ABSTRACT
PURPOSE: The aim of this study was to demonstrate the efficacy of zero-cost interventions on the reduction of infectious waste (IW) stream production in interventional radiology (IR). METHODS: This quality improvement initiative was developed using needs identification through department-wide meetings with IR stakeholders (physicians, nurses, and radiologic technologists). Department leadership identified and implemented two interventions to reduce disposal of noninfectious waste (NIW) in the IW stream. First, hospital waste management provided focused education for sorting IW versus NIW to IR staff members. Next, the number of IW bins was reduced, and the IW bins were strategically placed on the perimeter of the room. Radiologic technologists tracked IW and NIW bags per case for 25 case days before the intervention and 175 case days after the intervention. A run chart was created to visualize change over time. Wilcoxon rank sum and signed rank tests were performed to evaluate the difference in IW and NIW bags per case before and after the intervention. A goal of significant reduction in NIW stream production was set. RESULTS: Before the intervention, the production of IW and NIW bags per case was similar (median, 1.0 [interquartile range (IQR), 0.86-1.31] vs 1.1 [IQR, 0.86-1.40]; P = .20). After the intervention, IW bags per case decreased (median, 1.0 [IQR, 0.86-1.31] vs 0.05 [IQR, 0.00-0.13]; P < .001). Fewer IW bags than NIW bags were produced per case after the intervention (median, 0.05 [IQR, 0.00-0.13] vs 1.53 [IQR, 1.30-1.76]; P < .001). CONCLUSIONS: Zero-cost interventions, including focused education, stakeholder engagement, and strategic placement of waste bins, can significantly reduce the environmental and economic impact of waste produced in IR.
Subject(s)
Medical Waste Disposal , Waste Management , Humans , HospitalsSubject(s)
Varicose Veins , Venous Insufficiency , Humans , Vascular Surgical Procedures , Saphenous Vein , Treatment OutcomeSubject(s)
Coronavirus Infections/prevention & control , Infection Control/organization & administration , Leadership , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Radiology Department, Hospital/organization & administration , Trust , Betacoronavirus , COVID-19 , Communication , Coronavirus Infections/epidemiology , Cross Infection/prevention & control , Humans , Occupational Exposure/prevention & control , Organizational Policy , Personal Protective Equipment , Planning Techniques , Pneumonia, Viral/epidemiology , SARS-CoV-2 , WorkloadABSTRACT
Endovascular treatment of venous disease encompasses a broad range of interventions. Both central and peripheral venous interventions can range from the simple to the complex which increases the need for proper patient selection, procedural planning and technical proficiency. The following article will discuss the importance of avoiding, recognizing and addressing complications associated with venous interventions. Our goal is to raise awareness and educate to help the reader improve performance.
Subject(s)
Endovascular Procedures/adverse effects , Radiography, Interventional , Vascular Diseases/therapy , Extremities/blood supply , Humans , Patient Care Planning , Patient Selection , Pulmonary VeinsSubject(s)
Advisory Committees/organization & administration , Patient Participation , Patient-Centered Care/organization & administration , Professional-Patient Relations , Radiology Department, Hospital/organization & administration , Decision Making , Guidelines as Topic , Humans , Organizational Innovation , Organizational Objectives , TennesseeSubject(s)
Catheterization/standards , Hemorrhage/prevention & control , Hemostatic Techniques/standards , Quality Improvement/standards , Quality Indicators, Health Care/standards , Radiography, Interventional/standards , Vascular Access Devices/standards , Catheterization/adverse effects , Catheterization/instrumentation , Equipment Design , Hemorrhage/etiology , Hemostatic Techniques/adverse effects , Hemostatic Techniques/instrumentation , Humans , Patient Safety/standards , Punctures , Radiography, Interventional/adverse effects , Radiography, Interventional/instrumentation , Risk Assessment , Risk Factors , Treatment OutcomeSubject(s)
Anti-Bacterial Agents/administration & dosage , Antibiotic Prophylaxis/standards , Digestive System Surgical Procedures/standards , Endovascular Procedures/standards , Radiography, Interventional/standards , Vascular Surgical Procedures/standards , Adult , Drug Administration Schedule , Drug Resistance, Bacterial , Evidence-Based Medicine , Humans , Societies, Medical/standards , Terminology as TopicSubject(s)
Leiomyoma/therapy , Outcome and Process Assessment, Health Care/standards , Quality of Health Care/standards , Uterine Artery Embolization/standards , Uterine Neoplasms/therapy , Advisory Committees , Clinical Competence/standards , Evidence-Based Medicine , Female , Humans , Patient Selection , Risk Assessment , Societies, Medical/standards , Terminology as Topic , Treatment Outcome , Uterine Artery Embolization/adverse effectsSubject(s)
Ambulatory Surgical Procedures/standards , Lower Extremity/blood supply , Quality Assurance, Health Care/standards , Vascular Surgical Procedures/standards , Veins/surgery , Venous Insufficiency/surgery , Humans , Internationality , Lower Extremity/diagnostic imaging , Patient Care Team/standards , Phlebography/standards , Radiology, Interventional/standards , Venous Insufficiency/diagnostic imagingABSTRACT
The development of a pleural effusion or ascites in patients with underlying malignancy typically heralds end-stage disease and often results in a significant reduction in the patient&'s quality of life. The goal of treatment is the safe and effective palliation of symptoms with minimal inconvenience to the patient. Malignant fluid collections in the chest and abdomen are amenable to percutaneous management with either intermittent thoracentesis or paracentesis or by placement of temporary or permanent drainage catheters.
ABSTRACT
A 64-year-old man with portal hypertension secondary to hepatic nodular transformation was awaiting liver transplantation when he presented with severe, unrelenting abdominal pain, fever, and hypotension. Computed tomographyrevealed pneumatosis within the cecum and ascending colon. Because of his advanced liver disease and the perceived high likelihood of a poor outcome after colonic resection, he was managed medically. He improved initially but had a lengthy hospital course notable for intractable intestinal ischemia and gastrointestinal bleeding. Magnetic resonance angiography demonstrated patent mesenteric, portal, and hepatic vessels. His blood pressure was typically 90/55 mm Hg (mean arterial pressure, 65-70 mm Hg) despite intravenous fluids and blood product replacement. The hypothesis developed that the patient's level of portal hypertension was sufficiently severe (in the face of his low mean systemic arterial pressure) to compromise perfusion of the colonic mucosa. Were this hypothesis correct, then portal decompression might enhance the blood pressure gradient across the bowel and improve mucosal perfusion. With this in mind, a transjugular intrahepatic portosystemic shunt (TIPS) was placed. There was reduction of the portal vein to inferior vena cava gradient from 29 mm Hg to 9 mm Hg and his abdominal pain and gastrointestinal bleeding ceased. His prompt and sustained improvement following TIPS shunt placement is consistent with the hypothesis that high portal pressure was flow limiting, thus contributing to persisting intestinal ischemia. This case represents the first report of use of a TIPS shunt to address colonic ischemia associated with portal hypertension.
Subject(s)
Colitis, Ischemic/etiology , Colitis, Ischemic/surgery , Hypertension, Portal/surgery , Liver Transplantation , Portasystemic Shunt, Transjugular Intrahepatic/methods , Colitis, Ischemic/diagnostic imaging , Colonoscopy , Follow-Up Studies , Humans , Hypertension, Portal/diagnosis , Hypertension, Portal/etiology , Magnetic Resonance Angiography , Male , Middle Aged , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonics , UltrasonographyABSTRACT
A Günther Tulip retrievable inferior vena cava filter was placed in a 9-year-old boy with T-cell ALL who had both iliofemoral deep vein thrombosis (DVT) and acute intracranial hemorrhage. The filter was removed 147 days after placement, when the patient was no longer at increased risk for DVT or pulmonary embolus. Removal of the filter did not compromise flow through the vena cava.