Practical techniques for safely removing long-term implanted ventricular catheters to minimize bleeding.

INTRODUCTION: Removing ventricular catheters, particularly those implanted for extended periods, poses significant challenges for neurosurgeons due to potential complications such as bleeding from adhesions to the ependyma or choroid plexus. OBJECTIVE: This study aimed to review various techniques for safely removing ventricular catheters, emphasizing methods that minimize the risk of hemorrhagic complications. METHODS: A comprehensive narrative review focused on techniques developed and documented in the literature for safely detaching ventricular catheters adhered to brain structures. RESULTS: Various techniques have been identified that enhance the safety of catheter removal. Notably, the use of monopolar diathermy to coagulate and release adhesions has proven effective. Innovations such as insulated suction devices and the strategic use of flexible endoscopes have also contributed to safer removal procedures, minimizing the risk of damaging surrounding cerebral tissue and preventing catastrophic hemorrhage. CONCLUSION: The removal of ventricular catheters, especially those with long-term implantation, requires precise and cautious techniques to avoid severe complications. The study underscores the importance of adopting advanced surgical techniques and the continuous evolution of safer practices in neurosurgery. These methods not only ensure patient safety but also facilitate the handling of potentially complex and life-threatening situations during catheter removal.

Comparison of early and late removal of the urinary catheter after rectal cancer surgery.

OBJECTIVE: This study is aiming to compare the results of early and late removal of urinary catheters after rectal cancer surgery. MATERIALS AND METHODS: Patients who undergone rectal cancer surgery in a single center were included in this prospective randomized study. The timing of the urinary catheter removal was randomized by a computer-assisted program and divided into 2 groups, which are early (first 48 h) and late (after 48 h). The primary outcome of this study was to compare the urinary retention and re-catheterization rates between patients with early and those with late catheter removal. RESULTS: Sixty-six patients were included in this study. The median age was 60 (31-88 years), and the patient group was predominantly male (n: 40, 60.9%). Urinary retention after catheter removal developed in 8 (12%) of 66 patients. There was no difference between the two groups in terms of the need for re-catheterization (14% vs. 10%, p: 0.63). All the patients who required re-catheterization (n: 8) and were discharged with a urinary catheter (n: 4) were male. When the male and female patients were evaluated separately, there was no difference in urinary retention in the early or late groups. CONCLUSIONS: Early or late removal of the catheter does not play a role in the development of urinary retention in patients undergoing rectal cancer surgery.

OBJETIVO: Comparar los resultados de la retirada precoz y tardía de la sonda urinaria tras la cirugía de cáncer rectal. MÉTODO: Estudio prospectivo aleatorizado que incluyó pacientes sometidos a cirugía de cáncer rectal en un único centro. El momento de la retirada de la sonda urinaria se aleatorizó y se dividió en dos grupos: primeras 48 horas y después de 48 horas. Se compararon las tasas de retención urinaria y de nueva cateterización entre los pacientes con retirada precoz y tardía de la sonda. RESULTADOS: Se incluyeron 66 pacientes, con una mediana de edad de 60 años (31-88 años) y predominio del sexo masculino (n = 40, 60.9%). Se produjo retención urinaria tras la retirada de la sonda en 8 (12%). No hubo diferencias entre los dos grupos en cuanto a necesidad de nueva cateterización (14% frente a 10%, p = 0.63). Todos los pacientes que precisaron un nuevo cateterismo (n = 8) y fueron dados de alta con una sonda urinaria (n = 4) eran varones. CONCLUSIONES: La retirada precoz o tardía de la sonda no influye en la aparición de retención urinaria en pacientes intervenidos de cáncer de recto.

A clinical model to predict successful renal replacement therapy (RRT) discontinuation in patients with Acute Kidney Injury (AKI).

INTRODUCTION: Ideal timing of Renal Replacement Therapy (RRT) discontinuation in Acute Kidney Injury (AKI) is still unknown. We aimed to study the role of creatinine-related variables in predicting RRT successful discontinuation and to propose a clinical predictive score. METHODS: In this single-centre retrospective study, we evaluated all AKI patients in whom RRT was interrupted for at least 48 hours. Patients who were still RRT-independent 7 days after initial RRT cessation were included in the "Success" group and opposed to the "Failure" group. We evaluated baseline characteristics and variables collected at the time of RRT interruption, as well as the Kinetic estimated Glomerular Filtration Rate (KeGFR), the simple variation in serum Creatinine (ΔsCr), and the incremental creatinine ratio on the first three days after RRT interruption. Multivariable analysis was performed to evaluate prediction of success. Internal validation using a simple binomial generalized regression model with Lasso estimation and 5-fold cross validation method was performed. RESULTS: We included 124 patients, 49 in the "Failure" group and 75 in the "Success" group. All creatinine-related variables predicted success in simple and multiple logistic regression models. The best model generated a clinical score based on the odds ratio obtained for each variable and included urine output, non-renal SOFA score, fluid balance, serum urea, serum potassium, blood pH, and the variation in sCr values after RRT discontinuation. The score presented an area under the ROC of 0.86 (95% CI 0.76‒1.00). CONCLUSION: Creatinine variation between the first 2 consecutive days after RRT discontinuation might predict success in RRT discontinuation. The developed clinical score based on these variables might be a useful clinical decision tool to guide hemodialysis catheter safe removal.

A clinical model to predict successful renal replacement therapy (RRT) discontinuation in patients with Acute Kidney Injury (AKI)

Abstract Introduction Ideal timing of Renal Replacement Therapy (RRT) discontinuation in Acute Kidney Injury (AKI) is still unknown. We aimed to study the role of creatinine-related variables in predicting RRT successful discontinuation and to propose a clinical predictive score. Methods In this single-centre retrospective study, we evaluated all AKI patients in whom RRT was interrupted for at least 48 hours. Patients who were still RRT-independent 7 days after initial RRT cessation were included in the "Success" group and opposed to the "Failure" group. We evaluated baseline characteristics and variables collected at the time of RRT interruption, as well as the Kinetic estimated Glomerular Filtration Rate (KeGFR), the simple variation in serum Creatinine (ΔsCr), and the incremental creatinine ratio on the first three days after RRT interruption. Multivariable analysis was performed to evaluate prediction of success. Internal validation using a simple binomial generalized regression model with Lasso estimation and 5-fold cross validation method was performed. Results We included 124 patients, 49 in the "Failure" group and 75 in the "Success" group. All creatinine-related variables predicted success in simple and multiple logistic regression models. The best model generated a clinical score based on the odds ratio obtained for each variable and included urine output, non-renal SOFA score, fluid balance, serum urea, serum potassium, blood pH, and the variation in sCr values after RRT discontinuation. The score presented an area under the ROC of 0.86 (95% CI 0.76‒1.00). Conclusion Creatinine variation between the first 2 consecutive days after RRT discontinuation might predict success in RRT discontinuation. The developed clinical score based on these variables might be a useful clinical decision tool to guide hemodialysis catheter safe removal.