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Purpose: The study aimed to evaluate the efficacy of the Biologically Transparent Illumination (BTI) device for confirming the correct placement of nasogastric (NG) tubes in children, as an alternative to X-ray, which exposes patients to radiation. Methods: In this prospective observational study, 106 pediatric patients (ages 0–16) undergoing NG-tube insertion after general anesthesia were evaluated. The BTI catheter was used to emit bio-permeable red light from the NG tube, which was then visually confirmed in the cervical, thoracic, and epigastric regions. X-ray confirmed NG-tube placement in all patients. The ethics committee approved the study. Results: The average patient age was 3.8 years, with a male-to-female ratio of 72:34. BTI was successfully detected in the epigastric area in 105 of 106 patients, with one 9-year-old patient having unclear BTI visibility. X-ray confirmed NG-tube placement in the stomach for all patients, resulting in a BTI sensitivity of 99%. The mean NG-tube insertion time was 38 s, and the mean abdominal thickness was 9.8 mm. Conclusions: The BTI device proved to be a safe and effective method for NG-tube placement in children, offering a radiation-free alternative with 100% successful placement when BTI was detected in the epigastric area. [ABSTRACT FROM AUTHOR]

The effectiveness of various stroke treatments depends on the anatomical variability of the cerebral vasculature, particularly the collateral blood vessel network. Collaterals at the level of the Circle of Willis and distal collaterals, such as the leptomeningeal arteries, serve as alternative avenues of flow when the primary pathway is obstructed during an ischemic stroke. Stroke treatment typically involves catheterization of the primary pathway, and the potential risk of further flow reduction to the affected brain area during this treatment has not been previously investigated. To address this clinical question, we derived the lumped parameters for catheterized blood vessels and implemented a corresponding distributed compartment (0D) model. This 0D model was validated against an experimental model and benchmark test cases solved using a 1D model. Additionally, we compared various off‐center catheter trajectories modeled using a 3D solver to this 0D model. The differences between them were minimal, validating the simplifying assumption of the central catheter placement in the 0D model. The 0D model was then used to simulate blood flows in realistic cerebral arterial networks with different collateralization characteristics. Ischemic strokes were modeled by occlusion of the M1 segment of the middle cerebral artery in these networks. Catheters of different diameters were inserted up to the obstructed segment and flow alterations in the network were calculated. Results showed up to 45% maximum blood flow reduction in the affected brain region. These findings suggest that catheterization during stroke treatment may have a further detrimental effect for some patients with poor collateralization. [ABSTRACT FROM AUTHOR]

Strokes are one of the leading causes of death in the United States. Stroke treatment involves removal or dissolution of the obstruction (usually a clot) in the blocked artery by catheter insertion. A computer simulation to systematically plan such patient‐specific treatments needs a network of about 105 blood vessels including collaterals. The existing computational fluid dynamic (CFD) solvers are not employed for stroke treatment planning as they are incapable of providing solutions for such big arterial trees in a reasonable amount of time. This work presents a novel one‐dimensional mathematical formulation for blood flow modeling in an elastic blood vessel with a centrally placed rigid catheter. The governing equations are first‐order hyperbolic partial differential equations, and the hypergeometric function needs to be computed to obtain the characteristic system of these hyperbolic equations. We employed the Discontinuous Galerkin method to solve the hyperbolic system and validated the implementation by comparing it against a well‐established 3D CFD solver using idealized vessels and a realistic truncated arterial network. The results showed clinically insignificant differences in steady flow cases, with overall variations between 1D and 3D models remaining below 10%. Additionally, the solver accurately captured wave reflection phenomena at domain discontinuities in unsteady cases. A primary advantage of this model over 3D solvers is its ease in obtaining a discretized geometry of complex vasculatures with multiple arterial branches. Thus, the 1D computational model offers good accuracy and applicability in simulating complex vasculatures, demonstrating promising potential for investigating patient‐specific endovascular interventions in strokes. [ABSTRACT FROM AUTHOR]

This study investigates the effects of comprehensive nursing interventions on wound pain in patients undergoing catheter insertion for peritoneal dialysis. Sixty patients who underwent catheter insertion for peritoneal dialysis from January 2021 to January 2023 at our hospital were selected as subjects and randomly divided into an experimental group and a control group using a random number table method. The control group received routine nursing care, while the experimental group was subjected to comprehensive nursing interventions. The study compared the impact of nursing measures on visual analogue scale (VAS), self‐rating anxiety scale (SAS), self‐rating depression scale (SDS) and nursing satisfaction between the two groups. The analysis revealed that on the third, fifth and seventh days post‐intervention, the experimental group's wound VAS scores were significantly lower than those of the control group (p < 0.001). Furthermore, levels of anxiety and depression were markedly lower in the experimental group compared with the control group (p < 0.001). In addition, the nursing satisfaction rate was significantly higher in the experimental group than in the control group (96.67% vs. 73.33%, p = 0.011). This study indicates that the application of comprehensive nursing interventions in patients undergoing catheter insertion for peritoneal dialysis is highly effective. It can alleviate wound pain and negative emotions to a certain extent, while also achieving high patient satisfaction, thus demonstrating significant clinical value. [ABSTRACT FROM AUTHOR]

Introduction: The Pulmonary Artery (PA) catheter continues to be used for monitoring haemodynamic parameters in the majority of patients undergoing Coronary Artery Bypass Grafting (CABG) surgeries, despite concerns raised regarding costeffectiveness and safety issues. Sometimes, placement takes longer or is difficult just by looking at the pressure waves. There are several factors that may influence the duration of Pulmonary Artery Catheter (PAC) insertion. Aim: To determine the factors affecting PAC in anaesthetised patients undergoing elective CABG. Materials and Methods: A single-centred, cross-sectional study was conducted in the Cardiothoracic and Vascular Surgery operation theartre at IPGME&R and SSKM Hospital, Kolkata, India including 138 patients aged 35-65 years of either sex undergoing elective CABG surgery in a tertiary care hospital in Eastern India. The attempt to perform successful first-time catheterisation or failure of the PAC done by a resident cardioanaesthesiologist was noted, as well as whether catheterisation was successfully done within a specified time or not. This time was obtained as the 75th percentile of the time taken for catheter placement for the first 30 cases catheterised in the first attempt. For ease of analysis, all first attempt successful cases were considered as Group A (n=125), and all first attempt failure cases as Group B (n=13). The study data on various parameters were recorded on a proforma and summarised as the mean and standard deviation for normally distributed numerical variables, median and interquartile range for skewed numerical variables, and counts and percentages for categorical variables. A p-value

Introduction: How patient, center, and insertion technique factors interact needs to be understood when designing peritoneal dialysis (PD) catheter insertion pathways. Methods: We undertook a prospective cohort study in 44 UK centers enrolling participants planned for first catheter insertion. Sequences of regressions were used to describe the associations linking patient and dialysis unit-level characteristics with catheter insertion technique and their impact on the occurrence of catheter-related events in the first year (catheter-related infection, hospitalization, and removal). Factors associated with catheter events were incorporated into a multistate model comparing the rates of catheter events between medical and surgical insertion alongside treatment modality transitions and mortality. Results: Of 784 first catheter insertions, 466 (59%) had a catheter event in the first year and 61.2% of transitions onto hemodialysis (HD) were immediately preceded by a catheter event. Catheter malfunction was less but infection was more common with surgical compared with medical insertions. Participants at centers with fewer late presenters and more new dialysis patients starting PD, had a lower probability of a catheter event. Adjusting for these factors, the hazard ratio for a catheter event following insertion (medical vs. surgical) was 0.70 (95% confidence interval [CI] 0.43 to 1.13), and once established on PD 0.77 (0.62 to 0.96). Conclusion: Offering both medical and surgical techniques is associated with lower catheter event rates and keeps people on PD for longer.

Introduction: The Pulmonary Artery (PA) catheter continues to be used for monitoring haemodynamic parameters in the majority of patients undergoing Coronary Artery Bypass Grafting (CABG) surgeries, despite concerns raised regarding cost-effectiveness and safety issues. Sometimes, placement takes longer or is difficult just by looking at the pressure waves. There are several factors that may influence the duration of Pulmonary Artery Catheter (PAC) insertion. Aim: To determine the factors affecting PAC in anaesthetised patients undergoing elective CABG. Materials and Methods: A single-centred, cross-sectional study was conducted in the Cardiothoracic and Vascular Surgery operation theartre at IPGME&R and SSKM Hospital, Kolkata, India including 138 patients aged 35-65 years of either sex undergoing elective CABG surgery in a tertiary care hospital in Eastern India. The attempt to perform successful first-time catheterisation or failure of the PAC done by a resident cardioanaesthesiologist was noted, as well as whether catheterisation was successfully done within a specified time or not. This time was obtained as the 75th percentile of the time taken for catheter placement for the first 30 cases catheterised in the first attempt. For ease of analysis, all first attempt successful cases were considered as Group A (n=125), and all first attempt failure cases as Group B (n=13). The study data on various parameters were recorded on a proforma and summarised as the mean and standard deviation for normally distributed numerical variables, median and interquartile range for skewed numerical variables, and counts and percentages for categorical variables. A p-value <0.05 was considered statistically significant. Results: A total of 138 patients were analysed during the entire study. There was a predominance of male patients (82.6%) with a male-to-female ratio of 114:24. The first attempt failure rate of successful PAC was 13 out of 138, i.e., 9.42% (95% confidence interval 4.55% to 14.29%). The cut-off time for the procedure as the 75th percentile of the first 30 successful cases is 269 seconds. The number of cases in which it was done within this time was 109 cases, i.e., 78.99%. There was a significant difference (p<0.05) in terms of body weight, body surface area, and neck length between the two groups. Conclusion: Increased body weight and increased body surface area are significant factors associated with difficult PAC placement. On the other hand, short neck length is a significant factor for taking more time in the placement of the catheter. [ABSTRACT FROM AUTHOR]

Registered nurses (RNs) competent in catheter insertion and management reduce catheter days and catheter associated urinary tract infections (CAUTIs). Guidelines suggest that education in catheter insertion and management should occur regularly to ensure competency. However, there is no evidence to suggest this occurs in the United Kingdom. The databases Cinahl and Medline databases and the grey literature were searched and revealed that CAUTIs account for ~40% of hospital acquired infections and are associated with increased mortality, morbidity, length of stay and hospital costs. Prevalence, however, can be reduced if all evidence‐based measures in insertion and management are carried out. The literature review demonstrated that clinical catheter related education improves nurses' knowledge which, translated into behaviour, results in reduced catheter days and CAUTI rates. A pragmatic, descriptive mixed methods convergent parallel approach was used to survey RNs from two professional associations through their mailing lists and social media platforms, using an online Qualtrics™ questionnaire. An online survey method was chosen to maximize geographical reach. Respondents confirmed their consent on accessing the online survey prior to commencing the questionnaire. All participants and their responses were anonymous. Results were saved on the Qualtrics™ platform and analysed quantitatively using descriptive statistics and qualitatively using a pragmatic approach to thematic analysis. Of the 72 responses, 61% (n = 44) worked in an acute hospital and 47% (n = 34) worked in the London area. There was representation from all over the United Kingdom except Scotland. 96% (n = 69) RNs were offered education in catheter insertion and management. Content of education included theory, practical, competency and ongoing education. 51% (n = 36) were offered education on a frequent basis. The results indicated that education in catheter insertion and management for RNs in the United Kingdom is not standardized. This may have implications for patient outcome measures such as CAUTI and on a macro level may be a symptom of wider organizational cultural inadequacies. Future research could inform the design of a standardized catheter insertion and management education package and measure its effect and impact on practice. The sampling method and subsequent response rate was a limitation of this study, and it may have been appropriate to use a more generic sampling frame to achieve representative results. [ABSTRACT FROM AUTHOR]

Background: Peritoneal dialysis (PD) is an effective home‐based form of dialysis. Although several factors limit its use, the timely and successful insertion of a PD catheter is essential for increased uptake. Aims: This retrospective observational study was performed at a tertiary teaching hospital in Sydney with the aim of comparing outcomes of PD catheter insertion using a percutaneous, modified Seldinger technique utilised by a trained nephrologist to the traditional surgical insertion using a mini‐laparotomy. Results: Over an 8‐year period, 194 PD catheters were inserted. Aside from lower body mass indexes in the nephrologist‐led interventions (P = 0.02), patient demographics were well matched. Time‐to‐insertion was significantly shorter with the percutaneous technique (P < 0.001). Univariant logistic regression noted no difference in the complication rate between the nephrologist‐inserted and surgically inserted groups (likelihood ratio, 1.59; P = 0.08). There were differences in the type of adverse outcomes with each technique. Surgical procedures were more likely to have exit site leaks (P = 0.009) and peritonitis (P = 0.004), whereas procedure abandonment (P = 0.009) was more common in nephrologist‐led procedures. Conclusions: The current study highlights that with careful patient selection, trained nephrologists in metropolitan areas can successfully insert PD catheters. Our experience noted fewer delays to catheter insertion, with similar total complication rates. [ABSTRACT FROM AUTHOR]

Background and Objectives: In peritoneal dialysis (PD) therapy, intra-abdominal adhesions (IAAs) can cause catheter insertion failure, poor dialysis function, and decreased PD adequacy. Unfortunately, IAAs are not readily visible to currently available imaging methods. The laparoscopic approach for inserting PD catheters enables direct visualization of IAAs and simultaneously performs adhesiolysis. However, a limited number of studies have investigated the benefit/risk profile of laparoscopic adhesiolysis in patients receiving PD catheter placement. This retrospective study aimed to address this issue. Materials and Methods: This study enrolled 440 patients who received laparoscopic PD catheter insertion at our hospital between January 2013 and May 2020. Adhesiolysis was performed in all cases with IAA identified via laparoscopy. We retrospectively reviewed data, including clinical characteristics, operative details, and PD-related clinical outcomes. Results: These patients were classified into the adhesiolysis group (n = 47) and the non-IAA group (n = 393). The clinical characteristics and operative details had no remarkable between-group differences, except the percentage of prior abdominal operation history was higher and the median operative time was longer in the adhesiolysis group. PD-related clinical outcomes, including incidence rate of mechanical obstruction, PD adequacy (Kt/V urea and weekly creatinine clearance), and overall catheter survival, were all comparable between the adhesiolysis and non-IAA groups. None of the patients in the adhesiolysis group suffered adhesiolysis-related complications. Conclusions: Laparoscopic adhesiolysis in patients with IAA confers clinical benefits in achieving PD-related outcomes comparable to those without IAA. It is a safe and reasonable approach. Our findings provide new evidence to support the benefits of this laparoscopic approach, especially in patients with a risk of IAAs. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical effect of manual intervention on relieving the pain stimulus and lower urinary tract symptoms（LUTS） of male patients after catheter removal, and to guide effective intervention measures to alleviate the discomfort of patients after catheter removal.Methods From February 2020 to February 2021,a totoal of 266 male patients admitted to the Department of Urology of this Hospital and needed catheter removel were divided into the study group and the control group by computer random number table method, with 133 cases in each group.The control group pulled out the catheter according to the routine operation process.The study group used manual intervention to clamp the catheter before pulling out the catheter until the patient complained of urination.When pulling out the catheter, the penis was raised to 60 with the abdominal wall.During the removal process, the catheter was slowly removed by rotating left and right alternately.The pain score after catheter removal, LUTS during urination and the rate of catheter replacement were compared between the two groups.Results LUTS and pain in the study group were significantly better than those in the control group, and the difference were statistically significant（P<0.05）;There was no significant difference between the two groups in the rate of urinary tube replacement（P>0.05）.Conclusion In the process of catheter removal for male patients, the improvement of the removal technique based on the routine operation process can reduce the pain during catheter removal and LUTS after catheter removal. [ABSTRACT FROM AUTHOR]

Background: In tunnel infection (TI) refractory to medical therapy or in case of TI that occurs simultaneously with peritonitis, the removal of the peritoneal catheter has been proposed. This approach requires the interruption of peritoneal dialysis (PD) and the creation of a temporary vascular access. However, simultaneous removal and reinsertion of the PD catheter (SCR) represents another possible therapeutic approach. Methods: We analysed the outcome of 20 patients (10 men and 10 women, mean age 65.5 ± 16.3 years) treated by CAPD for a mean period of 24.3 ± 14.2 months who underwent to SCR for the treatment of TI unresponsive to medical therapy or TI that occurred simultaneously with peritonitis at Fondazione Ca' Granda Ospedale Maggiore Policlinico. All the patients restarted CAPD exchanges within 24 h from catheter placement. Results: SCR was successful in 80% (16/20) of the cases. In particular, SCR was effective in 100% (11/11) of the TI with or without associated peritonitis sustained by S. aureus. However, SCR failed in 57% (4/7) of TI associated with relapsing peritonitis and in one patient with TI secondary to Enterobacter. No early mechanical complications (within 3 months after SCR) occurred when CAPD was restarted. Conclusions: SCR of the PD catheter through double-purse string technique represents an effective treatment for TI without or with simultaneously peritonitis sustained by S. aureus avoiding the patient the need for temporary hemodialysis and second surgical procedure. However, SCR could be contraindicated in case of relapsing peritonitis. [ABSTRACT FROM AUTHOR]

Objective: The literature describes many techniques to increase vein visibility and palpability that facilitate peripheral intravenous catheter insertion. However, there is only one study examining the effect of topical essential black pepper oil on veins. We aimed to determine the effects of topical application of black pepper essential oil on peripheral intravenous catheter insertion success.Methods: This randomized controlled trial was carried out on 60 patients randomly assigned to either the experimental group (n=30) or the control group (n=30) reporting to the endoscopy unit of the clinic between May 2019 and October 2019. The study results were evaluated using an information form, a catheter insertion form, and a visual analog scale (VAS). In the experimental group, black pepper essential oil was used to increase vein degree before the procedure, while in the control group, no extra interventions were applied. The time taken in determining an appropriate vein, time taken for successful catheter insertion, and the patient's and nurse's satisfaction after the process were recorded.Results: Significant improvements in vein degree were detected after the experimental group's oil application (p1<0.001). The period of appropriate vein selection and successful catheter insertion showed a statistically significant decrease in the experimental group (p<0.05). The satisfaction levels of patients and nurses in the control group were significantly lower than those of the patients from the experimental group (p<0.05).Conclusion: Topical black pepper oil application can increase the vein degree and the success of the procedure. [ABSTRACT FROM AUTHOR]

Background: The optimal technique for inserting peritoneal dialysis catheters in uremic patients remains debated. This meta-analysis aimed to summarize the current evidence evaluating the efficacy and safety of percutaneous insertion methods compared to surgical methods. Method: A literature search was performed in the PubMed, EMBASE, Cochrane, and Web of Science databases. The primary outcome was defined as catheter survival. The secondary outcomes were mechanical and infectious complications related to catheter insertion. Results: Twenty studies were finally identified, including 2 randomized controlled trials. The pooled results of catheter survival, overall mechanical complications, and infectious complications were not significant (odds ratio [OR] = 1.10, 95% confidence interval (CI) = 0.76–1.57, p = 0.62; OR = 0.73, 95% CI = 0.48–1.11, p = 0.14; and OR = 0.64, 95% CI = 0.37–1.09, p = 0.14, respectively). Comparison stratified by the blind percutaneous method versus open surgery indicated a lower overall number of mechanical complications (OR = 0.54, 95% CI = 0.31–0.93, I2 = 72%) and malposition rate (OR = 0.56, 95% CI = 0.34–0.90, I2 = 0%). The leakage rate was higher in the blind percutaneous group than in the open surgery group (OR = 2.55, 95% CI = 1.72–3.79, I2 = 0%); the guided percutaneous method achieved a similar leakage risk to the surgical methods. Conclusions: The blind percutaneous method performed better with fewer overall mechanical complications and less malposition than open surgery. The leakage risk was higher in the blind percutaneous group, while the guided percutaneous placement group showed similar outcomes to the surgical method groups. Percutaneous methods also had a lower infection risk, which needs further evidence to be confirmed. [ABSTRACT FROM AUTHOR]

This study is focused to investigate the blood flow pattern with motion of motile gyrotactic microorganisms. Since nanoparticles play an essential factor for enhancing delivery efficiency in vascular flow therefore physiochemical properties of these particles are considered in this examination. Prandtl fluid characteristics are instigated to discuss the blood flow rheology. Moreover, considerations of gyrotactic microbes with nanoparticles will exaggerate the thermal features of considered base fluid. The governing model output containing coupled nonlinear systems is evaluated by HPM technique. The features of flow defining parameters in an anisotropic stenotic region with motile microbes are inspected and presented through different illustrations. It is concluded from the governing nanofluid model that with addition of gyrotactic microbe's hemodynamics factors of stenotic lesion are enhanced. Heat transfer rate phenomena depict opposite trends for nanoparticles key parameters involved in a governing problem. [ABSTRACT FROM AUTHOR]

Background and Objectives: In peritoneal dialysis (PD) therapy, intra-abdominal adhesions (IAAs) can cause catheter insertion failure, poor dialysis function, and decreased PD adequacy. Unfortunately, IAAs are not readily visible to currently available imaging methods. The laparoscopic approach for inserting PD catheters enables direct visualization of IAAs and simultaneously performs adhesiolysis. However, a limited number of studies have investigated the benefit/risk profile of laparoscopic adhesiolysis in patients receiving PD catheter placement. This retrospective study aimed to address this issue. Materials and Methods: This study enrolled 440 patients who received laparoscopic PD catheter insertion at our hospital between January 2013 and May 2020. Adhesiolysis was performed in all cases with IAA identified via laparoscopy. We retrospectively reviewed data, including clinical characteristics, operative details, and PD-related clinical outcomes. Results: These patients were classified into the adhesiolysis group (n = 47) and the non-IAA group (n = 393). The clinical characteristics and operative details had no remarkable between-group differences, except the percentage of prior abdominal operation history was higher and the median operative time was longer in the adhesiolysis group. PD-related clinical outcomes, including incidence rate of mechanical obstruction, PD adequacy (Kt/V urea and weekly creatinine clearance), and overall catheter survival, were all comparable between the adhesiolysis and non-IAA groups. None of the patients in the adhesiolysis group suffered adhesiolysis-related complications. Conclusions: Laparoscopic adhesiolysis in patients with IAA confers clinical benefits in achieving PD-related outcomes comparable to those without IAA. It is a safe and reasonable approach. Our findings provide new evidence to support the benefits of this laparoscopic approach, especially in patients with a risk of IAAs.

Objective: There are several methods for dialysis in children with chronic renal failure. One of the methods is the insertion of a peritoneal dialysis (PD) catheter, which can be embedded with para-median and midline approaches. In this study, we aim to compare the complications and the success rate of these two approaches. Materials and Methods: In this retrospective study, 41 patients under seven years who had undergone PD due to renal failure were included in this study. PD catheter was inserted via the paramedian approach in 15 and midline approach in 26 cases. Any early or late complications, as well as success rate, were compared between two approaches. Results: Paramedian compared to midline approach had a significantly lower rate of catheter obstruction (20% vs. 53.8%, p=0.03), leakage (13.3% vs. 46.2%, p=0.03) and local infection (13.3% vs. 50%, p=0.02) from early complications and lower rate of late fluid leakage (13.3% vs. 46.2%, p=0.03) and tunnel or exit site infection (6.7% vs. 38.5%, p=0.02) from late complications. The paramedian approach had a significantly higher rate of success (80% vs. 42.3%, p=0.02). Conclusion: Paramedian is a better approach for PD catheter insertion due to lower early and late complications, as well as a higher success rate.

Objective Postdural puncture headache (PDPH) is a potential complication of certain neuraxial anesthesia and spinal procedures, and some risk factors for PDPH have been identified. However, there have been no detailed analyses of rates and risk factors of PDPH after various spinal and neuraxial anesthesia procedures. Methods Patient data from January 1, 2015, to December 31, 2017, were retrospectively analyzed. The patients underwent dural puncture procedures (spinal anesthesia, lumbar puncture [spinal tap], lumbar cerebrospinal fluid [CSF] drainage) or nondural puncture procedures (transforaminal epidural injection, interlaminar epidural injection, epidural catheterization with patient-controlled analgesia for delivery). PDPH incidence and risk factors were evaluated. Results For dural puncture procedures, PDPH incidence was 2.96%, and risk factors were younger age, female sex, and lumbar puncture. Larger needle gauge was a risk factor according to Student t -test but not during logistic regression analysis. PDPH incidence was higher after lumbar puncture using a 22 G Tuohy needle (4.63%) than after lumbar CSF drainage using an 18 G Tuohy needle (3.05%). For nondural puncture procedures, PDPH incidence was 0.53% and did not differ between procedure types; no risk factors were identified. Conclusions PDPH incidence and risk factors depended on the type of neuraxial anesthesia and spinal procedures. PDPH incidence after lumbar puncture using a 22 G Tuohy needle was higher than that after lumbar CSF drainage using an 18 G Tuohy needle, suggesting that catheter insertion may reduce PDPH risk. In non-dural puncture procedures, PDPH risk did not differ according to type of procedure, and no risk factors were found. [ABSTRACT FROM AUTHOR]

Objective: There are several methods for dialysis in children with chronic renal failure. One of the methods is the insertion of a peritoneal dialysis (PD) catheter, which can be embedded with para-median and midline approaches. In this study, we aim to compare the complications and the success rate of these two approaches. Materials and Methods: In this retrospective study, 41 patients under seven years who had undergone PD due to renal failure were included in this study. PD catheter was inserted via the paramedian approach in 15 and midline approach in 26 cases. Any early or late complications, as well as success rate, were compared between two approaches. Results: Paramedian compared to midline approach had a significantly lower rate of catheter obstruction (20% vs. 53.8%, p=0.03), leakage (13.3% vs. 46.2%, p=0.03) and local infection (13.3% vs. 50%, p=0.02) from early complications and lower rate of late fluid leakage (13.3% vs. 46.2%, p=0.03) and tunnel or exit site infection (6.7% vs. 38.5%, p=0.02) from late complications. The paramedian approach had a significantly higher rate of success (80% vs. 42.3%, p=0.02). Conclusion: Paramedian is a better approach for PD catheter insertion due to lower early and late complications, as well as a higher success rate. [ABSTRACT FROM AUTHOR]

A literature review was conducted to develop more realistic medical simulators that better prepare aspiring health professionals to perform a medical procedure in vivo. Thus, this review proposes an approach that might assist researchers design improved medical simulators, particularly new materials that would enhance the sensation of touch for skin substitutes. By targeting the current needs in the field of simulation learning, we concluded that peripheral venous catheter insertion simulators lack realistic haptic feedback. Enhanced peripheral venous catheter insertion simulators will accelerate the mastery of the medical procedure, thus decreasing the number of failures in patients and costs related to this procedure. [ABSTRACT FROM AUTHOR]

Introduction: Intracerebral structures and pathologies such as intracerebral hemorrhages (ICH) can be displayed sufficiently by transcranial sonography (TCS). In some patients with ICH clot evacuation via surgery or catheter drainage to reduce secondary parenchymal injuries may be necessary. We hypothesized that bedside-placement of drainage-catheters, which is a minimal invasive evacuation-technique complicated by a higher rate of catheter misplacement can be optimized via TCS.Methods: Eleven consecutive ICH-patients diagnosed via computertomography (CT) were included in this prospective observational pilot study. All patients were examined via TCS, firstly in order to illustrate the hematoma, secondly to optimize catheter placement. Catheter placement was primarily validated via CT.Results: The TCS-depiction of ICH-extension was optimal in 10 patients; one patient showed a partially insufficient transtemporal bone window. Catheter positioning could be traced and adapted correctly via TCS-examination in all patients. Follow-up CT-scans confirmed TCS-description of catheter-positioning in all patients without any complications. Reduction of symptoms and ICH-volumes confirmed effectiveness of treatment.Conclusions: The illustration of ICH and the drainage-placement is possible via TCS in a cost- and time-efficient way.

Introduction: How patient, center, and insertion technique factors interact needs to be understood when designing peritoneal dialysis (PD) catheter insertion pathways., Methods: We undertook a prospective cohort study in 44 UK centers enrolling participants planned for first catheter insertion. Sequences of regressions were used to describe the associations linking patient and dialysis unit-level characteristics with catheter insertion technique and their impact on the occurrence of catheter-related events in the first year (catheter-related infection, hospitalization, and removal). Factors associated with catheter events were incorporated into a multistate model comparing the rates of catheter events between medical and surgical insertion alongside treatment modality transitions and mortality., Results: Of 784 first catheter insertions, 466 (59%) had a catheter event in the first year and 61.2% of transitions onto hemodialysis (HD) were immediately preceded by a catheter event. Catheter malfunction was less but infection was more common with surgical compared with medical insertions. Participants at centers with fewer late presenters and more new dialysis patients starting PD, had a lower probability of a catheter event. Adjusting for these factors, the hazard ratio for a catheter event following insertion (medical vs. surgical) was 0.70 (95% confidence interval [CI] 0.43 to 1.13), and once established on PD 0.77 (0.62 to 0.96)., Conclusion: Offering both medical and surgical techniques is associated with lower catheter event rates and keeps people on PD for longer., (© 2023 International Society of Nephrology. Published by Elsevier Inc.)