Probing the entire vascular system

Microscopic endovascular probes that navigate by blood flow and an external magnetic field may increase the capabilities of vascular catheterization.

Ultrasound-guided peripheral vascular catheterization in pediatric patients: a narrative review

Peripheral vascular catheterization (PVC) in pediatric patients is technically challenging. Ultrasound guidance has gained the most interest in perioperative and intensive care fields because it visualizes the exact location of small target vessels and is less invasive than other techniques. There have been a growing number of studies related to ultrasound guidance for PVC with or without difficult access in pediatric patients, and most findings have demonstrated its superiority to other techniques. There are various ultrasound guidance approaches, and a comprehensive understanding of the basics, operator experience, and selection of appropriate techniques is required for the successful utilization of this technique. This narrative review summarizes the literature regarding ultrasound-guided PVC principles, approaches, and pitfalls to improve its clinical performance in pediatric settings.

Endovascular biometrics and engineering

Aim. To study technical problems in the provision of endovascular care and to develop technological solutions for its improvement based on endovascular biometry. Methods. For the period 20152019 an expert analysis of the results of endovascular treatment of 1546 patients with chronic lower limb ischemia was performed, in which it was not possible to perform lower limb revascularization according to the standard method using a guide catheter, guidewire and balloon catheter. The expert group included 5 interventional radiologists who performed endovascular procedures. The results were assessed by the effectiveness of revascularization using the developed innovative technology from a system of catheters of various diameters and stiffness in comparison with the results of using standard endovascular technique. Calculation of adequate statistical indicators and their reliability were undertaken using Statistica software (version 6.0). Results. The critical and weak zones of the vascular bed were identified for the first time to substantiate the development of a technology for safe and effective endovascular revascularization. It has been established that technical difficulties in catheterization of vessels create the prevalence of atherosclerotic lesions and the limited technical capabilities of catheters and guidewires, which are manipulated under the conditions of increasing high friction with the vessel wall caused by tortuosity and atherosclerosis, the presence of weak and critical zones of the blood vessels, as well as a significant distance from the surgeon's hands to the area of medical manipulation, reaching 130200 cm. The developed innovative design from the catheter system ensured the effectiveness of endovascular lower limb revascularization in all patients (100%) using the femoral and brachial accesses compare to the standard technique of endovascular care (p 0.001). Conclusion. Endovascular instruments offered on the domestic market do not guarantee the effective completion of revascularization. The technology of vascular catheterization developed based on endovascular biometry ensures the successful completion of revascularization in 100% of cases.

MONITORING OF PERIPHERAL VENOUS CATHETERIZATION AT THE SURGICAL HOSPITAL

Introduction. Peripheral venous catheters are widely used in medical practice to provide continuous venous access for therapeutic and diagnostic purposes. Peripheral vascular catheterization can be accompanied by infectious complications, including catheter-related bloodstream infections. An effective system of epidemiological surveillance and infection control of catheter-related bloodstream infections has not been developed at the state level in Ukraine; there is no proper monitoring for administration site and no registration of complications associated with the vascular catheterization. The purpose of this work was to assess the validity and propriety of the use of peripheral venous catheters in patients who receive inpatient treatment. Materials and methods: Between October 2019 and April 2020, 93 adult patients who were peripheral venous catheterized in a surgical hospital in Kharkiv were included in a prospective epidemiological study. The author's observation card was used for data collection for each patient daily. The catheter site was observed daily, and the following symptoms were entered into the card: flushed skin, swelling, discharge, and pain at the administration site at rest and on palpation. Interpretation of symptoms was conducted using the visual infusion phlebitis scale by A. Jackson. Statistical processing of data was carried out using descriptive statistics methods. To identify the relationship between the nominative values, Pearson's criterion χ2 was determined with P < 0.01. Research results: 51 women (54.8%) and 42 men (45.2%) aged 18 to 84 were enrolled. In total, patients spent 619 bed-days in the hospital, of which the proportion of days with vascular catheters equaled 90.8% (n = 562). The main indication for the catheterization procedure was multicomponent therapy or the use of incompatible medications (98.9% / n = 92). In total, 148 peripheral venous catheters were inserted in these patients. The number of vascular catheters per patient ranged 1 to 3. According to the data of daily monitoring of the administration site, the signs of inflammation were observed in 65.5% of cases (n = 97). The incidence of signs of inflammation at the administration site with the first catheterization was significantly higher (χ2 = 25.2804; p < 0.00001) than that with the second or third catheterization. The signs of local inflammation, which were more common in patients with vascular catheters, included flushed skin in the area of the catheter site (65.5% / n = 97), complaints of pain on palpation in the area of the catheter site (60.8% / n = 90) and swelling in the area of the catheter site (57.4% / n = 85). It was found that for more than half of the cases (55.4% / n = 82), the patients had symptoms of middle-stage phlebitis. It was also revealed that the most common reason for the removal of a peripheral venous catheter (n = 148) in the studied hospital were signs of local inflammation at the catheter site (61.5% / n = 91). However, in 16.9% of cases (n = 25), the occurrence of at least two signs of local inflammation at the catheter site, which indicated the initial stage of phlebitis and required to rearrange the catheter, was not the reason for immediate catheter removal. Conclusions: Health care workers make mistakes when working with peripheral venous catheters; in particular, there is no timely replacement of vascular catheters in the event of signs of infusion phlebitis. To reduce the risk of infectious complications of vascular catheterization at a health facility, the indications for insertion and removal of peripheral venous catheters and central venous catheters should be clearly defined, and standard operating procedures for ensuring vascular access and algorithms for managing patients with vascular catheters should be developed and implemented. Keywords intravascular catheter, prospective epidemiological study, assessment of the catheter insertion site, infusion phlebitis, catheter-related bloodstream infections, infection control.

Challenges in using anesthesia for open chest and aorta surgery in swine

Anesthesia for aorta surgery in pigs remains challenging due to the requirements for mechanical ventilation and the need for maintaining adequate homeostasis. We report an improved anesthesia protocol in an in vivo animal model to test a novel bacterial nanocellulose (BNC) within the ‘Kardio-BNC’ trial. Forty-four 6-month-old DanBred pigs comprising 6 males and 38 females (body weight ca. 82 kg) underwent implantation of pericardium reconstructive patches (n = 8), thoracic aorta prostheses (n = 15), or both procedures (n = 17) to test the biocompatibility of the novel BNC. The primary endpoint was 90-day survival, and the secondary outcome was death for any reason before reaching the study endpoint. Univariate analysis and linear regression were used to identify variables associated with premature mortality. Of the 44 pigs that underwent surgery, 10 (23%) were lost intra-operatively because of arrhythmia (n = 1), anesthesiological causes (n = 4), or surgical complications (n = 5). Modifications to tracheal intubation, tube fixation, temperature maintenance, and vascular catheterization increased the survival rate to 91% in the last quartile of the animals that underwent surgery. Of the 34 animals that survived surgery, n = 10 (29%) were lost post-operatively because of hematoma (n = 2), pneumothorax (n = 1), or infection (n = 7). Infection was associated with the type of surgery (highest prevalence in animals undergoing the combined procedure; p = 0.02), azaperone dose (p = 0.03), intra-operative heart rate variability (p = 0.03), and crystalloid transfusion (p = 0.04). The anesthesiological strategies and modifications to surgery described here allowed safe open chest and aorta surgery in up to 91% of the procedures performed