Distance that the catheter covers from skin to the vein using the US-guided in-plane technique: The impact of footprint of the probe and depth of the vein

Employing the in-plane technique in infants the footprint of the ultrasound probe should be considered along with the depth of the vein, and the angle between the needle and the face of the probe, which is crucial in optimization of the visibility of the needle in the beam. Three different ultrasound probes are evaluated for different depths of vein. The hockey-stick probe provided a shorter minimum distance while maintaining the angle between the needle and the face of the probe within an optimal range for visualization of the needle in the beam, supporting its recommendation for infants with regard to its frequency and physical size.

A study of large-scale vertical motion over West Africa

Three separately recorded cases of thundery weather over West Africa that occurred during the conduct of the West African Monsoon Experiment (WAMEX) of 1979, are investigated with the kinematic vertical p-velocity field. The scheme employed here is based on a least-squares-plane technique which has been desribed in Jegede and Balogun (1991), as a variant to the similar methods used by Kung (1972, 1973), and Pedder (1981). The aim in this study is to demonstrate the practicability of the kinematic method for interpreting observed surface weather. In all the three cast-s, there was some consistency noted between the precipitation patterns and the computed vertical velocity fields within the sub-region.

Clavipectoral plane block as a sole anesthetic technique for clavicle surgery - A case report -

Background: The clavipectoral fascial plane block was introduced by Dr. Luis Valdes in a symposium at the 2017 European Society of Regional Anesthesia and Pain Therapy Congress. Case: Clavipectoral plane block (CPB) with intravenous sedation provided surgical anesthesia and analgesia in a 39-year-old male patient with a right midshaft clavicle fracture. This in-plane technique was used to deposit 30 ml of a local anesthesia mixture between the clavipectoral fascia and periosteum on both the medial and lateral sides of the fracture line. Conclusions: Excellent anesthesia and analgesia for up to 16 h post-block were provided by CPB during the clavicle surgery.

Comparison of PLANE Technique versus Standard Echocardiography Guidance for Pediatric Pericardiocentesis

Percutaneous pericardiocentesis remains a challenging and potentially dangerous procedure, particularly in small, critically ill patients. We present outcomes of the PLANE (pericardiocentesis using long-axis in-plane real-time echocardiography) technique for pediatric pericardiocentesis compared with a standard echocardiography (ECHO) guidance cohort. This was a retrospective chart review of all children undergoing percutaneous pericardiocentesis from March 2013 to February 2021 at a single center. A total of 78 procedures were performed, 52 utilizing PLANE technique and 26 utilizing standard ECHO-guidance technique. There was 100% technical success rate with only one minor complication for the entire cohort. Procedures were evenly split between the bedside intensive care unit and cardiac catheterization laboratory. PLANE technique was utilized in significantly younger (1.4 vs. 8.4 years, p = 0.008) and smaller (11.1 vs. 31.8 kg, p = 0.007) patients, as well as in most patients deemed high risk (postoperative < 7 days, extracorporeal membrane oxygenation (ECMO) support, and/or weight less than 5 kg; 19/22, p = 0.021). Other patient characteristics were similar between the two groups. There was a trend toward PLANE technique utilization by noncardiology trained operators. The PLANE technique for pediatric pericardiocentesis is safe and effective and can be effectively utilized in small and high-risk patient populations. The technical similarity to other long-axis ultrasound-guided procedures may facilitate adoption and mastery by critical care trained operators.

Radial symmetry for an elliptic PDE with a free boundary

In this paper we prove symmetry for solutions to the semi-linear elliptic equation Δ u = f ( u ) in B 1 , 0 ≤ u > M , in B 1 , u = M , on ∂ B 1 , \begin{equation*} \Delta u = f(u) \quad \text { in } B_1, \qquad 0 \leq u > M, \quad \text { in } B_1, \qquad u = M, \quad \text { on } \partial B_1, \end{equation*} where M > 0 M>0 is a constant, and B 1 B_1 is the unit ball. Under certain assumptions on the r.h.s. f ( u ) f (u) , the C 1 C^1 -regularity of the free boundary ∂ { u > 0 } \partial \{u>0\} and a second order asymptotic expansion for u u at free boundary points, we derive the spherical symmetry of solutions. A key tool, in addition to the classical moving plane technique, is a boundary Harnack principle (with r.h.s.) that replaces Serrin’s celebrated boundary point lemma, which is not available in our case due to lack of C 2 C^2 -regularity of solutions.

A Novel Ultrasound-guided With Needle Visualization Pericardiocentesis Via Subcostal Approach

Cardiac tamponade is a condition when fluids or blood fill the pericardial space resulting in compression of the heart and subsequently compromising hemodynamic status of the patient. It is a potentially fatal medical or traumatic emergency that requires rapid recognition and immediate treatment. Formerly, blind or surgical techniques were used to aspirate the pericardial fluid and they were associated with plenty of risks and complications. In the recent era, medical technology development has enabled us to perform the procedure safely with the assistance of ultrasound devices. The ultrasound-guided procedure is not only proven to be effective and safe, but it also has very minimal drawbacks and complications. In the literature, there are many ultrasound-guided pericardiocentesis procedures performed with different approaches at different regions. They include subcostal, parasternal, and para-apical approaches and phased array echocardiography transducers are typically preferred for the procedures. We report a case of cardiac tamponade presented with hemodynamic compromise. Ultrasound-guided pericardiocentesis was carried out using in-plane technique with high frequency linear ultrasound transducer at the subcostal region as lifesaving procedure. This particular technique provided full visualization of needle trajectory throughout the procedure. It was successfully completed with no complications and patient’s hemodynamic status improved post-procedure. This article highlights the novel use of in-plane method with high frequency linear transducer at subcostal area as a safe option for pericardiocentesis in patients with cardiac tamponade.

Ultrasound guidance for internal jugular vein cannulation in neonates: Modified dynamic needle tip positioning short-axis out-of-plane technique versus long-axis in-plane technique, a randomized controlled trial

Background: Ultrasound-guided central venous catheter placement has significantly improved the success rate of punctures and reduced the risk of complications. However, catheterizing the internal jugular vein under ultrasound guidance in neonates remains challenging. Methods: Ninety-six patients were screened for eligibility in this randomized controlled trial between November 2018 and October 2019. After meeting the inclusion criteria, 90 term neonates undergoing cardiothoracic, general, or neurosurgery procedures were randomly assigned to the modified dynamic needle tip positioning short-axis ( n = 45) or long-axis groups ( n = 45) using a computer-generated random numbers table. The primary outcome was the first-attempt success rate. The secondary outcomes included the total success rate, cannulation time, and incidence of cannulation-related complications, including hematoma, accidental arterial puncture, or pneumothorax. Data were compared between the two groups. Results: The success rate for the first attempt was higher (88.9% vs 64.4%; p = 0.001; relative risk, 1.4; 95% confidence interval, 1.1–1.8), while the cannulation time was shorter (171.0 ± 47.8 s vs 304.4 ± 113.5 s; p = 0.001; estimated difference, −133.4; 95% confidence interval, −170.1 to −96.7), in the modified dynamic needle tip positioning short-axis group compared with the long-axis group. Six hematomas and two common carotid artery punctures were identified in the long-axis group, while none were identified in the modified dynamic needle tip positioning short-axis group. Conclusions: The modified dynamic needle tip positioning short-axis out-of-plane technique enhanced the procedural efficacy and safety of internal jugular vein catheterization in neonates.