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PURPOSE: Diagnostic computed tomography (CT) imaging, utilizing intravenous (IV) contrast administration, has become increasingly common. Potential IV contrast-associated complications include local skin and soft tissue reactions due to extravasation. The goal of this study is to describe the risk of contrast extravasation based on IV catheter anatomic location in patients receiving contrast-enhanced CT imaging. METHODS: The study was conducted as a retrospective cohort study of patients receiving contrast-enhanced CT imaging performed over a 26-month period at a single institution. The rate of contrast extravasation was calculated by IV catheter vessel anatomic location and compared by relative risk (RR) and absolute risk reduction (ARR). RESULTS: Of 17,767 contrast administrations for CT imaging studies performed, 14,558 met study inclusion criteria. Forty-nine (0.34%) extravasation events were identified. Forty-one (0.28%, 95% CI 0.21-0.39%) extravasation events were observed in 14,275 peripheral IV catheters placed in a non-upper arm location. Eight (2.8%, 95% CI 1.3-5.3%) extravasation events were observed in 283 IV catheters placed, most commonly with point-of-care ultrasound (POCUS) guidance, in upper arm vessels (RR 10.1, 95% CI 4.69-21.8). Non-upper arm located IV catheters were associated with an ARR of 2.54% (95% CI 0.61-4.47%) when compared to upper arm catheters. CONCLUSIONS: IV catheter placement in upper arm vessels is associated with a relatively minimal increase in extravasation risk when compared to catheters placed in a non-upper arm location. In patients without alternative available peripheral vascular access, POCUS-guided upper arm IV cannulation may be an appropriate approach.
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Medios de Contraste/administración & dosificación , Extravasación de Materiales Terapéuticos y Diagnósticos , Tomografía Computarizada por Rayos X , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
INTRODUCTION: Point-of-care ultrasound (POCUS) education is a requirement of graduate medical education in EM. Milestones have been established to assess resident US competency. However, the delivery of POCUS education has not been standardized. This study aims to evaluate the impact of implementing a longitudinal, structured POCUS curriculum during EM residency on trainee competency and confidence. METHODS: A prospective study of PGY-3 trainees before and after implementation of a novel POCUS curriculum was performed over an 18-month period at an EM residency training program. Curriculum design included longitudinal POCUS application-based monthly electronic content, bi-monthly residency conference sessions, and hands-on rotations. PGY-3 resident's POCUS knowledge was assessed with a 38-question multiple-choice and image-based exam. Further, PGY-3 residents were surveyed regarding POCUS confidence. Survey results evaluated provider confidence, satisfaction with the novel curriculum, and overall perception of POCUS utility scored on a 1 (low) to 5 (high) scale. Results were evaluated using an unpaired t test for data analysis. RESULTS: Mean quiz scores of 8 pre-curriculum PGY-3 residents (84%; 95%CI 78.46-89.54) were not significantly different when compared with 13 post-curriculum PGY-3 residents (82%; 95%CI 77.11-86.89) (p = 0.6126). Survey results for pre-curriculum trainees across each section were 4.13 (95%CI 3.91-4.35), 3.68 (95%CI 3.32-4.04), and 4.33 (95%CI 4.06-4.6). Results for post-curriculum trainees trended higher for each section at 4.22 (95%CI 4.04-4.40) (p = 0.4738), 3.84 (95%CI 3.52-4.16) (p = 0.5279), and 4.49 (95%CI 4.21-4.77) (p = 0.4534). CONCLUSIONS: Implementation of a structured, longitudinal POCUS curriculum resulted in a trend towards improved trainee confidence, satisfaction, and perception of POCUS. Future studies are needed to identify the optimal structure for POCUS educational content delivery and competency assessment for EM resident providers.
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Competencia Clínica , Curriculum/normas , Educación de Postgrado en Medicina , Medicina de Emergencia/educación , Sistemas de Atención de Punto , Ultrasonografía/normas , Adulto , Evaluación Educacional , Humanos , Internado y Residencia , Evaluación de Programas y Proyectos de Salud , Estudios ProspectivosRESUMEN
The ability of smaller than 100 nm antibody (Ab) nanoparticle conjugates to target and modulate the biology of specific cell types may enable major advancements in cellular imaging and therapy in cancer. A key challenge is to load a high degree of targeting, imaging, and therapeutic functionality into small, yet stable particles. A versatile method called thin autocatalytic growth on substrate (TAGs) has been developed in our previous study to form ultrathin and asymmetric gold coatings on iron oxide nanocluster cores producing exceptional near-infrared (NIR) absorbance. AlexaFluor 488 labeled Abs were used to correlate the number of Abs conjugated to iron oxide/gold nanoclusters (nanoroses) with the hydrodynamic size. A transition from submonolayer to multilayer aggregates of Abs on the nanorose surface was observed for 54 Abs and an overall particle diameter of â¼60-65 nm. The hydrodynamic diameter indicated coverage of a monolayer of 54 Abs, in agreement with the prediction of a geometric model, by assuming a circular footprint of 16.9 nm diameter per Ab molecule. The targeting efficacy of nanoclusters conjugated with monoclonal Abs specific for epidermal growth factor receptor (EGFR) was evaluated in A431 cancer cells using dark field microscopy and atomic absorbance spectrometry (AAS) analysis. Intense NIR scattering was achieved from both high uptake of nanoclusters in cells and high intrinsic NIR absorbance of individual nanoclusters. Dual mode imaging with dark field reflectance microscopy and fluorescence microscopy indicates the Abs remained attached to the Au surfaces upon the uptake by the cancer cells. The ability to load intense multifunctionality, specifically strong NIR absorbance, conjugation of an Ab monolayer in addition to a strong r2 MRI contrast that was previously demonstrated in a total particle size of only 63 nm, is an important step forward in development of theranostic agents for combined molecular specific imaging and therapy.