Search

Blood collection, one of the most frequently performed procedures in healthcare settings. The study aimed to develop a scale for phlebotomy procedures based on national phlebotomy guidelines and to assess the tendencies of phlebotomy personnel in certain blood collection practices.The survey included a 5-point likert scale, which consisted of 20 items and multiple-choice questions. The survey was disseminated to the attendees via an online platform (Google Forms®, Mountain View, California, USA), and they were requested to complete it, and a total of 1,439 participants were included in the study.The data showed that the scale complied with the guidelines and was highly valid and reliable. A significant finding from the study indicates that 47.9 % of the participants (689 individuals) chose the syringe response during the blood collection procedure. The variable of prior phlebotomy training exhibited no statistically significant effect on these responses (χ²=1.893, p=0.093). A statistically significant difference was observed in the frequency of tendencies for using intravenous cannulas/catheters in inpatient settings (p<0.05).The standardization of blood collection practices may be enhanced through the implementation of these procedures by specialized medical professionals. It is necessary to audit the quality of current practices and identify the most vulnerable steps in phlebotomy. The implementation of phlebotomy guidelines in healthcare settings should be encouraged. Furthermore, greater commitment is required from relevant authorities to develop educational programs and establish continuous education courses for healthcare phlebotomy personnel. [ABSTRACT FROM AUTHOR]

Objectives: Although it is the most performed invasive procedure, peripheral intravenous catheter (PIVC) insertion in children can be difficult. The primary objective of the study was to identify the factors associated with difficult intravenous access (DIVA) in the paediatric ED, including patient, proceduralist and situational factors. Methods: This was a single‐centre prospective observational cohort study conducted over 28 consecutive days. Research assistants observed PIVC insertion attempts for children under 16 years of age and recorded data for variables relating to the patient, proceduralist and event. Univariate logistic regression modelling was performed to identify factors associated with DIVA, defined as unsuccessful PIVC insertion on the first attempt. Results: A total of 134 participants were recruited; 66 were male (49%) with a median age of 5.7 years. Fifty‐two (39%) were classified as having DIVA. There was a total of 207 PIVC insertion attempts with two or more attempts needed for 48 children (36%). Patient factors associated with DIVA included age of 3 years or less and limited vein options. Proceduralist factors included gestalt of 50% or less chance of success, use of a larger gauge (smaller bore) PIVC and less PIVC insertion experience. Situational factors included a combative child, higher pain score and loud ambient noise. Conclusions: The present study identified multiple patient, proceduralist and situational factors that were associated with DIVA in the paediatric ED. Future studies should explore the development and implementation of a package to address DIVA in children, with the patient‐centred goals of reducing pain and improving success. [ABSTRACT FROM AUTHOR]

The use of high flow nasal cannula (HFNC) in the treatment of bronchiolitis has markedly increased in the last decade, yet randomized controlled trials have reported little clinical benefit with early, routine use. This article provides a concise overview of the current status of HFNC therapy, discusses successful de-implementation strategies to curtail HFNC overuse, and explores future bronchiolitis and HFNC quality improvement and research considerations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Standard high-flow nasal cannula (HFNC) is a respiratory support device widely used to manage post-extubation hypoxemic acute respiratory failure (hARF) due to greater comfort, oxygenation, alveolar recruitment, humidification, and reduction of dead space, as compared to conventional oxygen therapy. On the contrary, the effects of the new asymmetrical HFNC interface (Optiflow® Duet system (Fisher & Paykel, Healthcare, Auckland, New Zealand) is still under discussion. Our aim is investigating whether the use of asymmetrical HFNC interface presents any relevant difference, compared with the standard configuration, on lung aeration (as assessed by end-expiratory lung impedance (EELI) measured by electrical impedance tomography (EIT)), diaphragm ultrasound thickening fraction (TFdi) and excursion (DE), ventilatory efficiency (estimated by corrected minute ventilation (MV)), gas exchange, dyspnea, and comfort. METHODS: Pilot physiological crossover randomized controlled study enrolling 20 adults admitted to the Intensive Care unit, invasively ventilated for at least 24 h, and developing post-extubation hARF, i.e., PaO2/set FiO2

Concentric tube robots (CTR) have gained popularity in robotic research due to their potential for smaller instrument sizes, enhanced dexterity and reduced trauma. However, CTR control can be complex, with tip direction and curvature being kinematically coupled. To address this, a symmetric eccentric tube robot (ETR) is presented, where three identical pre-curved wires are arranged in parallel and constrained by an outer sheath. Instrument curvature is controlled by a single input angle. This study aims to demonstrate the suitability as manually actuated instrument. A model for curvature as a function of input angle is presented, and a prototype ETR with an outer diameter of 1 mm is assembled and evaluated. The results show that the ETR follows the expected shape, the curvature decreasing with the separation angle in an almost linear way that may be perceived as intuitive and predictable by the human user. However, some unsteady behavior (snapping) is observed, which may be addressed by preventing torsion of the wires through mechanical means. The simplified model neglecting the sheath stiffness provides precise enough predictions for the working space of a manual ETR. The findings suggest that manual ETRs have potential applications in superficial interventions, such as injections, arthroscopy, or ophthalmic surgery, where their curved section can be beneficial in comparison to current straight needles. Further research could explore interlocking mechanical designs to prevent torsion or modular setups for enhanced functionality.

Background: Ventricular assist devices (VADs) are used to bridge pediatric patients to heart transplantation. Paracorporeal VADs require the placement of cannulas, which can create an environment for infections. We examined cannula infections in pediatric VAD patients and the role of nutritional status. Methods: This retrospective study (2005–2021) included patients <20 years old on VAD support using Berlin Heart EXCOR® cannulas. Cannula infections were defined by a positive culture and need for antibiotic therapy. Malnutrition was defined using the American Society of Parenteral and Enteral Nutrition guidelines as well as the Michigan MTool. Results: There were 76 patients with a median age at implant of 0.9 years (IQR 0.4, 3.6), 50% male, with 73.7% having non‐congenital heart disease. More than one‐quarter (26.3%) of patients developed a cannula infection. Higher pre‐implant weight (OR = 1.93, p = 0.05), creatinine (OR = 1.02, p = 0.044), and pre‐albumin (OR = 15.79, p = 0.025), as well as duration of VAD support (OR = 1.01; p = 0.003) were associated with increased odds of developing a cannula infection. There was no difference in the malnutrition parameters between those with and without an infection. Conclusions: Further exploration in a larger cohort is needed to see whether these associations remain and if the incorporation of objective measures of nutritional status at the time of infection are predictive. [ABSTRACT FROM AUTHOR]

Objective: To elucidate the pattern of the influence of the port angle of the superior vena cava supplying cannula (SVCS) on hemodynamics within the right atrium in VV-ECMO. Methods: A three-dimensional model of the right atrium was established based on CT images of a real patient. The 3D models of the SVCS and inferior vena cava draining cannula (IVCD) were established based on the Edwards 18Fr and Medos 22Fr real intubation models, respectively. Based on these models, three-dimensional models of the SVCS ports with bending angles of −90°, −60°, −30°, 0°, 30°, 60°, and 90° in the plane formed by the centerline of the SVCS and the center point of the tricuspid valve (TV) were established. Transient-state computational fluid dynamics (CFD) was performed to clarify the right atrium blood flow pattern and hemodynamic states at different SVCS port orientation angles. The velocity clouds, wall pressure, wall shear stress (WSS), relative residence time (RRT), and recirculation fraction (RF) were calculated to assess hemodynamic changes in the right atrium at different angles of the port of the SVCS. Results: As the angle of the port of the superior chamber cannula changed, the location of the high-velocity blood impingement from the SVCS changed, and the pattern of blood flow within the right atrium was dramatically altered. The results for the maximum right atrial wall pressure were 13,472 pa, 13,424 pa, 10,915 pa, 7680.2 pa, 5890.3 pa, 5597.6 pa, and 7883.5 pa (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°), and the results for the mean right atrial wall pressure were 6788.9 pa, 8615.1 pa, 8684.9 pa, 6717.2 pa, 5429.2 pa, 5455.6 pa, and 7117.8 pa (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°). The results of the maximum right atrial wall WSS in the seven cases were 63.572 pa, 55.839 pa, 31.705 pa, 39.531 pa, 40.11 pa, 28.474 pa, and 35.424 (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°), respectively, and the results of the mean right atrial wall WSS results were 3.8589 pa, 3.6706 pa, 3.3013 pa, 3.2487 pa, 2.3995 pa, 1.3304 pa, and 2.0747 pa (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°), respectively. The results for the area percentage of high RRT in the seven cases were 3.44%, 2.23%, 4.24%, 1.83%, 3.69%, 7.73%, and 3.68% (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°), and the results for the RF were 21.57%, 23.24%, 19.78%, 12.57%, 10.24%, 5.07%, and 8.05% (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°). Conclusions: The more the port of the SVCS is oriented toward the TV, the more favorable it is for reducing RF and the impingement of blood flow in the right atrial wall, but there may be an increased risk of RRT. The opposite orientation of the SVCS port to the TV is not conducive to reducing flow impingement on the right atrial wall and RF. [ABSTRACT FROM AUTHOR]

Simple Summary: This study compared the bacterial contamination between two common peripheral intravenous catheter placement sites, in the front leg versus the hind leg, in dogs undergoing dental scaling under general anaesthesia. Regardless of the dog's size, a significantly higher bacterial contamination load was found at the front leg compared to the hind leg placement site. The bacteria isolated from the injection port of the cannula were mainly Staphylococcus, Neisseria, and Bacillus species. These findings suggest that to reduce the risk of contamination of the peripheral intravenous catheter during dental scaling procedures in dogs, placing the catheter in the hind leg may be beneficial. During dental scaling in dogs under general anaesthesia, contamination of the peripheral intravenous catheter (PIVC) is unavoidable due to splatter and the generated aerosol. Bacterial contamination was compared between two commonly used PIVC placement sites. Thirty-nine client-owned dogs with a minimum length from their nose to their tail base of 50 cm were randomly assigned to receive a PIVC in either their cephalic or saphenous vein. Irrespective of the PIVC placement site, brain heart infusion agar dishes were placed in the cephalic and saphenous vein areas. Their lids were closed 0, 5, and 10 min into the procedure. Contamination was measured by counting the colony-forming units after incubation on different substrates. The data were analysed with descriptive statistics, ANOVA, and ANCOVA (p < 0.05). The cephalic vein area showed a significantly higher bacterial load than the saphenous vein area (p ≈ 0.0) regardless of the length of the dog. Furthermore, the dorsal PIVC injection ports were sampled before and after scaling, and the colonies isolated were counted and subjected to MALDI-TOF-MS for identification. The bacteria mainly belonged to the genera Staphylococcus, Neisseria, and Bacillus. Our results suggest that for dental scaling in dogs, the PIVC should be placed in the pelvic limb whenever possible to reduce the potential risk of contamination. [ABSTRACT FROM AUTHOR]

The unacceptably high stroke rate associated with HeartMate 3 ventricular assist device (VAD) without signs of adherent pump thrombosis is hypothesized to be the result of the emboli produced by the inflow cannula, that are ingested and ejected from the pump. This in vitro and numerical study aimed to emulate the surface features and supraphysiological shear of a ventricular cannula to provide insight into their effect on thrombogenesis. Human whole blood was perfused at calibrated flow rates in a microfluidic channel to achieve shear rates 1000–7500 s−1, comparable to that experienced on the cannula. The channel contained periodic teeth representative of the rough sintered surface of the HeartMate 3 cannula. The deposition of fluorescently labeled platelets was visualized in real time and analyzed with a custom entity tracking algorithm. Numerical simulations of a multi-constituent thrombosis model were performed to simulate laminar blood flow in the channel. The sustained growth of adherent platelets was observed in all shear conditions ( p < 0.05). However, the greatest deposition was observed at the lower shear rates. The location of deposition with respect to the microfluidic teeth was also found to vary with shear rate. This was confirmed by CFD simulation. The entity tracking algorithm revealed the spatial variation of instances of embolic events. This result suggests that the sintered surface of the ventricular cannula may engender unstable thrombi with a greater likelihood of embolization at supraphysiological shear rates. [ABSTRACT FROM AUTHOR]

Since the beginning of the twentieth century, oxygen has been an essential therapeutic drug. Patients with chronic lung disease and other conditions rely on supplemental oxygen provided by oxygen cylinders for treatment. Because of the sudden increase in oxygen demand caused by the COVID-19 pandemic, combined with a lack of oxygen supply, new methods of oxygen delivery have been investigated as a potential solution. We propose OxySaver, a novel low-cost (∼60$) demand oxygen delivery system that may significantly reduce oxygen consumption. The proposed system consists of a pressure sensor that detects the patient's demand for oxygen, a normally open solenoid valve that switches the supply ON/OFF on demand, and a processing unit that ensures the supply of oxygen only during the patients' inhalation. It is simple to install using existing oxygen cylinders and oxygen pipelines in hospitals. The preliminary prototype tests have been promising, with OxySaver able to save up to 67% more oxygen than conventional methods. OxySaver's pulse setting can reach 18 LPM, as opposed to the 0.2–4 LPM typically found in oxygen concentrators. The system only needs 3.72 W at 50 bpm, which is less than other similar devices. OxySaver in multiplexing mode has the potential to reduce the logistical challenges associated with oxygen refilling and transport. The device is now ready for clinical testing at the bedside. [ABSTRACT FROM AUTHOR]

Less invasive rumen sampling methods, such as oro-esophageal tubing, became widely popular for exploring the rumen microbiome and metabolome. However, it remains unclear if such methods represent well the rumen contents from the rumen cannula technique. Herein, we characterized the microbiome and metabolome in the rumen content collected by an oro-esophageal tube and by rumen cannula in ten multiparous lactating Holstein cows. The 16S rRNA gene was amplified and sequenced using the Illumina MiSeq platform. Untargeted metabolome was characterized using gas chromatography of a time-of-flight mass spectrometer. Bacteroidetes, Firmicutes, and Proteobacteria were the top three most abundant phyla representing ~ 90% of all samples. Although the pH of oro-esophageal samples was greater than rumen cannula, we found no difference in alpha and beta-diversity among their microbiomes. The overall metabolome of oro-esophageal samples was slightly different from rumen cannula samples yet more closely related to the rumen cannula content as a whole, including its fluid and particulate fractions. Enrichment pathway analysis revealed a few differences between sampling methods, such as when evaluating unsaturated fatty acid pathways in the rumen. The results of the current study suggest that oro-esophageal sampling can be a proxy to screen the 16S rRNA rumen microbiome compared to the rumen cannula technique. The variation introduced by the 16S rRNA methodology may be mitigated by oro-esophageal sampling and the possibility of increasing experimental units for a more consistent representation of the overall microbial population. Studies should consider an under or over-representation of metabolites and specific metabolic pathways depending on the sampling method.

ObjectivesBronchiolitis is the most common cause for nonelective infant hospitalization in the United States with increasing utilization of high-flow nasal cannula (HFNC). We standardized initiation and weaning of HFNC for bronchiolitis and quantified the impact on outcomes. Our specific aim was to reduce hospital and ICU length of stay (LOS) by 10% between two bronchiolitis seasons after implementation.DesignA quality improvement (QI) project using statistical process control methodology.SettingTertiary-care children's hospital with 24 PICU and 48 acute care pediatric beds.PatientsChildren less than 24 months old with bronchiolitis without other respiratory diagnoses or underlying cardiac, respiratory, or neuromuscular disorders between December 2017 and November 2018 (baseline), and December 2018 and February 2020 (postintervention).InterventionsInterventions included development of an HFNC protocol with initiation and weaning guidelines, modification of protocol and respiratory assessment classification, education, and QI rounds with a focus on efficient HFNC weaning, transfer, and/or discharge.Measurements and main resultsA total of 223 children were included (96 baseline and 127 postintervention). The primary outcome metric, average LOS per patient, decreased from 4.0 to 2.8 days, and the average ICU LOS per patient decreased from 2.8 to 1.9 days. The secondary outcome metric, average HFNC treatment hours per patient, decreased from 44.0 to 36.3 hours. The primary and secondary outcomes met criteria for special cause variation. Balancing measures included ICU readmission rates, 30-day readmission rates, and adverse events, which were not different between the two periods.ConclusionsA standardized protocol for HFNC management for patients with bronchiolitis was associated with decreased hospital and ICU LOS, less time on HFNC, and no difference in readmissions or adverse events.

Objective: To compare introducer needle technique versus cannula over the needle technique for guide-wire placement to perform successful central venous cannulation in neonates using ultrasonography Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anaesthesia, Pak Emirates Military Hospital Rawalpindi Pakistan, from Feb 2020 to Jun 2021. Methodology: A total of 78 neonates who required central venous cannulation under general anaesthesia were randomly divided into two equal groups, Introducer Needle Group, Group-I (n=39), and Cannula Over the Needle Group, Group-I (n=39). Primary outcome measure was success on first atempt and secondary outcomes were total number of atempts until success and duration of procedure. Procedure related complications were also recorded. Results: Success on first atempt was much higher in Cannula over the Needle (CN) Group. Total number of atempts until successful cannulation were less in cannula over the needle (CN) group and time taken to perform successful cannulation was less in Cannula Over the Needle Group as compared to introducer needle group. Conclusion: In neonates if cannula over the needle is used instead of introducer needle, success on first atempt is more likely. Moreover, number of atempts are reduced and less time is taken to perform successful procedure. [ABSTRACT FROM AUTHOR]

At the Royal Perth Hospital, we have been developing and teaching a can't intubate, can't oxygenate (CICO) rescue algorithm for over 19 years, based on live animal simulation. The algorithm involves a 'cannula-first' approach, with jet oxygenation and progression to scalpel techniques if required in a stepwise fashion. There is little reported experience of this approach to the CICO scenario in humans. We present eight cases in which a cannula-first Royal Perth Hospital approach was successfully implemented during an airway crisis. We recommend that institutions teach and practice this approach; we believe it is effective, safe and minimally invasive when undertaken by clinicians who have been trained in it and have immediate access to the requisite equipment. The equipment is low cost, comprising a 14G Insyte cannula, saline, 5 ml syringe and a Rapid-O2. Training can be provided using low-fidelity manikins or part-task trainers. [ABSTRACT FROM AUTHOR]

Introduction: Hand rejuvenation treatment is in high demand in cosmetic medicine. Radiesse, a commercially available formulation of calcium hydroxylapatite (CaHA), is a safe, biocompatible, and provides long-lasting results. Objective: We sought to retrospectively evaluate the efficacy and safety of our formulation of Radiesse and its injection procedure. Methods: We treated the hands of 58 women, employing Radiesse diluted with lidocaine. The treatment was performed using a blunt cannula following the proximal-to-distal fanning technique at 2 entry points on the dorsum of the hands. The patients received 1-4 treatments over a follow-up period of up to 5 years. Results: The hands of 58 women were evaluated using the Merz Hand Grading Scale (MHGS) and treated with our CaHA formulation. After the first treatment, 55 women (94.8%) achieved a 1-point improvement, and 19 patients (32.8%) did not receive further treatments, being satisfied with the results. The remaining 39 women (67.2%) received 2-4 follow-up treatments. At the end of the treatment(s), 46 women (79%) achieved a final improvement of 1 point, and 12 women (21%) a final improvement of 2 points. Three minor adverse events were registered. Conclusions: Radiesse diluted with lidocaine is an excellent choice for hand rejuvenation. Our formulation and technique proved to be safe and efficient. In our experience, a blunt cannula should be employed for optimal vein correction. The treatment was highly satisfying, although planning a second treatment during the 1-month follow-up visit is recommended to best achieve long-lasting results.

ABSTRACT Objective To evaluate and compare the efficacy of high-flow nasal cannula treatment and that of bilevel positive airway pressure treatment as respiratory physiotherapy interventions for pediatric patients who are hospitalized because of asthma exacerbation. Methods During a randomized clinical trial, treatment was performed using a high-flow nasal cannula and bilevel positive airway pressure for hospitalized children with asthma. After randomization, data regarding lung function, vital signs, and severity scores (pulmonary index, pediatric asthma severity, and pediatric asthma scores) were collected. Results Fifty patients were included in this study (25 in the Bilevel Group and 25 in the high-flow nasal cannula group). After 45 minutes of therapy, an improvement in the forced expiratory volume in 1 second was observed. The high-flow nasal cannula group required fewer days of oxygen (O2) use, used fewer bronchodilators (number of salbutamol puffs), and required shorter hospitalization periods than the Bilevel Group (6.1±1.9 versus 4.3±1.3 days; 95% confidence interval, -5.0 to -0.6) Conclusion A high-flow nasal cannula is a viable option for the treatment of asthma exacerbation because it can reduce the hospitalization period and the need for O2 and bronchodilators. Additionally, it is a safe and comfortable treatment modality that is as effective as bilevel positive airway pressure. ClinicalTrials.gov Identifier: NCT04033666.

Tadios Lidetu Bayeh,1 Alemshet Yirga Birhie,1 Elisabet Mesfin Alene2 1Department of Adult Health Nursing, Bahir Dar University, Bahir Dar, Ethiopia; 2Department of Nursing, Felege Hiwot Referral Hospital, Bahir Dar, EthiopiaCorrespondence: Tadios Lidetu Bayeh, P.O. Box 1072 Bahir Dar, Bahir Dar, Ethiopia, Tel +251955185671, Email tadioslidetu@gmail.comBackground: Phlebitis is an inflammation of vein and the common complication of peripheral intravenous cannula. Phlebitis leads patient to sepsis, pulmonary embolism and other serious complications that increase patient morbidity and mortality. Phlebitis-related literature is scarce in Ethiopia. Therefore, the incidence and predictors of phlebitis were the focus of this study.Methods and Materials: An institution-based prospective observational study was carried out at public hospitals of Bahir Dar city. Four hundred sixty-two patients with peripheral intravenous cannulas who were admitted to the medical ward were selected using a systematic random sampling technique. Jackson’s Visual Infusion Phlebitis Scoring system was used to determine the presence of phlebitis. We used Cox proportional hazards regression model, to identify significant predictors of phlebitis.Results: In this study, 462 patients included, and 171 (37.01%) of them developed phlebitis. The median survival time of phlebitis was six days. Patients whose age group > 60 years had low probability to develop phlebitis (AHR = 0.49, 95% CI 0.29– 0.82), whereas chronic-diseases (AHR = 1.50, 95% CI 1.09– 2.07), drugs and blood administer in one vein (AHR = 2.03, 95% CI 1.44– 2.86), inappropriate cannula dressing (AHR = 1.81, 95% CI 1.31– 2.51), large cannula size (AHR = 1.52, 95% CI 1.08– 2.15) and longer cannula dwelling time (AHR = 7.39, 95% CI 4.12– 13.32) had high probability to develop phlebitis.Conclusion: The post-peripheral intravenous cannula phlebitis that frequently affects hospitalized cannulated patients requires particular attention and follow-up for cannulated patients with known risk factors.Keywords: time, incidence, predictors, phlebitis, cannula, patients

Objective: To elucidate the pattern of the influence of the port angle of the superior vena cava supplying cannula (SVCS) on hemodynamics within the right atrium in VV-ECMO. Methods: A three-dimensional model of the right atrium was established based on CT images of a real patient. The 3D models of the SVCS and inferior vena cava draining cannula (IVCD) were established based on the Edwards 18Fr and Medos 22Fr real intubation models, respectively. Based on these models, three-dimensional models of the SVCS ports with bending angles of −90°, −60°, −30°, 0°, 30°, 60°, and 90° in the plane formed by the centerline of the SVCS and the center point of the tricuspid valve (TV) were established. Transient-state computational fluid dynamics (CFD) was performed to clarify the right atrium blood flow pattern and hemodynamic states at different SVCS port orientation angles. The velocity clouds, wall pressure, wall shear stress (WSS), relative residence time (RRT), and recirculation fraction (RF) were calculated to assess hemodynamic changes in the right atrium at different angles of the port of the SVCS. Results: As the angle of the port of the superior chamber cannula changed, the location of the high-velocity blood impingement from the SVCS changed, and the pattern of blood flow within the right atrium was dramatically altered. The results for the maximum right atrial wall pressure were 13,472 pa, 13,424 pa, 10,915 pa, 7680.2 pa, 5890.3 pa, 5597.6 pa, and 7883.5 pa (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°), and the results for the mean right atrial wall pressure were 6788.9 pa, 8615.1 pa, 8684.9 pa, 6717.2 pa, 5429.2 pa, 5455.6 pa, and 7117.8 pa ( −90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°). The results of the maximum right atrial wall WSS in the seven cases were 63.572 pa, 55.839 pa, 31.705 pa, 39.531 pa, 40.11 pa, 28.474 pa, and 35.424 (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°), respectively, and the results of the mean right atrial wall WSS results were 3.8589 pa, 3.6706 pa, 3.3013 pa, 3.2487 pa, 2.3995 pa, 1.3304 pa, and 2.0747 pa (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°), respectively. The results for the area percentage of high RRT in the seven cases were 3.44%, 2.23%, 4.24%, 1.83%, 3.69%, 7.73%, and 3.68% (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°), and the results for the RF were 21.57%, 23.24%, 19.78%, 12.57%, 10.24%, 5.07%, and 8.05% (−90° vs. −60° vs. −30° vs. 0° vs. 30° vs. 60° vs. 90°). Conclusions: The more the port of the SVCS is oriented toward the TV, the more favorable it is for reducing RF and the impingement of blood flow in the right atrial wall, but there may be an increased risk of RRT. The opposite orientation of the SVCS port to the TV is not conducive to reducing flow impingement on the right atrial wall and RF.

During dental scaling in dogs under general anaesthesia, contamination of the peripheral intravenous catheter (PIVC) is unavoidable due to splatter and the generated aerosol. Bacterial contamination was compared between two commonly used PIVC placement sites. Thirty-nine client-owned dogs with a minimum length from their nose to their tail base of 50 cm were randomly assigned to receive a PIVC in either their cephalic or saphenous vein. Irrespective of the PIVC placement site, brain heart infusion agar dishes were placed in the cephalic and saphenous vein areas. Their lids were closed 0, 5, and 10 min into the procedure. Contamination was measured by counting the colony-forming units after incubation on different substrates. The data were analysed with descriptive statistics, ANOVA, and ANCOVA (p < 0.05). The cephalic vein area showed a significantly higher bacterial load than the saphenous vein area (p ≈ 0.0) regardless of the length of the dog. Furthermore, the dorsal PIVC injection ports were sampled before and after scaling, and the colonies isolated were counted and subjected to MALDI-TOF-MS for identification. The bacteria mainly belonged to the genera Staphylococcus, Neisseria, and Bacillus. Our results suggest that for dental scaling in dogs, the PIVC should be placed in the pelvic limb whenever possible to reduce the potential risk of contamination.

Objective: To assess whether the respiratory oxygenation index (ROX index) measured after the start of high-flow nasal cannula oxygen therapy can help identify the need for intubation in patients with acute respiratory failure due to coronavirus disease 2019. Methods: This retrospective, observational, multicenter study was conducted at the intensive care units of six Brazilian hospitals from March to December 2020. The primary outcome was the need for intubation up to 7 days after starting the high-flow nasal cannula. Results: A total of 444 patients were included in the study, and 261 (58.7%) were subjected to intubation. An analysis of the area under the receiver operating characteristic curve (AUROC) showed that the ability to discriminate between successful and failed high-flow nasal cannula oxygen therapy within 7 days was greater for the ROX index measured at 24 hours (AUROC 0.80; 95%CI 0.76 - 0.84). The median interval between high-flow nasal cannula initiation and intubation was 24 hours (24 - 72), and the most accurate predictor of intubation obtained before 24 hours was the ROX index measured at 12 hours (AUROC 0.75; 95%CI 0.70 - 0.79). Kaplan-Meier curves revealed a greater probability of intubation within 7 days in patients with a ROX index = 5.54 at 12 hours (hazard ratio 3.07; 95%CI 2.24 - 4.20) and = 5.96 at 24 hours (hazard ratio 5.15; 95%CI 3.65 - 7.27). Conclusion: The ROX index can aid in the early identification of patients with acute respiratory failure due to COVID-19 who will progress to the failure of high-flow nasal cannula supportive therapy and the need for intubation. [ABSTRACT FROM AUTHOR]

Background: With the expansion of the COVID-19, the study of different oxygen therapy methods has yielded different results. In the current study, we compare the effects of non-invasive ventilation and oxygen therapy through the high-flow nasal cannula. Methods: Non-intensive care unit-admitted COVID-19 patients were randomly divided into two groups. The first group received oxygen therapy with High Flow Nasal Cannula (HFNC) and the second group received Non-Invasive Ventilation (NIV). Clinical conditions and results obtained from laboratory tests were compared in two groups before oxygen therapy, and after 24 and 48 hr. Results: The average age of the participants was 56.25. According to the results, after 24 hr of respiratory intervention, dyspnea was the most frequent in the NIV group with 83.33% and in the HFNC group with 90%. After 48 hr, in the NIV group, nasal flaring was observed with a frequency of 60%, and in the HFNC group, weakness and lethargy were the most common symptoms (56.66%). Comparison of clinical status and laboratory indices of the two groups of patients showed that most of the indices in patients in three time periods were not significantly different, while the results demonstrated that after 24 hours, the mean PaCo2 in the HFNC group was significantly lower than the NIV group (0.002) and the mean PH in the HFNC group was significantly higher than the other group (p=0.039). Conclusion: The effectiveness of using HFNC compared to NIV is the same and shows no significant difference. [ABSTRACT FROM AUTHOR]

Background: Weaning from mechanical ventilation and tracheostomy after prolonged intensive care consume enormous resources with optimal management not currently well described. Restoration of respiratory flow via the upper airway is essential and early cuff‐deflation using a one‐way valve (OWV) is recommended. However, extended OWV use may cause dry airways and thickened secretions which challenge the weaning process. High‐flow therapy via the tracheostomy tube (HFT‐T) humidifies inspired air and may be connected via an in‐line OWV (HFT‐T‐OWV) alleviating these problems. We aim to provide clinical and experimental data on the safety of HFT‐T‐OWV along with a practical guide to facilitate clinical use during weaning from mechanical ventilation and tracheostomy. Methods: Data on adverse events of HFT‐T‐OWV were retrieved from a quality register for patients treated at an intensive care rehabilitation center between 2019 and 2022. Benchtop experiments were performed to measure maximum pressures and pressure support generated by HFT‐T‐OWV at 25–60 L/min flow using two different HFT‐T adapters (interfaces). In simulated airway obstruction using a standard OWV (not in‐line) maximum pressures were measured with oxygen delivered via the side port at 1–3 L/min. Results: Of 128 tracheostomized patients who underwent weaning attempts, 124 were treated with HFT‐T‐OWV. The therapy was well tolerated, and no adverse events related to the practice were detected. The main reason for not using HFT‐T‐OWV was partial upper airway obstruction using a OWV. Benchtop experiments demonstrated HFT‐T‐OWV maximum pressures <4 cmH2O and pressure support 0–0.6 cmH2O. In contrast, 1–3 L/min supplemental oxygen via a standard OWV caused pressures between 84 and 148 cmH2O during simulated airway obstruction. Conclusions: Current study clinical data and benchtop experiments indicate that HFT‐T‐OWV was well tolerated and appeared safe. Pressure support was low, but humidification may enable extended use of a OWV without dry airway mucosa and thickened secretions. Results suggest the treatment could offer advantages to standard OWV use, with or without supplementary oxygen, as well as to HFT‐T without a OWV, for weaning from mechanical ventilation and tracheostomy. However, for definitive treatment recommendations, randomized clinical trials are needed. [ABSTRACT FROM AUTHOR]

Background: Phlebitis is an inflammation of vein and the common complication of peripheral intravenous cannula. Phlebitis leads patient to sepsis, pulmonary embolism and other serious complications that increase patient morbidity and mortality. Phlebitis-related literature is scarce in Ethiopia. Therefore, the incidence and predictors of phlebitis were the focus of this study.Methods and Materials: An institution-based prospective observational study was carried out at public hospitals of Bahir Dar city. Four hundred sixty-two patients with peripheral intravenous cannulas who were admitted to the medical ward were selected using a systematic random sampling technique. Jackson's Visual Infusion Phlebitis Scoring system was used to determine the presence of phlebitis. We used Cox proportional hazards regression model, to identify significant predictors of phlebitis.Results: In this study, 462 patients included, and 171 (37.01%) of them developed phlebitis. The median survival time of phlebitis was six days. Patients whose age group > 60 years had low probability to develop phlebitis (AHR = 0.49, 95% CI 0.29– 0.82), whereas chronic-diseases (AHR = 1.50, 95% CI 1.09– 2.07), drugs and blood administer in one vein (AHR = 2.03, 95% CI 1.44– 2.86), inappropriate cannula dressing (AHR = 1.81, 95% CI 1.31– 2.51), large cannula size (AHR = 1.52, 95% CI 1.08– 2.15) and longer cannula dwelling time (AHR = 7.39, 95% CI 4.12– 13.32) had high probability to develop phlebitis.Conclusion: The post-peripheral intravenous cannula phlebitis that frequently affects hospitalized cannulated patients requires particular attention and follow-up for cannulated patients with known risk factors. [ABSTRACT FROM AUTHOR]

Bone biopsies have great value for the diagnosis of, amongst others, hematologic diseases. Although the bone biopsy procedure is mostly performed minimally invasive with the use of a slender cannula, the patient may still experience discomfort, especially when the procedure has to be repeated due to an unsuccessful biopsy. This review presents a comprehensive overview of bone biopsy devices presented in the patent literature. The patents were obtained using a classification search combined with keywords in the Espacenet patent database and were subsequently verified using pre-set eligibility criteria. This resulted in 62 unique patents included in this review. The included patents were categorized based on the used strategies for the three steps that can be identified during a bone biopsy (1) biopsy sampling, (2) biopsy severing and (3) biopsy harvesting. Most patents described strategies for multiple steps. Insight into the used strategies and the comprehensive overview may serve as a source of inspiration for the design of novel bone biopsy devices. [ABSTRACT FROM AUTHOR]

Coronavirus disease-2019 (COVID-19) has rapidly spread worldwide and causes high mortality of elderly patients. High-flow nasal cannula therapy (HFNC) is an oxygen delivery method for severely ill patients. We retrospectively analyzed the course of illness and outcomes in 110 elderly COVID-19 patients (≥65 years) treated with HFNC from 6 hospitals. 38 patients received HFNC (200 mmHg < PaO2/FiO2 ≤ 300 mmHg, early HFNC group), and 72 patients received HFNC (100 mmHg < PaO2/FiO2 ≤ 200 mmHg, late HFNC group). There were no significant differences of sequential organ failure assessment (SOFA) scores and APECH II scores between early and late HFNC group on admission. Compared with the late HFNC group, patients in the early HFNC group had a lower likelihood of developing severe acute respiratory distress syndrome (ARDS), longer time from illness onset to severe ARDS and shorter duration of viral shedding after illness onset, as well as shorter lengths of ICU and hospital stay. 24 patients died during hospitalization, of whom 22 deaths (30.6%) were in the late HFNC group and 2 (5.3%) in the early HFNC group. The present study suggested that the outcomes were better in severely ill elderly patients with COVID-19 receiving early compared to late HFNC.

Abstract Background The removal of high-viscosity silicone oil in retinal surgery is time-intensive. In this laboratory and porcine eye study, we evaluated the efficiency of novel extraction techniques, namely shortened polyimide-cannulas, an extraction sleeve and an experimental luer-trocar system, for commercially available silicone oils. Methods The volume of silicone oil after a 5-min removal time was quantified. The feasibility of all studied techniques was additionally tested in vitrectomized porcine eyes. Siluron 1000, 2000, 5000 and Xtra, as well as Densiron 68 and Densiron Xtra were examined. Results Shortening the 23G-polyimide-cannula from 6 mm up to 1.5 mm led to a significantly higher mean aspirated volume (e.g., 1 ml/min to 1.7 ml/min for Siluron Xtra). The extraction sleeve and luer-trocar increased the flow threefold compared to the shortest polyimide cannulas at 23G (5.2 ml/min and 5.2 ml/min vs 1.7 ml/min for Siluron Xtra, respectively). The extraction sleeve and luer-trocar system reached a similar flow at 27G as the best performing 23G-cannula. Angulation and movement of the eye was possible with the 2 mm-cannula, no angulation was possible when using the extraction sleeve. Stability and control were not impaired with the experimental luer-trocar setup. Conclusion Shorter polyimide-cannulas and extraction sleeves increase the extraction flow but may decrease stability during surgery. The luer-trocar system facilitates rapid removal while offering great stability and control. Small 27G silicone oil removal is possible and time efficient.

IntroductionInsulin Infusion Sets (IIS) play a crucial role in ensuring the safe delivery of insulin through a Continuous Subcutaneous Insulin Infusion (CSII) for individuals with Type 1 Diabetes (T1D). Recent advancements in therapy have highlighted the need to address issues such as unexplained hyperglycemia and IIS occlusion.ObjectiveTo investigate the adverse events (AEs) associated with IIS that impact the treatment of T1D, with a specific focus on promoting effective educational practices.MethodsOne hundred and eighteen patients under treatment at the Diabetes Center Insulin Pump Ambulatory, Federal University of São Paulo responded to a semi-structured questionnaire. Over 6 months, a nurse researcher interviewed them via video calls.ResultsCatheter-related adverse events (AEs) included catheter knots, folding, and accidental traction. AEs associated with cannula use were mainly related to cannula fixation adhesive, insulin leakage, bleeding episodes, and skin problems. The cannula patch tends to detach easily in hot conditions or when used for more than 3 days, leading to local itching. Adhesive glue can cause redness and pain. Insulin leakage typically occurs after the catheter disconnects from the cannula, accidental cannula traction, or beneath the cannula patch. Bleeding has been reported inside the cannula or at the insertion site, resulting in local pain and, in some cases, obstruction of insulin flow. When accidental cannula traction occurs, it is recommended to replace the entire IIS system. In situations involving bleeding, leakage, insulin odor, or unsuccessful attempts to correct hyperglycemic episodes with a “bolus” of insulin, it is advisable to change the IIS system and evaluate appropriate techniques for handling and infusing the device. Moreover, regular inspections of the device and reservoir/cartridge are essential.ConclusionSerious AEs can occur even in cases where the occlusion alarm is not activated, leading to interruptions in insulin flow. Conversely, in less severe situations, alarm activation can occur even in the absence of insulin flow interruption. Accidental catheter traction and catheter bending are commonly encountered in everyday situations, while issues related to the cannula directly affect blood glucose levels. AEs related to the IIS cannula often involve insulin leakage into the skin, bleeding, and skin events attributed to adhesive issues with the cannula.

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Trendelenburg position (TP) is used to transport gaseous emboli away from the cerebral region during cardiac surgery. However, TP effectiveness has not been fully considered when combined with varying the cardiopulmonary bypass (CPB) flow. This study simulated the supine and TP at different pump flows and assessed the trapped emboli and embolic load entering the aortic arch branch arteries (AABA). Methods: A computational fluid dynamics (CFD) approach used a centrally cannulated adult patient-specific aorta model replicating a CPB circuit. Air emboli of 0.1 mm, 0.5 mm, and 1.0 mm (n = 700 each) were injected into the aorta placed in the supine position (0°) and the TP (−20°) at 2 L/min and 5 L/min. The number of emboli entering the AABA were compared. An aortic phantom flow experiment was performed to validate air bubble behaviour. Results: TP at 5 L/min had the lowest 0.1 mm mean (±SD) embolic load compared to the supine 2 L/min (55.3 ± 30.8 vs 64.3 ± 35.4). For both the supine and TP, the lower flow of 2 L/min had the highest number of simulated trapped emboli in higher elevated regions than at 5 L/min (541 ± 185 and 548 ± 191 vs 520 ± 159 and 512 ± 174), respectively. The flow experiment demonstrated that 2 L/min promoted bubble coalescence and high amounts of trapped emboli and 5 L/min transported air emboli away from the AABA. Conclusions: TP effectiveness was improved by using CPB flow to manage air emboli. These results provide insights for predicting emboli behaviour and improving emboli de-airing procedures. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the use of the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and saturation of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict weaning from high-flow nasal cannula (HFNC) in patients with respiratory distress in a pediatric intensive care unit. Methods: A total of 107 children admitted to the pediatric intensive care unit were enrolled in the study between January 1, 2017, and December 31, 2021. Data on clinical and personal information, ROX index, ROX-HR index, and SF ratio were collected from nursing records. The data were analyzed using an independent t-test, χ² test, Mann--Whitney U test, and area under the curve (AUC). Results: Seventy-five (70.1%) patients were successfully weaned from HFNC, while 32 (29.9%) failed. Considering specificity and sensitivity, the optimal cut off points for predicting treatment success and failure of HFNC oxygen therapy were 6.88 and 10.16 (ROX index), 5.23 and 8.61 (ROX-HR index), and 198.75 and 353.15 (SF ratio), respectively. The measurement of time showed that the most significant AUC was 1 hour before HFNC interruption. Conclusion: The ROX index, ROX-HR index, and SF ratio appear to be promising tools for the early prediction of treatment success or failure in patients initiated on HFNC for acute hypoxemic respiratory failure. Nurses caring for critically ill pediatric patients should closely observe and periodically check their breathing patterns. It is important to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time. [ABSTRACT FROM AUTHOR]

There has not been a major change in how neuroscientists approach stereotaxic methods in decades. Here, we present a new stereotaxic method that provides an alternative approach to a traditional u-frame stereotaxic device and reduces costs, surgical time, and aids repeatability. The RatHat brain implantation system is a 3D-printable stereotaxic device for rats that is fabricated prior to surgery and fits to the shape of the skull. RatHat builds are directly implanted into the brain without the need for head-leveling or coordinate-mapping during surgery. The RatHat can be used in conjunction with the traditional u-frame stereotaxic device, but does not require the use of a micromanipulator for successful implantations. Each RatHat contains several primary components including the implant for mounting intracranial components, the surgical stencil for targeting drill sites, and the protective cap for preventing damage from impacts and debris. Each component serves a unique function and can be used together or separately. We demonstrate the feasibility of the RatHat in four different proof-of-principle experiments: (1) a three-pole cannula apparatus, (2) an optrode-electrode assembly, (3) a fixed-electrode array, and (4) a tetrode hyperdrive. Implants were successful, durable, and long-lasting (up to nine months). RatHat print files are easily created, can be modified in computer aided design (CAD) software for a variety of applications, and are easily shared, contributing to open science goals and replications. The RatHat has been adapted to multiple experimental paradigms in our lab and should be a useful new way to conduct stereotaxic implant surgeries in rodents.

A child being supported with an extracorporeal ventricular assist device, such as the Berlin Heart EXCOR (Berlin Heart GmbH, Berlin, Germany), must have at least 2 large cannulae for a long period. Management of cannula wounds is crucial since a cannula forms a track of prosthetic material passing the mediastinum to the heart. Deep wound complications, if they occur, can be troublesome and difficult to control with conventional methods. We applied vacuum-assisted closure to a patient who had Berlin-Heart EXCOR and a gap at the cannulation site. Herein, we describe the technical aspects of management in detail.

The development of low-traumatic surgical drains aimed at maximum possible separation of blood and air, is an important trend in modern medicine. The objective of this work is to create an inexpensive, user-friendly and low-traumatic dynamic blood aspiration system (DBAS). The system allows effective separation of blood and air when drawing blood from a wound under vacuum conditions required for blood aspiration. The operating principle of the system is to separate liquid and gas fractions of the blood-air mixture by modifying the blood intake cannula. The effect is achieved by applying the principles of centrifugal forces of a rotating blood-air flow combined with Archimedes lift forces.

The vascular cannulation step is of great importance for the effective and safe implementation of extracorporeal membrane oxygenation (ECMO) support. We experienced various problems associated with ECMO vascular cannulation (malposition, thrombosis, recannulation, collapse) in 3 patients who developed coronavirus disease-2019 acute respiratory distress syndrome and received veno-venous ECMO support, and here we share our experience in their management. Appropriate vascular cannula size, vascular cannula structure, selection of the vascular cannulation site, and precise vascular cannulation can make ECMO support more effective and reliable.

Background: The removal of high-viscosity silicone oil in retinal surgery is time-intensive. In this laboratory and porcine eye study, we evaluated the efficiency of novel extraction techniques, namely shortened polyimide-cannulas, an extraction sleeve and an experimental luer-trocar system, for commercially available silicone oils. Methods: The volume of silicone oil after a 5-min removal time was quantified. The feasibility of all studied techniques was additionally tested in vitrectomized porcine eyes. Siluron 1000, 2000, 5000 and Xtra, as well as Densiron 68 and Densiron Xtra were examined. Results: Shortening the 23G-polyimide-cannula from 6 mm up to 1.5 mm led to a significantly higher mean aspirated volume (e.g., 1 ml/min to 1.7 ml/min for Siluron Xtra). The extraction sleeve and luer-trocar increased the flow threefold compared to the shortest polyimide cannulas at 23G (5.2 ml/min and 5.2 ml/min vs 1.7 ml/min for Siluron Xtra, respectively). The extraction sleeve and luer-trocar system reached a similar flow at 27G as the best performing 23G-cannula. Angulation and movement of the eye was possible with the 2 mm-cannula, no angulation was possible when using the extraction sleeve. Stability and control were not impaired with the experimental luer-trocar setup. Conclusion: Shorter polyimide-cannulas and extraction sleeves increase the extraction flow but may decrease stability during surgery. The luer-trocar system facilitates rapid removal while offering great stability and control. Small 27G silicone oil removal is possible and time efficient. [ABSTRACT FROM AUTHOR]

Introduction: Varying the insertion depth of the aortic cannula during cardiopulmonary bypass (CPB) has been investigated as a strategy to mitigate cerebral emboli, yet its effectiveness associated with CPB flow is not fully understood. We compared different arterial cannula insertion depths and pump flow influencing air microemboli entering the aortic arch branch arteries (AABA). Methods: A computational approach used a patient-specific aorta model to evaluate four cannula locations at (1) proximal arch, (2) mid arch, (3) distal arch, and (4) descending aorta. We injected 0.1 mm microemboli (N=720) at 2 and 5 L/min and assessed the embolic load and the particle averaged transit times (entering the AABA. Results: Location 4 had the lowest embolic load (2 L/min: N= 63) and (5 L/min: N= 54) compared to locations 1 to 3 in the range of (N= 118 to 116 at 2 L/min:) and (N= 92 to 146 at 5 L/min). There was no significant difference between 2 L/min and 5 L/min (p = 0.31), despite 5 L/min attaining a lower mean (±standard deviation) than 2 L/min (38.0±23.4 vs 44.5±21.1), respectively. Progressing from location 1 to 4, increased 3.11s -7.40 s at 2 L/min and 1.81s -4.18s at 5 L/min. Conclusion: It was demonstrated that the elongated cannula insertion length resulted in lower embolic loads, particularly at a higher flow rate. The numerical results suggest that CPB management could combine active flow variation with improving cannula performance and provide a foundation for a future experimental and clinical investigation to reduce surgical cerebral air microemboli. [ABSTRACT FROM AUTHOR]

Neonatal procedures can be challenging and difficult for many neonatal practitioners, clinical/trust fellows and doctors in training to undertake. In this guide, we detail the steps and tips that can be used as a guide by practitioners for the following procedures: IV cannulation, longline (PICC) insertion, umbilical arterial catheterisation and umbilical venous catheterisation, needle thoracocentesis, chest drain insertion, intubation and lumbar puncture. The guide features pictures of equipment required with a further 'tips' section detailing anecdotal advice on how best to aim for success in these procedures. [ABSTRACT FROM AUTHOR]

Blood flow disturbance of veno-venous extracorporeal membrane oxygenation (VV-ECMO) can be a risk factor of weaning failure. We report an alternative position of cannulae of VV-ECMO which can maintain blood flow. The recirculation rate could be controlled by adjusting a position of return cannula using dilutional ultrasound monitoring. [ABSTRACT FROM AUTHOR]

Introduction: Limb ischemia is a severe complication of peripheral veno-arterial extracorporeal life support (V-A ECLS). Several techniques have been developed to prevent this, but it remains a major and frequent adverse event (incidence: 10–30%). In 2019, a new cannula with bidirectional flow (retrograde towards the heart and antegrade towards the distal limb) has been introduced. A single-centre experience with this cannula in patients undergoing peripheral V-A ECLS is herewith reported. Methods: This prospective observational study included adults (≥18 years) undergoing V-A ECLS from January 2021 to October 2022 with the use of a bidirectional femoral artery cannula. Primary outcome was limb ischemia requiring intervention during cardio-circulatory support. Secondary outcomes were compartment syndrome, limb amputation, cannulation site bleeding, need for other surgical intervention due to cannula related complications, duplex ultrasound parameters from the femoral vessels, and in-hospital survival. Results: Twenty-two consecutive patients were included. During extracorporeal life support (ECLS) support, limb ischemia requiring intervention occurred in one patient (4.5%) and no patients developed a compartment syndrome, or required a fasciotomy or amputation. Significant bleeding was reported in two patients (9%) due to slight cannula dislodgement, easily solved with cannula repositioning. In-hospital survival was 63.6%. Conclusions: The bidirectional cannula is associated with a low risk for limb ischemia-related complications compared to current literature, and apparently represents a safe alternative to dedicated distal perfusion cannula. Further studies are warranted to confirm these preliminary findings. [ABSTRACT FROM AUTHOR]

Background: Pulsatile extracorporeal circulation (ECC) may improve perfusion of critical organs during cardiac surgery. This study analyzed the influence of the components of a minimal invasive ECC (MiECC) on the transfer of pulsatile energy into the pseudo‐patient of a mock circulation. Methods: An aortic model with human‐like geometry and compliance was perfused by a diagonal pump. Surplus hemodynamic energy (SHE) was determined from flow and pressure data. Five adult‐size oxygenator models and three sizes of cannulas were compared. Pulsatile pump settings were optimized, and parallel dual‐pump configurations were evaluated. Results: Oxygenator models showed up to twofold differences in pressure gradients and influenced SHE at flow rates up to 2.0 L min−1. Adjustments of frequency, systole duration, and rotational speed gain significantly improved SHE compared with empirical settings, with SHE above 21% of mean arterial pressure at flow rates of 1.0 L min−1 to 1.5 L min−1 and SHE above 5% at 3.5 L min−1. Small diameter cannula (15 Fr) limited SHE compared with larger cannula (21 Fr and 23 Fr). Two diagonal pumps did not provide higher SHE than a single pump, but permitted additional control over pulse pressure and SHE by varying the total fraction of pulsatile flow and the fraction of flow bypassing the oxygenator. Conclusions: Proper selection of components and optimizations of pump settings significantly improved pulse pressure and SHE of pulsatile MiECC. Surplus hemodynamic energy depended on flow rate with a maximum at 1.0 L min−1–1.5 L min−1. Pulsatile MiECC may specifically assist organ perfusion during phases of low flow. [ABSTRACT FROM AUTHOR]

Introduction: The evolution of liposuction and fat graft technique with the oncologic safety allowed to use the fat as autologous filler in patients with breast cancer and submitted to breast reconstruction. The objective is to introduce an innovation in the instrument used to harvest fat grafts for breast reconstruction. Methods: Search of anteriority and trademarks were performed at international and national databases, and a prototype was built as a fat harvest instrument with 35cm in length, 4cm in diameter, with 10 holes at the distal extremity, with 2mm diameter each. It was experimented with a harvest of a viscous substance, comparing the prototype with two regular industry cannulas types: three holes Mercedes’ type and five roles Pitanguy’s type. Results: Four high-relevance patents and one medium-relevance patent were found, which differ from the proposed utility model when comparing the type of design of the distal end of the studied cannulas and the function of the instruments identified. When the prototype’s efficiency was compared with the other cannulas, the cannula with five holes in Pitanguy’s type was the most efficient, and it was no statistical difference between the prototype and the cannula with three roles in Mercedes’ type. Conclusion: The innovation presented to harvest fat graft for breast reconstruction had the same efficiency in harvesting the viscose substance as the cannula Mercedes type with three holes in this experimental model.

Central venous access devices (CVADs) are commonly used in malignancies. We conducted an online, anonymous cross‐sectional survey of practice regarding CVAD management in haematology centres among clinicians in Australia and New Zealand. We identified variation in clinical practice regarding CVAD selection, insertion, management and removal. These findings highlight research gaps in CVAD care. [ABSTRACT FROM AUTHOR]