. Using serial, daily ultrasound evaluations and clinical assessments via the phlebitis scale, we identified patients with asymptomatic and symptomatic thrombosis. The primary goal was to identify demographic, clinical, and IV related risk factors associated with thrombophlebitis. Univariate and multivariate analyses were employed to identify risk factors for thrombophlebitis. Results: A total of 62 PIVCs were included between July and August 2020. About 54 (87.10%) developed catheter-related thrombosis with 22 (40.74%) of the thrombosed catheters were characterized as symptomatic. Multivariate cox regression demonstrated that catheter diameter relative to vein diameter greater than one-third [AHR = 5.41 (1.91, 15.4) p = 0.0015] and angle of distal tip of catheter against vein wall ⩾5° [AHR = 4.39 (1.39, 13.8) p = 0.0116] were associated with increased likelihood of thrombophlebitis. Conclusions: Our study found that the increased proportion of catheter relative to vein size and steeper catheter tip angle increased the risk of thrombophlebitis. Catheter size relative to vein size is a modifiable factor that should be considered when inserting PIVCs. Additional larger prospective investigations using objective methodologies are needed to further characterize complications in PIVCs.

The Risk Factors of Phlebitis in The Installation of Intravent Catalysts

Background: A hospital is a health service facility that allows nosocomial infections, namely phlebitis. Phlebitis is a complication of intravenous catheter placement that is characterized by redness, pain, swelling, and fever. The high rate of phlebitis in various countries is due to the risk factors that predispose to the incidence of phlebitis due to intravenous catheter placement.Objective: This study aims to determine the risk factors for phlebitis in intravenous catheter placement.Methodology: This study uses an observational analytic method with a cohort design. The study was conducted on 27 February - 14 March 2020 with 22 samples taken using purposive accidental sampling in the inward and RST surgery Dr. Soedjono Magelang. The instrument used was an observation sheet designed by researchers that had been tested by experts and a standard operational checklist for infusion. Data analysis uses a chi-square test and multiple logistic regression.Results: The incidence of phlebitis was 7 respondents (31.8%) and the associated risk factors were the type of infusion fluid (RR = 4.37 CI 95% 1.09-17.58; p-value 0.020). While the factors of age, sex, nutritional status, chronic diseases, types of injection drugs, insertion location, duration of installation, nurse skills, installation techniques, and catheter size were not related to the incidence of phlebitis (p-value 0.05).Conclusion: Although several factors are not related to the incidence of phlebitis, these factors can be a support for the incidence of phlebitis.

Impact of aspiration catheter size on first-pass effect in the combined use of contact aspiration and stent retriever technique

Background and purposeThe first-pass effect (FPE), defined as a first-pass Expanded Treatment in Cerebral Ischaemia (eTICI) 2c/3 reperfusion, has emerged as a key metric of efficacy in mechanical thrombectomy (MT) for acute ischaemic stroke. The proximal balloon occlusion together with direct thrombus aspiration during stent retriever thrombectomy (PROTECT)-PLUS technique consists in the use of a balloon guide catheter and a combined MT approach involving contact aspiration and a stent retriever. The aim of this study is to assess the effectiveness and safety of the PROTECT-PLUS technique using distal aspiration catheters (DACs) with different inner diameters by comparing the large-bore DAC Catalyst 7 versus the use of medium-bore DACs.MethodsRetrospective analysis of a prospectively maintained database of patients treated with PROTECT-PLUS using Catalyst 7, Catalyst 6 or Catalyst 5 with an occlusion of either the terminal carotid artery or the M1 or M2 segments of the middle cerebral artery from 2018 to 2020 in two comprehensive stroke centres. Baseline characteristics and procedural, safety and clinical outcomes were compared between groups. Multivariable logistic regression analysis was performed in order to find independent predictors of FPE.ResultsWe identified 238 consecutive patients treated with PROTECT-PLUS as front-line approach using Catalyst 7 (n=86), Catalyst 6 (n=78) and Catalyst 5 (n=76). The rate of FPE was higher with Catalyst 7 (54%) than Catalyst 6 (33%, p=0.009) and Catalyst 5 (32%, p=0.005), in addition to higher final eTICI 2c/3 reperfusion rates, shorter procedural times, lower need of rescue therapy and fewer procedure-related complications. After multivariable analysis the sole independent factor associated to FPE was the use of Catalyst 7 (OR 2.34; 95% CI 1.19 to 4.58; p=0.014).ConclusionFurther development of combined MT by incorporating larger-bore aspiration catheters is associated with higher reperfusion rates, shorter procedure times, and lower need of rescue therapy while reducing the complication rates.

Critical Review III to Standardize the Textbooks of Fundamentals of Nursing: Nutrition, Urinary and Bowel Elimination Needs

Purpose: To identify the discrepancies in the textbook of fundamentals of nursing in nutrition and elimination needs in terms of number, range, definition and etc.Methods: The 10 textbooks which are the most frequently used were selected and reviewed. After then compared it with the protocols of essential nursing skills of Korean Accreditation Board of Nursing Education and evidence-based clinical nursing practice guidelines of Korean Hospital Nurses’ Association.Results: The most significant discrepancies in nutrition domain were criteria of obesity, confirmation of nasogastric tube placement. In elimination domain, there were several mixed or miss uses of French and number unit in catheter size. And appropriate catheter size for urinary catheterization and enema is different to books and guidelines.Conclusion: In order to conduct an effective resource in education of nursing, textbooks need to be revised constantly and contain the recent researches and guidelines.