difficult IV access

Pyoderma gangrenosum manifests as recurrent deep ulceration of the skin and is associated with a variety of disorders. We report a 40-year-old man who developed ulcers on the flexor surface of his right lower limb following a trauma 10 years prior to the current presentation. He was diagnosed with ulcerative colitis 20 years ago, and was previously placed on sulfasalazine and prednisolone. He also developed an enterocutaneous fistula at the right iliac fossa following an appendectomy he had 16 years previously...

Peripheral intravenous cannulation (PIVC) is a routine procedure in perioperative, and critical care settings and nearly one-third of the patients may have difficult intravenous access (DIVA). PIVC is challenging in a prone position in an intraoperative setting when there is a need for emergency access. Point of care ultrasonography (POCUS) is becoming the standard for assisting DIVA and improving the success rate. The small saphenous vein (SSV) in the posterolateral side of the mid-calf is a consistent vein in the lower extremity that provides an acceptable diameter and optimal depth for POCUS-guided PIVC in the prone position...

BACKGROUND: Tinnitus is the perception of sound in the absence of external acoustic stimulation. Being one of the most common diseases of the ear, it has a global prevalence ranging from 4.1 to 37.2%. To date, it has been difficult to treat tinnitus as its pathophysiology is poorly understood and there are limited treatment options. OBJECTIVE: To investigate the effect of OKN-007 (also known as HPN-07), a nitrone-based investigational drug, in combination with oral N-acetylcycsteine (NAC), for the treatment of hearing loss and chronic tinnitus under an individual expanded access protocol...

The current high rate of urbanization in developing countries and its consequences, like traffic congestion, slum development, scarcity of resources, and urban heat islands, raise a need for better Land Use Land Cover (LULC) classification mapping for improved planning. This study mainly deals with two objectives: 1) to explore the applicability of machine learning-based techniques, especially the Random forest (RF) algorithm and Support Vector Machine (SVM) algorithm as the potential classifiers for LULC mapping under different scenarios, and 2) to prepare a better LULC classification model for mountain terrain by using different indices with combination of spectral bands...

Here we report the results of a study on the association between drug delivery via intravenous route or intraosseous route in out-of-hospital cardiac arrest. Intraosseous drug delivery is considered an alternative option in resuscitation if intravenous access is difficult or impossible. Intraosseous uptake of drugs may, however, be compromised. We have performed a retrospective cohort study of all Danish patients with out-of-hospital cardiac arrest in the years 2016-2020 to investigate whether mortality is associated with the route of drug delivery...

Despite the complexity of hematopoietic cell transplantation in humans, researchers commonly perform intravenous or intrafemoral (IF) injections in mice. In murine models, this technique has been adapted to enhance the seeding efficiency of transplanted hematopoietic stem and progenitor cells (HSPCs). This paper describes a detailed step-by-step technical procedure of IF injection and the following bone marrow (BM) aspiration in mice that allows for serial characterization of cells present in the BM. This method enables the transplantation of valuable samples with low cell numbers that are particularly difficult to engraft by intravenous injection...

Ice IV is a metastable high-pressure phase of ice in which the water molecules exhibit orientational disorder. Although orientational ordering is commonly observed for other ice phases, it has not been reported for ice IV. We conducted in situ powder neutron diffraction experiments for DCl-doped D2 O ice IV to investigate its hydrogen ordering. We found abrupt changes in the temperature derivative of unit-cell volume, d V /d T , at ∼120 K, and revealed a slightly ordered structure at low temperatures based on the Rietveld method...

BACKGROUND: The authors report a case of symptomatic cavernous sinus (CS) dural arteriovenous fistula (dAVF) that was successfully treated using direct puncture of the superior ophthalmic vein (SOV) with craniotomy. CS dAVF is commonly treated using transvenous embolization (TVE), with the most common access route via the inferior petrosal sinus (IPS). However, this route is sometimes unavailable because of an occluded, hypoplastic, aplastic, or tortuous IPS. The SOV is an alternative, albeit tortuous and long, route to the CS; therefore, direct SOV puncture is occasionally performed...

Placement of peripheral intravenous catheters (PIVCs) is a frequent occurrence. Yet, PIVCs consistently require multiple attempts for successful cannulation, leading to an increased use of resources and risk of complications. Even though hospitals have established vascular access teams to improve outcomes and increase longevity of PIVCs, not every facility has one, and some struggle to meet demand. In these cases, PIVC placement depends on the confidence and skills of bedside nurses. Difficult access risk identification tools, as well as vein visualization technologies, like near infrared (nIR), have been developed to assist nurses with cannulation...

OBJECTIVE: To demonstrate a novel surgical technique using hysteroscopic lysis of adhesions after interventional radiology (IR)-guided access in patients with severe intrauterine adhesions and challenging uterine access. DESIGN: This video illustrates the technique of the safe division of intrauterine adhesions after IR-guided access. SETTING: Conventional hysteroscopic adhesiolysis might be inadequate or risky in cases of severely narrowed or obstructed uterine flow tract, possibly resulting in incomplete adhesiolysis, false passages, or uterine perforation...

There is increased risk of cardiovascular disease in patients with rheumatoid arthritis. Primary cardiovascular disease prevention in rheumatoid arthritis patients is difficult, especially in those with high disease activity. According to current evidence, people with rheumatoid arthritis can significantly improve clinical indices and patient-reported outcomes by engaging in organized physical activity such as resistance training and aerobic activities. Additionally, participating in an exercise regimen can lower the risk of experiencing cardiovascular problems...

Establishing intravenous (IV) access in younger patient populations via the traditional cannulation technique for procedures requiring anesthesia is often challenging. Infrared (IR) vein visualization is a modality that aids venous cannulation; however, few reports of this technique exist in the infant and toddler population. The primary aim of this study was to compare the efficacy of IR vein visualization to the standard cannulation technique for obtaining peripheral IV access in infant and toddler populations...

Extravasation of iodinated contrast material (ICM) is an uncommon complication (0.1%-1.2%) following intravenous injection for computed tomography exams and other procedures. Most cases of contrast extravasation are mild and resolve without treatment. Alternative injections sites are occasionally necessary among patients with difficult vascular access and are at increased risk of contrast extravasation and subsequent complications compared to the antecubital fossa. We describe a rare case of airway compromise necessitating intubation following iodinated contrast extravasation from an external jugular IV line...

Patients with sickle cell disease require frequent venous access for red blood cell exchange transfusions to manage their condition. Such frequent access can lead to scar tissue formation, increased pain on insertion, and difficult vascular access for the patients. Previous attempts at achieving successful venous access for patients with difficult venous access has been made with central venous lines, usually femoral lines, which required a large amount of nursing input and resulted in anxiety and pain on insertion for patients...

INTRODUCTION: In 2016, a 263-bed public district hospital in California trialed a peripheral intravenous catheter (PIVC) inserted using ultrasound, with the potential to increase first attempt success in difficult intravenous access (DIVA) patients. This led to the implementation of a hospital-wide initiative to improve nursing vascular access skills and expedite vascular access device (VAD) placement. METHODS: To trial a PIVC and ultrasound-guided (USG) insertion, a training program was developed and led to a doctoral Capstone project piloting an evidence-based nurse-driven protocol for the identification of DIVA patients...

Bacterial infections in people who inject drugs (PWID) are a significant cause of hospitalizations and increased morbidity in this group. In this review, we evaluated bacterial trends in the most common infections and appropriate empiric antibiotic coverage. Articles from PubMed and Google Scholar were curated in a Google document with shared access. Discussion and development of the paper were achieved over Zoom meetings. The common infections in PWID were skin and soft tissue infections (SSTIs), infective endocarditis, septic arthritis, osteomyelitis, and bloodstream infections (BSIs)...

Refractory delirium is a complex, often underdiagnosed, and difficult-to-treat phenomenon. It poses significant challenges to healthcare providers, especially in patients without prior intravenous access. In extreme cases, anesthetic management may be needed to treat refractory delirium. Here, we present a unique case of postoperative hyperactive refractory delirium in a patient without intravenous access, ultimately requiring anesthetic management for resolution.

BACKGROUND: Disparities in the availability of reperfusion services for acute ischaemic stroke are considerable globally, and require urgent attention. Contemporary data on the availability of reperfusion services in different countries provide the necessary evidence to prioritise where access to acute stroke treatment is needed. AIMS: To provide a snapshot of published literature on the provision of reperfusion services globally, including when facilitated by telemedicine or mobile stroke unit services...

Wounds are difficult to treat in patients with diabetes, affecting their quality of life (QoL) and requiring a multidisciplinary approach to their treatment. In addition to systemic treatments such as intravenous antibiotics and debridement, local therapies used in appropriate cases help prevent situations that may result in the need for amputation. Boric acid, an easily accessible agent in local wound care, was considered for use in wounds because of its bactericidal and fungicidal properties, as well as its positive effects on angiogenesis, collagen synthesis and re-epithelialisation...

BACKGROUND AND AIMS: The practice patterns for airway management vary among anaesthesiologists, depending on various setups and geographical divides. This survey assessed practice patterns in unanticipated difficult intubation and cannot intubate or cannot ventilate (CICV) situations/complete ventilation failure among Indian anaesthesiologists'. METHODS: A validated questionnaire of 22 items related to practice preferences for airway management among anaesthesiologists was sent to Indian Society of Anaesthesiologists members online through Google Forms and distributed manually to delegates in continuing medical education programme...