Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.24462/jnse.11.0_208

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1080/17434440.2024.2346191

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Abstract

Introduction

Non-invasive biofeedback of pelvic floor muscle training (PFMT) is required for continuous training in home care. Therefore, we considered self-performed ultrasound (US) in adult women with a handheld US device applied to the bladder. However, US images are difficult to read and require assistance when using US at home. In this study, we aimed to develop an algorithm for the automatic evaluation of pelvic floor muscle (PFM) contraction using self-performed bladder US videos to verify whether it is possible to automatically determine PFM contraction from US videos.

Methods

Women aged ≥ 20 years were recruited from the outpatient Urology and Gynecology departments of a general hospital or through snowball sampling. The researcher supported the participants in their self-performed bladder US and videos were obtained several times during PFMT. The US videos obtained were used to develop an automatic evaluation algorithm. Supervised machine learning was then performed using expert PFM contraction classifications as ground truth data. Time-series features were generated from the x- and y-coordinate values of the bladder area including the bladder base. The final model was evaluated for accuracy, area under the curve (AUC), recall, precision, and F1. The contribution of each feature variable to the classification ability of the model was estimated.

Results

The 1144 videos obtained from 56 participants were analyzed. We split the data into training and test sets with 7894 time series features. A light gradient boosting machine model (Light GBM) was selected, and the final model resulted in an accuracy of 0.73, AUC = 0.91, recall = 0.66, precision = 0.73, and F1 = 0.73. Movement of the y-coordinate of the bladder base was shown as the most important.

Conclusion

This study showed that automated classification of PFM contraction from self-performed US videos is possible with high accuracy.

DOI： 10.1186/s12905-024-03041-y

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Other Link： https://link.springer.com/article/10.1186/s12905-024-03041-y/fulltext.html

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Mark Allen Group  

Objective:

We implemented augmented reality (AR) in remote consultations for enhanced pressure injury (PI) care in homecare nursing and improved the efficiency of on-site technical education for homecare nurses. The study aimed to depict expert techniques using AR technology to improve PI healing time in a male patient.

Method:

We developed and implemented a new system that combines a transparent hand with an image and gives an output as a video image in the existing remote consultation software. The system was used to support remote care of PIs by nurses.

Results:

We succeeded in superimposing the expert nurse's nonverbal hand gestures onto the patient's wound in real time. The visiting nurse's understanding of the system had improved and there was an improvement in the patient's PI healing.

Conclusion:

These results suggest that remote consultation using AR is effective to observe precise wound care demonstrations of the steps of the PI treatment and provide effective treatment.

DOI： 10.12968/jowc.2023.32.sup8.clxvi

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SAGE Publications  

Background:

Ultrasound guidance increases the success rate of peripheral intravenous catheter placement. However, the longer time required to obtain ultrasound-guided access poses difficulties for ultrasound beginners. Notably, interpretation of ultrasonographic images is considered as one of the main reasons of difficulty in using ultrasound for catheter placement. Therefore, an automatic vessel detection system (AVDS) using artificial intelligence was developed. This study aimed to investigate the effectiveness of AVDS for ultrasound beginners in selecting puncture points and determine suitable users for this system.

Methods:

In this crossover experiment involving the use of ultrasound with and without AVDS, we enrolled 10 clinical nurses, including 5 with some experience in peripheral intravenous catheterization using ultrasound-aided methods (categorized as ultrasound beginners) and 5 with no experience in ultrasound and less experience in peripheral intravenous catheterization using conventional methods (categorized as inexperienced). These participants chose two puncture points (those with the largest and second largest diameter) as ideal in each forearm of a healthy volunteer. The results of this study were the time required for the selection of puncture points and the vein diameter of the selected points.

Results:

Among ultrasound beginners, the time required for puncture point selection in the right forearm second candidate vein with a small diameter (<3 mm) was significantly shorter when using ultrasound with AVDS than when using it without AVDS (mean, 87 vs 247 s). Among inexperienced nurses, no significant difference in the time required for all puncture point selections was found between the use of ultrasound with and without AVDS. In the vein diameter, significant difference was shown only in the absolute difference at left second candidate among inexperienced participants.

Conclusion:

Ultrasonography beginners needed less time to select the puncture points in a small diameter vein using ultrasound with AVDS than without AVDS.

DOI： 10.1177/11297298231156489

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Other Link： http://journals.sagepub.com/doi/full-xml/10.1177/11297298231156489

Language：Japanese   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

皮膚・排泄ケア認定看護師(WOCN)の資格をもちWOC領域の専門外来に従事している11名にアンケートとインタビューを行い、以下の項目について調査した結果を報告した。1)実施している特定行為の内容。2)従事している専門外来の概要。3)同行訪問の状況。4)専門外来における診療報酬の算定。5)専門外来におけるアウトカム評価。6)主治医との連携。7)病棟との連携。8)訪問看護師との連携。9)在宅医療との連携。10)高齢者施設との連携。11)施設管理職との関係性。12)所属する施設の組織体制。13)所属施設での環境調整。14)施設の医師との関係性。15)施設の職員との関係性。16)複数のWOCN間の連携。17)WOCNの業務の調整。18)物品の調達。19)専門外来におけるWOCNの存在意義。20)専門外来におけるWOCNの役割。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J05543&link_issn=&doc_id=20230203450011&doc_link_id=%2Fdv9etwoc%2F2022%2F002604%2F011%2F0396-0416%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdv9etwoc%2F2022%2F002604%2F011%2F0396-0416%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/jjns.12496

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/jjns.12496

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES: Complications due to peripheral intravenous catheters (PIVC) can be assessed using ultrasound imaging; however, it is not routinely conducted due to the need for training in image reading techniques. This study aimed to develop and validate a system that automatically measures blood vessel diameters on ultrasound images using artificial intelligence (AI) and provide recommendations for selecting an implantation site. DESIGN: Pilot study. SETTING: The University of Tokyo Hospital, Japan. PRIMARY AND SECONDARY OUTCOME MEASURES: First, based on previous studies, the vessel diameter was calculated as the mean value of the maximum long diameter plus the maximum short diameter orthogonal to it. Second, the size of the PIVC to be recommended was evaluated based on previous studies. For the development and validation of an automatic detection tool, we used a fully convoluted network for automatic estimation of vein location and diameter. The agreement between manually generated correct data and automatically estimated data was assessed using Pearson's product correlation coefficient, systematic error was identified using the Bland-Altman plot, and agreement between catheter sizes recommended by the research nurse and those recommended by the system was evaluated. RESULTS: Through supervised machine learning, automated determination was performed using 998 ultrasound images, of which 739 and 259 were used as the training and test data set, respectively. There were 24 false-negatives indicating no arteries detected and 178 true-positives indicating correct detection. Correlation of the results between the system and the nurse was calculated from the 178 images detected (r=0.843); no systematic error was identified. The agreement between the sizes of the PIVC recommended by the research nurse and the system was 70.2%; 7% were underestimated and 21.9% were overestimated. CONCLUSIONS: Our automated AI-based image processing system may aid nurses in assessing peripheral veins using ultrasound images for catheterisation; however, further studies are still warranted.t.

DOI： 10.1136/bmjopen-2021-051466

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

There are two types of pressure injuries: self-load-related pressure injuries (PIs) and medical device-related pressure injuries (MDRPIs), but the differences in risk factors between PIs and MDRPIs have not yet been clarified. If risk factors for PIs and MDRPIs differ, preventive interventions should take this into account. This is a prospective cohort study aimed to determine the cumulative incidence of PIs and MDRPIs in critically ill patients and to identify corresponding risk factors. The study included 1418 patients who were admitted to the critical care medical center of a single university hospital in Tokyo, Japan, between 1 December 2019 and 31 August 2020. The Kaplan-Meier method was used to calculate the cumulative incidence of PIs and MDRPIs. Furthermore, the Cox proportional hazards model was used to analyse the predictors in both the PI and MDRPI incidence and non-incidence groups. Predictors were based on data from the 0th disease day. The cumulative incidence of PIs and MDRPIs was 4.6/1000 person-days and 3.6/1000 person-days, respectively. Multivariate analysis using the Cox proportional hazards model showed that common risk factors for the occurrence of PIs and MDRPIs were possession of PI on admission, higher blood lactate, blood purification therapy, and positional restriction. The risk factors for PIs only were diabetes mellitus, septic shock, and a lower serum albumin level, while the risk factors for MDRPIs only were the D-dimer level and extracorporeal membranous oxygenation treatment. Therefore, prophylactic interventions need to consider these different risk factors.

DOI： 10.1111/wrr.13022

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Research and Cooperation Association for Bio & Socio-Sciences Advancement (IRCA-BSSA)  

This study aimed to determine whether the placement of a peripheral intravenous catheter (PIVC) in the cephalic vein of the forearm could prevent PIVC failure in patients receiving hyperosmotic drugs through the peripheral vein. This retrospective cohort study included patients aged ≥ 20 years who had received infusion therapy via a PIVC in our institution between July and November 2017. Patients were divided into groups according to PIVC insertion into the cephalic, basilic, and medial veins. PIVCs used to administer drugs with osmotic pressure ratios > 2.0 were included. The primary outcome was survival time to catheter failure. Catheter failure was defined as accidental and unplanned catheter removal. We set the cephalic vein and other veins, including the medial and basilic veins, in the forearm as cohort groups. We used the Kaplan-Meier survival curves to compare the time until catheter failure in the cohort groups. The Cox proportional hazard models were fitted, and the hazard ratios were calculated. A total of 46 catheters with hyperosmotic agents were included in the analysis. Catheter failure was observed in 25 (54.3%) cases. Time to catheter failure in patients receiving high-dose drugs via the cephalic vein was significantly longer than that in the other two groups (p < 0.01). Thus, the cephalic vein, which has a high blood flow, is the ideal site of PIVC insertion in patients receiving high drug concentrations to prevent catheter failure.

DOI： 10.5582/ddt.2021.01080

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Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.ijnurstu.2021.103932

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Language：English   Publishing type：Research paper (scientific journal)  

Nurse call data may be used to evaluate the quality of nursing. However, traditional frequency-based statistics may not easily apply to nurse calls due to the large individual variability and daily call changes. We intended to propose a probabilistic modeling of nurse calls based on Bayesian statistics. We constructed the model including nurse call daily changes, individual variability, and adjustment according to characteristics (age and sex). Nurse call differences after surgery were analyzed based on data from the orthopedic ward from April 2014 to October 2017. Results show that there were differences in nurse calls from day 1 to day 10 after surgery between patients who had undergone orthopedic surgery and those who had undergone other surgeries such as tumor surgery. Furthermore, there were differences in nurse calls from day 1 to day 8 after surgery between patients who used extra pain relief medicine and those who did not. Although the analysis required multiple comparisons regarding daily nurse call changes and fixed data samples per day, our approach using Bayesian statistics could detect the periods and significant differences. This indicates that our nurse call modeling based on Bayesian statistics may be used to analyze nurse call changes.

DOI： 10.1097/CIN.0000000000000712

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：看護理工学会  

末梢静脈カテーテル留置中は,患者の睡眠を含むさまざまな日常生活が妨げられる.本研究は末梢静脈にカテーテルが留置されることによる,睡眠への影響を明らかにすることを目的とした.大学病院の眼科病棟に入院し,翌日に手術予定で就床前に末梢静脈カテーテルが留置された患者を「留置群」(53人)とし,「非留置群」(55人)とともに,睡眠状態を観察した.睡眠パラメータの測定にはシート型体振動計,主観的睡眠感の調査には質問票を使用した.留置群,非留置群の間で,睡眠の質に違いは認められなかった.留置群の36.5%はカテーテルが気になり中途覚醒し,覚醒の理由で最も多かったのは「動きに伴う痛み」(63.2%)であった.留置群のサブグループ解析をしたところ,動きに伴う痛みを感じていた者は,感じていなかった者よりも,睡眠の断片化指標が有意に高く(p=0.004),主観的睡眠感が悪くなっていた.カテーテル留置群と,非留置群とを比較した場合,睡眠の質に違いは認められなかったが,カテーテルによって体動に伴う痛みを感じていた患者の睡眠の質には影響していた.(著者抄録)

DOI： 10.24462/jnse.8.0_134

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Language：English   Publishing type：Research paper (scientific journal)  

AIM: To estimate diagnostic accuracy of ultrasonography for detecting aspiration and pharyngeal residue in patients with dysphagia. METHODS: A systematic search was conducted in MEDLINE (via PubMed), CINAHL, EMBASE, Ichushi-Web, and Cochrane Library databases to identify articles that showed diagnostic accuracy of ultrasonography for detecting aspiration and residue published in English and Japanese until August 2019. Cross-sectional studies, case-control studies, and cohort studies were included. The diagnostic accuracy results were extracted and the pooled estimated sensitivity and specificity were calculated. The risk of bias of the studies was assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies 2. The certainty of the evidence was assessed using the Grades of Recommendation Assessment, Development, and Evaluation methodology. RESULTS: Five studies were included in this review. The pooled estimated sensitivity and specificity for detecting aspiration were 0.82 (95% CI: 0.72-0.89) and 0.87 (95% CI: 0.81-0.92), respectively. One study was included that evaluated ultrasound assessments of pharyngeal residue. The sensitivity and specificity were 0.62 (95% CI: 0.32-0.86) and 0.67 (95% CI: 0.22-0.96), respectively. The certainty of the evidence was low and very low for the diagnostic accuracy of aspiration and pharyngeal residue, respectively. CONCLUSION: Ultrasound is a non-invasive method with good sensitivity and specificity in detecting aspiration as well as reference standards. While risk of bias and small number of studies limited the strength of this systematic review, our results suggested that ultrasound examination was useful as a bedside screening tool for detecting aspiration.

DOI： 10.1111/jjns.12396

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Language：English   Publisher：看護理工学会  

末梢静脈カテーテル留置中は,患者の睡眠を含むさまざまな日常生活が妨げられる.本研究は末梢静脈にカテーテルが留置されることによる,睡眠への影響を明らかにすることを目的とした.大学病院の眼科病棟に入院し,翌日に手術予定で就床前に末梢静脈カテーテルが留置された患者を「留置群」(53人)とし,「非留置群」(55人)とともに,睡眠状態を観察した.睡眠パラメータの測定にはシート型体振動計,主観的睡眠感の調査には質問票を使用した.留置群,非留置群の間で,睡眠の質に違いは認められなかった.留置群の36.5%はカテーテルが気になり中途覚醒し,覚醒の理由で最も多かったのは「動きに伴う痛み」(63.2%)であった.留置群のサブグループ解析をしたところ,動きに伴う痛みを感じていた者は,感じていなかった者よりも,睡眠の断片化指標が有意に高く(p=0.004),主観的睡眠感が悪くなっていた.カテーテル留置群と,非留置群とを比較した場合,睡眠の質に違いは認められなかったが,カテーテルによって体動に伴う痛みを感じていた患者の睡眠の質には影響していた.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J06462&link_issn=&doc_id=20210304330003&doc_link_id=10.24462%2Fjnse.8.0_134&url=https%3A%2F%2Fdoi.org%2F10.24462%2Fjnse.8.0_134&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Authorship：Lead author   Publishing type：Research paper (scientific journal)  

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Language：English  

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Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Peripheral intravenous catheter failure is a significant concern in the clinical setting. We investigated the effectiveness of care protocols, including an ultrasonographic "pre-scan" for selecting a large-diameter vein before catheterization, a "post-scan" for confirming the catheter tip position after catheterization with ultrasonography, and the use of a flexible polyurethane catheter to reduce the mechanical irritation that contributes to the incidence of catheter failure. This intervention study was a non-randomized controlled trial to investigate the effectiveness of the abovementioned care protocols, the effects of which were compared to the outcomes in the control group, which received conventional care. For both groups, participants were selected from patients in two wards at the University of Tokyo in Japan between July and November 2017. Inverse probability score-based weighted methods (IPW) using propensity score were used to estimate the effectiveness of care protocols. The primary outcome was catheter failure, which was defined as accidental and unplanned catheter removal. We used Kaplan-Meier survival curves to compare rates of time until catheter failure. We analysed 189 and 233 catheters in the intervention and control groups, respectively. In the control group, 68 catheters (29.2%) were determined to have failed, whereas, in the intervention group, only 21 catheters (11.1%) failed. There was a significant difference between each group regarding the ratio of catheter failure adjusted according to IPW (p = 0.003). The relative risk reduction of the intervention for catheter failure was 0.60 (95% CI: 0.47-0.71). Care protocols, including assessment of vein diameter, vein depth, and catheter tip location using ultrasound examination for reducing mechanical irritation is a promising method to reduce catheter failure incidence.

DOI： 10.1038/s41598-019-56873-2

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Publishing type：Research paper (international conference proceedings)   Publisher：IEEE  

DOI： 10.1109/EMBC44109.2020.9176336

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Other Link： https://dblp.uni-trier.de/db/conf/embc/embc2020.html#NoguchiMKNTSM20

Publishing type：Research paper (international conference proceedings)   Publisher：IEEE  

DOI： 10.1109/EMBC44109.2020.9176256

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Other Link： https://dblp.uni-trier.de/db/conf/embc/embc2020.html#KangNNTSM20

Language：English   Publishing type：Research paper (scientific journal)  

Up to 50% peripheral intravenous catheters (PIVs) are removed prematurely because of failures. Catheter failure (CF) leads to replacement and is a great concern for patients and medical staff. It is known that visualization of catheters and vessels with ultrasonography (US) during placement prevents CF. However, US is not a common technique for general nurses. In order to standardize US-assisted PIV placement techniques, an algorithm is needed. This study aimed to develop an algorithm using US-assisted PIV placement to reduce CF rate. Furthermore, to evaluate the effectiveness of the algorithm, CF rates were compared before and after intervention. A pretest-posttest study was performed. The intervention was PIV placement by 23 nurses undergoing training sessions for the algorithm. Intention to treat, per protocol analyses were applied. Logistic regression analysis was used for factor analysis. The CF rate in the pre-intervention group 35.2% (19/54) did not significantly differ from post-intervention group 33.6% (48/143) (p = 0.831), yet significantly differ from complete algorithm-use group 8.7% (2/23; p = 0.017). In factor analysis, compliance to the algorithm was significantly correlated with CF (p = 0.032). The compliance rate was low 16.1% (23/143). Algorithm compliance reduced CF by confirming appropriate catheter tip position from the insertion to the securement phase. This algorithm effectively reduced CF, however, the compliance rate was unacceptable. In order to increase the compliance rate, modified algorithm and new visualizing technology is required.

DOI： 10.5582/ddt.2019.01094

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Language：Japanese   Publisher：(一社)日本医療情報学会  

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.2309/j.java.2019.002.007

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Few studies have investigated the molecular mechanisms of catheter failure (CF). Herein, we performed histological and molecular biological analyses of the catheter tip to demonstrate its potential as a resource for biological investigation. Additionally, we searched for risk factors for the development of inflammation and coagulation, which are pathological conditions clarified by biological analysis. The CF group included 30 failed catheters involving thrombus and subcutaneous edema identified by ultrasonography. The No-CF group included 26 catheters with no complications. The removed catheter tips were fixed for hematoxylin-eosin (HE) staining with the application of a real-time reverse transcriptase polymerase chain reaction for eukaryotic 18S ribosomal RNA (rRNA), interleukin 1β, tumor necrosis factor α, tissue plasminogen activator, and plasminogen activator inhibitor 1 (SERPINE1). HE staining identified attached nuclear cells on the inner surfaces of both CF and No-CF catheters. The 18S rRNA was amplified in all samples. The expression level of SERPINE1 was significantly higher in the CF group than in the No-CF group (p = 0.01), whereas the expression levels of other genes did not differ between the groups. Symptoms of CF associated with the expression of SERPINE1 were analyzed. The catheter being in contact with blood vessels during placement was a suggested factor related to the high expression of SERPINE1 (p = 0.04). Catheter tips are a potential resource for biological investigation, and expression analysis of the attached cells can reflect the pathological condition of the catheterized tissue. Further studies using catheter tips are required to elucidate the molecular mechanisms of CF.

DOI： 10.5582/ddt.2019.01073

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Authorship：Lead author   Publishing type：Research paper (scientific journal)   Publisher：The Society for Nursing Science and Engineering  

&emsp;This study aimed to describe the relationship between inappropriate conditions due to multiple puncture attempts for catheterization and thrombus formation with subcutaneous edema at catheter failure by qualitative analysis and ultrasonography. Seven categories were extracted, and two stories were identified using qualitative-descriptive analyses. First, when attempting multiple insertions, ＜puncture sites＞ were chosen, such as the ulnar side and dorsum of the hand, while ＜visual judgment of target vein＞ was difficult, and the ＜posture at insertion＞ was contorted. The catheters were not inserted parallel to the sagittal plane, and the echo image confirmed that ＜intravascular position of catheter tip＞ were not parallel to the vessels. Second, with IV cannulation on the radial side, during manipulation of the ＜securement by dressing films＞, the mesh part of the IV dressing covered the connector area and caused it to sink into the patient's skin in the ＜peripheral condition of the hubs/connectors attached to the apparatus＞. These phenomena were observed in many echo images in which the tip of the catheter was placed in the upstream direction of the blood vessels. Our results suggested that the posture of the body during insertion and the securement methods could affect thrombus and edema formation, since mechanical stimuli affected the blood vessels and subcutaneous tissue.

DOI： 10.24462/jnse.5.1_2

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Other Link： http://search.jamas.or.jp/link/ui/2018185675

Language：English   Publishing type：Research paper (scientific journal)  

The risk of peripheral intravenous catheter failure varies according to the insertion site. This study examined catheter shape just after removal to evaluate the causes of catheter failure according to site. This study was a secondary analysis of previous study data. Our observational study was conducted during a 6-month period at The University of Tokyo Hospital. Participants were hospitalized adults who received infusion therapy via a short peripheral catheter. We acquired ultrasound images of blood vessels and surrounding tissues at the catheter insertion site before catheter removal and clinical images of the removed catheters. We analyzed 184 catheters from 142 participants. There were no significant differences in the catheter failure rate (29.9%) among insertion sites. Curvature in the middle of the catheter was present in 9.2% of cases; the median bend angle at the catheter base was 9.1° (range: 0.0°-68.3°). The bend angle of catheters inserted in the upper arm was significantly greater than of catheters in the forearm (p = 0.013). Catheter curvature was related to catheter failure (14.8% of failed catheters had curvature; p = 0.035) and occlusion (35.3% of occluded catheters had curvature; p = 0.008) in upper arm and forearm placements. The median distance from the elbow to the insertion site was shorter for failed catheters than for surviving catheters. To prevent catheter failure, especially occlusion resulting from catheter curvature, a catheter should be inserted at an appropriate insertion site far from the antecubital fossa.

DOI： 10.5582/ddt.2018.01024

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Purpose: Extravasation, or leakage of vesicant drugs into subcutaneous tissues, causes serious complications such as induration and necrosis in chemotherapy-treated patients. As macroscopic observation may overlook symptoms during infusion, we focused on skin temperature changes at puncture sites and studied thermographic patterns related to induration or necrosis caused by extravasation.
Methods: Outpatients undergoing chemotherapy using peripheral intravenous catheters were enrolled in this prospective observational study. We filmed and classified infrared thermography movies of puncture sites during infusion; ultrasonography was also utilized at puncture sites to observe the subcutaneous condition. Multiple logistic regression analysis was performed to examine the association of thermographic patterns with induration or necrosis observed on the next chemotherapy day. Differences in patient characteristics, puncture sites, and infusions were analyzed by Mann-Whitney's U test and Fisher's exact test according to thermographic patterns.
Results: Eight patients developed induration among 74 observations in 62 patients. Among six thermographic patterns, a fan-shaped lower temperature area gradually spreading from the puncture site (fan at, puncture site) was significantly associated with induration. Ultrasonography revealed that catheters of patients with fan at puncture site remained in the vein at the end of infusion, indicating that the infusion probably leaked from the puncture site. Patients with fan at puncture site had no significant differences in characteristics and infusion conditions compared with those with the other five thermographic patterns.
Conclusion: We determined that fan at puncture site was related to induration caused by extravasation. Continuous thermographic observation may enable us to predict adverse events of chemotherapy. (C) 2017 Published by Elsevier Ltd.

DOI： 10.1016/j.ejon.2017.02.009

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Authorship：Lead author   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/NAN.0000000000000216

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Lippincott Williams and Wilkins  

This prospective observational study was designed to clarify the rate of peripheral intravenous catheter, especially short peripheral catheter, failures among adult patients in medical and surgical wards. The study was conducted during a 2-month period at a university hospital in Tokyo, Japan. A total of 5316 catheters from 2442 patients were studied. The rate of catheter removal as a result of catheter failure was 18.8%. The reasons for removal in catheter failures were infiltration (41.3%) and pain (19.3%). Pain was a major reason for catheter failure and removal. For this reason, observing changes under the skin before signs and symptoms appear might help prevent catheter failures.

DOI： 10.1097/NAN.0000000000000168

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WICHTIG PUBLISHING  

Introduction: Peripheral intravenous catheters (PIVCs) are frequently removed due to phlebitis. We hypothesized that catheters made of polyurethane, which is more flexible than Teflon, would decrease phlebitis, and that flexibility could be estimated by measuring the catheter-tip angle. Ultrasonography in two groups of patients with different catheter types was then used to compare catheter-tip angles and phlebitis.
Methods: Observational studies were carried out at a medical ward in a university hospital. Infusion therapy was administered to one group of patients in 2014 using Teflon catheters (control group, n = 200), and to another group of patients in 2015 using polyurethane catheters (investigational group, n = 207). The symptoms were assessed according to a scale developed by the Infusion Nurses Society. Long-axis ultrasonography images taken immediately before catheter removal were used to measure the angle between the central line of the catheter within 2 mm from the distal point and a tangent to the vessel wall.
Results: There were no significant differences between the two groups with respect to sex, age, and medical diagnosis. In the control and investigational groups, the rates of phlebitis were 37% (73/200) and 17% (36/207), respectively (p&lt; 0.001). The median angles of the catheter tip were 7.8 degrees and 4.1 degrees, respectively (p&lt; 0.001). Phlebitis occurred more frequently when the catheter-tip was placed at angle &gt;5.8 degrees.
Discussion: The frequency of phlebitis was lower in the polyurethane, in which the catheter was placed at lower angle, almost parallel to the vessel. Our results will aid in developing new catheters and in improving PIVC-securement techniques.

DOI： 10.5301/jva.5000601

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier (Singapore) Pte Ltd  

Background Our aim in this study was to determine the ability of ultrasonography (US) to assess and classify the degree of subcutaneous edema caused by infusion via peripheral intravenous catheter, compared to assessment by the Infusion Nurses Society infiltration scale. Methods This prospective study included 64 adult patients who underwent infusion via peripheral intravenous catheter. All patients underwent US imaging of the subcutaneous tissue just after the insertion of indwelling catheters and just before catheter removal. The grade of swelling was then assessed using the infiltration scale. Subcutaneous edema and edema thickness were analyzed on transverse US images, and the edema was classified as normal, mild, or severe. The relationship between US-determined subcutaneous edema and that determined by using the infiltration scale was evaluated. Results Among the 64 patients, US images of the subcutaneous edema were classified into three groups: normal in 15 patients, mild subcutaneous edema in 41 patients, and severe subcutaneous edema in eight patients. Thus, US classification of subcutaneous edema could provide more detailed information than the infiltration scale. Conclusion The results of the present study suggest that US imaging of subcutaneous tissue could help classify the degree of subcutaneous edema.

DOI： 10.1016/j.jmu.2016.02.001

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Lippincott Williams and Wilkins  

Small veins are a risk factor for infiltration. However, there are no data regarding the ideal vein diameter for preventing infiltration. Using ultrasound, vessel diameter and calculated ratios of the vessel diameter to the catheter gauge were measured. The relationship between the ratio and infiltration was assessed to establish a cutoff point. The mean ratio of the infiltration group was significantly smaller than that of the no-infiltration group (P &lt
.01), and the ratio was an independent risk factor according to the multivariable analysis. The ratio of 3.3 was determined to be the cutoff point that enables health care professionals to identify veins appropriately.

DOI： 10.1097/NAN.0000000000000159

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Language：English   Publishing type：Research paper (scientific journal)  

Infiltration is a frequent complication of infusion therapy. We previously demonstrated the usefulness of infrared thermography as an objective method of detecting infiltration in healthy people. However, whether thermography can detect infiltration in clinical settings remains unknown. Therefore, we report two cases where thermography was useful in detecting infiltration at puncture sites. In both cases, tissue changes were verified ultrasonographically. The patients were a 56-year-old male with cholangitis and a 76-year-old female with hepatoma. In both cases, infiltration symptoms such as swelling and erythema occurred one day after the insertion of a peripheral intravenous catheter. Thermographic images from both patients revealed low-temperature areas spreading from the puncture sites
however, these changes were not observed in other patients. The temperature difference between the low-temperature areas and their surrounding skin surface exceeded 1.0°C. Concurrently, ultrasound images revealed that tissues surrounding the vein had a cobblestone appearance, indicating edema. In both patients, subcutaneous tissue changes suggested infiltration and both had low-temperature areas spreading from the puncture sites. Thus, subcutaneous edema may indicate infusion leakage, resulting in a decrease in the temperature of the associated skin surface. These cases suggest that infrared thermography is an effective method of objectively and noninvasively detecting infiltration. © 2016, International Research and Cooperation Association for Bio &amp
Socio-Sciences Advancement. All rights reserved.

DOI： 10.5582/ddt.2016.01033

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

本研究は、末梢静脈カテーテル留置が、症状・徴候を伴う留置継続困難(signs and symptoms-related catheter failure:SRCF)にいたったことと、血液検査所見を含む患者背景、輸液製剤との関連を明らかにすることを目的とした後ろ向き研究である。都内大学病院における2ヵ月の調査ののち、診療録よりデータを取得した2,150人に留置された4,854カテーテルのうち、857カテーテルがSRCFであった。SRCFのリスク因子として、女性、刺激性薬剤の投与、抜去日に最も近い血液検査値が関連していた。C反応性蛋白(CRP)が2.0mg/dL以上、血清アルブミン(Alb)が3.5g/dL未満であることは、多変量解析において有意に関連が認められた(調整オッズ比:OR=1.37,95%信頼区間;CI=1.11-1.69、1.35,1.07-1.70)。さらに、血清アルブミン低値であることは、抜去日に刺激性薬剤が投与されていない場合でもSRCFに関連しており(OR=1.57,CI=1.14-2.16)、血清アルブミン値が低いことはSRCFを促進している可能性があった。SRCFのリスク因子には性別、既往歴、刺激性薬剤のみならず、特に血清アルブミン値のような血液検査値も含まれていた。医療職者は症状や徴候を観察するだけでなく、血液検査所見を含めた患者背景情報を考慮する必要がある。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J05543&link_issn=&doc_id=20160201450004&doc_link_id=1504242&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F1504242&type=%8D%C5%90V%8A%C5%8C%EC%8D%F5%88%F8Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：English   Publishing type：Research paper (scientific journal)   Publisher：IRCA-BSSA  

The present observational study aimed to clarify the relationship between the tip position of an indwelling venous catheter and the subcutaneous edema using ultrasonography images. Data were obtained before catheter removal in a medical ward of a university hospital in Tokyo, Japan. Two hundred peripheral intravenous catheters (PIVCs) from 154 patients were observed just before removal. We analyzed data for 194 PIVCs from 150 patients. Subcutaneous edema was observed in 43.8% of ultrasonography images. According to the univariate analysis, insertion site, PIVC tip contact with the vessel wall, and irritant drug's presence were selected as independent variables for logistic regression analysis. Both irritant drug and PIVC tip contact were associated with the presence of subcutaneous edema [adjusted odds ratio (OR) = 2.68, 95% confidence interval (CI) = 1.14-6.33; and OR = 2.01, 95% CI = 1.04-3.88, respectively]. To the best of our knowledge, this is the first study to use ultrasonography to simultaneously observe PIVC tip position and subcutaneous edema. Using ultrasonography to observe PIVC may be a useful method to understand these mechanisms. Medical staff should select an appropriate vein and indwelling catheter to avoid contact of PIVC tip with the vessel wall. Further studies exploring the causality of the relationship between subcutaneous edema, catheter placement, and thrombus formation is required. In addition, further development of nursing skills and medical devices to reduce mechanical stress is required.

DOI： 10.5582/bst.2015.01114

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DOI： 10.24462/jnse.2.1_40

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Publishing type：Article, review, commentary, editorial, etc. (scientific journal)   Publisher：Japan Academy of Nursing Science  

DOI： 10.5630/jans.42.790

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J-GLOBAL

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J05543&link_issn=&doc_id=20230203450011&doc_link_id=10.32201%2Fjpnwocm.26.4_396&url=https%3A%2F%2Fdoi.org%2F10.32201%2Fjpnwocm.26.4_396&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)   Publisher：Japanese Nursing Association Publishing Company  

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：看護理工学会  

&emsp;This study aimed to describe the relationship between inappropriate conditions due to multiple puncture attempts for catheterization and thrombus formation with subcutaneous edema at catheter failure by qualitative analysis and ultrasonography. Seven categories were extracted, and two stories were identified using qualitative-descriptive analyses. First, when attempting multiple insertions, ＜puncture sites＞ were chosen, such as the ulnar side and dorsum of the hand, while ＜visual judgment of target vein＞ was difficult, and the ＜posture at insertion＞ was contorted. The catheters were not inserted parallel to the sagittal plane, and the echo image confirmed that ＜intravascular position of catheter tip＞ were not parallel to the vessels. Second, with IV cannulation on the radial side, during manipulation of the ＜securement by dressing films＞, the mesh part of the IV dressing covered the connector area and caused it to sink into the patient's skin in the ＜peripheral condition of the hubs/connectors attached to the apparatus＞. These phenomena were observed in many echo images in which the tip of the catheter was placed in the upstream direction of the blood vessels. Our results suggested that the posture of the body during insertion and the securement methods could affect thrombus and edema formation, since mechanical stimuli affected the blood vessels and subcutaneous tissue.

DOI： 10.24462/jnse.5.1_2

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Other Link： http://search.jamas.or.jp/link/ui/2018185675

Language：English   Publisher：(一社)日本創傷・オストミー・失禁管理学会  

本研究は、末梢静脈カテーテル留置が、症状・徴候を伴う留置継続困難(signs and symptoms-related catheter failure:SRCF)にいたったことと、血液検査所見を含む患者背景、輸液製剤との関連を明らかにすることを目的とした後ろ向き研究である。都内大学病院における2ヵ月の調査ののち、診療録よりデータを取得した2,150人に留置された4,854カテーテルのうち、857カテーテルがSRCFであった。SRCFのリスク因子として、女性、刺激性薬剤の投与、抜去日に最も近い血液検査値が関連していた。C反応性蛋白(CRP)が2.0mg/dL以上、血清アルブミン(Alb)が3.5g/dL未満であることは、多変量解析において有意に関連が認められた(調整オッズ比:OR=1.37,95%信頼区間;CI=1.11-1.69、1.35,1.07-1.70)。さらに、血清アルブミン低値であることは、抜去日に刺激性薬剤が投与されていない場合でもSRCFに関連しており(OR=1.57,CI=1.14-2.16)、血清アルブミン値が低いことはSRCFを促進している可能性があった。SRCFのリスク因子には性別、既往歴、刺激性薬剤のみならず、特に血清アルブミン値のような血液検査値も含まれていた。医療職者は症状や徴候を観察するだけでなく、血液検査所見を含めた患者背景情報を考慮する必要がある。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J05543&link_issn=&doc_id=20160201450004&doc_link_id=1504242&url=https%3A%2F%2Fkango-sakuin.nurse.or.jp%2Fnid%2F1504242&type=%8D%C5%90V%8A%C5%8C%EC%8D%F5%88%F8Web&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00014_1.gif

Language：English   Publisher：看護理工学会  

【目的】末梢静脈カテーテル留置(以下カテーテル)が血管に与える影響について、超音波画像(US)による検討を行った。【方法】対象は大学病院の入院患者で、留置カテーテル抜去前に留置部のUSを撮影した30例である。USは、長軸像と短軸像の動画を撮影し、血管壁肥厚、血栓、皮下脂肪の浮腫の有無、およびカテーテル先端の位置について検討した。【結果】全30例中26例はカテーテル先端が血管内に位置し、4例は評価できなかった。26例のUSは、血栓型8例、血管壁肥厚型2例、血栓および血管壁肥厚の混合型8例の3つに分類できた。残りの8例は血管内腔に異常は認められなかった。【結論】USは、カテーテル留置が血管に与える影響を評価することができ、利用可能な方法と考える。(著者抄録)

DOI： 10.24462/jnse.2.1_40

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J06462&link_issn=&doc_id=20150130600006&doc_link_id=10.24462%2Fjnse.2.1_40&url=https%3A%2F%2Fdoi.org%2F10.24462%2Fjnse.2.1_40&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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