Suspected Short Peripheral Venous Catheter Intravascular Embolization: Identification and Management

Embolization of a standard short peripheral venous catheters (S-PVC) related to catheter fracture is an extremely rare complication. Early identification and management is essential to avoid potential complications (i.e. central embolization, arrhythmias, cardiorespiratory failure, etc.). In this report, we describe a case of suspected short-PVC fracture in a pediatric patient. The goal is to review available literature and provide insight on what to do in the setting of suspected PVC fracture

Microporous polysaccharide hemosphere absorbable hemostat use in cardiothoracic surgical procedures

BACKGROUND: Topical hemostatic agents are used to reduce bleeding and transfusion need during cardiothoracic surgery. We report our experience with Arista® AH Absorbable Hemostatic Particles (Arista® AH), a novel plant-based microporous polysaccharide hemostatic powder. METHODS: Data were retrospectively collected for patients (n = 240) that received cardiothoracic surgery at our institution from January 2009 to January 2013 with (n = 103) or without (n = 137) the use of Arista® AH. Endpoints included protamine to skin closure time (hemostasis time), cardiopulmonary bypass time, quantity of Arista® AH applied, intraoperative blood product usage, intraoperative blood loss, chest tube output 48 hours postoperatively, blood products required 48 hours postoperatively, length of stay in the intensive care unit, 30-day morbidity, and 30-day mortality. RESULTS: 240 patients (176 M: 64 F) underwent 240 cardiothoracic procedures including heart transplantation (n = 53), cardiac assist devices (n = 113), coronary artery bypass grafts (n = 20), valve procedures (n = 19), lung transplantation (n = 17), aortic dissection (n = 8), and other (n = 10). Application of Arista® AH led to significant reduction in hemostasis time versus the untreated control group (Arista® AH: 93.4 ± 41 min. vs. Control: 107.6 ± 56 min., p = 0.02). Postoperative chest tube output in the first 48 hours was also significantly reduced (Arista® AH: 1594 ± 949 mL vs. Control: 2112 ± 1437 mL, p < 0.001), as well as transfusion of packed red blood cells (Arista® AH: 2.4 ± 2.5 units vs. Control: 4.0 ± 5.1 units, p < 0.001). There was no significant difference in 30-day mortality or postoperative complications. CONCLUSION: Use of Arista® AH in complex cardiothoracic surgery resulted in a significant reduction in hemostasis time, postoperative chest tube output, and need for postoperative blood transfusion

Delayed diagnosis of subungual osteochondroma

Subungual osteochondroma is a rare benign tumor that is often missed at initial evaluation. In this case report, we present a prepubescent boy that presented with a subungual mass, which was misdiagnosed and treated as a simple wart

Identification and management of cough-induced laryngotracheitis

Chronic cough is associated with repetitive injury to the upper airway and trachea, which can lead to an underdiagnosed pathology known as “cough-induced” laryngotracheitis (CILT). In this report, we describe a case of CILT that responded well to dual therapy

Ventricular Assist Devices (VAD) Therapy: New Technology, New Hope?

Ventricular assist devices are commonly utilized in the treatment of end-stage heart failure. Advances in continuous flow technology have improved efficiency, size, implantability, extended support, and overall patient outcomes. This has led to an expanded role of left ventricular assist device (LVAD) clinical use and applications. This review describes the advances and current state of LVAD devices and provides a future outlook for this technology

Large cardiac tumor managed with resection and two ventricular assist devices

Symptomatic cardiac tumors can lead to a rapid clinical deterioration and death. Prompt surgical resection is ideal in this situation as it is the only proven treatment to date. We report the radical resection of a large malignant cardiac tumor that obstructed the right ventricular outflow tract. Extensive resection precluded reconstruction and limited the ability to implant a total artificial heart; thus, 2 paracorporeal devices were implanted instead

General Surgery Considerations in the Era of Mechanical Circulatory Assist Devices

Much of the success of left ventricular assist devices (LVAD) can be attributed to the second-generation HeartMate II (Thoratec, Pleasanton, CA, USA), which is the most commonly used device to date. The latest generation of LVADs is currently undergoing clinical trials worldwide. Developers have focused on improving the limitations of the second generation with emphasis on enhancing efficiency further, decreasing complications, and increasing ease of implantability. Clinical management of a patient with an LVAD is also an excellent example of the multidisciplinary approach of care that is undoubtedly the future of medicine

Managing central venous access during a health care crisis.

ObjectiveDuring the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns, and outcomes of these vascular access teams during the COVID-19 pandemic.MethodsWe conducted a cross-sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. To participate in the study, hospitals were required to meet one of the following criteria: development of a formal plan for a central venous access line team during the pandemic; implementation of a central venous access line team during the pandemic; placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice; or management of an iatrogenic complication related to central venous access in a patient with COVID-19.ResultsParticipants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis (Santa Clara, Calif) catheters, and nontunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience in placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of the hospitals. Less than 50% (24 [41%]) of the participating sites reported managing thrombosed central lines in COVID-19 patients. Twenty-three of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group).ConclusionsImplementation of a dedicated central venous access line team during a pandemic or other health care crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed health care&nbsp;system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained intensive care unit, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We&nbsp;recommend that a plan for central venous access line team implementation be in place for future health care crises