1
|
Kamisako A, Ikoma A, Suzuki T, Kakimoto N, Suenaga T, Tokuhara D, Sonomura T. Successful retrieval of a foreign body in an infant's right pulmonary artery using the new boomerang loop-snare technique: A case report. Radiol Case Rep 2024; 19:1965-1969. [PMID: 38434777 PMCID: PMC10909603 DOI: 10.1016/j.radcr.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
We report successful percutaneous retrieval of a foreign body located in an infant's right pulmonary artery using the new boomerang loop-snare technique. The case was an 18-month-old girl. A central venous catheter for chemotherapy was inserted from the right subclavian vein during treatment for myelodysplastic syndrome at another hospital. A postprocedural chest X-ray showed a foreign body in her right lung, and contrast-enhanced computed tomography confirmed the linear foreign body was located in the right pulmonary artery. The patient was transferred to our hospital to retrieve the foreign body. Under cooperation with pediatric cardiologists, a 6 Fr sheath was inserted via the right femoral vein, and a guiding catheter was advanced into the right pulmonary artery. Owing to the risk of vascular injury when using endoscopic forceps, we decided to use the loop-snare technique. We successfully crossed over the foreign body using a steerable microcatheter and a long microguidewire. The microguidewire was reinserted into the guiding catheter, and a loop was created by grasping the end of the wire using a microsnare catheter, which was inserted coaxially within the guiding catheter. By pulling the microsnare catheter, we were able to pull the foreign body into the guiding catheter and successfully retrieved it. There were no complications, such as pulmonary artery injuries or thrombi. The recovered foreign body was a piece of a guidewire. The boomerang loop-snare technique using a small-diameter system is useful for the retrieval of a foreign body in infants.
Collapse
Affiliation(s)
- Atsufumi Kamisako
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
| | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
| | - Takayuki Suzuki
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
| | - Nobuyuki Kakimoto
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
| | - Tomohiro Suenaga
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama 641-8509, Japan
| |
Collapse
|
2
|
Naber CE, Salt MD. POCUS in the PICU: A Narrative Review of Evidence-Based Bedside Ultrasound Techniques Ready for Prime-Time in Pediatric Critical Care. J Intensive Care Med 2024:8850666231224391. [PMID: 38193214 DOI: 10.1177/08850666231224391] [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: 01/10/2024]
Abstract
Point-of-care ultrasound (POCUS) is an accessible technology that can identify and treat life-threatening pathology in real time without exposing children to ionizing radiation. We aim to review current evidence supporting the use of POCUS by pediatric intensivists with novice-level experience with bedside ultrasound. Current evidence supports the universal adoption of POCUS-guided internal jugular venous catheter placement and arterial line placement by pediatric critical care physicians. Focused cardiac ultrasound performed by PICU physicians who have completed appropriate training with quality assurance measures in place can identify life-threatening cardiac pathology in most children and important physiological changes in children with septic shock. POCUS of the lungs, pleural space, and diaphragm have great potential to provide valuable information at the bedside after validation of these techniques for use in the PICU with additional research. Based on currently available evidence, a generalizable and attainable POCUS educational platform for pediatric intensivists should include training in vascular access techniques and focused cardiac examination. A POCUS educational program should strive to establish credentialing and quality assurance programs that can be expanded when additional research validates the adoption of additional POCUS techniques by pediatric intensive care physicians.
Collapse
Affiliation(s)
- Catherine E Naber
- Emergency Medicine, Massachusetts General Hospital; Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Michael D Salt
- Massachusetts General Hospital; Pediatrics, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Jaffray J, Mosha M, Branchford B, Goldenberg NA, Silvey M, Croteau SE, Fargo JH, Cooper JD, Bakeer N, Stillings A, Krava E, Young G, Amankwah EK. Evaluation of venous thromboembolism risk factors reveals subtype heterogenicity in children with central venous catheters: a multicenter study from the Children's Hospital Acquired Thrombosis consortium. J Thromb Haemost 2023; 21:2441-2450. [PMID: 37100395 DOI: 10.1016/j.jtha.2023.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/13/2023] [Accepted: 03/25/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Acutely ill and medically complex children frequently rely on central venous catheters (CVCs) to provide life-sustaining treatment. Unfortunately, catheter-related thrombosis (CRT) is a serious and common complication. Little is known why some with a CVC develop CRT and others develop venous thromboembolism unrelated to the CVC (non-CRT). OBJECTIVES The aim of this study was to identify factors associated with CRT in children with hospital-acquired venous thromboembolism (HA-VTE). METHODS This case-case study included participants in the Children's Hospital Acquired Thrombosis Registry with HA-VTE and CVC aged 0 to 21 years from 8 US children's hospitals. Participants were excluded if they developed HA-VTE prior to CVC insertion or if the CVC insertion date was unknown. Logistic regression models were used to assess associations between clinical factors and CRT status. RESULTS There were 1144 participants with HA-VTE who had a CVC. CRT developed in 833 participants, and 311 developed non-CRT. Multivariable analysis showed increased odds of CRT (compared with non-CRT) in participants with peripherally inserted central catheters (odds ratio [OR], 3.80; 95% CI, 2.04-7.10; p < .001), CVCs inserted in the femoral vein (OR, 4.45; 95% CI, 1.70-11.65; p = .002), multiple CVCs (OR, 1.42; 95% CI, 1.18-1.71; p < .001), and CVC malfunction (OR, 3.30; 95% CI, 1.80-6.03; p < .001). CONCLUSION The findings of this study provide new insights on risk factor differences between CRT and non-CRT. Prevention efforts should be directed at modifying the type of CVC, insertion location, and/or number of CVCs placed, if possible, to decrease the incidence of CRT.
Collapse
Affiliation(s)
- Julie Jaffray
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California, USA; Division of Hematology/Oncology, Rady Children's Hospital, San Diego, California, USA.
| | - Maua Mosha
- Data Coordinating Center, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, USA
| | - Brian Branchford
- Versiti Medical Sciences Institute, Milwaukee, Wisconsin, USA; Division of Hematology/Oncology, Children's Wisconsin Hospital, Milwaukee, Wisconsin, USA
| | - Neil A Goldenberg
- Data Coordinating Center, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, USA; Departments of Pediatrics and Medicine, Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Silvey
- Division of Hematology/Oncology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Stacy E Croteau
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - John H Fargo
- Division of Hematology/Oncology, Akron Children's Hospital, Akron, Ohio, USA
| | - James D Cooper
- Division of Hematology/Oncology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nihal Bakeer
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Amy Stillings
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Emily Krava
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Guy Young
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California, USA; Division of Hematology/Oncology, Rady Children's Hospital, San Diego, California, USA
| | - Ernest K Amankwah
- Data Coordinating Center, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, USA; Departments of Oncology and Pediatrics, Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
4
|
Nosaka N, Anzai T, Uchimido R, Mishima Y, Takahashi K, Wakabayashi K. An anthropometric evidence against the use of age-based estimation of bodyweight in pediatric patients admitted to intensive care units. Sci Rep 2023; 13:3574. [PMID: 36864218 PMCID: PMC9981604 DOI: 10.1038/s41598-023-30566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/25/2023] [Indexed: 03/04/2023] Open
Abstract
Age-based bodyweight estimation is commonly used in pediatric settings, but pediatric ICU patients often have preexisting comorbidity and resulting failure to thrive, hence their anthropometric measures may be small-for-age. Accordingly, age-based methods could overestimate bodyweight in such settings, resulting in iatrogenic complications. We performed a retrospective cohort study using pediatric data (aged < 16 years) registered in the Japanese Intensive Care Patient Database from April 2015 to March 2020. All the anthropometric data were overlaid on the growth charts. The estimation accuracy of 4 age-based and 2 height-based bodyweight estimations was evaluated by the Bland-Altman plot analysis and the proportion of estimates within 10% of the measured weight (ρ10%). We analyzed 6616 records. The distributions of both bodyweight and height were drifted to the lower values throughout the childhood while the distribution of BMI was similar to the general healthy children. The accuracy in bodyweight estimation with age-based formulae was inferior to that with height-based methods. These data demonstrated that the pediatric patients in the Japanese ICU were proportionally small-for-age, suggesting a special risk of using the conventional age-based estimation but supporting the use of height-based estimation of the bodyweight in the pediatric ICU.
Collapse
Affiliation(s)
- Nobuyuki Nosaka
- Department of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryo Uchimido
- Department of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Yuka Mishima
- Department of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenji Wakabayashi
- Department of Intensive Care Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| |
Collapse
|
5
|
Faustino EVS, Raffini LJ, Hanson SJ, Cholette JM, Pinto MG, Li S, Kandil SB, Nellis ME, Shabanova V, Silva CT, Tala JA, McPartland T, Spinella PC. Age-Dependent Heterogeneity in the Efficacy of Prophylaxis With Enoxaparin Against Catheter-Associated Thrombosis in Critically Ill Children: A Post Hoc Analysis of a Bayesian Phase 2b Randomized Clinical Trial. Crit Care Med 2021; 49:e369-e380. [PMID: 33566465 PMCID: PMC7979442 DOI: 10.1097/ccm.0000000000004848] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We explored the age-dependent heterogeneity in the efficacy of prophylaxis with enoxaparin against central venous catheter-associated deep venous thrombosis in critically ill children. DESIGN Post hoc analysis of a Bayesian phase 2b randomized clinical trial. SETTING Seven PICUs. PATIENTS Children less than 18 years old with newly inserted central venous catheter. INTERVENTIONS Enoxaparin started less than 24 hours after insertion of central venous catheter and adjusted to anti-Xa level of 0.2-0.5 international units/mL versus usual care. MEASUREMENTS AND MAIN RESULTS Of 51 children randomized, 24 were infants less than 1 year old. Risk ratios of central venous catheter-associated deep venous thrombosis with prophylaxis with enoxaparin were 0.98 (95% credible interval, 0.37-2.44) in infants and 0.24 (95% credible interval, 0.04-0.82) in older children greater than or equal to 1 year old. Infants and older children achieved anti-Xa level greater than or equal to 0.2 international units/mL at comparable times. While central venous catheter was in situ, endogenous thrombin potential, a measure of thrombin generation, was 223.21 nM.min (95% CI, 8.78-437.64 nM.min) lower in infants. Factor VIII activity, a driver of thrombin generation, was also lower in infants by 45.1% (95% CI, 15.7-74.4%). Median minimum platelet count while central venous catheter was in situ was higher in infants by 39 × 103/mm3 (interquartile range, 17-61 × 103/mm3). Central venous catheter:vein ratio was not statistically different. Prophylaxis with enoxaparin was less efficacious against central venous catheter-associated deep venous thrombosis at lower factor VIII activity and at higher platelet count. CONCLUSIONS The relatively lesser contribution of thrombin generation on central venous catheter-associated thrombus formation in critically ill infants potentially explains the age-dependent heterogeneity in the efficacy of prophylaxis with enoxaparin.
Collapse
Affiliation(s)
| | - Leslie J Raffini
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Sheila J Hanson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Jill M Cholette
- Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester, NY
| | - Matthew G Pinto
- Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY
| | - Simon Li
- Department of Pediatrics, New York Medical College, Maria Fareri Children's Hospital, Valhalla, NY
| | - Sarah B Kandil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Marianne E Nellis
- Department of Pediatrics, NY Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | | | - Cicero T Silva
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT
| | - Joana A Tala
- Pediatric Intensive Care Unit, Yale-New Haven Children's Hospital, New Haven, CT
| | - Tara McPartland
- Yale Center for Clinical Investigation, Yale School of Medicine, New Haven, CT
| | - Philip C Spinella
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| |
Collapse
|
6
|
Ultrasound of Venous Diameters for Central Line Selection: Can We "Measure Up" to Expectations? Pediatr Crit Care Med 2020; 21:1105-1106. [PMID: 33278225 DOI: 10.1097/pcc.0000000000002501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|