Indwelling catheter and conservative measures in the treatment of abdominal compartment syndrome in fulminant acute pancreatitis

AIM： To study the effect of combined indwelling catheter, hemofiltration, respiration support and traditional Chinese medicine （e.g. Dahuang） in treating abdominal compartment syndrome of fulminant acute pancreatitis. METHODS： Patients with fulminant acute pancreatitis were divided randomly into 2 groups of combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring and routine conservative measures group （group 1） and control group （group 2）. Routine non-operative conservative treatments including hemofiltration, respiration support, gastrointestinal TCM ablution were also applied in control group patients. Effectiveness of the two groups was observed, and APACHE Ⅱ scores were applied for analysis. RESULTS： On the second and fifth days after treatment, APACHE Ⅱ scores of group 1 and 2 patients were significantly different. Comparison of effectiveness （abdominalgia and burbulence relief time, hospitalization time） between groups 1 and 2 showed significant difference, as well as incidence rates of cysts formation. Mortality rates of groups 1 and 2 were 10.0% and 20.7%, respectively. For patients in group 1, celiac drainage quantity and intra-abdominal pressure, and hospitalization time were positively correlated （r = 0.552, 0.748, 0.923, P 〈 0.01） with APACHE Ⅱ scores. CONCLUSION： Combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring, short veno-venous hemofiltration （SVVH）, gastrointestinal TCM ablution, respiration support have preventive and treatment effects on abdominal compartment syndrome of fulminant acute pancreatitis.

Management of recurrent malignant pleural effusions with a tunneled indwelling pleural catheter

In this review, we report on the use of indwelling pleural catheters in the treatment of malignant pleural effusions. We describe the most commonly used catheter. Also, treatment with indwelling pleuralcatheters as compared to talc pleurodesis is reviewed. A comparison of efficacy, costs, effects on quality of life, and complications is made. Only one randomized controlled trial comparing the two is available up to date, but several are underway. We conclude that treatment for malignant pleural effusions with indwelling pleural catheters is a save, cost-effective, and patientfriendly method, with low complication rates.

Development and validation of a risk prediction model for repeated indwelling urinary catheterization in patients with cervical cancer after surgery

Objective:To study the factors influencing secondary indwelling catheterisation after cervical cancer surgery and to develop a predictive risk model.Methods:A total of 260 patients in a tertiary hospital in Chongqing were selected from January 2020 to December 2021 via convenience sampling.Relevant information of patients was recorded,including age;body mass index;history of hypertension and diabetes,bladder dysfunction,postoperative urinary retention,and postoperative urinary tract infection;Histology;staging;surgical approach;Operation time;Time of first remove of catheter;indwelling catheter days;Hospitalization days.Least absolute shrinkage and selection operator was used to reduce dimensionality and select patient characteristics,and multivariate analysis was performed based on the selected variables.Based on the outcome of analysis,a line chart model was developed for predicting the risk of secondary catheterization in patients with indwelling catheterization after radical cervical cancer surgery.The coefficient of conformity index(C-index)and calibration curves were used to evaluate the accuracy and fit.The model was internally validated via bootstrapping(1000 random samples),and the clinical utility of the model was assessed via decision curve analysis(DCA).Results:Four characteristic variables were selected,including preoperative bladder function,postoperative urinary tract infection,surgical approach,and Time of first remove of catheter.They are independent risk factors affecting urinary tract.The risk prediction model exhibited good discrimination performance with a C-index of 0.722(95%CI,0.661-0.783)and was well calibrated.The C-index was 0.708 in internal validation analysis.DCA showed that the risk model was clinically useful for predicting secondary catheterization,and clinical benefits were observed at the decision threshold of≥11%.Conclusion:A novel model was developed to predict the risk of secondary catheterization.The model was based on preoperative bladder dysfunction,postoperative urinary tract infection,surgical approach,and number of days since the removal of the primary catheter.

New cannulation method for pancreatic duct cannulationbile duct guidewire-indwelling method

The patient was a 58-year-old male with symptomatic alcoholic chronic pancreatitis.Since a 10 mm calculus was observed in the pancreatic body and abdominal pain occurred due to congestion of pancreatic juice,endoscopic retrograde cholangiopancreatography was conducted for assessment of the pancreatic duct and treatment of pancreatic calculus.Pancreatogram was slightly and insuff iciently obtained by injecting the contrast media via the common channel of the duodenal main papilla.We tried to cannulate selectively into the pancreatic duct for a clear image.However,the selective cannulation of the pancreatic duct was difficult because of instability of the papilla.On the other hand,selective cannulation of the bile duct was relatively easily achieved.Therefore,after the imaging of the bile duct,a guidewire was retained in the bile duct to immobilize the duodenal papilla and cannulation of the pancreatic duct was attempted.As a result,selective pancreatic duct cannulation became possible.It is considered that the bile duct guidewire-indwelling method may serve as one of the useful techniques for cases whose selective pancreatic duct cannulation is diff icult("selective pancreatic duct diff icult cannulation case").

Application of Modified Gastric Tube Placement in Patients with Indwelling Gastric Tube

Objective:To explore the effect of modified nasogastric tube placement and Rehabilitation New Liquid Spray in patients with indwelling gastric tube.Methods:Eighty-six cases with indwelling gastric tube in our hospital from January 2020 to May 2021 were randomly selected and divided into the reference group and the research group.The reference group was treated by modified gastric tube placement,and the research group was given the Rehabilitation New Liquid Spray intervention.The effect of the interventions on two groups was observed.Results:The incidence of nasal mucosal injury in the research group was lower than that in the reference group,and the incidence of pharyngeal mucosal injury in the research group was lower than that in the reference group(P<0.05).The pain score of the study group was lower than that of the reference group at 8 h,12 h and 24 h after replacement,and the incidence of hoarseness,swallowing discomfort and dry oropharynx was lower than that of the reference group(P<0.05).Conclusion:The application of modified gastric tube placement and Rehabilitation New Liquid Spray intervention in patients with indwelling gastric tube can effectively reduce the nasopharyngeal injury and improve the pain of catheterization.

Indwelling Pleural Catheter Insertion Following Inefficient Thoracoscopic Decortication in Postpneumonic Empyema: Beneficial or Contraindicated?

Video assisted thoracic surgery in advanced stage postpneumonic empyema aims for thorough debridement and washout of the pleural space followed by an attempt to release the entrapped lung (decortication). When the latter isn’t successful, and the patient is in a poor performance status, applying tube thoracostomy is the usual routine, to avoid conversion to thoracotomy and open decortication. Tube thoracostomy, however, is associated with complications necessitating further surgery, needs long term follow up and also entails quality of life distorting issues. To overcome these disadvantages, we instead inserted a PleurX&reg indwelling pleural catheter in four patients in the above situation. The method brought success (lung re-expansion and complete or partial pleurodesis) without the need for further surgery or quality of life problems in either patient. Although the use of the indwelling pleural catheter in infected pleural space is not recommended by manufacturers, we noted no complications.

Application of Intravenous Indwelling Needle in Undergraduate's Pharmacology Teaching Experiment

In this study,an intravenous indwelling needle was placed in the central artery of rabbit ear for collecting blood.The results show that this method greatly improves the success rate of blood sampling and well controls the experimental time.The students'unanimous feedback was that the method is simple and easy to operate,which is of great help to the stability of the experimental results.

Sonographic guidance for tunneled central venous catheters insertion in pediatric oncologic patients: guided punctures and guide wire localization

Objective Totally implantable devices (TIDs) and external tunneled catheters (ETCs) became a basic requirement in the treatment of pediatric oncologic patients. Techniques for implantation and confirmation of proper position vary among different centers. The article presented different techniques for sonographic guided puncture of the target central vein and confirmation of the proper position of tunneled catheters.

Effect of Cluster Nursing in Preventing Urinary Tract Infection in Postoperative Patients with Indwelling Urinary Catheter

Objective:This paper expounds and analyzes the effect of cluster nursing in preventing urinary tract infection in postoperative patients with indwelling urinary catheter.Methods:A total of 400 postoperative patients with indwelling urinary catheter,treated in Yancheng No.1 People’s Hospital in recent two years,were recruited as research subjects.The patients were equally divided into group A and group B,with 200 patients in each group,and all received routine anti-infectives.The patients in group A(200 cases)received routine nursing.On the basis of group A,cluster nursing was implemented for patients in group B(200 cases).Results:The indwelling time of urinary catheter,the disappearance time of bladder irritation symptoms,and the probability of urinary tract infection were compared between both groups,which showed that the nursing effect of group B was better than that of group A(P<0.05).Conclusion:The implementation of cluster nursing in postoperative patients with indwelling urinary catheter can improve the deficiency of routine nursing,consolidate the treatment effect,and reduce the complication rate of urinary tract infection.

Clinical analysis on nosocomial pulmonary infection in patients with indwelling tracheal tube

Tracheal intubation by tracheotomy or by placing a tracheal tube through larynx into trachea,is not only one of important measures which are taken to rescue critically ill patients with respiratory failure etc.,but a commonly used method to prevent patients from airway obstruction in the postoperative period and facilitate mechanical ventilation.Meanwhile,the incidence rate of pulmonary infection,a complication caused by indwelling tracheal tubes,especially the incidence rate of hospital acquired pulmonary infection is apparently increasing.Particularly,pulmonary infection of this kind has characteristics of easily recurrent seizures,long treatment period and high drug-resistance.Hence,it is required for medical personnel to summarize,analyze and study not only general nursing,airway nursing and prevention of pulmonary infection,but also antibiotic selection as well as how and when to use those drugs after the incidence of pulmonary infection for the benefit of patients with indwelling tracheal tube.This article is based on a case collected from Comprehensive Surgery Department of the Third Affiliated Hospital of Inner Mongolia Medical University.The patient’s history is as follows:1.Pulmonary infection;2.Indwelling tracheal catheter after tracheotomy;3.Carbon monoxide toxic cerebrosis,mute state.By means of this case analysis,it is expected to make an early detection,and give an early and proper treatment to patients with pulmonary infection caused by indwelling tracheal tubes in clinical practice.

Role of Fine Management in Maintenance of Deep Venous Indwelling Catheter in Hemodialysis Patients

Objective:This paper mainly explores the effect of fine management application in maintenance of deep venous indwelling catheter in hemodialysis patients.Methods:150 hemodialysis patients with deep venous catheter indwelling in our hospital from December 2019 to September 2020 were divided into routine group and study group.The routine group was given routine nursing,and the study group was given fine management nursing.The nursing effect of the two groups was analyzed.Results:After nursing intervention,the incidence of complications in the study group was 14.66%,which was lower than that in the conventional group(53.33%),and the nursing compliance in the study group(98.66%)was higher than that in the conventional group(89.33%),all P<0.05.Conclusion:Fine management plays a significant role in the maintenance of deep venous indwelling catheter in hemodialysis patients,which can reduce the occurrence of complications.

Focus on peripherally inserted central catheters in critically ill patients

Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.

Antimicrobial-impregnated catheters for the prevention of catheter-related bloodstream infections

Central venous catheters are commonly used in critically ill patients. Such catheterization may entail mechanica and infectious complications. The interest in catheterrelated infection lies in the morbidity, mortality and costs that it involved. Numerous contributions have been made in the prevention of catheter-related infection and the current review focuses on the possible current role of antimicrobial impregnated catheters to reduce catheter-related bloodstream infections(CRBSI). There is evidence that the use of chlorhexidine-silver sulfadiazine(CHSS), rifampicin-minocycline, or rifampicin-miconazol impregnated catheters reduce the incidence of CRBSI and costs. In addition, there are some clinical circumstances associated with higher risk of CRBSI, such as the venous catheter access and the presence of tracheostomy. Current guidelines for the prevention of CRBSI recommended the use of a CHSS or rifampicin-minocycline impregnated catheter in patients whose catheter is expected to remain in place > 5 d and if the CRBSI rate has not decreased after implementation of a comprehensive strategy to reduce it.

Comparing Epidural Analgesia and ON-Q Infiltrating Catheters for Pain Management after Hepatic Resection

Background and Objectives: Pain control after hepatic resection presents unique challenges as subcostal incisions, rib retraction, and diaphragmatic irritation can lead to significant pain. Both epidural analgesia and ON-Q catheters have been used for postoperative pain management after hepatic surgery, but to our knowledge have not been directly compared. Methods: The records of 143 patient between the ages 18 and 70 were reviewed who underwent hepatic resection by a single surgeon. Patients were categorized according to method of postoperative pain control. Average pain scores for both study groups were collected until POD#3. Results: Demographic data and the length of surgery were similar between the groups (all P > 0.05). On the day of surgery and POD#1, average pain scores for the epidural group were lower than the ON-Q group (P 0.0001 and P = 0.0008 respectively). There was no difference in pain scores on POD #2 (P = 0.2369) or POD #3 (P = 0.2289). Conclusions: Epidural analgesia provides superior pain control on the day of surgery and POD#1 when compared to On-Q catheter with IV PCA. There was no difference in pain scores on POD#2 or POD#3. Future prospective randomized trials comparing these analgesic methods will be required to further evaluate enhanced recovery after hepatic surgery.

Targeted Ultrasound-Guided Double Catheters (Infraclavicular-Brachial Plexus, Median Nerve) Facilitate Hand Rehabilitation with Superb Analgesia and Motor Function Retention

A 44-year-old male who suffered a crush-degloving hand injury complicated by Complex Regional Pain Syndrome (CRPS) type I was scheduled for operative hand manipulation and inpatient physiotherapy. Preoperative placement of an ultrasound-guided infraclavicular catheter provided incomplete analgesia requiring supplemental morphine during physiotherapy sessions despite continuous infusion of 0.1% bupivacaine at 20 mL/hour. Due to the patient’s adamant refusal of replacement of the infraclavicular catheter, a second ultrasound-guided median nerve catheter was placed distally at the mid-forearm level and elicited complete sensory blockade of the hand. Dual infusions were maintained with 0.25% bupivacaine at 5 mL/hour through the median nerve catheter and 0.1% bupivacaine at 20 mL/hour through the infraclavicular catheter, and subsequent daily physiotherapy progressed productively. Continuous perineural catheter use to facilitate rehabilitation is an emerging practice that may improve overall recovery. Combination catheters, infusing local anesthetics at separate locations, can be used synergistically to preserve motor function and reach a superior analgesic endpoint.

Electrocautery vs non-electrocautery dilation catheters in endoscopic ultrasonography-guided pancreatic fluid collection drainage

AIM: To investigate the safety and utility of an electrocautery dilation catheter for endoscopic ultrasonography(EUS)-guided pancreatic fluid collection drainage.METHODS: A single-center, exploratory, retrospective study was conducted between August 2010 and August 2014. This study was approved by the Medical Ethics Committee of our institution. Informed, written consent was obtained from each patient prior to the procedure. The subjects included 28 consecutive patients who underwent EUS-guided transmural drainage(EUS-TD) for symptomatic pancreatic and peripancreatic fluid collections(PFCs) by fine needle aspiration using a 19-gauge needle. These patients were retrospectively divided into two groups based on the use of an electrocautery dilation catheter as a fistula dilation device; 15 patients were treated with an electrocautery dilation catheter(electrocautery group), and 13 patients were treated with a non-electrocautery dilation catheter(non-electrocautery group). We evaluated the technical and clinical successes and the adverse events associated with EUS-TD for the treatment of PFCs between the two groups.RESULTS: There were no significant differences in age, sex, type, location and diameter of PFCs between the groups. Thirteen patients(87%) in the electrocauterygroup and 10 patients(77%) in the non-electrocautery group presented with infected PFCs. The technical success rates of EUS-TD for the treatment of PFCs were 100%(15/15) and 100%(13/13) for the electrocautery and the non-electrocautery groups, respectively. The clinical success rates of EUS-TD for the treatment of PFCs were 67%(10/15) and 69%(9/13) for the electrocautery and the non-electrocautery groups, respectively(P = 0.794). The procedure time of EUS-TD for the treatment of PFCs in the electrocautery group was significantly shorter than that of the non-electrocautery group(mean ± SD: 30 ± 12 min vs 52 ± 20 min, P < 0.001). Adverse events associated with EUS-TD for the treatment of PFCs occurred in 0 patients and 1 patient for the electrocautery and the non-electrocautery groups, respectively(P = 0.942).CONCLUSION: EUS-TD using an electrocautery dilation catheter as a fistula dilation device for the treatment of symptomatic PFCs appears safe and contributes to a shorter procedure time.

Steerable microcatheters for complex percutaneous coronary interventions in octogenarians: from Venture to Swift Ninja

0ctogenarians represent the fastest growing group of patients undergoing percutaneous coronary intervention(PCI),now constituting more than one in five patients treated with PCI in real-world practice.[1,2]Comparing coronary lesion characteristics of patients aged<≥80 years to those≥80 years undergoing PCI,the octogenarians have a higher prevalence of calcified and ostial lesions,tortuous coronary anatomy,multi-vessel disease and left main stem(LMS)stenosis.⑶Furthermore,they often have greater ischemic burden than their younger counterparts,suggesting an even greater benefit following revascularization.

Surface Treated Catheters for Vascular Access—Useful?

Background: Catheter-related infections (CRI), thrombosis, and stenosis are among the most frequent complications associated with catheters which are inserted in vessels as vascular access. These problems are usually related to the handling of the staff, the catheter materials, and the surface properties of the catheter. To mitigate such complications surface treatment process of the outer surface, such as ion beam assisted deposition is investigated in a retrospective study from 1992 to 2007, to prove if the surface treatment of the catheters is a sufficient solution. Methods: This study (1992-2007) evaluated silver coated and non-coated implanted large-bore catheters used for extracorporeal detoxification. In 159 patients, 54 patients received a silver coated catheter (Spi-Argent, Spire Corporation, Bedford, MA, USA) and 105 patients, an untreated catheter served as controls. The catheters were inserted into the internal jugular or subclavian veins. After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. They were also examined using a scanning electron microscope (SEM). Results: The silver coated catheters showed a tendency towards longer in situ time. The microbiologic examinations of the catheter tips were in both catheter types high positive, but not significant. Conclusion: The silver coated catheters showed no significant reduction in infection rate by evaluation of all collected data in this retrospective study. There was no association between both catheters in significantly reducing patient discomfort. Other surface treatments which include the outer and inner surface are necessary. New developed catheter materials such as the microdomain structured inner and outer surface, as an example, are considered more biocompatible because they mimic the structure of natural biological surface.

Combined Spinal Epidural Catheters for Epidural Cooling, Cerebrospinal Fluid Aspiration and Spinal Intralipid Infusion for Treatment of Spinal and Brain Injuries, Diseases and Protection

A new proposal for spinal cord and brain treatment and protection due to injuries and diseases is made herein. It is composed of two 20G nylon catheters with 6 lateral holes arranged circumferentially within 3 cm from the tip and a closed end. One catheter is inserted into the epidural space and the other catheter is inserted into the spinal space in two different lumbar interspaces using an 18G Tuohy needle 90 mm. The epidural catheter is used for cooled saline injection and infusion. The spinal catheter is used for Intralipid spinal injections and CSF aspiration. The proposal is based on the current studies on spinal cord cooling and CSF aspiration as well as on the Intralipid resuscitation properties and lipid brain protection. A study is needed to evaluate the clinical value of this combined approach.

The Effect and Nursing of Indwelling Nasal Jejunal Feeding Tube for Enteral Nutrition in Acute Severe Pancreatitis

Objective:To analyze the effect of enteral nutrition and nursing intervention in patients with indwelling nasojejunal tube in acute severe pancreatitis.Methods:Sixty cases of patients with indwelt nasojejunal tubes treated in our hospital from August 2019 to August 2020 were divided into routine group and observation group as research subjects.Patients in both groups received enteral nutrition,patients in the routine group received routine care,and patients in the observation group received quality care.The recovery time of gastrointestinal function,length of hospital stay,hospitalization cost,nutritional indicators and incidence of complications in the two groups were compared.Results:The recovery time of gastrointestinal function in observation group was lower than that in routine group,P<0.05;The length and cost of hospitalization in observation group were lower than those in routine group,P<0.05;The nutritional indexes in observation group were higher than those in routine group,P<0.05;The incidence of complications in observation group was lower than that in routine group,P<0.05.Conclusion:Quality nursing service improve the effect of enteral nutrition,so as to ensure that patients get sufficient nutritional support.Its effect is remarkable and it is worthy of widespread clinical application.