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.

Coring, which is the name for when a piece of rubber is shaved off from the rubber stopper of a vial when the needle punctures it, is herein reported. We investigated whether or not coring could happen with insulin injections, and also whether or not such pieces of rubber could then actually pass through the needle. Vials for syringes and pen type injectors were used with 29, 30 and 31 gauge (G) needles, under cool and room temperature conditions, and at 60/90 degree puncturing angles. The shapes, sizes and number of pieces of rubber were measured at the 10th and 30 th puncturing times. For the passage test, the presence rubber pieces was measured during air venting, as well as in the insulin liquid actually ejected and in the liquid in the vial.Coring often occurs in vials for syringes under cool conditions. Vials for pen type injectors also show coring under all the above conditions. The rubber pieces which passed through the needle could be found in both air venting and the insulin liquid. Coring was shown in thin hypodermic syringes, such as 29-31 G, and there was evidence that such rubber pieces may be dangerous if they enter the body. Rubber pieces can pass through the needle in a vial for pen type injectors, due to the design of the fixed needle in the injector. Based on our findings a safer injection system which prevents coring should thus be develepoed.In addition Careful attention should also be paid to patients with rubber allergies.

We aimed to assess liver and splenic volumetry (LV and SV), extracellular-volume (ECV) on dual-layer-spectral-detector CT (DLCT) and scoring-systems identifying liver fibrosis (LF). In 45 patients with pathologically staged LF, ECV measured on CT value (HU-ECV), iodine-density (ID-ECV), atomic-number (Zeff-ECV), and electron-density (ED-ECV) were calculated by two-readers. LV or SV/body-surface-area (BSA), albumin-bilirubin-grade (ALBI), model-for-end-stage-liver-disease-score (MELD), aspartate-aminotransferase-platelet-ratio-index (APRI), and fibrosis-index-based-on-the-four-factors (FIB-4) were also recorded. ALBI was weakly associated with LF (p = 0.451), while MELD (p < 0.001), APRI (p = 0.010), and FIB-4 (p = 0.010) were significantly associated with LF. SV/BSA had a higher AUC than MELD, APRI, and FIB-4 for estimating > F4 (AUC = 0.815,95%-CI = 0.63–0.999), but MELD (AUC = 0.799,95%-CI = 0.634–0.965), APRI (AUC = 0.722,95%-CI = 0.561–0.883), and FIB-4 (AUC = 0.741,95%-CI = 0.582–0.899) had higher AUCs than SV/BSA. SV/BSA significantly contributed to differentiation between F0–3 and F4; the odds ratio (OR) was 1.304 (Reader1;R1) and 1.353 (Reader2;R2), whereas MELD significantly contributed to the differentiation between F0–2 and F3–4; the OR was 1.528 (R1) and 1.509 (R2). AUC for SV/BSA and MELD combined was 0.877 (95%-CI = 0.748–1.000). In conclusion, SV/BSA allows for higher estimation of liver-cirrhosis (≥ F4). MELD is more suitable for assessing severe LF (≥ F3-4). The combination of SV/BSA and MELD had a higher AUC than SV/BSA alone for liver-cirrhosis (≥ F4).

Background Hepatic fibrosis (HF) is an important factor in patients for liver surgery, because HF may lead to surgical restrictions and affect the patient's prognosis. Intravoxel incoherent motion (IVIM) is used for HF investigation, and the restricted diffusion observed in patients with cirrhosis may be related to D* variations. Splenic volumetry (SV) has been reported to be effective in the evaluation of severe cirrhosis. Our purpose of this study is to compare the predictive ability of IVIM and SV for HF. Methods This study included 67 patients with pathologically staged HF who underwent magnetic resonance imaging and computed tomography (CT). SV was semi-automatically measured from the CT images. IVIM indices, such as the slow diffusion coefficient related to molecular diffusion (D), fast diffusion coefficient related to perfusion in microvessels (D*), apparent diffusion coefficient (ADC), and perfusion-related diffusion fraction (f), were calculated with 10 b-values by two observers (R1 and R2). Receiver operating characteristic curve analysis was performed to determine the predictive ability of HF for IVIM and SV/body surface area (BSA). The inter-rater agreement was discussed for each IVIM parameter. Results D (P = 0.718 for R1, P = 0.087 for R2) and D* (P = 0.513, P = 0.708, respectively) showed a poor correlation with HF grade. ADC (P = 0.034 and P = 0.528, respectively) and f (P < 0.001 and P = 0.007, respectively) decreased as HF progressed, whereas SV/BSA increased (P = 0.015 for R1). The AUCs of SV/BSA (0.649–0.698 for R1) were higher than those of f (0.575–0.683 for R1 + R2) for severe HF (≥ F3-4 and ≥ F4), although the AUCs of f (0.705–0.790 for R1 + R2) were higher than those of SV/BSA (0.628 for R1) for mild or no HF (≤ F0-1). However, no significant differences in the ability to identify HF were observed between IVIM and SV/BSA. Conclusions SV/BSA allows a higher estimation for evaluating severe HF than IVIM. IVIM is more suitable than SV/BSA for the assessment of mild or no HF.