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Journal of Cardiothoracic Surgery Oct 2022Crescent cannula adhesion in the setting of COVID-19 respiratory failure requiring extracorporeal membrane oxygenation (ECMO) support is a novel complication. The...
BACKGROUND
Crescent cannula adhesion in the setting of COVID-19 respiratory failure requiring extracorporeal membrane oxygenation (ECMO) support is a novel complication. The objective of this case presentation is to highlight this rare complication and to explore potential predisposing factors and our management strategies.
CASE PRESENTATION
We present the case of a 25 y.o. patient with COVID-19 respiratory failure requiring ECMO support for 16-days in which a 32 Fr crescent cannula became adherent to the SVC and proximal jugular vein. Attempts to remove the cannula at the bedside failed due to immobility of the cannula. Ultrasound of the right neck was unremarkable, so he was taken to the hybrid OR where both TEE and fluoroscopy were unrevealing. An upper sternotomy was performed, and the superior vena cava and proximal jugular vein were dissected revealing a 2 cm segment of the distal SVC and proximal jugular vein that was densely sclerosed and adherent to the cannula. The vessel was opened across the adherent area at the level of the innominate vein and the cannula was then able to be withdrawn. The patient suffered no ill effects and had an unremarkable recovery to discharge.
CONCLUSIONS
To date, there have been no reports of crescent cannula adhesion related complications. In patients with COVID-19 respiratory failure requiring ECMO, clinicians should be aware of widespread hypercoagulability and the potential of unprovoked, localized venous sclerosis and cannula adhesion. We report our technique of decannulation in the setting of cannula adhesion and hope that presentation will shed further light on this complication allowing clinicians to optimize patient care.
Topics: COVID-19; Cannula; Extracorporeal Membrane Oxygenation; Humans; Male; Respiratory Distress Syndrome; Respiratory Insufficiency; Vena Cava, Superior
PubMed: 36209244
DOI: 10.1186/s13019-022-02004-4 -
Arthroscopy Techniques Feb 2016A technique of single portal knee arthroscopy was reported in 2013. Using a parallel working cannula assembled to the arthroscope cannula, the instruments are passed...
A technique of single portal knee arthroscopy was reported in 2013. Using a parallel working cannula assembled to the arthroscope cannula, the instruments are passed into the joint in line with the arthroscope. The original technique video in Arthroscopy Techniques shows the use of a 25 mm tube assembly with a parallel portal through which biters and proximally bent cutter instruments are used to perform procedures in the knee. This 2015 technical update shows the current preferred and most versatile method of single portal knee arthroscopy using a parallel locking and rotating hub for passage of biters and double-bend cutters. The video shows adequate completion of a partial meniscectomy using only 1 portal.
PubMed: 27073772
DOI: 10.1016/j.eats.2015.08.018 -
Medical Devices (Auckland, N.Z.) 2022To test the compatibility of PiC Insupen needles with a broad range of pens produced by different manufacturers for the injection of subcutaneously administered drugs.
PURPOSE
To test the compatibility of PiC Insupen needles with a broad range of pens produced by different manufacturers for the injection of subcutaneously administered drugs.
PATIENTS AND METHODS
The "extreme" products in PiC pen needles range were considered (G33x4 mm and G29x12 mm), to verify that the compatibility was not affected by the cannula diameter and length. Following the launch of the G34x3.5mm needle, additional tests were performed comparing G33x4 and G34x3.5 pen needles. A test medium with viscosity similar to insulin was used. Additional tests were performed with a liquid with a much higher viscosity. All the requirements of the technical standard ISO 11608-2 were satisfied, and the differences between G29, G33 and G34 were negligible. Therefore, the PiC Insupen needle G33x4mm was chosen as representative of the PiC pen needles. Dose accuracy and needle hub torque were assessed, according to the ISO 11608-2:2012 norms. For pens with variable volume, two different volumes were tested (Vlow and Vhigh) in random order, testing 60 needles with Vlow and 60 with Vhigh.
RESULTS
Overall, 50 different pens were tested. Dose accuracy acceptance criteria were met for all the pens tested, with the only exception of Vhigh for Berlipen Precision pen. The removal torque was adequate for all pens, with the only exception of Berlipen 301 and Berlipen 302 pens.
CONCLUSION
We documented that Pikdare needles are compatible with a large array of different pens for the injection of insulin and other drugs administered subcutaneously.
PubMed: 35378795
DOI: 10.2147/MDER.S352849 -
Studies in Health Technology and... 2011This paper presents the design of a magnetic resonance imaging (MRI) compatible needle placement system actuated by piezoelectric actuators for prostate brachytherapy...
This paper presents the design of a magnetic resonance imaging (MRI) compatible needle placement system actuated by piezoelectric actuators for prostate brachytherapy and biopsy. An MRI-compatible modular 3 degree-of-freedom (DOF) needle driver module coupled with a 3-DOF x-y-z stage is proposed as a slave robot to precisely deliver radioactive brachytherapy seeds under interactive MRI guidance. The needle driver module provides for needle cannula rotation, needle insertion and cannula retraction to enable the brachytherapy procedure with the preloaded needles. The device mimics the manual physician gesture by two point grasping (hub and base) and provides direct force measurement of needle insertion force by fiber optic force sensors. The fabricated prototype is presented and an experiment with phantom trials in 3T MRI is analyzed to demonstrate the system compatibility.
Topics: Brachytherapy; Equipment Design; Equipment Failure Analysis; Humans; Magnetic Resonance Imaging; Male; Micro-Electrical-Mechanical Systems; Needles; Prostatic Neoplasms; Prosthesis Implantation; Punctures; Surgery, Computer-Assisted; User-Computer Interface
PubMed: 21335868
DOI: No ID Found -
Discover Health Systems 2023As a Covid Hub in Emilia Romagna, we have experienced an increasing number of tracheostomized patients, prompting us to develop a standardized decannulation protocol for...
As a Covid Hub in Emilia Romagna, we have experienced an increasing number of tracheostomized patients, prompting us to develop a standardized decannulation protocol for COVID-19 ARDS patients. Currently, there are no guidelines or protocols for decannulation in this population, and few studies have investigated the early outcomes of tracheostomy in COVID-19 patients, with no detailed analysis of the decannulation process. We recognized the importance of mutual reliance among our team members and the significant achievements we made compared to previous decannulation methods. Through the optimization of the decannulation process, we identified a clear, safe, and repeatable method based on clinical best practice and literature evidence. We decided to implement an existing standardized decannulation protocol, which was originally designed for severe brain-damaged patients, due to the growing number of COVID-19 patients with tracheostomy. This protocol was designed for daily practice and aimed to provide a uniform approach to using devices like fenestrated cannulas, speaking valves, and capping. The results of our implementation include:expanding the applicability of the protocol beyond severe brain-damaged patients to different populations and settings (in this case, patients subjected to a long period of sedation and invasive ventilation)early activation of speech therapy to facilitate weaning from the cannula and recovery of physiological swallowing and phonationearly activation of otolaryngologist evaluation to identify organic problems related to prolonged intubation, tracheostomy, and ventilation and address proper speech therapy treatmentactivation of more fluid and effective management paths for decannulation with a multiprofessional team.
PubMed: 37520514
DOI: 10.1007/s44250-023-00031-z -
Journal of Clinical and Diagnostic... Nov 2016Peripheral Intravenous Catheters (PIV) are extensively used in sick neonates for administration of medicines and nutrition. When these PIVs are used on intermittent...
INTRODUCTION
Peripheral Intravenous Catheters (PIV) are extensively used in sick neonates for administration of medicines and nutrition. When these PIVs are used on intermittent basis, they are flushed with saline in order to keep the hub of the catheter free from blood. Presence of blood in the hub of the catheter can be potentially dangerous as it could facilitate infection.
AIM
The aim of this study was to find the magnitude of blood contamination of PIV catheter hub after routine flushing.
MATERIALS AND METHODS
We measured the volume of 24 g PIV by filling it with saline and thereby measuring its volume. The PIVs which were in situ for at least 6 hours and removed were used for this study. These catheters were flushed with 0.2 ml of saline and the RBC count was calculated.
RESULTS
A total of 94 PIVs were studied, out of which 84% showed blood tinged residual flush and 15% of them had visible blood clot. All (100%) of the catheter studied showed RBCs on microscopic examination. The median RBC count was 36960/cu mm and the interquartile range was 10000 - 113920/cu mm. The highest RBC count was 2080000/cu mm.
CONCLUSION
Blood contamination of the small bore PIVs after flushing is universal in neonates.
PubMed: 28050372
DOI: 10.7860/JCDR/2016/20513.8841 -
Turkish Journal of Emergency Medicine Jul 2019Venous air embolism is a catastrophic complication that can result in sudden cardiac arrest and death. Massive air embolism has been reported with central venous...
INTRODUCTION
Venous air embolism is a catastrophic complication that can result in sudden cardiac arrest and death. Massive air embolism has been reported with central venous catheter through the internal jugular and subclavian veins. Though external jugular vein is a potential site of an air embolism to cardiac chambers and subsequently to vital organs such as brain, heart and lungs but has not been reported yet in literature.
CASE PRESENTATION
We are reporting a case of sudden pulmonary air embolism in a patient through the open hub of an intravenous cannula, vigilant monitoring and timely action saved the patient from a catastrophic outcome.
CONCLUSION
We recommend vigilant monitoring and adequate precaution in patients with external jugular venous cannulation in the operation theater, intensive care unit or wards to prevent iatrogenic complications.
PubMed: 31321347
DOI: 10.1016/j.tjem.2019.06.002 -
The Lancet. Digital Health Nov 2019Enhanced methods of drug monitoring are required to support the individualisation of antibiotic dosing. We report the first-in-human evaluation of real-time...
BACKGROUND
Enhanced methods of drug monitoring are required to support the individualisation of antibiotic dosing. We report the first-in-human evaluation of real-time phenoxymethylpenicillin monitoring using a minimally invasive microneedle-based β-lactam biosensor in healthy volunteers.
METHODS
This first-in-human, proof-of-concept study was done at the National Institute of Health Research/Wellcome Trust Imperial Clinical Research Facility (Imperial College London, London, UK). The study was approved by London-Harrow Regional Ethics Committee. Volunteers were identified through emails sent to a healthy volunteer database from the Imperial College Clinical Research Facility. Volunteers, who had to be older than 18 years, were excluded if they had evidence of active infection, allergies to penicillin, were at high risk of skin infection, or presented with anaemia during screening. Participants wore a solid microneedle β-lactam biosensor for up to 6 h while being dosed at steady state with oral phenoxymethylpenicillin (five 500 mg doses every 6 h). On arrival at the study centre, two microneedle sensors were applied to the participant's forearm. Blood samples (via cannula, at -30, 0, 10, 20, 30, 45, 60, 90, 120, 150, 180, 210, 240 min) and extracellular fluid (ECF; via microdialysis, every 15 min) pharmacokinetic (PK) samples were taken during one dosing interval. Phenoxymethylpenicillin concentration data obtained from the microneedles were calibrated using locally estimated scatter plot smoothing and compared with free-blood and microdialysis (gold standard) data. Phenoxymethylpenicillin PK for each method was evaluated using non-compartmental analysis. Area under the concentration-time curve (AUC), maximum concentration, and time to maximum concentration were compared. Bias and limits of agreement were investigated with Bland-Altman plots. Microneedle biosensor limits of detection were estimated. The study was registered with ClinicalTrials.gov, number NCT03847610.
FINDINGS
Ten healthy volunteers participated in the study. Mean age was 42 years (SD 14). Seven (70%) were men. Microdialysis and microneedle results were similar for phenoxymethylpenicillin ECF maximum concentration (0·74 mg/L vs 0·64 mg/L; 95% CI -0·24 to 0·44; p=0·53), time to maximum concentration (1·18 h vs 1·10 h; -0·52 to 0·67; p=0·79), and AUC (1·54 mg × h/L vs 1·67 mg × h/L; -1·10 to 0·85; p=0·79). In total, 440 time points were compared with mean difference between measurements -0·16 mg/L (95% CI -1·30 to 0·82). Mean phenoxymethylpenicillin AUCs for free serum and microneedle PK were similar (1·77 mg × h/L [SD 0·59] vs 1·67 mg × h/L [1·00]; -0·77 to 0·97; p=0·81). Median coefficient of variation between sensors within individuals was 7% (IQR 4-17). Limit of detection for the microneedles was estimated at 0·17 mg/L.
INTERPRETATION
This study is proof-of-concept of real-time, microneedle sensing of penicillin in vivo. Future work will explore microneedle use in patient populations, their role in data generation to inform dosing recommendations, and their incorporation into closed-loop control systems for automated drug delivery.
FUNDING
National Institute for Health Research Imperial Biomedical Research Centre, Mérieux Foundation.
Topics: Adult; Anti-Bacterial Agents; Biosensing Techniques; Drug Monitoring; Extracellular Fluid; Female; Healthy Volunteers; Humans; London; Male; Microdialysis; Needles; Penicillin V
PubMed: 33323208
DOI: 10.1016/S2589-7500(19)30131-1 -
Pain Physician 2008Radiofrequency neurolysis is a common technique used in the treatment of chronic pain, particularly facet (zygapophyseal joint) arthralgia. A needle-like cannula is...
BACKGROUND
Radiofrequency neurolysis is a common technique used in the treatment of chronic pain, particularly facet (zygapophyseal joint) arthralgia. A needle-like cannula is insulated except for the exposed active tip, which is positioned as parallel and adjacent as possible to the targeted nerve branch. Via an inserted probe connected to a radiofrequency generator, energy flowing from the tip of the cannula creates a heat lesion in the 80 - 85 degree Celsius range mostly about the length of the exposed active tip and in proportion to the diameter of the probe. The common active tip lengths used for neurolysis are 5mm or 10mm. The cannulae are FDA approved. The manufacturer advises physicians not to bend or otherwise modify a cannula prior to use. The cannulae are available straight or bent, sharp and blunt. The technique is guided under C-arm fluoroscopy. X-rays passing through the patient demonstrate in 2 dimensions the projected relative radio-opaque bony landmarks and the metallic cannula. Most currently available cannulae are uniform in their radio-opacity from tip to hub. The physician must make an educated guess as to the portion of the cannula that will be making the lesion in relationship to the bony landmark.
OBJECTIVE
A new radiofrequency cannula with a radio-opaque marker (ROC) delineates the proximal end of the active tip. The cannula was used in a phantom model. Images were reproduced with explanation of the potential advantage of the new device.
RESULT
The marker on the new cannula was visible and did help delineate the active tip as well as its orientation. It was also helpful in making sequential lesions at the same nerve using a "tip to tail" repositioning technique.
CONCLUSION
The ROC did represent an improvement over standard cannulae to optimize visualization of cannula and thus lesion placement using a phantom model. The applications described were only for conventional or "hot" RF.
Topics: Arthrography; Catheter Ablation; Catheterization; Cervical Vertebrae; Fluoroscopy; Ganglia, Spinal; Ganglia, Sympathetic; Humans; Image Processing, Computer-Assisted; Low Back Pain; Lumbar Vertebrae; Models, Anatomic; Neck Pain; Spinal Nerve Roots; Spinal Nerves; Zygapophyseal Joint
PubMed: 19057632
DOI: No ID Found -
Diseases (Basel, Switzerland) Jan 2024Bronchiolitis is an acute viral infection of the lower respiratory tract that affects infants and young children. Respiratory syncytial virus (RSV) is the most common...
Bronchiolitis is an acute viral infection of the lower respiratory tract that affects infants and young children. Respiratory syncytial virus (RSV) is the most common causative agent; however, other viruses can be involved in this disease. We retrospectively reviewed the clinical features of infants aged less than 12 months hospitalized for acute bronchiolitis in our Pediatric Units of Chivasso, Cirié, and Ivrea in Piedmont, Northern Italy, over two consecutive bronchiolitis seasons (September 2021-March 2022 and September 2022-March 2023). Patient-, disease-, and treatment-related variables were analyzed. The probability of therapeutic success (discharge home) was 96% for all patients (93% for RSV vs. 98% for non-RSV patients, > 0.05). Among 192 patients, 42 infants (22%) underwent high-flow oxygen support (HFNC), and only 8 (4%) needed to be transferred to our hub referral hospital. Factors associated with hub hospital transfer were the age under 1 month and the failure of HFNC. The wide and increasing use of HFNC in pediatric inpatients improved the management of bronchiolitis in Spoke hospitals, reducing transfer to a hub hospital provided with Intensive Care Units.
PubMed: 38248376
DOI: 10.3390/diseases12010025