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Whitesell RT, Burnett AM, Johnston SK, Sheafor DH. Pre-hospital emergency medicine: a spectrum of imaging findings. Emerg Radiol 2024; 31:405-415. [PMID: 38528277 DOI: 10.1007/s10140-024-02223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 03/14/2024] [Indexed: 03/27/2024]
Abstract
The goal of emergency medical services (EMS) is to provide urgent medical care and stabilization prior to patient transport to a healthcare facility for definitive treatment. The number and variety of interventions performed in the field by EMS providers continues to grow as early management of severe injuries and critical illness in the pre-hospital setting has been shown to improve patient outcomes. The sequela of many field interventions, including those associated with airway management, emergent vascular access, cardiopulmonary resuscitation (CPR), patient immobilization, and hemorrhage control may be appreciated on emergency department admission imaging. Attention to these imaging findings is important for the emergency radiologist, who may be the first to identify a malpositioned device or an iatrogenic complication arising from pre-hospital treatment. Recognition of these findings may allow for earlier corrective action to be taken in the acute care setting. This review describes common EMS interventions and their imaging findings.
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Affiliation(s)
- Ryan T Whitesell
- Division of Emergency Radiology, Midwest Radiology, 2355 Highway 36 West, Roseville, MN, USA.
| | - Aaron M Burnett
- Department of Emergency Medicine, Regions Hospital, 640 Jackson St, St. Paul, MN, USA
| | - Sean K Johnston
- Division of Emergency Radiology, Midwest Radiology, 2355 Highway 36 West, Roseville, MN, USA
| | - Douglas H Sheafor
- Division of Emergency Radiology, Midwest Radiology, 2355 Highway 36 West, Roseville, MN, USA
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Yu K, Li J, Zhang D, Liu B, Wang K, Liu W, Shi Y, Zhao Y, Liu Y, Guo N, Sun W. Types of peripherally inserted central catheters and the risk of unplanned removals in patients: A prospective cohort study. Int J Nurs Stud 2024; 149:104621. [PMID: 37922685 DOI: 10.1016/j.ijnurstu.2023.104621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Peripherally inserted central catheters are widely used in clinical practice. Despite the many advantages of peripherally inserted central catheters, unplanned removals can occur owing to irreversible complications and may have adverse consequences for patients. However, the relationship between peripherally inserted central catheter type and the incidence of unplanned removal is unclear. OBJECTIVE To investigate the association between the type of peripherally inserted central catheter and unplanned catheter removal. DESIGN A multicenter prospective cohort study. SETTINGS Sixty hospitals located in 30 cities across seven provinces in China. PARTICIPANTS Three thousand two hundred and twenty-two patients aged 18 years or older with one peripherally inserted central catheter inserted for treatment were enrolled, and 3166 (98.3 %) patients with follow-up data were included in the final analysis. METHODS The included participants had peripherally inserted central catheters that either had a proximal valve (n = 2436) or were open-ended (n = 730). A competing risk Cox regression model was used, and both univariate and multivariate analyses were conducted. A sub-distribution hazard model was applied to test the validity of the results. RESULTS Of the 2436 peripherally inserted central catheters with a proximal valve and 730 that were open-ended, 272 (11.2 %) and 46 (6.3 %) were removed unplanned, respectively. The whole incidence of unplanned removal was 10.04 %; multivariate Cox regression was conducted and it was determined that unplanned removal was statistically significantly associated with the proximal valve peripherally inserted central catheter type (hazard ratio: 1.86, 95 % confidence interval: 1.28 to 2.70, p = 0.001). In patients without cancer, the risk of unplanned removal of peripherally inserted central catheters with a proximal valve was 8.14 times higher than that of open-ended peripherally inserted central catheters (p < 0.001). CONCLUSIONS In this study, peripherally inserted central catheters with a proximal valve had a higher risk of unplanned removals, especially in patients without cancer. The peripherally inserted central catheter type should be considered in advance, and clinical staff should take appropriate measures to prevent unplanned removals after insertion.
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Affiliation(s)
- Kunrong Yu
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiaqian Li
- Department of Clinical Nutrition, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Dingding Zhang
- Medical Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bing Liu
- Department of Clinical Nutrition, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Kai Wang
- Department of Clinical Nutrition, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Weinan Liu
- Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanping Shi
- Department of Plastic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanwei Zhao
- Department of Nursing, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Liu
- Department of Clinical Nutrition, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Na Guo
- Department of Nursing, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | - Wenyan Sun
- Department of Clinical Nutrition, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Caramia R, Recchia N, Santoro S, Ammirabile L, Fedele P. A late spontaneous peripherally inserted central catheter migration: two cases series. Arch Clin Cases 2023; 10:61-65. [PMID: 37220597 PMCID: PMC10194171 DOI: 10.22551/2023.39.1002.10242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
A central venous catheter is a flexible catheter that is inserted into a vein and ends close to the superior vena cava. It may be inserted through a vein in the neck, chest, or arm. It's also called a central venous line or central line. Peripherally inserted central venous catheters (PICCs) are usually implanted in arm veins such as the basilic vein, the brachial veins or in some cases in the cephalic vein. PICCs can remain in place for up to six months or more. If properly managed, they last even more than a year. PICCs offer the advantage of greater safety for infusion of vesicants/irritants and hyperosmolar solutions and enable the administration of antibiotics, prolonged parenteral nutrition, and chemotherapy agents. They are however, associated with some adverse events such as spontaneous late migration. The reasons for these complications are not yet fully understood. There are now established causes and in some cases hypotheses to explain these phenomena. We describe two clinical cases in which apparently correctly positioned PICCs migrated spontaneously from their original position. The identification of the migration of the vascular catheter was accidental in the two patients, and they did not developed complications. One of the two patients had a pacemaker. The remote migration of a PICC is an event that can occur, and the causes are not definitively clarified in all cases.
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Affiliation(s)
- Remo Caramia
- Anesthesia, Resuscitation and Pain Therapy Unit, “D. Camberlingo” Hospital, Francavilla Fontana (BR), Italy
| | - Nicola Recchia
- Radiology Unit, “D. Camberlingo” Hospital, Francavilla Fontana (BR), Italy
| | - Silvia Santoro
- Radiology Unit, “D. Camberlingo” Hospital, Francavilla Fontana (BR), Italy
| | - Lorenzo Ammirabile
- Day Service General Surgery - Endoscopy, “Umberto I” Hospital, Fasano, (BR), Italy
| | - Pietro Fedele
- Anesthesia, Resuscitation and Pain Therapy Unit, “D. Camberlingo” Hospital, Francavilla Fontana (BR), Italy
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Wan L, Yin L, Zhang W, Yang J, Yi X, Guo L. Application value of modified skin expansion in PICC catheterization under the guidance of B-ultrasound in gastrointestinal cancer patients with chemotherapy. Am J Transl Res 2022; 14:7932-7941. [PMID: 36505288 PMCID: PMC9730118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the clinical value of modified skin expansion in peripherally inserted central venous catheter (PICC) catheterization under the guidance of B-ultrasound in gastrointestinal cancer patients with chemotherapy. METHODS In this retrospective study, 60 gastrointestinal cancer patients with chemotherapy were included and divided into an experimental group (treated with modified skin expansion in PICC catheterization under the guidance of B-ultrasound) and a control group (treated with the longitudinal skin expansion in PICC catheterization under the guidance of B-ultrasound). The bleeding volume, pain score, success rate of one-time PICC catheterization and the incidence of complication were compared between the two groups. RESULTS The modified skin expansion in PICC catheterization under the guidance of B-ultrasound had obvious effect on gastrointestinal cancer patients with chemotherapy. The VAS scores were significantly lower after PICC catheterization in the experimental group compared with the control group (P < 0.05). The success rate of one-time PICC catheterization in the experimental group was significantly higher than that in the control group. Moreover, the incidence of complication and massive bleeding during puncture and 24 hours after puncture was significantly lower in the observation group compared with that in the control group. CONCLUSIONS Modified skin expansion in PICC catheterization under the guidance of B-ultrasound in gastrointestinal cancer patients with chemotherapy can improve the success rate of one-time sheath delivery, effectively reduce the amount of blood leakage after catheterization, reduce patients' pain and reduce the incidence of complications.
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Affiliation(s)
- Lijuan Wan
- Fifth Department of General Surgery, The First Affiliated Hospital of Gannan Medical CollegeGanzhou 341000, Jiangxi, China
| | - Ling Yin
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Gannan Medical CollegeGanzhou 341000, Jiangxi, China
| | - Wenhong Zhang
- Fifth Department of General Surgery, The First Affiliated Hospital of Gannan Medical CollegeGanzhou 341000, Jiangxi, China
| | - Jiejie Yang
- Gastrointestinal Endoscopy Room, The First Affiliated Hospital of Gannan Medical CollegeGanzhou 341000, Jiangxi, China
| | - Xiuying Yi
- Fifth Department of General Surgery, The First Affiliated Hospital of Gannan Medical CollegeGanzhou 341000, Jiangxi, China
| | - Lihua Guo
- First Department of General Surgery, The First Affiliated Hospital of Gannan Medical CollegeGanzhou 341000, Jiangxi, China
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Erskine B, Tea J, Diehl A, Phan T, Moriarty HK. Knot quite right: Implications for central venous access in the presence of an RVAD. J Med Imaging Radiat Oncol 2021; 66:799-801. [PMID: 34902227 DOI: 10.1111/1754-9485.13370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Brendan Erskine
- Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Julie Tea
- Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Arne Diehl
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tuan Phan
- Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Heather K Moriarty
- Department of Radiology, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
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