Snare-assisted vascular access: A new technique

Access to the central circulation can be difficult in small infants, particularly when normal anatomic landmarks have been altered. We describe a new technique that utilizes any existing central catheter to establish additional sites of vascular access. A 4 Fr end hole catheter is advanced under fluoroscopic guidance to the desired site of new vascular access. A 10-mm Amplatz snare catheter is advanced through the end hole catheter and the loop opened within the target vessel lumen. The snare is then used to guide percutaneous placement of a Cope wire through a 21-gauge needle and then to pull the wire into the central circulation. New access is then achieved by introducing an additional catheter over the guidewire. This technique has now been successfully utilized 16 times in 13 patients. Snare assistance is a safe and effective technique that provides a reliable means of establishing additional secure vascular access. Cathet. Cardiovasc. Intervent. 47:315–318, 1999. © 1999 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/35244/1/13_ftp.pd

Concurrent Heart Rate and Energy Expenditure Validity of Polar Verity Sense Devices During Light and Moderate Intensity Resistance Training in Recreationally Active Adults: A Pilot Study

Wearable technology is again the top fitness trend from ACSM for 2024. Our lab recently found that bicep-worn devices (Polar Verity Sense) are valid for measuring average/maximal heart rate (HR) but are not valid for estimating energy expenditure (EE) during acute resistance exercise training (RT). We postulated that the errors may have been due to the device’s algorithms assuming higher intensity during RT, but no study has directly tested these outcomes with various RT intensities. PURPOSE: To determine the concurrent validity of identical Polar Verity Sense bicep-devices to record valid measures of average and maximal HR as well as estimated EE following light and moderately heavy RT. METHODS: Twelve recreationally active adults (n=5 females, n=7 males, age: 29.9±7.5 yrs; mass: 87.7±27.6 kg; height: 178.1±12.1 cm) completed 4 sets of 6 repetitions of the deadlift exercise at a light (3-4 on 0-10 RPE scale) and moderately heavy (6-8 on 0-10 RPE scale) intensity (8 total sets), with 1-1.5 min. rest between sets. Two Polar Verity Sense devices were evaluated, along with the Polar H10 chest strap (average/maximal HR criterion) and Cosmed K5 portable metabolic cart (EE criterion). Data were analyzed for validity (Mean Absolute Percent Error [MAPE] and Lin’s Concordance Coefficient [CCC]), with predetermined thresholds of MAPE\u3c10% and CCC\u3e0.70 (n=6 participants). A two-way ANOVA was used to determine differences between identical Polar devices, p\u3c0.05 (n=12 participants). RESULTS: Independent of intensity condition, there were no differences between Verity #1 or #2 for average HR (p=0.85), maximal HR (p=0.58), or EE (p=0.52). Polar verity #1 and #2 were valid for light intensity average/maximal HR (MAPE range: 3.3-4.8%; CCC range: 0.89-0.95) but were only approaching validity for moderate intensity average/maximal HR (MAPE range: 7.9-10.6%; CCC range: 0.60-0.75). Moreover, neither device was valid for estimating EE at light (MAPE range: 45.4-51.0%; CCC range: 0.59-0.64) or moderate (MAPE range: 45.0-53.6%; CCC range: 0.48-0.58) intensities. CONCLUSIONS: The wearable bicep-worn devices tested herein can be utilized for measuring average/maximal HR but should not be utilized for accurate measurements of EE during RT at various intensities, and identical devices provide similar readouts for these parameters

Improving the Patient Experience in Pediatric Pulmonary and Sleep Medicine

As of January 2013, Intermountain Patient Perceptions of Quality Score for "How would you rate the overall quality of care and services you received?" PCMC: 70.6/100 Riverton: 63.2/100 As of April 2013, experienced average room turns/hour at < 0.50, compared to Department expected of 1.25 to 1.50; As of April 2013, posted a ($381K) YTD revenue variance, when compared to FY13 YTD budget; As of April 2013, operated at a$524K loss without Department subsidy; As of April 2013, produced clinically at 58% of expected, compared to AAAP median wRVUs, adjusted for cFTE; Ran new patient lag at 24 days, compared to a Department goal of <14 days; Scheduled half day clinics are 300 less than Departmental expectation for equivalent faculty cFTEs

Safety of endomyocardial biopsy in children

Endomyocardial biopsy in children remains important in the evaluation of cardiomyopathy, myocarditis, and rejection following cardiac transplantation. We sought to evaluate the morbidity associated with endomyocardial biopsy on the basis of a large experience from a single institution.We reviewed records of all endomyocardial biopsies performed at our institution. Complications were defined as adverse events resulting from the biopsy requiring intervention or additional observation. We also reviewed the most recent echocardiogram from all the patients for the presence and severity of tricuspid valvar regurgitation.Between November 1986 and April 2002, we performed 1051 endomyocardial biopsies in 135 patients ranging in age from 9 days to 18 years. The internal jugular vein was the site of vascular access in 68% of the procedures. There were 10 acute procedural complications requiring intervention or additional observation. Severe tricuspid regurgitation developed in two patients who had undergone multiple biopsies after cardiac transplantation, one of whom underwent subsequent replacement of the tricuspid valve. There were no deaths or cardiac perforations. The total incidence of morbidity was 1.1%. No demographic or procedural factors were identified to be predictive of complications.In experienced hands, therefore, endomyocardial biopsy can be safely performed in children with very low morbidity.</jats:p