Management of a malpositioned central venous catheter in the accessory hemiazygos vein

Malposition of a central venous catheter (CVC) in the accessory hemiazygos vein is an uncommon but potentially fatal complication; however, there is limited information regarding the preferred removal technique. We report a patient, a 57-year-old woman, who presented with overdose of her prescribed sedatives, who experienced this catheter complication after CVC insertion in the left internal jugular vein. The CVC was placed without resistance but routine postplacement chest X-ray showed abnormal coursing of the catheter close to the descending aorta. We used non-enhanced CT as an adjunct to safely identify the catheter position and assess for any bleeding during removal. CT images taken after retraction of the catheter tip by 10 cm showed no bleeding and we were able to remove the catheter safely. We recommend using CT as an adjunct to safely remove malpositioned catheters and reduce the risk of further complication.

CLiP, catheter and line position dataset

Correct catheter position is crucial to ensuring appropriate function of the catheter and avoid complications. This paper describes a dataset consisting of 50,612 image level and 17,999 manually labelled annotations from 30,083 chest radiographs from the publicly available NIH ChestXRay14 dataset with manually annotated and segmented endotracheal tubes (ETT), nasoenteric tubes (NET) and central venous catheters (CVCs).

Lung Ultrasonography Decreases Radiation Exposure in Newborns with Respiratory Distress

Chest X-ray(CXR) is commonly used as a first line imaging method to diagnose the reason of respiratory distress in NICUs.Lung ultrasound is a new diagnostic tool for lung imaging. We aimed to determine the decrease in the number of CXRs on the first day of life in newborns with respiratory distress,with the use of lung ultrasonography. From January 2019 to June 2020,104 newborn infants hospitalized in the NICU with respiratory distress on the first day of life enrolled in this study(ClinicalTrials.govIdentifier NCT04722016).We used ultrasound as the first line technique for lung imaging.CXR was taken to determine endotracheal tube and umbilical catheter position or if considered necessary by the physician in charge of the infant.We calculated decreased number of CXR for every patient and evaluated the estimated decrease in radiation exposure. 104 neonates with median 36 weeks(25–40)gestational age and birth weight 2410gr(600–4100) enrolled in the study.Seventy(67,3%)of these babies were male.In the study group,24(23,1 %)patients were diagnosed with respiratory distress syndrome(RDS),49(47,1 %) patients with transient tachypnea of newborn(TTN),27(26 %) with pneumonia,4(3,8 %)with congenital heart diseases.Lung ultrasonography were performed 210 times for all infants,but CXRs were performed a total of only 107 times.CXR wasnot taken in 27 of the patients with a diagnosis of TTN,in 2 of the patients with a diagnosis of congenital pneumonia,and in one of the patients with congenital heart disease.The rate of patients who have never had a chest x-ray was 28,8%.Conclusions:We observed that usage of lung ultrasonography decreased the number of chest X-ray and radiation exposure in newborns with respiratory distress.

Neuronavigation device for stereotaxic external ventricular drainage insertion

Background: The insertion of an external ventricular drainage (EVD) is one of the most frequently used neurosurgical procedures. It is performed to adjust intracranial hypertension in cases of severe craniocerebral injury, acute posthemorrhagic hydrocephalus, meningitis, and oncological diseases related to impaired circulation of cerebrospinal fluid circulation (CSF). Methods: In 2020, three patients with subarachnoid aneurysmal hemorrhage underwent insertion of an EVD navigation percutaneous stereotaxic device. Three cases introduced. Results: In all cases, satisfactory EVD functioning was noted during the surgery and during the early postoperative period. The EVD insertion procedure took an average of 10 min. The EVD insertion route calculations using the software took about 5–15 min. No cases showed any infection, hemorrhagic complications, or EVD dysfunction. According to the control brain computed tomography data, the catheter position was satisfactory and corresponded to the target coordinates in all cases. Conclusion: The use of the device, with its high accuracy and efficiency, can reduce the incidence of unsatisfactory EVD implantation cases in patients with neurosurgical pathology.

Use of Bony Landmarks during Adrenal Venous Sampling to Guide Catheterization of the Left Adrenal Vein

Purpose The aim of this study was to examine the utility of fluoroscopic bony landmarks in predicting the location of the left adrenal vein during adrenal vein sampling (AVS). Methods Eighty-six AVS procedures were performed in 81 patients between August 2013 and March 2020. A selectivity index was calculated for each case by dividing the measured left adrenal vein cortisol level by the peripheral vein cortisol level. Successful “target” left adrenal vein catheterization was confirmed in cases with a selectivity index of three or greater. Intraprocedural AVS fluoroscopic images were selected that demonstrated catheter position in the left adrenal vein. Lateral distance from the catheter tip in the left adrenal vein to the lateral margin of the left pedicle at the associated vertebral body level was measured. Results Mean patient age was 56.4 years (range: 19–80 years) and 48 (59.3%) patients were male. Target sampling in the left adrenal vein was confirmed in 82 (95.3%) cases. In 78 (95.1%) targeted cases, the catheter terminated less than 25 mm from the left lateral pedicle at a mean distance of 11.2 mm. The catheter was most frequently placed at the T12 and L1 vertebral body levels. Four (4.7%) cases demonstrated nontarget catheter positioning, two (50.0%) of these cases were within 25 mm. Conclusion The position of the left adrenal vein is generally located in a predictable position relative to bony landmarks. By utilizing these landmarks, positioning of the sampling catheter during AVS can be more reliable with the potential to avoid repeat procedures and delays in patient care.

Catheter insertion depths in less-invasive surfactant administration

IntroductionLess-invasive surfactant administration (LISA) under continuous positive airway pressure is increasingly used for the treatment of neonatal respiratory distress. Different procedures are described, but data on the optimal catheter insertion depth are sparse.ObjectiveTo generate data for recommending an optimal catheter insertion depth in LISA.MethodsWe examined 112 anterior–posterior chest X-rays from intubated infants and determined the carina’s vertebral projection, whenever possible. After that, distances between the middle of cervical vertebra 4 (C4) and thoracic vertebra 2 and the middle of C4 to thoracic vertebra 3, respectively, were measured. Results were plotted against infant’s weight.ResultsA weight-based chart and recommendations for the optimal intratracheal catheter position in infants with a body weight between 350 and 4000 g were created.ConclusionsGenerated data offer standardisation and may thus help to find a balance between risk of surfactant reflux and unilateral surfactant administration.