Eventos adversos associados ao uso de cateteres arteriais em unidades de terapia intensiva: um estudo transversal / Adverse events associated with the use of arterial catheters in intensive care units: a cross-sectional study

Introdução: A monitorização de pressão arterial invasiva e a manipulação do circuito são processos fundamentais na assistência de enfermagem em terapia intensiva, mas práticas inadequadas podem gerar riscos significativos para o paciente, incluindo eventos adversos. Objetivos: Geral: Analisar os fatores contribuintes para a ocorrência de eventos adversos associados ao uso de cateteres arteriais, à luz da segurança do paciente. Específicos: 1 - Verificar a ocorrência de eventos associados ao uso de cateteres arteriais em terapia intensiva. 2 - Identificar os fatores contribuintes para a ocorrência de eventos adversos associados ao uso de cateteres arteriais em terapia intensiva; 3 - Correlacionar a ocorrência de eventos adversos associados ao uso de cateteres arteriais com os fatores contribuintes relacionados à segurança do paciente; 4 - Discutir a implicação dos fatores contribuintes para a prática segura de enfermagem, à luz da segurança do paciente. Método: estudo transversal, com dados retrospectivos, de caráter analítico e de natureza quantitativa. A amostra documental foi composta por todas as notificações de eventos adversos relacionados a cateteres arteriais entre dezembro de 2019 e janeiro de 2023 nas terapias intensivas da instituição coparticipante. Para a complementação de dados clínicos dos pacientes, foram utilizados os prontuários eletrônicos e físicos do hospital. Realizada análise descritiva e inferencial com cálculos de frequências e testes de associação, como qui-quadrado e exato de Fisher. Em toda análise foi considerado o nível de significância máximo de 10% (p-valor < 0,1). O estudo seguiu as diretrizes do Checklist STROBE. Resultados: O estudo incluiu 39 notificações de eventos adversos com cateteres arteriais, com uma taxa de ocorrência de 1,25%. O incidente de maior prevalência foi a perda inadvertida (41%), seguido por formação pseudoaneurisma e/ou hematoma (25,6%), e obstrução (20,51%). Quanto às consequências dos eventos, a necessidade de nova punção ocorreu em 61,5% dos casos, sendo a maioria dos danos classificados como leves (53,8%). Recursos humanos (p-valor 0,069), necessidade de sedação (p-valor 0,011) e sítio de inserção (p-valor 0,074) foram fatores que estiveram associados à perda acidental do dispositivo. Fatores relacionados ao paciente (p-valor 0,079) e ao método de punção (p-valor 0,079) estiveram relacionados à formação de pseudoaneurisma e hematomas. E recursos humanos (p-valor 0,001), utilização de aminas vasoativas (p-valor 0,032) e o sítio de inserção (p-valor 0,012) estiveram associados à obstrução do sistema. Conclusão: A partir dos resultados foi possível elucidar potenciais fragilidades que podem comprometer a segurança do paciente crítico em uso de monitorização de pressão arterial, como método de punção, manejo do circuito e características clínicas dos pacientes. Fatores como recursos humanos, uso de sedação e o local de inserção do cateter estiveram vinculados à perda acidental do mesmo. Além disso, características relativas ao paciente e ao método de punção foram associadas à formação de pseudoaneurisma e/ou hematoma. Por fim, a combinação de fatores como recursos humanos, uso de aminas vasoativas, método de manuseio e o local de inserção demonstrou associação com a obstrução do cateter. Futuros estudos de acompanhamento com amostras maiores podem fortalecer a compreensão do fenômeno.

Introduction: Invasive blood pressure monitoring and circuit manipulation are fundamental processes in intensive care nursing, but inadequate practices can generate significant risks for the patient, including adverse events. Objectives: General: To analyze the contributing factors to the occurrence of adverse events associated with the use of arterial catheters, in the light of patient safety. Specific: 1 - To verify the occurrence of events associated with the use of arterial catheters in intensive care; 2 - To identify the contributing factors for the occurrence of adverse events associated with the use of arterial catheters in intensive care; 3 - To correlate the occurrence of adverse events associated with the use of arterial catheters with the contributing factors related to patient safety; 4 - To discuss the implication of the contributing factors for safe nursing practice, in the light of patient safety. Method: cross-sectional study, with retrospective data, of an analytical and quantitative nature. The documentary sample consisted of all reports of adverse events related to arterial catheters between December 2019 and January 2023 in the intensive care units of the co-participating institution. The hospital's electronic and physical medical records were used to supplement the patients' clinical data. Descriptive and inferential analysis was carried out using frequency calculations and association tests such as chi-square and Fisher's exact test. A maximum significance level of 10% (p-value < 0.1) was considered in all analyses. The study followed the guidelines of the STROBE Checklist. Results: The study included 39 reports of adverse events with arterial catheters, with an occurrence rate of 1.25%. The most prevalent incident was inadvertent loss (41%), followed by pseudoaneurysm and/or hematoma formation (25.6%), and obstruction (20.51%). As for the consequences of the events, the need for a new puncture occurred in 61.5% of cases, with most of the damage being classified as mild (53.8%). Human resources (p-value 0.069), need for sedation (p-value 0.011) and insertion site (p-value 0.074) were factors associated with accidental device loss. Factors related to the patient (p-value 0.079) and the puncture method (p-value 0.079) were related to the formation of pseudoaneurysms and hematomas. Human resources (p-value 0.001), the use of vasoactive amines (p-value 0.032) and the insertion site (p-value 0.012) were associated with system obstruction. Conclusion: From the results, it was possible to elucidate potential weaknesses that could compromise the safety of critically ill patients using blood pressure monitoring, such as the method of puncture, circuit management and the clinical characteristics of the patients. Factors such as human resources, the use of sedation and the catheter insertion site were linked to accidental catheter loss. In addition, characteristics relating to the patient and the method of puncture were associated with the formation of pseudoaneurysms and/or hematomas. Finally, the combination of factors such as human resources, use of vasoactive amines, handling method and insertion site was associated with catheter obstruction. Future follow-up studies with larger samples could strengthen our understanding of this phenomenon.

Introducción: La monitorización invasiva de la presión arterial y la manipulación del circuito son procesos fundamentales en la enfermería de cuidados intensivos, prácticas inadecuadas pueden generar riesgos significativos para el paciente, incluyendo eventos adversos. Objetivos: General: Analizar los factores que contribuyen a la ocurrencia de eventos adversos asociados al uso de catéteres arteriales, a la luz de la seguridad del paciente. Específicos: 1 - Verificar la ocurrencia de eventos asociados al uso de catéteres arteriales en cuidados intensivos; 2 - Identificar los factores contribuyentes para la ocurrencia de eventos adversos asociados al uso de catéteres arteriales en cuidados intensivos; 3 - Correlacionar la ocurrencia de eventos adversos asociados al uso de catéteres arteriales con los factores contribuyentes relacionados a la seguridad del paciente; 4 - Discutir la implicación de los factores contribuyentes para la práctica segura de enfermería, a la luz de la seguridad del paciente. Método: Estudio transversal, con datos retrospectivos, de carácter analítico y cuantitativo. La muestra documental consistió en todos los informes de eventos adversos relacionados con catéteres arteriales entre diciembre de 2019 y enero de 2023 en las unidades de cuidados intensivos de la institución coparticipante. Se utilizaron las historias clínicas electrónicas y físicas del hospital para complementar los datos clínicos de los pacientes. Se realizaron análisis descriptivos e inferenciales mediante cálculos de frecuencias y pruebas de asociación como chi-cuadrado y la prueba exacta de Fisher. Consideró un nivel de significación máximo del 10% (valor p < 0,1). El estudio siguió las directrices de la STROBE Checklist. Resultados: El estudio incluyó 39 notificaciones de acontecimientos adversos con catéteres arteriales, con una tasa de ocurrencia del 1,25%. El incidente más prevalente fue la pérdida inadvertida (41%), seguido de la formación de pseudoaneurismas y/o hematomas (25,6%) y la obstrucción (20,51%). En cuanto a las consecuencias de los sucesos, la necesidad de una nueva punción se produjo en el 61,5% de los casos, clasificándose la mayoría de los daños como leves (53,8%). Los recursos humanos (p-valor 0,069), la necesidad de sedación (p-valor 0,011) y el lugar de inserción (p-valor 0,074) fueron factores asociados a la pérdida accidental del dispositivo. Los factores relacionados con el paciente (p-valor 0,079) y el método de punción (p-valor 0,079) se relacionaron con la formación de pseudoaneurismas y hematomas. Los recursos humanos (p-valor 0,001), el uso de aminas vasoactivas (p-valor 0,032) y el lugar de inserción (p-valor 0,012) se relacionaron con la obstrucción del sistema. Conclusiones: A partir de los resultados, fue posible dilucidar las debilidades que podrían comprometer la seguridad de los pacientes críticos que utilizan la monitorización de la presión arterial, como el método de punción, el manejo del circuito y las características clínicas de los pacientes. Factores como los recursos humanos, el uso de sedación y el lugar de inserción del catéter se relacionaron con la pérdida accidental del catéter. Además, las características relacionadas con el paciente y el método de punción se asociaron a la formación de pseudoaneurismas y/o hematomas. Por último, la combinación de factores como los recursos humanos, el uso de aminas vasoactivas, el método de manipulación y el lugar de inserción se asoció a la obstrucción del catéter. Futuros estudios de seguimiento con muestras más amplias podrían reforzar la comprensión del fenómeno.

Facial edema associated to central vein stenosis in a chronic kidney disease patient / Edema facial associado a estenose de veia central em paciente com doença renal crônica

Introduction: central vein stenosis (CVS) is a common complication in chronic kidney disease (CKD) patients, leading to vascular complications and higher mortality. Exposure to catheters is an important risk factor, and there is a wide spectrum of clinical presentation, including edema of the upper arm, neck, upper chest, and face, impairment of dialysis efficiency, and reduction of vascular accesses. Case report: a 41-year-old woman with CKD on dialysis and a history of multiple vascular accesses was admitted with a 3-month history of cervical and left hemiface edema. An angiotomography revealed marked stenosis in the proximal segment of the left brachiocephalic vein, and a venography confirmed the diagnosis of CVS, with subocclusive stenosis of the venous trunk and significant collateral veins. An endovascular treatment was performed with balloon angioplasty. She presented considerable improvement in the edema after the procedure. Conclusion: to avoid the development of central vein obstruction, it is important to enhance our knowledge about the main risk factors associated with this pathology. Although it is a treatable condition, recurrence of symptoms may occur, and subsequent vascular interventions may be needed. Therefore, prevention strategies are the most efficient approach.

Introdução: a estenose venosa central é uma complicação comum em pacientes com doença renal crônica (DRC), levando a complicações vasculares e maior mortalidade. A exposição a cateteres é um importante fator de risco, e a sua apresentação clínica envolve um amplo espectro de sinais e sintomas, incluindo edema em membros superiores, região cervical, tórax e face, comprometimento da eficiência da diálise e redução de sítios viáveis para confecção de acessos vasculares. Relato de caso: paciente do sexo feminino, 41 anos, com DRC dialítica e história prévia de múltiplos acessos vasculares, foi admitida com história de edema em região cervical e hemiface esquerda há três meses. A angiotomografia revelou estenose acentuada no segmento proximal da veia braquiocefálica esquerda, e a flebografia confirmou o diagnóstico de estenose venosa central, com estenose suboclusiva do tronco venoso e veias colaterais significativas. Foi realizado tratamento endovascular com angioplastia com balão, apresentando melhora considerável do edema após o procedimento. Conclusão: para evitar o desenvolvimento de obstrução venosa central, é importante aprofundar o conhecimento a respeito dos principais fatores de risco associados a esta patologia. Embora corresponda a uma condição tratável, o paciente pode evoluir com recorrência dos sintomas, e intervenções vasculares subsequentes podem ser necessárias. Portanto, as estratégias de prevenção são a abordagem mais eficiente.

Antibiotics prophylaxis at the time of catheter removal after radical prostatectomy: a systematic review of the literature and meta-analysis

Purpose: To conduct a systematic literature review with meta-analysis to identify whether antibiotic prophylaxis after removal of the indwelling urinary catheter reduces posterior infections. Methods: A systematic literature review was conducted in the databases PubMed, Embase, Cochrane, Google Scholar, and Latin American and Caribbean Health Sciences Literature, using the keywords "antibiotics" AND "prostatectomy" AND "urinary catheter." Results: Three articles were identified having the scope of our review, with 1,040 patients, which were subjected to our meta-analysis revealing a marginally significant decrease in the risk of urinary infection after indwelling urinary catheter removal (odds ratio-OR = 0.51; 95% confidence interval-95%CI 0.27-0.98; p = 0.04; I2 = 0%). No difference was found regarding the presence of bacteriuria (OR = 0.39; 95%CI 0.12-1.24; p = 0.11; I2 = 73%). Conclusions: In our meta-analysis, there was a significant decrease in urinary tract infection with antibiotic prophylaxis after indwelling urinary catheter removal following radical prostatectomy.

Ultrasound-guided continuous costoclavicular block through retrograde stimulating catheter technique for postoperative analgesia in shoulder surgery: a case series

Abstract In five patient undergoing surgery for proximal humerus fracture we investigated into postoperative analgesia provided by continuous costoclavicular block using continuous stimulating catheter. The postoperative pain scores were less than 4 in all patients except in two patients who required intravenous tramadol 50 mg as a rescue analgesic. The radiocontrast dye study executed in two patients revealed contiguous contrast spread through the brachial plexus sheath with the catheter tip in the interscalene space. We propose that a continuous costoclavicular block with a retrograde stimulating catheter is a feasible alternative regional anesthesia technique for postoperative analgesia in shoulder surgery.

Catéter de arteria pulmonar en shock cardiogénico: novedades acerca de su valor pronóstico y marcadores derivados / Use of pulmonary artery catheter in patiens with cardiogenic shock: an upgrade

El uso del catéter de arteria pulmonar es un método eficaz para la monitorización de los pacientes críticos. Aunque ampliamente utilizado en las Unidades de Cuidados Críticos Cardiológicos, no se ha demostrado en estudios previos el beneficio de su uso. Registros recientes y numerosos en pacientes graves cursando shock cardiogénico muestran un beneficio en términos de mortalidad asociada, sobre todo relacionado con una adecuada interpretación. Además, nuevos parámetros relacionados con insuficiencia ventricular como son el poder cardíaco y el índice de pulsatilidad de arteria pulmonar, así como el conocimiento de las presiones de llenado ventriculares, tanto izquierdas, como derechas, ayudan en la toma de decisiones, las opciones de tratamiento y estimación del pronóstico. Complementando lo anterior, la modernización en la tecnología del catéter de arteria pulmonar permite la medición del gasto cardíaco de forma continua a través de un sistema termodilución integrada. Este sistema también permite la monitorización más precisa del ventrículo derecho por medio de la valoración continua de su fracción de eyección y volumen de fin de diástole. La información obtenida por medio del catéter de arteria pulmonar en shock cardiogénico ha llevado a que su uso comience a ser cada vez más frecuente en unidades de cuidados críticos cardiológicos y que se empleen estos valores por equipos de shock cardiogénico para la toma de decisiones complejas. La evidencia descrita sobre el valor pronóstico relacionada al uso del catéter de arteria pulmonar se resume en esta revisión.

The pulmonary artery catheter is an effective tool for monitoring critically ill patients; however, the evidence showed limited value and a posible increased risk. Recently, numerous registries in critical ill patients in cardiogenic shock have shown a benefit in mortality, especially related to an adequate interpretation of findings. In addition, new parameters related to ventricular failure, such as cardiac power output and pulmonary artery pulsatility index have shown to be useful for a better treatment and estimation of prognosis. Besides, determination of filling pressures (right and/or left side) have an important role in terms of prognosis and management. Advances in pulmonary artery catheter technology allows us to continuously measure cardiac output through an integrated thermodilution system. This system also allows the continuous assessment of right ventricular ejection fraction and end-diastolic volume. The information obtained has led to an increased use of the pulmonary artery catheter monitoring in cardiac Intensive Care Units allowing improvements in treatment and complex decision-making.

Flebite associada ao cateter venoso periférico em cardiologia: incidência, fatores de risco e custos associados / Phlebitis associated with peripheral venous catheter in cardiology: incidence, risk factors and associated costs

Objetivo: Determinar a incidência de flebite, fatores de risco associados e custos diretos de tratamento. Métodos: Estudo descritivo, correlacional, com análise de custo direto. Utilizaram-se dados da documentação dos enfermeiros entre janeiro 2019 e agosto 2021. Resultados: Incluíram-se 2.374 pessoas com cateter venoso periférico, com internamento na cardiologia. A incidência de flebite foi de 12,38%, das quais 78,23% eram de grau 1 de severidade. Verificou-se associação estatística entre o desenvolvimento de flebite e a administração de amiodarona endovenosa, dias de hospitalização e serviço de internamento. Estimaram-se 1662€ de custos adicionais ao tratamento da flebite, em material clínico e horas de cuidados de enfermagem. Conclusão: Os cuidados de enfermagem são eficazes na identificação precoce e tratamento da flebite, promovendo redução de custos adicionais e garantindo melhores cuidados e ganhos em saúde.

Objective: This study aimed to identify the incidence rate of phlebitis, associated risk factors and treatment direct costs. Methods: Descriptive, correlational study with direct cost analisys. Data from the nurses' clinical records between January 2019 and August 2021 were used. Results: Included 2,374 files of people with peripheral venous catheter who were admitted to Cardiology. The phlebitis incidence rate was 12.38% and regarding severity 78.23% were grade 1. The phlebitits was significantly related with intravenous amiodarone administration, length of stay and physical department. This represents €1662 of additional treatment costs, in clinical supplies and nursing time. Conclusion: Nursing care is effective in the early identification and treatment of phlebitis, reducing costs and improve clinical and economic outcomes.

A Novel Robotic Bronchoscopic Surgical System / 中国医疗器械杂志

Transbronchil biopsy has the characteristic of less trauma and quick recovery compared to percutaneous aspiration biopsy. In order to automate this procedure, it requires the development of a robotic surgical system that combines electromagnetic navigation and flexible endoscope. The robotic surgical system introduced herein consists of flexible endoscope, remote-control handle, electromagnetic navigation and dexterous manipulators. The robotic system supports lung bronchial model segmentation and reconstruction, automatic bronchial path planning, real-time navigation and visual biopsy. In the control of the endoscopic catheter, an elasticity compensation algorithm was proposed to improve the location accuracy of the catheter and operational efficiency. Clinical trials proved that the robotic system had high positioning accuracy, was intuitive to operate, and could improve the biopsy efficiency, shorten the learning time, reduce the burden of surgical operations, and lower radiation exposure and infection rate.

Application of Rotarex catheter system in femoropopliteal artery stenosis accompanied with thrombosis / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the effectiveness and safety of Rotarex catheter system in treating femoropopliteal artery stenosis accompanied with thrombosis.@*METHODS@#From Jun. 2017 to Dec. 2019, the clinical data of 32 femoropopliteal artery stenosis accompanied with thrombosis cases treated with Rotarex catheter system were retrospectively analyzed. There were 23 males and 9 females aged from 50 to 89 years and the mean age was (70.7±10.3) years. Six cases had acute course of disease (≤2 weeks), 17 cases had subacute course of disease (>2 weeks, ≤3 months), and 9 cases had chronic course of disease (>3 months). Mean lesion length was (23.4±13.7) cm, mean occlusion length was (19.9±13.3) cm, and in-stent occlusion 7 cases. The superficial femoral artery (SFA) was involved in 13 cases, the popliteal artery (PA) was involved in 8 cases, and both SFA and PA were involved in the other 11 cases. All the cases were treated with Rotarex catheter system. When necessary, suction with large lumen catheter was enabled. Residual stenosis was treated with percutaneous transluminal angioplasty (PTA). Drug-coated balloon (DCB) was only used in patients with financial status, and stent was used only when it was necessary. Heparin was used for 24 h after procedures, and after that, antiplatelet agents were used. Doppler ultrasonography was taken during the followed-up.@*RESULTS@#Technical success was 100%, and mean procedure time was (107.4±21.5) min. 8F (1F≈0.33 mm) and 6F Rotarex catheter were used in 27 and 5 cases respectively. In 27 cases, forward flow was obtained immediately after debulking with Rotarex catheter, and in the other 5 cases, suction with large lumen catheters were used. PTA was used in all 32 cases. DCB were used in 8 cases, of which 4 were used in in-stent stenosis. Twelve cases were implanted stents. There were no perioperative deaths. The only one procedure related complication was distal embolism. We took out the thrombus with guiding catheter. In all cases, mean hospital stay were (4.6±1.5) d. The ankle brachial index increased from 0.32±0.15 to 0.86±0.10 after treatment (t=-16.847, P < 0.001). The Rutherford stages decreased significantly (Z=-4.518, P < 0.001). All the patients were followed up for 6.0-36.0 months, and the median time was 16.0 months. 2 cases stopped antiplatelet agents, which resulted in acute thrombosis. Another percutaneous mechanical thrombectomy and PTA were taken in one of them. Two cases died of cardiovascular disease during the follow-up, and no amputation was observed. Target lesion restenosis occurred in 7 cases during the follow-up, and target lesion revascularization (TLR) was taken in two of them.@*CONCLUSION@#In treating femoropopliteal artery stenosis accompanied with thrombosis, Rotarex catheter can remove thrombus effectively, and that can expose underlying lesions and reduce stent use and complications rates. It is a safe and effective method.

The timing of pericardial drainage catheter removal and restart of the anticoagulation in patients suffered from perioperative pericardial tamponade during atrial fibrillation catheter ablation and uninterrupted dabigatran: Experiences from 20 cases / 中华心血管病杂志

Objective: To investigate the timing of pericardial drainage catheter removal and restart of the anticoagulation in patients with atrial fibrillation (AF) suffered from perioperative pericardial tamponade during atrial fibrillation catheter ablation and uninterrupted dabigatran. Methods: A total of 20 patients with pericardial tamponade, who underwent AF catheter ablation with uninterrupted dabigatran in Beijing Anzhen Hospital from January 2019 to August 2021, were included in this retrospective analysis. The clinical characteristics of enrolled patients, information of catheter ablation procedures, pericardial tamponade management, perioperative complications, the timing of pericardial drainage catheter removal and restart of anticoagulation were analyzed. Results: All patients underwent pericardiocentesis and pericardial effusion drainage was successful in all patients. The average drainage volume was (427.8±527.4) ml. Seven cases were treated with idarucizumab, of which 1 patient received surgical repair. The average timing of pericardial drainage catheter removal and restart of anticoagulation in 19 patients without surgical repair was (1.4±0.7) and (0.8±0.4) days, respectively. No new bleeding, embolism and death were reported during hospitalization and within 30 days following hospital discharge. Time of removal of pericardial drainage catheter, restart of anticoagulation and hospital stay were similar between patients treated with idarucizumab or not. Conclusion: It is safe and reasonable to remove pericardial drainage catheter and restart anticoagulation as soon as possible during catheter ablation of atrial fibrillation with uninterrupted dabigatran independent of the idarucizumab use or not in case of confirmed hemostasis.

Clinical Comparison of the Efficacy of Systemic Thrombolysis,Catheter-Directed Thrombolysis,and AngioJet Percutaneous Mechanical Thrombectomy in Acute Lower Extremity Deep Venous Thrombosis / 中国医学科学院学报

Objective To compare the clinical effects of three treatment methods including systemic thrombolysis(ST),catheter-directed thrombolysis(CDT),and AngioJet percutaneous mechanical thrombectomy(PMT)in acute lower extremity deep venous thrombosis(LEDVT). Methods The data of 82 patients diagnosed with LEDVT in the Department of Vascular and Gland Surgery of the First Affiliated Hospital of Hebei North University from January 2017 to December 2020 were collected.The patients were assigned into a ST group(n=50),a CDT group(n=16),and a PMT group(n=16)according to different treatment methods.The efficacy and safety were compared among the three groups. Results Compared with that before treatment,the circumferential diameter difference of both lower limbs on days 1,2,and 3 of treatment in the ST,CDT,and PMT groups reduced(all P<0.001).The PMT group showed smaller circumferential diameter difference of lower limbs on days 1,2,and 3 of treatment than the ST group(all P<0.001)and smaller circumferential diameter difference of the lower patellar margin on day 1 of treatment than the CDT group(P<0.001).The PMT group showed higher diminution rate for swelling of the affected limb at the upper and lower edges of the patella than the ST group(P<0.001)and higher diminution rate for swelling at the upper edge of the patella than the CDT group(P=0.026).The incidence of complications after treatment showed no significant differences among the three groups(all P>0.05).The median of hospital stay in the PMT group was shorter than that in the ST and CDT groups(P=0.002,P=0.001).The PMT group had higher thrombus clearance rate than the ST group(P=0.002)and no significant difference in the thrombus clearance rate from the CDT group(P=0.361).The vascular recanalization rates in the PMT(all P<0.001)and CDT(P<0.001,P=0.002,P=0.009)groups 3,6,and 12 months after treatment were higher than those in ST group,and there were no significant differences between PMT and CDT groups(P=0.341,P=0.210,P=0.341). Conclusions ST,CDT,and PMT demonstrated significant efficacy in the treatment of LEDVT,and PMT was superior to ST and CDT in terms of circumferential diameter difference of the lower limbs,diminution rate for swelling of the affected limb,thrombus clearance rate,length of hospital stay,and long-term vascular recanalization.There was no obvious difference in safety among the three therapies.

Efficacy and feasibility of catheter-based adrenal ablation on Cushing's syndrome associated hypertension / 中华心血管病杂志

Objective: To explore the value of catheter-based adrenal ablation in treating Cushing's syndrome (CS)-associated hypertension. Methods: A clinical study was conducted in patients with CS, who received catheter-based adrenal ablation between March 2018 and July 2023 in Daping Hospital. Parameters monitored were blood pressure (outpatient and 24-hour ambulatory), body weight, clinical characteristics, serum cortisol and adrenocorticotropic hormone (ACTH) at 8 am, 24-hour urinary free cortisol (24 h UFC), fasting blood glucose and postoperative complications. Procedure effectiveness was defined as blood pressure returning to normal levels (systolic blood pressure<140 mmHg (1 mmHg=0.133 kPa) and diastolic blood pressure<90 mmHg), cortisol and 24 h UFC returning to normal and improvement of clinical characteristics. The parameters were monitored during follow up in the outpatient department at 1, 3, 6, and 12 months after catheter-based adrenal ablation. Results: A total of 12 patients (aged (40.0±13.2) years) were reviewed. There were 5 males, with 5 cases of adenoma and 7 with hyperplasia from imaging studies. Catheter-based adrenal ablation was successful in all without interruption or surgical conversion. No postoperative complication including bleeding, puncture site infection, adrenal artery rupture or adrenal bleeding was observed. The mean follow up was 28 months. Compared to baseline values, body weight declined to (59.48±11.65) kg from (64.81±10.75) kg (P=0.008), fasting blood glucose declined to (4.54±0.83) mmol from (5.53±0.99) mmol (P=0.044), outpatient systolic blood pressure declined to (128±21) mmHg from (140±19) mmHg (P=0.005), diastolic blood pressure declined to (78±10) mmHg from (86±11) mmHg (P=0.041), and the mean ambulatory daytime diastolic blood pressure declined to (79±12) mmHg from (89±8) mmHg (P=0.034). Catheter-based adrenal ablation in 8 patients was defined as effective with their 24 h UFC significantly reduced after the procedure (1 338.41±448.06) mmol/L from (633.66±315.94) mmol/L, P=0.011). The change of 24 h UFC between the effective treatment group and ineffective group was statistically significant (P=0.020). The postoperative systolic blood pressure in the treated adenoma group was significantly lower than those of hyperplasia group (112±13) mmHg vs. (139±20) mmHg, P=0.026). Conclusions: For patients with CS-associated hypertension who are unwilling or unable to undergo surgical treatment, catheter-based adrenal ablation could improve the blood pressure and cortisol level. Catheter-based adrenal ablation could be a safe, effective, and minimally invasive therapy. However, our results still need to be validated in further large-scale studies.

Efficacy and feasibility of catheter-based adrenal ablation on Cushing's syndrome associated hypertension / 中华心血管病杂志

Objective: To explore the value of catheter-based adrenal ablation in treating Cushing's syndrome (CS)-associated hypertension. Methods: A clinical study was conducted in patients with CS, who received catheter-based adrenal ablation between March 2018 and July 2023 in Daping Hospital. Parameters monitored were blood pressure (outpatient and 24-hour ambulatory), body weight, clinical characteristics, serum cortisol and adrenocorticotropic hormone (ACTH) at 8 am, 24-hour urinary free cortisol (24 h UFC), fasting blood glucose and postoperative complications. Procedure effectiveness was defined as blood pressure returning to normal levels (systolic blood pressure<140 mmHg (1 mmHg=0.133 kPa) and diastolic blood pressure<90 mmHg), cortisol and 24 h UFC returning to normal and improvement of clinical characteristics. The parameters were monitored during follow up in the outpatient department at 1, 3, 6, and 12 months after catheter-based adrenal ablation. Results: A total of 12 patients (aged (40.0±13.2) years) were reviewed. There were 5 males, with 5 cases of adenoma and 7 with hyperplasia from imaging studies. Catheter-based adrenal ablation was successful in all without interruption or surgical conversion. No postoperative complication including bleeding, puncture site infection, adrenal artery rupture or adrenal bleeding was observed. The mean follow up was 28 months. Compared to baseline values, body weight declined to (59.48±11.65) kg from (64.81±10.75) kg (P=0.008), fasting blood glucose declined to (4.54±0.83) mmol from (5.53±0.99) mmol (P=0.044), outpatient systolic blood pressure declined to (128±21) mmHg from (140±19) mmHg (P=0.005), diastolic blood pressure declined to (78±10) mmHg from (86±11) mmHg (P=0.041), and the mean ambulatory daytime diastolic blood pressure declined to (79±12) mmHg from (89±8) mmHg (P=0.034). Catheter-based adrenal ablation in 8 patients was defined as effective with their 24 h UFC significantly reduced after the procedure (1 338.41±448.06) mmol/L from (633.66±315.94) mmol/L, P=0.011). The change of 24 h UFC between the effective treatment group and ineffective group was statistically significant (P=0.020). The postoperative systolic blood pressure in the treated adenoma group was significantly lower than those of hyperplasia group (112±13) mmHg vs. (139±20) mmHg, P=0.026). Conclusions: For patients with CS-associated hypertension who are unwilling or unable to undergo surgical treatment, catheter-based adrenal ablation could improve the blood pressure and cortisol level. Catheter-based adrenal ablation could be a safe, effective, and minimally invasive therapy. However, our results still need to be validated in further large-scale studies.

Safe duration of silicon catheter replacement in urological patients

Objectives: This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks, six weeks, and eight weeks). Design: A cross-sectional study with stratified simple random sampling Setting: Urology Unit, Korle Bu Teaching Hospital Participants: One hundred and thirty-seven male patients with long-term urinary catheters Interventions: Participants were grouped into 3 weeks, 6 weeks, and 8 weeks duration of catheter replacementsPrimary outcomes measures: Symptoms due to the urinary catheters, urinalysis, urine and catheter tip cultures, sensitivity, and catheter encrustations were assessed. Results: Eighty-six patients had a primary diagnosis of benign prostatic hyperplasia (BPH), 35 had urethral strictures,13 had prostate cancer, two had BPH and urethral strictures, and one participant had bladder cancer. There was no difference in the symptoms the participants in the different groups experienced due to the urinary catheters (p > 0.05). The frequency of occurrence of complications (pyuria, p = 0.784; blocked catheter, p=0.097; urethral bleeding, p=0.148; epididymo-orchitis, p=0.769 and bladder spasms, p=1.000) showed no differences in the three groups. There was no statistical difference in the urinalysis for the three groups (p>0.05) and the degree of encrustations (3 weeks: 0.03 ± 0.06, 6 weeks: 0.11±0.27 and eight weeks: 0.12 ±0.27) with p=0.065. Conclusions: In this study, the duration of urinary catheterisation using silicone Foley's catheters did not influence the complication and symptom rates; hence silicon catheters can be placed in situ for up to 8 weeks before replacement instead of the traditional three-weekly change.

Gestión del capital venoso de los recién nacidos hospitalizados: catéter de línea media (CM) con técnica adaptada. Servicio de Neonatología, Hospital Público de Chile / Venous capital management of hospitalized newborns: midline catheter (MC) with adapted technique. Neonatology Service, Chilean public hospital

INTRODUCCIÓN: El catéter midline o de línea media (CM) es un dispositivo de acceso vascular que mide de 6 a 20cm, con la punta del dispositivo ubicado en venas basílica, braquial o cefálica debajo del pliegue axilar. El catéter de línea media se caracteriza por ser un acceso confiable y proporcionar menores complicaciones que un catéter intravenoso periférico corto. Este tipo de dispositivo vascular se ha utilizado ampliamente en adultos, pero faltan estudios desarrollados en el área neonatal. OBJETIVO: fue describir las características de la utilización de catéter midline con técnica adaptada en recién nacidos hospitalizados con necesidad de terapia intravascular en un hospital público de Chile, durante 2 años de seguimiento. METODOLOGÍA: Investigación descriptiva y retrospectiva, estuvo orientada a la identificación de las variables relacionadas a: tiempo de permanencia, características de la terapia intravascular, sitio de inserción, complicaciones y causa de retiro. RESULTADOS: La muestra estuvo conformada por 163 usuarios entre 24 y 41 semanas de edad gestacional, peso de nacimiento en un rango de 500 y 4880 gramos. El 87,7% se retiró por término de tratamiento intravascular, mientras que el 12,3% del total de los CM presentó complicaciones. El promedio de rendimiento del CM fue de 7,99 días, el sitio de inserción más frecuente correspondió a extremidad superior derecha, mientras que su utilización estuvo dada principalmente para fleboterapia, antibióticos y nutrición parenteral periférica. CONCLUSIÓN: Se concluye que el CM con técnica adaptada en usuarios neonatales presenta una alta tasa de éxito para completar la terapia intravascular periférica y bajo porcentaje de complicaciones.

INTRODUCTION: The midline catheter (MC) is a vascular access device measuring 6 to 20cm, with the tip of the device located in the basilic, brachial or cephalic veins below the axillary crease. The midline catheter is characterized as a reliable access and provides fewer complications than a short peripheral intravenous catheter. This type of vascular device has been widely used in adults, but studies developed in the neonatal area are lacking. OBJECTIVE: to describe the characteristics of the use of midline catheter with adapted technique in hospitalized newborns in need of intravascular therapy in a public hospital in Chile, during 2 years of follow-up. METHODOLOGY: Descriptive and retrospective research was oriented to the identification of variables related to: length of stay, characteristics of intravascular therapy, site of insertion, complications and cause of withdrawal. RESULTS: The sample consisted of 163 users between 24 and 41 weeks of gestational age, birth weight in the range of 500 and 4880 grams. Eighty-seven point seven percent were withdrawn due to the end of intravascular treatment, while 12.3% of the total MC presented complications. The average MC performance was 7.99 days, the most frequent insertion site corresponded to the right upper extremity, while its use was mainly for phlebotherapy, antibiotics and peripheral parenteral parenteral nutrition. CONCLUSION: The MC with adapted technique in neonatal users presents a high success rate to complete peripheral intravascular therapy and a low percentage of complications.

Algoritmo de indicação de acesso venoso para recém-nascidos em unidade de terapia intensiva neonatal / Venous access indication algorithm for newborns in neonatal intensive care unit / Algoritmo de indicación de acceso venoso para recién nacidos en una unidad de cuidados intensivos neonatales

RESUMO: Objetivo: apresentar um algoritmo de indicação de acessos venosos para recém-nascidos em Unidade de Terapia Intensiva Neonatal. Desenvolvimento: estudo descritivo realizado na Unidade de Terapia Intensiva Neonatal no sul do Brasil, no período de 2017 a 2020 em duas etapas de idealização: desenho do algoritmo; e a adequação baseada na aplicação conforme observações realizadas pelos enfermeiros envolvidos. O algoritmo desenvolvido contemplou a previsão de acesso venoso para pacientes com indicação de cirurgia abdominal e outras cirurgias, prematuros estratificados em idade gestacional superior e inferior a 30 semanas, cardiopatias com dependência ou não de canal arterial e hipoglicemia neonatal persistente. De acordo com a rede venosa, número de terapias prescritas, jejum, antibioticoterapia e drogas vasoativas, há indicação inicial de um tipo de cateter que pode ser seguido de outro de acordo com a necessidade. Conclusão: a participação do enfermeiro na indicação de acesso venoso integra as práticas interprofissionais e incrementa a assistência neonatal.

ABSTRACT Objective: to present an algorithm for the indication of venous accesses for newborns in Neonatal Intensive Care Unit. Development: descriptive study conducted in a Neonatal Intensive Care Unit in southern Brazil, in the period from 2017 to 2020 in two stages of idealization: design of the algorithm; and the adequacy based on the application according to observations made by the nurses involved. The developed algorithm contemplated the prediction of venous access for patients with indication for abdominal and other surgeries, premature infants stratified in gestational age higher and lower than 30 weeks, heart diseases with dependence or not on arterial channel and persistent neonatal hypoglycemia. According to the venous network, number of prescribed therapies, fasting, antibiotic therapy and vasoactive drugs, there is an initial indication for one type of catheter that may be followed by another according to need. Conclusion: the participation of nurses in the indication of venous access integrates interprofessional practices and increases neonatal care.

RESUMEN Objetivo: presentar un algoritmo para la indicación de accesos venosos para recién nacidos en la Unidad de Cuidados Intensivos Neonatales. Desarrollo: estudio descriptivo realizado en una Unidad de Cuidados Intensivos Neonatales en el sur de Brasil, en el período de 2017 a 2020 en dos etapas de idealización: diseño del algoritmo; y la adecuación basada en la aplicación de acuerdo con las observaciones realizadas por las enfermeras involucradas. El algoritmo desarrollado contemplaba la predicción de acceso venoso para pacientes con indicación de cirugías abdominales y de otro tipo, prematuros estratificados en edad gestacional superior e inferior a 30 semanas, cardiopatías con dependencia o no de canal arterial e hipoglucemia neonatal persistente. En función de la red venosa, el número de terapias prescritas, el ayuno, la antibioticoterapia y los fármacos vasoactivos, existe una indicación inicial para un tipo de catéter que puede ir seguida de otra según las necesidades. Conclusión: la participación del enfermero en la indicación de acceso venoso integra las prácticas interprofesionales e incrementa la asistencia neonatal.

Tecnologias para manutenção do Cateter Central de Inserção Periférica em neonatos: revisão integrativa / Tecnologías para el mantenimiento del Catéter Central de Inserción Periférica en neonatos: revisión integrativa / Technologies for maintenance of Peripherally Inserted Central Catheter in neonates: an integrative review

Objetivo: analisar a literatura científica acerca das tecnologias e cuidados para posicionamento e reposicionamento do cateter central de inserção periférica (PICC) em neonatos. Método: revisão integrativa, com busca realizada em fevereiro de 2022 em quatro bases de dados. Resultados: incluíram-se 32 estudos que abordam uso de tecnologias para verificação da localização do PICC, procedimentos para seu posicionamento e manobras para reposicionamento. Para posicionamento adequado deve-se atentar para seleção do vaso, mensuração correta do dispositivo e manutenção do bem-estar do recém-nascido. Frente ao mal posicionamento sugere-se a movimentação do membro, flush, tração do cateter, e conduta expectante. A verificação da localização da ponta é rotineira, por meio de radiografia, ultrassonografia ou eletrocardiograma. Conclusão: recomenda-se a adoção de tecnologias não invasivas para o posicionamento e reposicionamento do PICC em neonatos. As evidências apontam para competência profissional na tomada de decisão para o cuidado seguro e de qualidade, e prevenção de eventos adversos.

Objective: to analyze the scientific literature on technologies and care for positioning and repositioning of the peripherally inserted central catheter (PICC) in neonates. Method: integrative review, with search conducted in February 2022 in four databases. Results: 32 studies were included that address the use of technologies to verify the location of the PICC, procedures for its positioning and maneuvers for repositioning. For proper positioning should pay attention to the selection of the vessel, correct measurement of the device and maintenance of the well-being of the newborn. In the face of poor positioning, it is suggested limb movement, flush, catheter traction, and expectant management. The verification of the tip location is routine, by radiography, ultrasonography or electrocardiogram. Conclusion: the adoption of non-invasive technologies for the positioning and repositioning of PICC in neonates is recommended. The evidence points to professional competence in decision making for safe and quality care and prevention of adverse events.

Objetivo: analizar la literatura científica acerca de las tecnologías y cuidados para posicionamiento y reposicionamiento del catéter central de inserción periférica (PICC) en neonatos. Método: revisión integrativa, con búsqueda realizada en febrero de 2022 en cuatro bases de datos. Resultados: se incluyeron 32 estudios que abordan el uso de tecnologías para verificar la localización del PICC, procedimientos para su posicionamiento y maniobras para reposicionamiento. Para un posicionamiento adecuado se debe prestar atención a la selección del recipiente, la medición correcta del dispositivo y el mantenimiento del bienestar del recién nacido. Frente al mal posicionamiento se sugiere el movimiento de la extremidad, color, tracción del catéter, y conducta expectante. La verificación de la localización de la punta es rutinaria, por medio de radiografía, ultrasonido o electrocardiograma. Conclusión: se recomienda la adopción de tecnologías no invasivas para el posicionamiento y reposicionamiento del PICC en neonatos. La evidencia apunta a la competencia profesional en la toma de decisiones para el cuidado seguro y de calidad, y la prevención de eventos adversos.

Dual epidural catheters for labor analgesia in a spinal cord injury patient: a case report

Abstract Impediment to local anesthetic solution in the epidural space results in unsatisfactory pain relief during labor epidural. Patients with a history of back trauma and spinal instrumentation have increased rates of epidural failure due to patchy spread of local anesthetic with obliterated epidural space. Dual Epidural Catheters (DEC) can be used in such clinical scenarios with complete labor analgesia and improved patient satisfaction. We present the successful management of a parturient with vertebral fracture at risk for epidural failure and neurologic injury due to bone fragments and inserted cranial and caudal to the fractured vertebra using ultrasound to avoid neurologic sequelae.