Study On Coronary Dissection Complication Caused by Uneven Rotational Atherectomy Due To Guidewire Bias for Severe Calcified Lesions

BACKGROUND In the treatment of coronary calcification by rotational atherectomy (ROTA), guidewire bias is often considered to lead to procedure associated coronary dissections or perforations. However, the actual meaning of guidewire bias is unclear, though it usually refers to the cross-section location of the intravascular imaging (IVI) catheter in the coronary artery. OBJECTIVES This study tentatively explores the quantitative criteria in optical coherence tomography (OCT) imaging of guidewire bias which may cause ROTA induced coronary dissection. METHODS A total of twenty-one patients with severe calcified coronary lesions who has undergone ROTA treatment were enrolled in our study. These patients were detected by OCT successfully pre- and post-ROTA. All the observational coronary segments were analyzed cross-sectionally at every mm interval after manual coregistration of OCT imaging pre- and post-ROTA. ROTA related coronary dissection was the primary endpoint. RESULTS A total of 388 OCT cross-sectional images were effectively measured and analyzed for distribution and characteristics of plaque and OCT catheter location pre-ROTA, and the presence or absence of coronary dissections post-ROTA after manual coregistration. According to the receiver operating characteristic (ROC) analysis, distance from the center of OCT catheter to media at the bias direction (Dcmb) (area under the curve (AUC): 1.000, p<0.001, 95% confidence intervals (CI): 0.999 to 1.000) and touch angle (AUC: 0.988, p<0.001, 95%CI: 0.968 to 1.000) had a higher correlation with ROTA-related coronary dissection with the corresponding cutoff value of 0.720mm and 98.2º significantly. CONCLUSIONS Dcmb and touch angle detected by OCT are two very valuable and convenient independent predictors of ROTA-related coronary intimal dissections caused by guidewire bias.

Incidence of Phlebitis Following the Use of Peripheral IV Line at X Hospital

Introduction: Intravenous (IV) line infusion therapy is a therapy given to patients who are admitted or having a specific therapy. The IV-line therapy may include fluid therapy, medication administration and blood therapy. Based on the data found in Hospital X, there were 30 incidence of phlebitis in 2017. This study aimed to describe the factors of phlebitis incidence in X hospital. Method: This study was a retrospective study using 50 clinical record of the inpatient patients. The inclusion criteria were all documents of those who are hospitalized at least three days. Result: The result describes three factors following the incidence of phlebitis, such as intrinsic factors, chemical factors, and mechanical factors. The Intrinsic factors included age, gender and medical diagnosis. While Mechanical factors consist of the size of catheter, location and length of infusion. The Chemical factors were of infusion fluid type and infusion rate. Conclusion: The conclusion of this study was the three factors are modifiable factors. Thus, nurses need to assess and evaluate patients’ infusion in order to prevent a higher case of phlebitis. As a recommendation for further study is to analyze the correlation between those factors to the incidence of phlebitis.

Abstract 15612: Force, Power, and Temperature Settings in Slow Pathway Modification Utilizing an Irrigated Force Sensing Ablation Catheter

Introduction: Atrioventricular node reentry tachycardia (AVNRT) ablation is typically performed with solid tip catheters set to temperature control (TC) mode. Radiofrequency (RF) output, tip temperature (T), and junctional rhythm response (JRR) during RF application have been well defined. JRR in an intermittent burst, sinus-junction-junction, or sinus-junction-sinus pattern is associated with successful modification of the AV nodal slow pathway (SP). Irrigated force-sensing catheters (IFSC) are often utilized for mapping and ablation of the SP. Despite this, parameters for IFSC used in TC mode resulting in JRR have not been well described. Hypothesis: Parameters predicting JRR and successful SP modification with IFSC include power (P), force (F), impedance drop (I), and target temperature (T). Methods: Consecutive patients that underwent electrophysiologic study and successful ablation of typical AVNRT with an IFSC were studied. Lesion parameters including P, T, F, time and I change were analyzed. Lesions producing JRR were considered efficacious. Independent T-Test and ANOVA were used to determine significance between the two groups (efficacious and non-efficacious lesions). Results: 296 lesions in 39 patients (age 52+/-14) were analyzed. All patients had successful SP modification without complication. Average F producing JRR was 8g, average T producing JRR was 41 o C, average I drop producing JRR was 9 Ohms, and average P producing JRR was 28W. Only RF lesion time was a significant predictor of JRR (p=0.009). (Table 1). Conclusions: Successful SP modification with IFSC was accomplished with catheter contact force as low as 2g. Lower average tip T, and lower average P settings compared to parameters typically used with solid tip catheters were observed. Parameters including P, F, T, and I change were not predictive of JRR. Additional studies controlling for catheter location while varying parameters are indicated.

Unicompartmental versus Tricompartmental Knee Arthroplasty with Continuous Adductor Canal and Femoral Nerve Blocks Analgesic Requirements and Implications for Discharge Readiness

Background: The relative analgesic requirements for tricompartmental (TKA) and unicompartmental (UKA) knee arthroplasty and their effects on discharge readiness remain unexamined when continuous adductor canal and femoral nerve blocks are used for analgesia in the immediate postoperative period. Methods: Data were collected from 2 previously-published clinical trials involving subjects undergoing TKA (n=79) or UKA (n=30) randomized to either an adductor canal or femoral perineural catheter and ropivacaine 0.2% infusion for 2 (UKA) or 3 (TKA) days. Originally, we compared each catheter location (adductor vs. femoral) while holding surgical procedure constant (comparing solely TKAs and solely UKAs). We now compare type of surgical procedure (TKA vs UKA) while holding catheter location (adductor vs. femoral) constant. The primary outcome was the time to attain 4 discharge criteria including pain, opioid requirements, and ambulation/mobilization. Results: For adductor canal catheters, UKA patients reached all 4 discharge criteria in 35 [24—43] hours which was significantly faster than those given TKA who took 55 [43—63] hours (difference: 18h; 95%CI 9 to 28 h; P<0.001). The results were similar for femoral catheters: UKA patients reach all four discharge criteria in 40 [27—58] hours which was significantly faster than those given TKA who took 61 [49—69] hours (difference: 20; 95%CI 4 to 30 h; P=0.009). For both catheter locations, pain scores, opioid requirements, and mobilization endpoints were better with UKA than TKA. Conclusion : UKA induces less pain and requires less opioid than TKA, regardless of perineural catheter location. Consequently, patients who have UKA are ready for discharge sooner.

Ventriculoperitoneal Shunt assisted by Neuroendoscopy

Object. We present our experience in ventriculoperitoneal shunt assisted by neuroendoscopy. Methods. Thirty-six patients with new communicating hydrocephalus were selected to VP shunt placement assisted by neuroendoscopy. Postoperative computerized tomography (CT) was performed in the first day in all patients and ventricular catheter location was analysed. A follow up of 12 months was performed and results showed. Results. Mean patient age at implantation was 57 ± 13.59 years (range, 16-77). There was a slight preponderance of males (22 patients, 61%). The most common cause for shunt surgery was hemorrhage (20 patients, 55%), including subarachnoid hemorrhage (14 patients, 39%), and intracerebral hemorrhage (ICH) or intraventricular hemorrhage (IVH) (5 patients, 16%). Posttraumatic hydrocephalus followed as a secondary cause (11 patients 31.5%). During the period covered by thestudy, 8 valves were revised, thereby meeting the criteria for shunt failure endpoint. The most common cause for shunt revision was underdrainage in 5 patients, followed by infection in 2 patients, and overdrainage in 1 patient. None of them had proximal obstruction and in all cases, the ventricular catheter was well located. Conclusions. Endoscopic view can be used to place the ventricular catheter in a good position inside the ventricular system.

Infection in Critically Ill Pediatric Patients on Continuous Renal Replacement Therapy

Introduction Continuous renal replacement therapies (CRRT) are frequently used in critically ill children and may increase the risk of infection. However, the incidence, characteristics and prognosis of infection in critically ill children on CRRT have not been studied. Methods Data from a prospective, single-center register of critically ill children treated with CRRT was analyzed. Results 55 children (40% under 1 year of age) were treated with CRRT between June 2008 and January 2012; 43 patients (78.2%) presented 1 or more infections. The most common condition of patients requiring CRRT was heart disease (69%). Infection occurred a median of 11 days after the initiation of CRRT (IQ range: 4 to 21 days). A total of 21 patients (48.8 %) developed 1 infection, 7 (16.2%) developed 2 infections and 15 (34.9%) developed 3 or more infections. The most frequent infection was catheter-related bacteremia, with no differences in catheter location. CRRT duration longer than 4.5 days was the only risk factor for infection. Patients with infection had a longer length of stay (LOS) in the Pediatric Intensive Care Unit (PICU) than patients without it (37.8 vs. 17.6, p = 0.019), but there were no differences in mortality (30.2% vs. 33.3%; p = 0.84). Conclusions Infection rate is high in critically ill children treated with CRRT. More than 4 days of CRRT increases the risk of infection. Infection in these patients entails a longer stay in the PICU but did not increase mortality.