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    12th WINFOCUS world congress on ultrasound in emergency and critical care.
    Crit Ultrasound J 2016 Sep;8(Suppl 1):12
    Anaesthesiology Department, University Science of Malaysia, Kota Bharu, Malaysia.
    Table Of Contents: A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization. A novel approach in emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA5 Clinical ultrasound in a septic and jaundice patient in the emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA6 Characterization of the eyes in preoperative cataract Saudi patients by using medical diagnostic ultrasoundMustafa Z. Read More

    The Barriers and Facilitators to Transfer of Ultrasound-Guided Central Venous Line Skills From Simulation to Practice: Exploring Perceptions of Learners and Supervisors.
    Teach Learn Med 2016 ;28(2):115-24
    b Department of Medical Education , University of Illinois at Chicago , Chicago , Illinois , USA.
    Unlabelled: PHENOMENON: Ultrasound-guided central venous line insertion is currently the standard of care. Randomized controlled trials and systematic reviews show that simulation is superior to apprenticeship training. The purpose of this study is to explore, from the perspectives of participants in a simulation-training program, the factors that help or hinder the transfer of skills from simulation to practice. Read More

    Ultrasonography for Central Catheter Placement in the Neonatal Intensive Care Unit-A Review of Utility and Practicality.
    Am J Perinatol 2016 May 21;33(6):525-30. Epub 2015 Dec 21.
    Division of Neonatology and the Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles and the LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California.
    Objective Central catheters (CCs) are routinely used in the neonatal intensive care unit (NICU). Ultrasonography (US) has been advocated as a procedural adjunct for CC placement to better localize catheter tip position (CTP), minimize radiation exposure, and decrease procedural burden. This review evaluates the clinical benefit, practical considerations for implementation, and limitations of US for CC placement in the NICU. Read More

    Lower Extremity Vascular Access in Neonates and Infants: A Single Institutional Experience.
    J Vasc Interv Radiol 2015 Nov;26(11):1660-8
    Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104.
    Purpose: To demonstrate feasibility and evaluate outcomes of direct-stick saphenous and single-incision tunneled femoral noncuffed central venous catheters (CVCs) placed in a large series of neonates and infants at a single institution.

    Materials And Methods: A retrospective review was performed for all neonates and infants receiving a lower extremity CVC by interventional radiology between 2007 and 2012. Technical success, mechanical and infectious complications, and catheter outcomes were recorded. Read More

    Saline Flush Test: Can Bedside Sonography Replace Conventional Radiography for Confirmation of Above-the-Diaphragm Central Venous Catheter Placement?
    J Ultrasound Med 2015 Jul;34(7):1295-9
    Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York USA (R.G., S.H., R.B., T.C., G.P., J.D., T.L.S., C.R., V.M., M.N.); St John's Riverside Hospital, Yonkers, New York USA (L.D.); and Long Island Jewish Medical Center, New Hyde Park, New York USA (A.C.).
    Objectives: Resuscitation often requires rapid vascular access via central venous catheters. Chest radiography is the reference standard to confirm central venous catheter placement and exclude complications. However, radiographs are often untimely. Read More

    Fluoroscopy-guided Umbilical Venous Catheter Placement in Infants with Congenital Heart Disease.
    Congenit Heart Dis 2015 Jul-Aug;10(4):317-25. Epub 2014 Nov 17.
    Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA.
    Objective: The objective of this study was to (1) describe the technical aspects of fluoroscopy-guided umbilical venous catheter placement (FGUVCP); and (2) determine the procedural success rate, factors contributing to procedural failure, and risks of the procedure.

    Background: Umbilical venous catheters are advantageous compared with femoral venous access, but can be difficult to place at the bedside.

    Materials And Methods: This was a retrospective chart review from a single tertiary care referral institution. Read More

    Ultrasound-guided central venous access using Google Glass.
    J Emerg Med 2014 Dec 1;47(6):668-75. Epub 2014 Oct 1.
    University of Arizona College of Medicine-Phoenix, Phoenix, Arizona; Phoenix Children's Hospital, Phoenix, Arizona.
    Background: The use of ultrasound during invasive bedside procedures is quickly becoming the standard of care. Ultrasound machine placement during procedures often requires the practitioner to turn their head during the procedure to view the screen. Such turning has been implicated in unintentional hand movements in novices. Read More

    A single institution experience of seven hundred consecutively placed peripherally inserted central venous catheters.
    J Vasc Access 2014 Nov-Dec;15(6):498-502. Epub 2014 May 9.
    1 Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, NY - USA.
    Introduction: Peripherally inserted central venous catheters (PICCs) are being increasingly placed at the bedside by trained vascular access professional such as nurses. This is to increase the availability of the service, for cost containment, and to reduce the workload on the interventional radiologist. We describe a single institution experience with over 700 PICC lines placed by trained nurses at the bedside and determine the success rate, malposition rate of the PICC line , degree of support needed from the Interventional radiologist, and factors affecting a successful placement of a PICC line by the nurses. Read More

    US-guided placement and tip position confirmation for lower-extremity central venous access in neonates and infants with comparison versus conventional insertion.
    J Vasc Interv Radiol 2014 Apr;25(4):548-55
    Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104.
    Purpose: To describe experience with the use of ultrasound (US)-guided placement and tip position confirmation for direct saphenous and single-incision tunneled femoral noncuffed central venous catheters (CVCs) placed in neonates and infants at the bedside.

    Materials And Methods: A retrospective review of the interventional radiology (IR) database and electronic medical records was performed for 68 neonates and infants who received a CVC at the bedside and for 70 age- and weight-matched patients with CVCs placed in the IR suite between 2007 and 2012. Technical success, complications, and outcomes of CVCs placed at the bedside were compared with those in an age- and weight-matched sample of children with CVCs placed in the IR suite. Read More

    Central vascular catheter placement evaluation using saline flush and bedside echocardiography.
    Acad Emerg Med 2014 Jan;21(1):65-72
    The Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC.
    Objectives: Central venous catheter (CVC) placement is a common procedure in critical care management. The authors set out to determine echocardiographic features during a saline flush of any type of CVC. The hypothesis was that the presence of a rapid saline swirl in the right atrium on bedside echocardiography would confirm correct placement of the CVC tip, similar to the accuracy of the postplacement chest radiograph (CXR). Read More

    Ultrasound-guided tunneled lower extremity peripherally inserted central catheter placement in infants.
    J Vasc Interv Radiol 2013 Dec;24(12):1910-3
    Department of Pediatric Radiology, Children's Hospital of Wisconsin, Medical College of Wisconsin, 9000 W Wisconsin Avenue, Milwaukee, WI 53226. Electronic address:
    Tunneled lower extremity peripherally inserted central catheters (PICCs) are placed in infants under combined ultrasound and fluoroscopic guidance in the interventional radiology suite. In infants requiring a bedside procedure, image guidance is limited, often using portable radiographs during the procedure. This report demonstrates feasibility of placing tunneled lower extremity PICCs using ultrasound as the sole imaging modality for vascular access, intravascular length measurement, and final confirmation of catheter tip position in a case series of 15 critically ill infants. Read More

    Topographic analysis and evaluation of anatomical landmarks for placement of central venous catheters based on conventional chest X-ray and computed tomography.
    Br J Anaesth 2014 Feb 31;112(2):265-71. Epub 2013 Oct 31.
    Department of Radiology, Charité-Universitätsmedizin Berlin, Hindenburgdamm 30, 12203 Berlin, Germany.
    Background: Positioning central venous catheters (CVCs) in the proper part of the superior vena cava (SVC) is difficult. The aim of this exploratory study was to analyse topographic relationships of the extrapericardial SVC using chest X-ray (CXR) and computed tomography (CT). This included an appraisal of rules for optimal CVC tip placement. Read More

    Percutaneous thrombin injection of common carotid artery pseudoaneurysm without cerebral protection.
    Tex Heart Inst J 2012 ;39(5):696-8
    Department of Radiology, Landspitali University Hospital, Reykjavik, Iceland.
    An 83-year-old man with sepsis sustained right common carotid artery injury during attempted central-line placement. A computed tomographic scan showed a large hematoma in the patient's neck and a carotid pseudoaneurysm. His clinical condition was such that transfer to the interventional suite was judged unsafe. Read More

    Central venous catheter placement: where is the tip?
    Am J Crit Care 2012 Sep;21(5):370-1
    Division of Neurosurgery, University of Toronto, Ontario, Canada.
    The insertion of central venous catheters is a common bedside procedure performed in intensive care units. Here, we present a case of an 82-year-old man who underwent insertion of a central venous catheter in the internal jugular vein without perceived complications. Postprocedural radiographs showed rostral migration of the catheter, and computed tomography performed coincidentally showed cannulation of the jugular bulb at the level of the jugular foramen. Read More

    Ultrasound-guided umbilical catheter insertion in neonates.
    J Perinatol 2011 May 10;31(5):344-9. Epub 2011 Feb 10.
    Division of Neonatology, UCSD Medical Center, San Diego, CA, USA.
    Objective: Umbilical catheter placement is a routine neonatal emergency procedure that has large variability in technical methods. Commonly used methods are unable to accurately estimate insertion lengths, and X-rays cannot always identify malpositioned catheters. In clinical practice, the placement of umbilical lines takes time away from nursing during a critical transition period. Read More

    Evaluation of proper above-the-diaphragm central venous catheter placement: the saline flush test.
    Am J Emerg Med 2011 Sep 25;29(7):842.e1-3. Epub 2010 Sep 25.
    Department of Emergency Medicine, The George Washington University, Washington, DC, USA.
    hest radiographs are routinely obtained after the insertion of above-the-diaphragm central venous catheters to confirm placement and detect mechanical complications. At times, performing the radiograph can be time-consuming and findings may be inaccurate. We present a case of a patient with difficult access who required emergent resuscitation. Read More

    Clinical applications of bedside ultrasonography in internal and emergency medicine.
    Intern Emerg Med 2011 Jun 3;6(3):195-201. Epub 2010 Aug 3.
    Department of Internal Medicine, Maggiore Hospital, Largo B. Nigrisoli 2, 40133, Bologna, Italy.
    Ultrasonography (US) is an invaluable tool in the management of many types of patients in Internal Medicine and Emergency Departments, as it provides rapid, detailed information regarding abdominal organs and the cardiovascular system, and facilitates the assessment and safe drainage of pleural or intra-abdominal fluid and placement of central venous catheters. Bedside US is a common practice in Emergency Departments, Internal Medicine Departments and Intensive Care Units. US performed by clinicians is an excellent risk reducing tool, shortening the time to definitive therapy, and decreasing the rate of complications from blind invasive procedures. Read More

    Bedside ultrasound can safely eliminate the need for chest radiographs after central venous catheter placement: CVC sono in the surgical ICU (SICU).
    J Surg Res 2010 Sep 11;163(1):155-61. Epub 2010 May 11.
    Department of Surgery, Division of Trauma, Acute Care, and Critical Care Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033-850, USA.
    Background: Real-time ultrasound guidance of central venous catheter (CVC)/peripherally inserted central catheter (PICC) insertion improves safety and efficacy. We hypothesized that a more robust ultrasound surveillance technique incorporating thoracic, vascular, and cardiac views-the CVC sono-would avoid the need for chest radiography to realize cost and efficiency gains.

    Methods: We conducted a prospective data collection in a high-volume, urban, academic SICU. Read More

    Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation.
    Radiology 2010 Jul;256(1):312-20
    Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, 1 Silverstein, Philadelphia, PA 19104, USA.
    Purpose: To prospectively evaluate outcomes associated with use of a triple-lumen (TL) peripherally inserted central catheter (PICC) in the intensive care unit (ICU) setting.

    Materials And Methods: Patients were prospectively enrolled in this HIPAA-compliant, institutional review board-approved study. Informed consent was obtained. Read More

    Are supine chest and abdominal radiographs the best way to confirm PICC placement in neonates?
    Neonatal Netw 2010 Jan-Feb;29(1):23-35
    Children's Hospital, Health Sciences Centre, Winnipeg, Manitoba.
    Background: Peripherally inserted central catheters (PICCs) are commonly used in NICUs. Although they have many benefits, they also have many potential complications. Confirming catheter tip position is essential to decreasing complications, but the best method to achieve confirmation is unclear. Read More

    Use of the StarClose device for closure of inadvertent subclavian artery punctures.
    Ann Vasc Surg 2009 Sep-Oct;23(5):688.e11-3
    Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, New York 11219, USA.
    Purpose: The placement of central catheters is a common procedure. It is also associated with multiple known complications. One of the potential complications that carry high morbidity and morality is arterial puncture and cannulation. Read More

    Ultrasound-guided central venous cannulation in bariatric patients.
    Obes Surg 2009 Oct 25;19(10):1365-70. Epub 2009 Jun 25.
    Section of Anesthesia and Intensive Care Medicine-DICMI, University of Genoa, Largo Rosanna Benzi 2, 16132, Genoa, Italy.
    Background: Central venous catheterization may be difficult in morbidly obese patients because anatomic landmarks are often obscured.

    Methods: We evaluated the efficacy and safety of ultrasound-guided central venous cannulation in 55 patients undergoing bariatric surgery. The usefulness of ultrasonic examination combined with intraatrial electrocardiogram as a diagnostic tool for catheter misplacement was studied. Read More

    Saline flush test for bedside detection of misplaced subclavian vein catheter into ipsilateral internal jugular vein.
    Br J Anaesth 2009 Apr 25;102(4):499-502. Epub 2009 Feb 25.
    Department of Neuroanaesthesiology, Neurosciences Center, All India Institute of Medical Sciences, New Delhi, India.
    Background: The most common misplacement during subclavian vein (SCV) catheterization is into the ipsilateral internal jugular vein (IJV). Chest radiography is the gold standard for the confirmation of correct placement. However, it is time-consuming and has the disadvantage of radiation exposure. Read More

    A randomized, controlled trial evaluating postinsertion neck ultrasound in peripherally inserted central catheter procedures.
    Crit Care Med 2009 Apr;37(4):1217-21
    University of Pennsylvania, Philadelphia, PA, USA.
    Objective: Insertion of peripherally inserted central catheters (PICCs) at the bedside may result in tip malposition. This study was designed to evaluate whether the addition of ultrasound (US) inspection of the ipsilateral neck provides immediate recognition of PICCs in aberrant position facilitating catheter reposition before completion of the procedure.

    Design: Randomized, controlled trial. Read More

    The efficacy of upper arm placement of peripherally inserted central catheters using bedside ultrasound and microintroducer technique.
    J Infus Nurs 2008 May-Jun;31(3):165-76
    South Georgia Medical Center, Valdosta, Georgia, USA.
    In one hospital in southern Georgia, the review and analysis of 500 peripherally inserted central catheter procedural attempts by designated, specialty nurses using microintroducer technique and ultrasound guidance revealed an overall catheter placement success rate of 94.6%. This research analysis also provided information on the disposition of those 6-French dual-lumen and triple-lumen, power-injectable peripherally inserted central catheters actually placed in situ on subjects who remained hospitalized or within the hospital's rehabilitation facility. Read More

    US-guided placement of central vein catheters in patients with disorders of hemostasis.
    Eur J Radiol 2008 Feb 4;65(2):253-6. Epub 2007 May 4.
    Baskent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
    Objective: To prospectively evaluate the technical success and immediate complication rates of temporary central catheter placement in a homogenous patient population with disorders of hemostasis.

    Materials And Methods: One hundred and thirty three temporary central vein catheters inserted under ultrasound guidance in 119 patients with bleeding disorders were analyzed over a 4-year period. Patients were males (n=51; 43%) and females (n=68; 57%) with a mean age of 56. Read More

    Ultrasound-guided interventional radiology in critical care.
    Crit Care Med 2007 May;35(5 Suppl):S186-97
    Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
    Ultrasound-guided intervention is becoming an increasingly popular and valuable tool in the critical care setting. In general, image-guided procedures can expedite wait times and increase the accuracy, safety, and efficacy of many procedures commonly performed within intensive care units. In the intensive care unit setting, ultrasound has particular advantages over other imaging modalities such as computed tomography and fluoroscopy, including real-time visualization, portability permitting bedside procedures, and reduced exposure to nephrotoxic contrast agents. Read More

    Echocardiographic diagnosis of air embolism associated with central venous catheter placement: case report and review of the literature.
    Echocardiography 2006 Apr;23(4):315-8
    Cardiovascular Imaging and Hemodynamic Laboratory, Division of Cardiology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
    Transthoracic echocardiography (TTE) is a valuable tool in the evaluation of patients with suspected air embolism. This report describes the presentation and evaluation of a critically ill woman with spontaneous air embolism occurring during a central venous catheter replacement. Bedside TTE established the diagnosis of air embolism, allowing prompt initiation of appropriate therapy. Read More

    Bedside ultrasonography in the ICU: part 2.
    Chest 2005 Sep;128(3):1766-81
    Division of Cardiology and Critical Care Medicine, Hôpital Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin O., Montreal, Quebec, Canada, H4J 1C5.
    This is the second of a two-part review on the application of bedside ultrasonography in the ICU. In this part, the following procedures will be covered: (1) echocardiography and cardiovascular diagnostics (second part); (2) the use of bedside ultrasound to facilitate central-line placement and to aid in the care of patients with pleural effusions and intra-abdominal fluid collections; (3) the role of hand-carried ultrasound in the ICU; and (4) the performance of bedside ultrasound by the intensivist. The safety and utility of bedside ultrasonography performed by adequately trained intensivists has now been well demonstrated. Read More

    Improved care and reduced costs for patients requiring peripherally inserted central catheters: the role of bedside ultrasound and a dedicated team.
    JPEN J Parenter Enteral Nutr 2005 Sep-Oct;29(5):374-9
    Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
    Background: We conducted a prospective quality assurance (QA) study to determine if a team dedicated to placing peripherally inserted central catheters (PICCs) would improve patient care and reduce costs.

    Methods: In April 2000, a dedicated team of physicians, physician assistants, nurses, and interventional radiologists (IR) was established to coordinate and approve all PICC placements at our hospital. Ultrasound (US) became available in November 2000 to assist with bedside PICC placement. Read More

    Bedside ultrasonography in the ICU: part 1.
    Chest 2005 Aug;128(2):881-95
    Division of Cardiology and Critical Care Medicine, Hôpital Sacré-Coeur de Montréal, Université de Montréal, 5400 boul. Gouin O., Montreal, Québec, Canada, H4J 1C5.
    Ultrasonography has become an invaluable tool in the management of critically ill patients. Its safety and portability allow for use at the bedside to provide rapid, detailed information regarding the cardiovascular system and the function and anatomy of certain internal organs. Echocardiography can noninvasively elucidate cardiac function and structure. Read More

    Vertebral artery dissection following intravascular catheter placement: a case report and review of the literature.
    Vasc Med 2004 May;9(3):199-203
    Vascular Surgery, Boston Medical Center, Boston VA Medical Center Boston, MA, USA.
    Vertebral artery dissections (VAD) are known to occur as a result of mechanical manipulations of the cervical region, traumatic injury, iatrogenic injury and are also known to arise spontaneously. We report a case of vertebral artery dissection following vertebral artery cannulation during a central line placement and review the literature. The patient underwent intravascular catheter placement that subsequently demonstrated arterial blood. Read More

    Hemodynamic and pulmonary changes after drainage of significant pleural effusions in critically ill, mechanically ventilated surgical patients.
    J Trauma 2004 Dec;57(6):1184-8
    Department of Surgery, New York Medical College, Valhalla, New York, USA.
    Purpose: Our purpose was to study the effects of drainage of significant pleural effusions in mechanically ventilated patients in a surgical intensive care unit.

    Methods: Twenty-two ventilated patients in the surgical intensive care unit of a tertiary care center over a 12-month period who developed a pleural effusion large enough to require drainage were studied prospectively. All patients underwent serial portable chest radiography in the upright or semiupright position; the radiographs were reviewed by a radiology attending. Read More

    Peripherally inserted central catheter malposition in a persistent left superior vena cava.
    J Infus Nurs 2004 May-Jun;27(3):181-4
    The Cleveland Clinic Foundation, Cleveland Ohio 44195, USA.
    Persistent left superior vena cava (PLSVC) is the most common congenital anomaly of the superior vena cava system. Left superior vena cava exists in early embryonic development, but this vessel degenerates as the cardiovascular system matures. Failure of this process to occur results in PLSVC. Read More

    Ultrasonic imaging as an adjunct to femoral venous catheterization in children.
    J Burn Care Rehabil 1997 Mar-Apr;18(2):156-8
    Shriners Burns Institute, Boston, MA 02114, USA.
    Central venous catheterization is critically important to the management of burned children, but major morbidity is associated with the technical misadventures that can occur when inserting these devices. We used a bedside ultrasound device to facilitate placement of femoral venous catheters in eight edematous children with an average age of 7.0 years, weight of 23 kg, and burn size of 54%. Read More

    Insertion of subclavian hemodialysis catheters in difficult cases: value of fluoroscopy and angiographic techniques.
    AJR Am J Roentgenol 1989 Mar;152(3):641-3
    Department of Radiology, University of Virginia Medical Center, Charlottesville 22908.
    Double-lumen hemodialysis catheters designed to be placed via a subclavian vein approach have gained rapid acceptance over the past several years. Several studies have shown a significant rate of subclavian vein stenosis or occlusion after placement of these catheters. A large number of these patients require repeat placement of catheters with access often becoming increasingly difficult to obtain. Read More

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