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Tip Position (tip + position)
Selected AbstractsRoutine chest X-ray is not required after a low-risk central venous cannulationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009A. PIKWER Background: Knowledge of the radiographic catheter tip position after central venous cannulation is normally not required for short-term catheter use. Detection of a possible iatrogenic pneumothorax may nevertheless justify routine post-procedure chest X-ray. Our aim was to design a clinical decision rule to select patients for radiographic evaluation after central venous cannulation. Methods: A total of 2230 catheterizations performed using external jugular, internal jugular or subclavian venous approaches during a 4-year period were included consecutively. Information on patient data and corresponding procedures was recorded prospectively. A post-procedure chest X-ray was obtained after each cannulation. Results: Thirteen cases (0.58%) of cannulation-associated pneumothorax were identified. The risk of pneumothorax after a technically difficult (1.8%) or subclavian (1.6%) cannulation was significantly higher than after cannulation not considered as difficult (0.37%) or performed using other routes (0.33%). Clinical signs of pneumothorax within 8 h of cannulation were found in all seven patients with pneumothorax requiring specific treatment. A new clinical decision rule for radiographic evaluation after central venous cannulation based on the results of the present study shows that 48% of the post-procedure chest X-rays performed in our patients were clinically redundant. Conclusion: Clinical symptoms were reported in all patients with pneumothorax requiring specific treatment. Approximately half of the post-procedure chest X-ray controls could be avoided using the proposed clinical decision rule to select patients for radiographic evaluation after central venous cannulation. A large prospective multi-centre study should be carried out to further evaluate this decision rule. [source] Fuzzy control of robot manipulator with a flexible toolJOURNAL OF FIELD ROBOTICS (FORMERLY JOURNAL OF ROBOTIC SYSTEMS), Issue 7 2005Aria Alasty In some tasks, a rigid robot manipulator handles a long, slender, and flexible tool, which usually has not been equipped with vibration measuring devices. This situation makes a different tool tip position control problem. In this paper, a new method will be presented for simultaneous tip position and vibration suppression control of a flexible tool on a rigid-link 3-DOF robot. This approach uses fuzzy logic rule-based controllers without using any sensors and actuators on the tool or a priori knowledge about the tool. Numerical simulation of robot and tool set has been accomplished and results support the fact that designed fuzzy controllers perform remarkably well in reducing vibrations and precision guidance of robot tool tip for tracking various trajectories. © 2005 Wiley Periodicals, Inc. [source] Variation in identifying neonatal percutaneous central venous line positionJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9-10 2004DE Odd Objective: The study objective was to obtain data on interpretation, including intra and interobserver variation and action taken for a given line tip location, for a series of radiographs demonstrating neonatal long lines. Methods: Nineteen radiographs taken to identify line tip position were digitized and published on an internet site. One film was included twice in order to assess intraobserver variation giving a total of 20 images. Fourteen used radio-opaque contrast and five no contrast. Australian and New Zealand Neonatal Network members and National Women's Hospital NICU staff were invited to participate in the study. For each radiograph, participants were asked to identify if long line tip could be identified, the likely anatomical position and desired action. Interobserver agreement was assessed by the maximum proportion of agreement per radiograph and by the number of different options selected. Intraobserver agreement was assessed by comparing the two reports from the duplicate radiograph. Results: Twenty-seven responses were received. Overall, 50% of the reports stated that the long line tips could be identified. The most commonly reported position was in the right atrium (31%) and most commonly reported action was to pull the line back (53%). The median agreement of whether the line was seen was 68%, agreement on position 62% and agreement on action 86%. On analysis of intraobserver variability, from the identical radiographs, 27% of respondents differed on whether the line tip could be visualized. Conclusion: Interobserver and intraobserver reliability was poor when using radiographs to assess long line tips. The major determinant of line repositioning was the perceived location. [source] (634) Reliability and Clinical Utility of an Implanted Intraspinal Catheter Used in the Treatment of Spasticity and PainPAIN MEDICINE, Issue 2 2000Article first published online: 25 DEC 200 Authors: Elliot Krames, Pacific Pain Treatment Center; Iva Chapple, Carolina Pain Center Objectives: To examine the performance and reliability of a redesigned implantable intrathecal catheter. Materials: A total of 212 catheters were implanted in 202 patients in this 22-center, prospective study of an implantable catheter/pump system used to deliver intrathecal drugs for the treatment of pain and spasticity. Along with physician assessments of each use, the rates of common catheter complications (dislodgements, disconnections, fractures, and kinks) experienced during the study were analyzed in relation to implant conditions (catheter entry site, tip position, and anchoring method). Results: A cumulative study of 3112.8 months of patient experience (average: 15.4 months; range: 0 to 30.2 months per catheter) revealed an overall catheter-caused complication rate of 0.3% per patient month. Physician assessments were favorable, with 89% rating this catheter as better than previously used intraspinal catheters. A measure of catheter survival estimates (Kaplan-Meier) at 9 months was 89% including all complications. Comparison of data relating to implant techniques demonstrated a variety of catheter implant techniques (entry, positioning, anchoring) with no correlation between any one technique and the common complications. Conclusions: Performance data and physician assessments indicate that this catheter is an improvement over the previously available catheter. [source] Tracheal tube fixation: the effect on depth of insertion of midline fixation compared to the angle of the mouth,ANAESTHESIA, Issue 4 2009K. Sharma Summary Following successful placement of a tracheal tube (TT), it is frequently moved from the midline to the angle of the mouth. This study investigates the tracheal tube tip position in the two fixation positions in 200 adult patients. Following tracheal intubation, a fibreoptic bronchoscope (FOB) was introduced through a swivel connector and the distances from the swivel connector to the lips, carina, tip of TT and the crico-tracheal membrane were measured with the TT in the midline and at the right angle of the mouth. The mean (SD) TT tip to carinal distance decreased from 3.60 (1.50) cm to 2.28 (1.55) cm in female patients, and 5.04 (1.43) cm to 3.69 (1.65) cm in male patients on moving the tracheal tube to the angle of the mouth. We conclude that there is a significant movement of the tracheal tube towards the carina on moving the TT from midline to angle of mouth and the depth of insertion of the tube should be adjusted accordingly. [source] | ||||||||||