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Ki S, Choi B, Cho SB, Hwang S, Lee J. Unexpected Tension Pneumothorax Developed during Anesthetic Induction Aggravated by Positive Pressure Ventilation: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1631. [PMID: 37763751 PMCID: PMC10535224 DOI: 10.3390/medicina59091631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Tension pneumothorax is a life-threatening emergency condition that requires immediate diagnosis and intervention. However, due to the non-specific symptoms and the rarity of its occurrence during surgery, anesthesiologists encounter difficulties in promptly diagnosing tension pneumothorax when it arises intraoperatively. Diagnosing tension pneumothorax can become even more challenging in unexpected situations in patients with normal preoperative evaluation for general anesthesia. Materials and Methods, Results: We report the case of a 66-year-old woman who underwent general anesthesia for oblique lateral interbody fusion surgery of her lumbar spine. Though she did not have any respiratory symptoms prior to the induction of anesthesia, auscultation following endotracheal intubation indicated decreased breathing sound in the left hemithorax of the chest. Subsequently, her vital signs showed tachycardia, hypotension, and hypoxemia, and the ventilator indicated a gradual increase in the airway pressure. We verified the proper depth of the endotracheal tube to exclude one-lung ventilation, and, in the meantime, learned that there had been unsuccessful attempts at left subclavian venous catheterization by the surgical department on the previous day. Tension pneumothorax was diagnosed through portable chest radiography in the operating room, and needle thoracostomy and chest tube insertion were performed immediately, which in turn stabilized her vital signs and airway pressure. The surgery was uneventful, and the chest tube was removed one week later after evaluation by the cardiothoracic department. The patient was discharged from hospital on postoperative day 14 without known complications. Conclusions: Anesthesiologists should be aware of the conditions and risk factors that may cause tension pneumothorax and remain vigilant for signs of its development throughout surgery, even for patients who show normal preoperative assessments. An undetected small pneumothorax without any symptoms can progress to tension pneumothorax through positive pressure ventilation during general anesthesia, posing a life-threatening situation. If a tension pneumothorax is highly suspected through clinical assessments, its prompt differentiation and timely diagnosis are crucial, allowing for rapid intervention to stabilize vital signs.
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Affiliation(s)
| | | | | | | | - Jeonghan Lee
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Republic of Korea; (S.K.); (B.C.); (S.B.C.); (S.H.)
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Chen YB, Bao HS, Hu TT, He Z, Wen B, Liu FT, Su FX, Deng HR, Wu JN. Comparison of comfort and complications of Implantable Venous Access Port (IVAP) with ultrasound guided Internal Jugular Vein (IJV) and Axillary Vein/Subclavian Vein (AxV/SCV) puncture in breast cancer patients: a randomized controlled study. BMC Cancer 2022; 22:248. [PMID: 35248019 PMCID: PMC8898472 DOI: 10.1186/s12885-022-09228-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/24/2022] [Indexed: 01/18/2023] Open
Abstract
Abstract
Background
Axillary vein/subclavian vein (AxV/SCV) and Internal jugular vein (IJV) are commonly used for implantable venous access port (IVAP) implantation in breast cancer patients for chemotherapy. Previous research focused on comparison of complications while patient comfort was ignored. This study aims to compare patient comfort, surgery duration and complications of IVAP implantation between IJV and AxV/SCV approaches.
Methods
Two hundred forty-eight breast cancer patients were enrolled in this randomized controlled study from August 2020 to June 2021. Patients scheduled to undergo IVAP implantation were randomly and equally assigned to receive central venous catheters with either AxV /SCV or IJV approaches. All patients received comfort assessment using a comfort scale table at day 1, day 2 and day 7 after implantation. Patient comfort, procedure time of operation as well as early complications were compared.
Results
Patient comfort was significantly better in the AxV/SCV group than that of IJV group in day 1 (P < 0.001), day 2 (P < 0.001) and day 7(P = 0.023). Procedure duration in AxV/SCV group was slightly but significantly shorter than IJV group (27.14 ± 3.29 mins vs 28.92 ± 2.54 mins, P < 0.001). More early complications occurred in AxV/SCV group than IJV group (11/124 vs 2/124, P = 0.019). No difference of complications of artery puncture, pneumothorax or subcutaneous hematoma between these two groups but significantly more catheter misplacement in AxV/SCV group than IJV group (6/124 vs 0/124, P = 0.029). Absolutely total risk of complications was rather low in both groups (8.87% in AxV/SCV group and 1.61% in IJV group).
Conclusions
Our study indicates that patients with AxV/SCV puncture have higher comfort levels than IJV puncture. AxV/SCV puncture has shorter procedure duration but higher risk of early complications, especially catheter misplacement. Both these two approaches have rather low risk of complications. Consequently, our study provides an alternative choice for breast cancer patients to reach better comfort.
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Tran QK, Fairchild M, Yardi I, Mirda D, Markin K, Pourmand A. Efficacy of Ultrasound-Guided Peripheral Intravenous Cannulation versus Standard of Care: A Systematic Review and Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3068-3078. [PMID: 34353670 DOI: 10.1016/j.ultrasmedbio.2021.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
Peripheral intravenous cannulation (PIV) is a common and necessary procedure in the emergency department (ED). Patients with PIV access encounter significant treatment delay. Ultrasound guidance for PIV (USGPIV) cannulation is a modality to reduce delay of care in such patients, but its efficacy, when compared with cannulation by the standard of care (SOC), the landmark and palpation method, has not been well established. We performed a random effects meta-analysis of available literature that compared USGPIV with SOC cannulation. We searched PubMed, Scopus and EMBASE until October 2020 for eligible studies in adult patients. We excluded non-English language, non-full-text studies. Our primary outcome was rate of first successful cannulation. Other outcomes were number of attempts and patient satisfaction. After identifying 284 studies and screening 74 studies, we included 10 studies. There were 1860 patients, 966 (52%) in the USGPIV group and 894 (48%) who received the SOC. Sixty-six percent of patients were female. USGPIV cannulation was associated with a two-times higher likelihood of first successful cannulation (odds ratio: 2.1, 95% confidence interval [CI]: 1.65-2.7, p < 0.001, I2 = 2.9%). While procedure length was similar in both groups, USGPIV was associated with a significantly smaller number of attempts (standardized mean difference [SMD]: -0.272, 95% CI: -0.539 to -0.004, p = 0.047) and significantly higher patient satisfaction (SMD: 1.467, 95% CI: 0.92-2.012, p < 0.001). There was low heterogeneity among our included studies, which were mostly randomized control trials. Our study confirmed that USGPIV cannulation offers a more effective modality, compared with SOC, to improve quality of care for patients with difficult PIV access.
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Affiliation(s)
- Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA; Program in Trauma, The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA; Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Matthew Fairchild
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Isha Yardi
- Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Danielle Mirda
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Katherine Markin
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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Thonon H, Espeel F, Frederic F, Thys F. Overlooked guide wire: a multicomplicated Swiss Cheese Model example. Analysis of a case and review of the literature. Acta Clin Belg 2020; 75:193-199. [PMID: 30931817 DOI: 10.1080/17843286.2019.1592738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Central venous catheter (CVC) implementation is now usual in emergency department. The most common complications are misplacement, bleeding, pleural perforation, thrombosis and sepsis. Forgetting a guide wire in the patient's body after catheterization is an underestimated complication of this procedure; only 76 cases are described. Even if the majority of patients remained asymptomatic, severe complications can happened even years later. This article's aim is to identify the sequence of elements that led to the event occurrence and to suggest recommendations of good practice to minimize complications related to central catheter placement.Method: After reviewing all the complications related to central venous catheterization and their frequencies, we analyse from a case report and a review of the literature the sequence of elements that led to the medical error. We use an Ishikawa diagram to show our results and the links between them.Results: Our Ishikawa diagram shows that material, human resources, procedural and radiological involvement factors are the main elements on which we can act to reduce the complications rate after central venous catheterization. We advocate for the establishment of standardized procedures before, during and after the technical gesture.Conclusions: Because of human nature, errors will always be possible when taking care of a patient. However, we propose good practice recommendations to avoid the repetition of a forgetting guide wire after central venous catheterization.
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Affiliation(s)
- Henri Thonon
- Emergency department, CHU UCL Namur, Yvoir, Belgium
| | - Florence Espeel
- Emergency Department, Grand Hopital de Charleroi, Charleroi, Belgium
| | - Ficart Frederic
- Patient safety manager, Grand Hôpital de Charleroi (GHdC), Charleroi, Belgium
| | - Frédéric Thys
- Emergency department, CHU UCL Namur, Yvoir, Belgium
- Université Catholique de Louvain (UCL), Belgium
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Criss CN, Gadepalli SK, Matusko N, Jarboe MD. Ultrasound guidance improves safety and efficiency of central line placements. J Pediatr Surg 2019; 54:1675-1679. [PMID: 30301606 DOI: 10.1016/j.jpedsurg.2018.08.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/03/2018] [Accepted: 08/26/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Use of ultrasound-guidance for central venous access in adults is the standard of care. There is, however, less clarity in the role of routine ultrasound use in obtaining venous access in children. We sought to evaluate safety and efficiency of the placement of central lines utilizing an ultrasound-guided approach compared to the traditional, landmark approach in pediatric patients. STUDY DESIGN A single-institution retrospective chart review, using CPT codes, was performed for all tunneled central venous catheters in children between 2005 and 2017 by the same pediatric surgery group. During the study period, a practice change occurred from exclusively landmark-based line placement to ultrasound-guided line placement. Groups were divided into three phases: a traditional/landmark era (Phase 1), transitional period (Phase 2), and the ultrasound era (Phase 3). The primary outcomes analyzed were postoperative chest tube insertions and operative time. RESULTS A total of 2010 tunneled central lines were included for analysis: Phase 1 (N = 930), Phase 2 (N = 313) and Phase 3 (N = 767). Venous access for chemotherapy was the most common indication (29%). Phase 1 had a chest tube placement rate of 9.7/1000 procedures, while Phase 2 had a rate of 6.4/1000 procedures, and Phase 3 had no chest tube insertions (p = 0.009). Phase 1 had longer OR times compared to Phase 2 (57 vs. 49, p = 0.0026) and Phase 3 (57 vs. 46 min, p < 0.001). CONCLUSIONS This study represents the largest analysis of ultrasound-guided access for children. A complete practice transition to the ultrasound-guided approach was feasible within a two-year period. The ultrasound-guided approach had a shorter operative time and less chest tube insertions than the traditional, landmark technique in children. Level III evidence.
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Affiliation(s)
- Cory N Criss
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI, USA 48109.
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI, USA 48109
| | - Niki Matusko
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA 48109
| | - Marcus D Jarboe
- Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, MI, USA 48109; Division of Interventional Radiology, Department of Radiology, Michigan Medicine, Ann Arbor, USA 48109
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Jung DE, Lee HC, Yoon HK, Park HP. The effects of ipsilateral tilt position on right subclavian venous catheterization: study protocol for a prospective randomized trial. Trials 2018; 19:292. [PMID: 29793550 PMCID: PMC5968706 DOI: 10.1186/s13063-018-2666-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background The cross-sectional area of the subclavian vein (csSCV) is an important factor determining the success rate of SCV catheterization. The head-down position increases the csSCV. However, the effects of lateral tilting on subclavian venous cross-sectional area have not yet been explored. In this trial, we test our hypothesis that ipsilateral tilt during right SCV catheterization may significantly increase the csSCV by impeding blood flow to the heart, thereby increasing the primary venipuncture success rate and reducing the complication rate and procedure time. Methods/design This is a two-staged, prospective, randomized, controlled trial conducted on 237 neurosurgical patients requiring SCV catheterization. Seventeen patients in stage I will be placed in supine, 20° ipsilateral tilt, and 20° contralateral tilt positions in random order. The right csSCV will be measured using ultrasonography at each position. In stage II, 220 patients will be randomly assigned to the ipsilateral tilt group (n = 110) and supine group (n = 110) according to the position for right SCV catheterization. Data on catheterization-related characteristics and complications will be collected during and after catheterization. The primary outcome measures are the right csSCV for stage I and primary venipuncture success rate for stage II. The secondary outcome measures for stage II are time to venipuncture, total catheterization time, first-pass success rate, and complications, such as arterial puncture, hematoma, pneumothorax, air embolism, and catheter misplacement. Discussion This is the first trial to investigate the effects of the ipsilateral tilt position on right SCV catheterization. We will attest the beneficial effects of the ipsilateral tilt position on the csSCV and the primary venipuncture success rate during right SCV catheterization. Furthermore, comparisons of the first-pass success rate, complications, and total catheterization time during SCV catheterization in the ipsilateral tilt position vs. the supine position will help us determine which position is better for safe and easy SCV catheterization. Trial registration ClinicalTrials.gov, ID: NCT03296735. Registered on 25 September 2017 for stage I; NCT03303274 Registered on 6 October 2017 for stage II. Electronic supplementary material The online version of this article (10.1186/s13063-018-2666-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dhong Eun Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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McCarter RN, Moayedi S, Witting MD. No Radiographic Safe Margin Found in the "Easy IJ" Internal Jugular Vein Procedure. J Emerg Med 2018; 55:29-33. [PMID: 29759657 DOI: 10.1016/j.jemermed.2018.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/21/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Easy IJ procedure involves placement of a 4.8-cm intravenous catheter into the internal jugular (IJ) vein using ultrasound guidance. It is not known whether this needle length has the potential to cause a pneumothorax. OBJECTIVE The objective of this study was to determine if a radiographic "safe margin" exists. We hypothesized that an average margin of ≥2 cm would exist between the catheter tip and the pleura. METHODS Operators used a central approach to the IJ vein. We reviewed radiographic images taken immediately after the Easy IJ procedure. Using digital software, we measured the distance from the catheter tip to the closest point of the pleura and from the catheter tip to the level of the lung apex. We defined distances exceeding the margin of safety-either passing the pleura or ending inferior to the apex-as negative for the purpose of calculating an average. We used the t distribution to calculate 95% confidence intervals (CIs) for average values. RESULTS Radiographs showing the catheter tip were available from 62 patients. The mean needle-to-pleura distance was -0.1 cm (95% CI -0.7 to 0.5 cm). The mean vertical distance to the apex was -0.2 cm (95% CI -0.8 to 0.3 cm), with a standard deviation of 2.25 cm. CONCLUSION Radiographic analysis failed to show a margin of safety for the Easy IJ procedure. Postprocedure imaging may still be necessary to exclude pneumothorax.
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Affiliation(s)
- Ryan N McCarter
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Siamak Moayedi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael D Witting
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Matiotti-neto M, Eskander MF, Tabatabaie O, Kasumova G, Bliss LA, Ng SC, Tawa NE, Murphy B, Critchlow JF, Tseng JF. Percutaneous versus Cut-Down Technique for Indwelling Port Placement. Am Surg 2017. [DOI: 10.1177/000313481708301214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The superiority of surgical cut-down of the cephalic vein versus percutaneous catheterization of the subclavian vein for the insertion of totally implantable venous access devices (TIVADs) is debated. To compare the safety and efficacy of surgical cut-down versus percutaneous placement of TIVADs. This is a single-institution retrospective cohort study of oncologic patients who had TIVADs implanted by 14 surgeons. Primary outcomes were inability to place TIVAD by the primary approach and postoperative complications within 30 days. Multivariate analysis was performed by logistic regression. Secondary outcomes included operative time. Two hundred and forty-seven (55.9%) percutaneous and 195 (44.1%) cephalic cut-down patients were identified. The 30-day complication rate was 5.2 per cent: 14 patients (5.7%) in the percutaneous and nine (4.6%) in the cut-down group. The technique was not a significant predictor of having a 30-day complication (odds ratio = 0.820; 95% confidence interval 0.342–1.879). Implantation failure was observed in 16 percutaneous patients (6.5%) and 28 cut-down patients (14.4%) (adjusted odds ratio for cephalic vs cut-down = 2.387; 95% confidence interval 1.275–4.606). The median operative time for percutaneous patients was 46 minutes (interquartile range = 35, 59) versus 37.5 minutes (interquartile range = 30, 49) for cut-down patients(P < 0.0001). Both the percutaneous and cut-down technique are safe and effective for TIVAD implantation. Operative times were shorter and the odds of implantation failure higher for cephalic cut-down. As implantation failure is common, surgeons should familiarize themselves with both techniques.
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Affiliation(s)
- Mario Matiotti-neto
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Mariam F. Eskander
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Omidreza Tabatabaie
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Gyulnara Kasumova
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Lindsay A. Bliss
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Sing Chau Ng
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Nicholas E. Tawa
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Blanche Murphy
- Central Line Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jonathan F. Critchlow
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
| | - Jennifer F. Tseng
- Department of Surgery, Surgical Outcomes Analysis and Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts and
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Senussi MH, Kantamneni PC, Omranian A, Latifi M, Hanane T, Mireles-Cabodevila E, Chaisson NF, Duggal A, Moghekar A. Revisiting Ultrasound-Guided Subclavian/Axillary Vein Cannulations: Importance of Pleural Avoidance With Rib Trajectory. J Intensive Care Med 2017; 32:396-399. [PMID: 28359216 DOI: 10.1177/0885066617701413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Centers for Disease Control and Prevention guidelines for the prevention of catheter-related bloodstream infections suggest using "a subclavian site, rather than an internal jugular or a femoral site, in adult patients." This recommendation is based on evidence of lower rates of thrombosis and catheter-related bloodstream infections in patients with subclavian central venous catheters (CVCs) compared to femoral or internal jugular sites. However, preference toward a subclavian approach to CVC insertion is hindered by increased risk of mechanical complications, especially pneumothorax, when compared to other sites. This is largely related to the proximity of the subclavian vein to the pleural space and the traditional "blind" or anatomic landmark approach used in subclavian vein cannulation. We revisit a method that may provide increased safety and avoidance of pneumothorax during ultrasound-guided subclavian/axillary vein cannulation. This is achieved by directing the needle toward the subclavian vein at a point where it traverses over the second rib, providing a protective rib shield between the vessel and pleura as a safety net for operators. The technique also allows for increased compressibility of the subclavian/axillary vein in the event of bleeding complication.
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Affiliation(s)
- Mourad H Senussi
- 1 Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Phani C Kantamneni
- 1 Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ali Omranian
- 1 Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mani Latifi
- 1 Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tarik Hanane
- 1 Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Neal F Chaisson
- 1 Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Abhijit Duggal
- 1 Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ajit Moghekar
- 1 Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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Szarpak L, Mateo RG, Marchese G, Czyzewski L, Kurowski A, Smereka J, Truszewski Z. Ultrasonography as a tool for prehospital recognition of tension pneumothorax. Am J Emerg Med 2016; 34:1302-3. [DOI: 10.1016/j.ajem.2016.03.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 03/26/2016] [Accepted: 03/27/2016] [Indexed: 11/24/2022] Open
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Departure From Central Line Ritual. AORN J 2016; 103:548-17. [PMID: 27129756 DOI: 10.1016/j.aorn.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/09/2016] [Indexed: 11/18/2022]
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Torosyan Y, Hu Y, Hoffman S, Luo Q, Carleton B, Marinac-Dabic D. An in silico framework for integrating epidemiologic and genetic evidence with health care applications: ventilation-related pneumothorax as a case illustration. J Am Med Inform Assoc 2016; 23:711-20. [PMID: 27107435 DOI: 10.1093/jamia/ocw031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 02/09/2016] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To illustrate an in silico integration of epidemiologic and genetic evidence that is being developed at the Center for Devices and Radiological Health/US Food and Drug Administration as part of regulatory research on postmarket device performance. In addition to using conventional epidemiologic evidence from registries, this innovative approach explores the vast potential of open-access omics databases for identifying genetic evidence pertaining to devices. MATERIAL AND METHODS A retrospective analysis of Agency for Healthcare Research and Quality (AHRQ)/Healthcare Cost and Utilization Project (HCUPNet) data (2002-2011) was focused on the ventilation-related iatrogenic pneumothorax (Vent-IP) outcome in discharges with mechanical ventilation (MV) and continuous positive airway pressure (CPAP). The derived epidemiologic evidence was analyzed in conjunction with pre-existing genomic data from Gene Expression Omnibus/National Center for Biotechnology Information and other databases. RESULTS AHRQ/HCUPNet epidemiologic evidence showed that annual occurrence of Vent-IP did not decrease over a decade. While the Vent-IP risk associated with noninvasive CPAP comprised about 0.5%, the Vent-IP risk due to longer-term MV reached 2%. Along with MV posing an independent risk for Vent-IP, female sex and white race were found to be effect modifiers, resulting in the highest Vent-IP risk among mechanically ventilated white females. The Vent-IP risk was also potentiated by comorbidities associated with spontaneous pneumothorax (SP) and fibrosis. Consistent with the epidemiologic evidence, expression profiling in a number of animal models showed that the expression of several collagens and other SP/fibrosis-related genes was modified by ventilation settings. CONCLUSION Integration of complementary genetic evidence into epidemiologic analysis can lead to a cost- and time-efficient discovery of the risk predictors and markers and thus can facilitate more efficient marker-based evaluation of medical product performance.
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Affiliation(s)
- Yelizaveta Torosyan
- Division of Epidemiology, Center for Devices and Radiological Health, CDRH/FDA, Silver Spring, MD, USA
| | - Yuzhi Hu
- Division of Epidemiology, Center for Devices and Radiological Health, CDRH/FDA, Silver Spring, MD, USA Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sarah Hoffman
- Division of Epidemiology, Center for Devices and Radiological Health, CDRH/FDA, Silver Spring, MD, USA Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Qianlai Luo
- Division of Epidemiology, Center for Devices and Radiological Health, CDRH/FDA, Silver Spring, MD, USA Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bruce Carleton
- Pharmaceutical Outcomes Programme, BC Children's Hospital; Division of Translational Therapeutics, Department of Pediatrics, Child and Family Research Institute, University of British Columbia, Vancouver, Canada
| | - Danica Marinac-Dabic
- Division of Epidemiology, Center for Devices and Radiological Health, CDRH/FDA, Silver Spring, MD, USA
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14
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Flannery KR, Wilson SP, Manteuffel J. Ventricular tachycardia cardiac arrest during central line placement. Am J Emerg Med 2016; 34:114.e3-4. [DOI: 10.1016/j.ajem.2015.04.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 11/28/2022] Open
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15
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Boban A, Lambert C, Hermans C. The use of short-term central venous catheters for optimizing continuous infusion of coagulation factor concentrate in haemophilia patients undergoing major surgical procedures. Haemophilia 2015; 21:e364-8. [DOI: 10.1111/hae.12722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/27/2022]
Affiliation(s)
- A. Boban
- Haemostasis and Thrombosis Unit; Division of Haematology; Haemophilia Clinic; Saint-Luc University Hospital; Brussels Belgium
- Division of Haematology; University Hospital Centre Zagreb; Zagreb Croatia
| | - C. Lambert
- Haemostasis and Thrombosis Unit; Division of Haematology; Haemophilia Clinic; Saint-Luc University Hospital; Brussels Belgium
| | - C. Hermans
- Haemostasis and Thrombosis Unit; Division of Haematology; Haemophilia Clinic; Saint-Luc University Hospital; Brussels Belgium
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16
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Çubuk S, Yücel O. Some tricks in iatrogenic pneumothorax. Am J Emerg Med 2015; 33:970. [PMID: 25910670 DOI: 10.1016/j.ajem.2015.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 02/11/2015] [Indexed: 10/24/2022] Open
Affiliation(s)
- Sezai Çubuk
- Department of Thoracic Surgery, Gata Medical Faculty, Ankara, Turkey.
| | - Orhan Yücel
- Department of Thoracic Surgery, Gata Haydarpasa Teaching Hospital, Istanbul, Turkey.
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17
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Vinson DR, Ballard DW, Mark DG. The indications for screening chest radiography after failed thoracic central venous catheterization. Am J Emerg Med 2015; 33:970-1. [PMID: 25726064 DOI: 10.1016/j.ajem.2015.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
- David R Vinson
- Kaiser Permanente Division of Research and The Permanente Medical Group, Oakland, CA; Department of Emergency Medicine, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, 95825.
| | - Dustin W Ballard
- Kaiser Permanente Division of Research and The Permanente Medical Group, Oakland, CA; Kaiser Permanente San Rafael Medical Center, San Rafael, CA
| | - Dustin G Mark
- The Permanente Medical Group, Oakland, CA; Kaiser Permanente Oakland Medical Center, Oakland, CA
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