Validação de aparência do bundle para manuseio do cateter central de inserção periférica em neonatos / Bundle appearance validation for peripherally inserted central catheter handling in neonates / Validación de la apariencia del paquete para el manejo del catéter central insertado periféricamente en neonatos

Objetivo: validar a aparência do bundle para manuseio do cateter central de inserção periférica em neonatos pela equipe de enfermagem. Método: estudo metodológico, desenvolvido durante os meses de novembro de 2020 e fevereiro de 2021, em unidades neonatais de um hospital de ensino. A amostra foi composta por 43 membros da equipe de enfermagem e os dados analisados pelo índice de validade de conteúdo acima de 80%. Aplicou-se um instrumento contendo dados de identificação, o bundle e a relevância para prática clínica no Google Formulários. Resultados: todos os itens do bundle apresentaram índice de validade de conteúdo acima de 80% e foram considerados relevantes para prática clínica. Conclusão: este estudo permitiu validar a aparência do bundle junto a equipe de enfermagem e incluiu cuidados relacionados a manutenção do cateter central de inserção periférica em neonatos.

Objective: to validate the appearance of the bundle and ematos of the central insertion catheter by the nursing team. Method:methodological study, developed during the months of November 2020 and February 2021, in neonatal units of a teaching hospital. The sample consisted of 43 members of the nursing team and the data analyzed by the content validity index above 80%. An instrument containing identification data, the bundle and relevance to clinical practice on Google Forms was applied. Results:all bundle items had a content validity index above 80% and were considered relevant for clinical practice. Conclusion: this study allowed us to validate the appearance of the bundle with the nursing team and included care related to the maintenance of peripherally inserted central catheter in neonates.

Objetivo: validar el aspecto del fascículo para manipulación del catéter central de inserción periférica en neonatos por el equipo de enfermería. Método: estudio metodológico, desarrollado durante los meses de noviembre de 2020 y febrero de 2021, en unidades neonatales de un hospital de enseñanza. La muestra estuvo compuesta por 43 miembros del equipo de enfermería y los datos analizados por el índice de validez de contenido superior al 80%. Se aplicó un instrumento que contiene los datos de identificación, el paquete y la relevancia para la práctica clínica en Google Forms. Resultados: todos los ítems del paquete tuvieron un índice de validez de contenido superior al 80% y se consideraron relevantes para la práctica clínica. Conclusión: este estudio permitió validar la apariencia del paquete con el equipo de enfermería e incluyó cuidados relacionados con el mantenimiento del catéter central de inserción periférica en los recién nacidos.

Embryo retention significantly decreases clinical pregnancy rate and live birth rate: a matched retrospective cohort study.

OBJECTIVE: To investigate the embryo retention (ER) rate in embryo transfer (ET) cycles and its effects on reproductive outcomes. DESIGN: Matched retrospective cohort study. SETTING: A tertiary hospital-based reproductive medicine center. PATIENT(S): A total of 6,089 ET cycles were performed from January 2013 to December 2018 in our unit. INTERVENTION(S): Each woman was matched with two separate control subjects of the same age (±1 year), embryo condition, main causes of infertility, type of protocol used for fresh or frozen ET cycles. MAIN OUTCOME MEASURE(S): ER rate, implantation, clinical pregnancy, ectopic pregnancy, and live birth rate. RESULTS: The overall incidence of ER was 1.59% (97/6,089). A significantly increased ER rate was observed in fresh ET cycles compared with frozen transfer cycles (2.71% vs. 1.08%). In fresh transfer cycles, the rate of mucus in or on the catheter after ET in ER group was significantly higher than in the non-ER group (48.09% vs. 13.65%). A total of 194 non-ER cycles were matched to the ER group. Compared with the matched group, the ER group was associated with a significantly lower clinical pregnancy rate (32.98% vs. 48.96%), implantation rate (20.88% vs. 35.97%), and live birth rate (22.68% vs. 37.63%, P<.01), and a higher ectopic pregnancy rate (12.50% vs. 3.16%). CONCLUSION: Our results suggest that ER rate is correlated with mucus on or in the transfer catheter in fresh transfer cycles. Retained embryos are associated with lower implantation, clinical pregnancy, live birth, and increases risk of ectopic pregnancy.

Analysis of the Rate and Pattern of Ventriculoperitoneal Shunt Infection and Ventricular Catheter Culture Yield: A 10-Year Single-Institute Experience.

AIM: We aimed to study the rate and pattern of ventriculoperitoneal shunt (VPS) infections at the Jordan University Hospital (JUH) over 10 years and investigate the yield of ventricular catheter tip culture in the evaluation of shunt infection. PATIENTS AND METHODS: All patients operated on at our institution for ventriculoperitoneal shunt (VPS) insertion, reinsertion, and revision between 2009 and 2018 were included. Data (age, gender, pathology, and history of shunt infection) were collected from patients' files. Rates of infection and results of culture (cerebrospinal fluid and ventricular catheter tip) were obtained from laboratory records. RESULTS: According to our hospital database, 310 patients were eligible for this study. The rate of infection was 11.1% per ventriculoperitoneal procedure, and the most common -organism was coagulase-negative Staphylococcus (CoNS) which was the cause of infection in 51.4% of the cases. Twenty-one percent of proved shunt infection cases showed a positive ventricular catheter tip culture. CONCLUSION: The rate and pattern of shunt infections at our institution are comparable with the international figures and data. Methods of catheter tip culturing should be improved to increase the yield of this practice.

Device Based Approaches to the Prevention of Contrast-Induced Acute Kidney Injury.

Contrast-induced acute kidney injury is not uncommon after percutaneous coronary intervention, particularly in high-risk patients. Pharmacologic approaches have not demonstrated significant benefit, and numerous device-based approaches exist targeting a variety of pathways. In this review, we summarize the most recent interventions and the evidence behind them.

A Novel Smart Assistance System for Blood Vessel Approaching: A Technical Report Based on Oximetry.

In clinical practice, the catheter has to be placed at an accurate position during anesthesia administration. However, effectively guiding the catheter to the accurate position in deeper tissues can be difficult for an inexperienced practitioner. We aimed to address the current issues associated with catheter placement using a novel smart assistance system for blood vessel catheter placement. We used a hollow introducer needle embedded with dual wavelength (690 and 850 nm) optical fibers to advance the tip into the subclavian vessels in anesthetized piglets. The results showed average optical density changes, and the difference between the absorption spectra and hemoglobin concentrations of different tissue components effectively identified different tissues (p < 0.05). The radial basis function neural network (RBFNN) technique was applied to distinguish tissue components (the F-measure value and accuracy were 93.02% and 94%, respectively). Finally, animal experiments were designed to validate the performance of the proposed system. Using this system based on oximetry, we easily navigated the needle tip to the target vessel. Based on the experimental results, the proposed system could effectively distinguish different tissue layers of the animals.

Catheter directed interventions for pulmonary embolism: current status and future prospects.

Introduction: Catheter directed interventions (CDIs) have evolved over the past decade in an attempt to reduce the complications of systemic thrombolysis, while providing equivalent therapeutic benefits.Areas covered: CDIs include a wide array of catheters that incorporate ultrasound technology, the infusion of thrombolytics through multi-side hole catheters and suction thrombectomy systems. We present a contemporary review summarizing the different catheter directed interventions currently available for acute PE, their indications, technical considerations, clinical effectiveness, complication rates and long-term outcomes.Expert opinion: For intermediate high-risk PE patients without a contraindication for thrombolysis, CDIs should be considered in patients at risk for clinical decompensation. For high risk PE patients with a major contraindication to thrombolytic therapy, suction thrombectomy can be considered in places with appropriate clinical and technical expertise.

Balloon-mounted stents for acute intracranial large vessel occlusion secondary to presumed atherosclerotic disease: evolution in an era of supple intermediate catheters.

INTRODUCTION: Treatment of acute large vessel occlusion (LVO) stroke secondary to intracranial atherosclerotic disease (ICAD) is more nuanced with disparate and infrequently reported outcomes. The deployment of balloon-mounted stents presents an expedient approach with renewed feasibility in the modern era of supple intermediate catheters. METHODS: A prospectively maintained endovascular stroke database was searched for patients undergoing intracranial stenting with balloon-mounted stents for acute LVO. Demographic, angiographic, and clinical data were extracted to determine procedural technique and success, measured both angiographically and clinically. RESULTS: Sixty patients underwent stenting for acute LVO secondary to ICAD. Mean presenting National Institutes of Health Stroke Scale (NIHSS) score was 18 and 62% of treated sites were in the posterior circulation. Cases were performed under IV conscious sedation unless the patient was already intubated. Successful recanalization was achieved in 93% of cases (Thrombolysis in Cerebral Infarction (TICI) grade 2b in 48% and TICI grade 3 in 45%). Mean improvement in NIHSS score on post-procedure day 1 was 3.4. Good outcome (modified Rankin Scale score 0-2) at 3 months was 34% and the mortality rate was 34%. The rate of peri-procedural symptomatic hemorrhage was 8% and the rate of acute/subacute stent thrombosis was 7%. In this small cohort, patient age, sex, presenting NIHSS, comorbidities, smoking, tissue plasminogen activator administration, and stent location were not significant predictors of recanalization or good outcome. CONCLUSION: Treatment of acute LVO stroke with balloon-mounted stents for ICAD has reperfusion rates and clinical outcomes comparable to thrombectomy, with higher rates of hemorrhage and mortality. Because stent placement was performed after attempted thrombectomy, a trial of primary stenting versus thrombectomy should be considered in patients suspected of underlying ICAD.

Dislocation rates of postoperative airway exchange catheters - a prospective case series of 200 patients.

BACKGROUND: The dislocation rate of oral versus nasal airway exchange catheters (AEC) in the postoperative care unit (PACU) are unknown. Our aim was to establish dislocation rates and to assess the usefulness of waveform capnography to detect dislocation. METHODS: In this non-randomized, prospective observational trial at the University Hospital Bern, Switzerland, we included 200 patients admitted to PACU after extubation via AEC, having provided written informed consent. The study was approved by the local ethical committee. AEC position was assessed by nasal fiberoptic endoscopy at beginning of PACU stay and before removal of the AEC. Capnography was continuously recorded via the AEC. Additional measurements included retching and coughing of the patient, and re-intubation, if necessary. RESULTS: Data from 182 patients could be evaluated regarding dislocation. Overall dislocation rate was not different between oral and nasal catheters (7.2% vs. 2.7%, p = 0.16). Retching was more often noted in oral catheters (26% vs. 8%, p < 0.01). Waveform capnography was unreliable in predicting dislocation (negative predictive value 17%). Re-intubation was successful in all five of the nine re-intubations where an AEC was still in situ. In four patients, the AEC was already removed when re-intubation became necessary, and re-intubation failed once, with a front of neck access as a rescue maneuver. CONCLUSIONS: We found no difference in dislocation rate between nasal and oral position of an airway exchange catheter. However, nasal catheters seemed to be tolerated better. In the future, catheters like the staged extubation catheter may further increase tolerance. TRIAL REGISTRATION: The study was registered in a clinical study registry ( ISRCTN 96726807 ) on 10/06/2010.

Novel aspiration catheter design for acute stroke thrombectomy.

BACKGROUND: Navigable, large diameter aspiration catheters demonstrate markedly improved recanalization rates over smaller lumen devices in suction embolectomy. We evaluated the performance of a novel aspiration catheter system designed to maximize lumen size, and compare it to other commercially available aspiration catheters. METHODS: The 6F R4Q aspiration catheter system comprises a proximal pusher wire of 117 cm length connected to a distal catheter of 25 cm length. When placed through standard guide catheters and into the cerebral circulation, the proximal catheter makes a tight seal between its outer surface and the guide catheter's inner surface. During aspiration, in vitro flow rates and tip suction force under gentle retraction were compared among 10 commercially available aspiration catheters and the R4Q system. RESULTS: The R4Q 6F, 5F, 4F, and 3F catheters achieved flow rates at least 21.9%, 24.7%, 61.9%, and 244.7% greater than the other catheters tested respectively and the R4Q 6F produced a 140.2% higher tip force than a catheter of similar size. Fluid flow rate in the R4Q 6F increased on retraction into the guide catheter, delivering a 58.2% increase from fully extended to fully retracted. CONCLUSION: The R4Q design demonstrates a substantial increase in aspirated flow rate and suction force due to an increased effective diameter than standard tubular catheter designs tested. The prominent increase in the aspiration parameters measured in vitro supports the potential for improved clinical results during stroke thrombectomy procedures.

A new method to statistically describe microcatheter tip position in patient-specific aneurysm models.

BACKGROUND AND PURPOSE: Evidence on how to select microcatheters to facilitate aneurysm catheterization during coil embolization is sparse. We developed a new method to define microcatheter tip location inside a patient-specific aneurysm model as a 3-dimensional probability map. We hypothesized that precision and accuracy of microcatheter tip positioning depend on catheter tip shape and aneurysmal geometry. MATERIALS AND METHODS: Under fluoroscopic guidance two to three operators introduced differently shaped microcatheters (straight, 45°, 90°) into eight aneurysm models targeting the anatomic center of the aneurysm. Each microcatheter position was recorded with flat-panel CT, and 3-dimensional probability maps of the microcatheter tip positions were generated. Maps were assessed with histogram analyses and compared between tip shapes, aneurysm locations and operators. RESULTS: Among a total of 530 microcatheter insertions, the precision (mean distance between catheter positions) and accuracy (mean distance to target position) were significantly higher for the 45° tip (1.10±0.64 mm, 3.81±1.41 mm, respectively) than for the 90° tip (1.27±0.57 mm, p=0.010; 4.21±1.60 mm p=0.014, respectively). Accuracy was significantly higher in posterior communicating artery aneurysms (3.38±1.20 mm) than in aneurysms of the internal carotid artery (4.56±1.54 mm, p<0.001). CONCLUSION: Our method can be used tostatistically describe statistically microcatheter behavior in patient-specific anatomy, which may improve the available evidence guiding microcatheter shape selection. Experience increases the ability to reach the intended position with a microcatheter (accuracy) that is also dependent on the aneurysm location, whereas catheter tip choice determines the variability of catheter tip placements versus each other (precision). Clinical validation is required.

Uma ferramenta em realidade virtual para auxílio na cateterização venosa periférica em criança hospitalizada / A virtual reality tool to aid in peripheral venous catheterization in hospitalized children

A mudança de um ambiente familiar com pessoas conhecidas para um novo ambiente, com pessoas desconhecidas, sem dúvida nenhuma mexe com o emocional da criança e seu familiar. Pois, somado a isso, ainda cabe relatar as inúmeras vezes que a criança é submetida a diversos procedimentos dolorosos como: a cateterização venosa periférica, coletas de sangue para exames laboratoriais, cateterismo nasogástrico e vesical etc. O que, indubitavelmente, concorre para desestabilização do estado de conforto e de bem-estar, vivenciados pela criança internada e por sua mãe/acompanhante, em que pese o fato de que tais procedimentos poderão proporcionar conforto mais adiante. Nosso problema fica evidenciado pela desestabilização do estado de conforto e de bem-estar, vivenciados pela criança hospitalizada e por sua mãe/acompanhante durante a técnica de cateterização venosa periférica. Objetivo: Construir uma ferramenta em Realidade Virtual que proporcione mais segurança e conforto para crianças, durante a cateterização venosa periférica. Tipologia/Estratificação do produto: caracteriza-se pelo desenvolvimento de um produto tecnológico, passível de proteção, podendo gerar registros de propriedade de patente. Método: Tratar-se-á de uma pesquisa aplicada, pois se propõem à produção tecnológica, com método qualitativo, a partir da seleção de dados secundários do tipo bibliográfico relacionados ao cateterismo venoso periférico em crianças hospitalizadas, obtidos na Base de Indexação internacional ­ SCOPUS, culminando no desenvolvimento de uma ferramenta de RV para minimizar o desconforto de crianças internadas no momento da punção venosa periférica, esteja ela acompanhada por familiares ou não. Resultados: O sistema foi desenvolvido baseado nos preceitos básicos do processo de desenvolvimento de software incremental contido na Engenharia de Software (PRESSMAN, 2011). No tocante a prototipação, com vistas a criação do nosso software, foram seguidos sistemas, ferramentas e procedimentos, compreendidos em um conjunto de seis fases de ciclo de vida de um software. Sendo elas: coleta e refinamento dos requisitos, elaboração de um projeto rápido, construção do protótipo, avaliação pelo cliente e posterior refinamento quando há necessidade de ajustes finais do projeto, com o intuito de satisfazer da melhor forma as necessidades do cliente antes de encaminhar, a última etapa, apresentação à engenharia do produto. Conclusão: o objetivo principal foi alcançado, em criar o Software/Protótipo em Realidade Virtual, para que possa proporcionar mais tranquilidade e conforto às crianças que são submetidas à cateterização venosa periférica, no decorrer da sua internação hospitalar. Cabe ressaltar, que a criação deste jogo em Realidade Virtual para ser utilizado no momento da cateterização venosa, é um produto inédito no ambiente hospitalar e de suma importância pois, o mesmo irá trabalhar diretamente o foco do problema: o medo, o estresse, etc

The change of a familiar environment with people known to a new environment, with unknown people, undoubtedly it messes with the emotional of the child and his/her family. Therefore, in addition, it is still worth reporting the many times that the child is subjected to several painful procedures such as: peripheral venous catheterization, blood collection for laboratory exams, nasogastric and bladder catheterism, etc. Which undoubtedly competes for the destabilization of the state of comfort and well-being, experienced by the hospitalized child and by his/her mother/companion, in which it weighs the fact that such procedures can provide comfort later. Our problem is evidenced by the destabilization of the state of comfort and wellbeing, experienced by the hospitalized child and by his/her mother/companion during the technique of peripheral venous catheterization. Objective: To construct a tool in virtual reality that provides more safety and comfort for children during peripheral venous catheterization. Product Typology/stratification: It is characterized by the development of a technological product, capable of protection, and can generate patent property records. Method: This is an applied research, because it proposes to the technological production, with qualitative method, from the selection of secondary bibliographic data related to peripheral venous catheterization in hospitalized children, obtained in International Indexing Base ­ SCOPUS, culminating in the development of an RV tool to minimize the discomfort of hospitalized children at the time of peripheral venous puncture, whether accompanied by relatives or not. Results: The system was developed based on the basic precepts of the incremental software development process contained in Software Engineering (PRESSMAN, 2011). With regard to prototyping, with a view to the creation of our software, systems, tools and procedures were followed, understood in a set of six phases of the life cycle of a software. These being: collection and refinement of the requirements, elaboration of a rapid design, prototype construction, evaluation by the client and subsequent refinement when there is need for final adjustments of the project, in order to satisfy the best way the Customer needs before forwarding, the last step, presentation to product engineering. Conclusion: The main objective was achieved, in creating the Software/prototype in Virtual reality, so that it can provide more tranquility and comfort to children who undergo peripheral venous catheterization, during their hospitalization Hospital. It is noteworthy, that the creation of this game in virtual reality to be used at the time of venous catheterization, is an unprecedented product in the hospital environment and of paramount importance because, the same will work directly the focus of the problem: fear, stress, etc

Steerable catheters for minimally invasive surgery: a review and future directions.

The steerable catheter refers to the catheter that is manipulated by a mechanism which may be driven by operators or by actuators. The steerable catheter for minimally invasive surgery has rapidly become a rich and diverse area of research. Many important achievements in design, application and analysis of the steerable catheter have been made in the past decade. This paper aims to provide an overview of the state of arts of steerable catheters. Steerable catheters are classified into four main groups based on the actuation principle: (1) tendon driven catheters, (2) magnetic navigation catheters, (3) soft material driven catheters (shape memory effect catheters, steerable needles, concentric tubes, conducting polymer driven catheters and hydraulic pressure driven catheters), and (4) hybrid actuation catheters. The advantages and limitations of each of them are commented and discussed in this paper. The future directions of research are summarized.

Initial clinical experience with the ADAPT technique: A direct aspiration first pass technique for stroke thrombectomy.

BACKGROUND: The development of new revascularization devices has improved recanalization rates and time but not clinical outcomes. We report our initial results with a new technique utilizing a direct aspiration first pass technique with a large bore aspiration catheter as the primary method for vessel recanalization. METHODS: A retrospective evaluation of a prospectively captured database of 37 patients at six institutions was performed on patients where the ADAPT technique was utilized. The data represent the initial experience with this technique. RESULTS: The ADAPT technique alone was successful in 28 of 37 (75%) cases although six cases had large downstream emboli that required additional aspiration. Nine cases required the additional use of a stent retriever and one case required the addition of a Penumbra aspiration separator to achieve recanalization. The average time from groin puncture to at least Thrombolysis in Cerebral Ischemia (TICI) 2b recanalization was 28.1 min, and all cases were successfully revascularized. TICI 3 recanalization was achieved 65% of the time. On average, patients presented with an admitting National Institutes of Health Stroke Scale (NIHSS) score of 16.3 and improved to an NIHSS score of 4.2 by the time of hospital discharge. There was one procedural complication. DISCUSSION: This initial experience highlights the fact that the importance of the technique with which new stroke thrombectomy devices are used may be as crucial as the device itself. The ADAPT technique is a simple and effective approach to acute ischemic stroke thrombectomy. Utilizing the latest generation of large bore aspiration catheters in this fashion has allowed us to achieve excellent clinical and angiographic outcomes.

Effect of intra-coronary administration of tirofiban through aspiration catheter on patients over 60 years with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention.

The aim of this study was to compare the efficacy and safety of 2 approaches for intra-coronary administration of tirofiban (aspiration catheter versus guiding catheter) in patients over 60 years of age undergoing percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). It has been suggested that the administration of tirofiban by intra-coronary injection could promote drug absorption in the diseased region and enhance the inhibition of platelet aggregation, decreasing bleeding rates, but little is known about the comparative efficiency and safety of using guiding catheter versus aspiration catheter for delivery.Eighty-nine patients over 60 years of age with STEMI undergoing PCI were randomly divided into 2 groups according to the injection route for intracoronary administration of tirofiban [guiding catheter (n = 41) and aspiration catheter (n = 48)]. Baseline features, epicardial and myocardial perfusion, major adverse cardiac and cerebrovascular events (MACCEs), and bleeding rate were compared.No differences in age, gender, and history of hypertension, hypercholesterolemia, diabetes, and so on were observed (P > .05). The patients in the aspiration catheter group generally had a higher incidence of cerebral vascular disease. Compared with those in the guiding catheter group, patients in the aspiration catheter group obtained more favorable myocardial perfusion (P < .05). In-hospital and at 3-month and 6-month follow-ups, the MACCE rate and frequency of bleeding events were similar between the 2 groups (P > .05).Intra-coronary delivery of tirofiban through aspiration catheter led to better myocardial perfusion in STEMI patients over 60 years of age undergoing PCI compared with intra-coronary injection of tirofiban through guiding catheter. The 2 delivery routes were associated with similar rates of MACCEs and bleeding events.

The Future of Catheter-Directed Therapy: Data Gaps, Unmet Needs, and Future Trials.

This article will focus on 3 avenues for future research: (1) addressing the lack of short- and long-term clinical outcome research on catheter-directed therapy; (2) determining the safety and efficacy of novel thrombus removal devices; and (3) translating our knowledge of the pathobiology and pathophysiology of pulmonary embolism into novel diagnostic and therapeutic strategies.

Hemoperitoneo y síndrome compartimental abdominal por catéter venoso femoral intraperitoneal / Hemoperitoneum and abdominal compartment syndrome due to intraperitoneal femoral venous catheter

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