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Tracheostomy decannulation readiness: A cross sectional study comparing standardised evaluation for tacheostomy decannulation to flexible endoscopic evaluation of swallowing examination

Tamin S, Shabrina F, Hutauruk SM, Rachmawati EZK, Fardizza F, Koento T, et al.

Med J Malaysia, 2024 Mar;79(2):119-123.

PMID: 38553913

INTRODUCTION: Tracheostomy is a procedure commonly performed in neurocritical and mechanically ventilated patients in the intensive care unit. Dysphagia and impaired airway protection are the main causes for a delay in tracheostomy decannulation in patients with neurological disorders. Endoscopic evaluation is an objective examination of readiness for tracheostomy decannulation with flexible endoscopic evaluation of swallowing (FEES) as the most commonly used method, yet it requires special expertise and is heavily dependent on its operator in assessing the parameters. A relatively new method for assessing decannulation readiness in neurologic disorder, the Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation (SESETD) was introduced in 2013 by Warnecke, et al. This method includes stepwise evaluation of secretion management, spontaneous swallowing and laryngeal sensitivity. This study aims to find conformity between the SESETD and FEES in assessing readiness for tracheostomy decannulation in patients with neurologic disorders.

MATERIALS AND METHODS: This study is a cross-sectional study conducted on 36 neurologic patients at Cipto Mangunkusumo General Hospital which was aimed to find the agreement between two modalities for tracheostomy decannulation readiness, FEES and SESETD based on parameters, standing secretion, spontaneous swallowing and laryngeal sensitivity.

RESULT: A total of 36 subjects were examined and 22 of them underwent successful tracheostomy decannulation. The agreement between FEES and SESETD showed significant results with p-value <0.0001 and Kappa value = 0.47.

CONCLUSION: There was conformity between FEES and SESETD in evaluating tracheostomy decannulation readiness based on three parameters: standing secretion, spontaneous swallowing and laryngeal sensitivity.

Matched MeSH terms: Device Removal/methods

Oldest-in-Human Successful Extraction Experience of a Novel Substernal Extravascular Defibrillator

Chauhan K, Royse A, Goh I, Crozier I, Wynn G

J Cardiovasc Electrophysiol, 2025 Jan;36(1):295-297.

PMID: 39575491 DOI: 10.1111/jce.16511

INTRODUCTION: Substernal extravascular defibrillators (EV ICDs) have been shown to be effective and safe for patients at risk of sudden cardiac death, however, there is little evidence around the safety of extracting chronic devices.

METHODS AND RESULTS: We present a 50-year-old patient in whom a Medtronic EV ICD system was successfully removed without specialist extraction tools, 186 weeks after implantation, by an operator experienced in transvenous lead extraction but without formal training in EVICD implantation.

CONCLUSION: The successful extraction of an EV ICD system is possible without specialised tools at least 3.6 years post-implant.

Matched MeSH terms: Device Removal*

Fulltext Comparison of Orthodontic Bracket Debonding Force and Bracket Failure Pattern on Different Teeth In Vivo by a Prototype Debonding Device

Ahmed T, Rahman NA, Alam MK

Biomed Res Int, 2021;2021:6663683.

PMID: 33959664 DOI: 10.1155/2021/6663683

Objective: To compare the orthodontic bracket debonding force and assess the bracket failure pattern clinically between different teeth by a validated prototype debonding device. Materials and Method. Thirteen (13) patients at the end of comprehensive fixed orthodontic treatment, awaiting for bracket removal, were selected from the list. A total of 260 brackets from the central incisor to the second premolar in both jaws were debonded by a single clinician using a validated prototype debonding device equipped with a force sensitive resistor (FSR). Mean bracket debonding forces were specified to ten (10) groups of teeth. Following debonding, Intraoral microphotographs of the teeth were taken by the same clinician to assess the bracket failure pattern using a 4-point scale of adhesive remnant index (ARI). Statistical analysis included one-way ANOVA with post hoc Tukey HSD and independent sample t-test to compare in vivo bracket debonding force, Cohen's kappa (κ), and a nonparametric Kruskal-Wallis test for the reliability and the assessment of ARI scoring.

Results: A significant difference (p < 0.001) of mean debonding force was found between different types of teeth in vivo. Clinically, ARI scores were not significantly different (p = 0.921) between different groups, but overall higher scores were predominant.

Conclusion: Bracket debonding force should be measured on the same tooth from the same arch as the significant difference of mean debonding force exists between similar teeth of the upper and lower arches. The insignificant bracket failure pattern with higher ARI scores confirms less enamel damage irrespective of tooth types.

Matched MeSH terms: Device Removal*

Fulltext Difficult Removal of a Stuck Chemoport Catheter of a Paediatric Patient in Post-Coronavirus Disease (COVID-19) Era - Management Strategies and Literature Review

Sen CJ, Cheng YC

Afr J Paediatr Surg, 2024 Jul 01;21(3):204-206.

PMID: 39162758 DOI: 10.4103/ajps.ajps_159_22

A chemoport is widely used in paediatric oncology population. Removal is a relatively easy procedure, but difficulty can be encountered in case the catheter is densely adherent to the vascular wall. It is a rare complication and is associated with long indwelling duration and acute lymphoblastic leukaemia (ALL). Forceful traction can lead to vascular injury and high morbidity. Herein, we report a 7-year-old girl with precursor B ALL who had delayed chemoport removal due to the coronavirus disease (COVID-19) pandemic. The removal process was difficult, as the catheter was adherent to the right innominate vein. Out of panic, the surgeon pulled it out forcefully. Fortunately, the catheter and its fragment were successfully retrieved completely and the child was discharged the next day. The management strategy varies and ranges from minimally invasive to open surgery. Leaving a stuck chemoport catheter in situ can be a bailout method or part of conservative management.

Matched MeSH terms: Device Removal*

Sonographically guided removal of a double J ureteral stent in an infant

Jutti RC, Subramaniam R, Balsingh D, Qureshi AM

J Clin Ultrasound, 2002 May;30(4):232-5.

PMID: 11981933 DOI: 10.1002/jcu.10062

A 2-month-old male infant with a prenatally diagnosed obstruction of the ureteropelvic junction underwent a dismembered Anderson-Hynes pyeloplasty. A transanastomotic double J ureteral stent was placed between the renal pelvis and the urinary bladder. This report describes the subsequent removal of the double J ureteral stent from the patient's urinary bladder without the aid of a cystoscope: a rigid biopsy forceps was introduced trans-urethrally into the urinary bladder, and the stent was removed with sonographic guidance. Removal of a ureteral stent with sonographic guidance has not been previously reported in infants. This technique may be particularly useful in developing countries, where appropriate-sized cystoscopes and accessories may not be available.

Matched MeSH terms: Device Removal/instrumentation; Device Removal/methods*

Fulltext Schizophrenia and anaesthesia

Constance LSL, Lansing MG, Khor FK, Muniandy RK

BMJ Case Rep, 2017 Nov 23;2017.

PMID: 29170175 DOI: 10.1136/bcr-2017-221659

Administering anaesthesia for elderly patients with chronic schizophrenia has always been a great challenge to anaesthetists. These patients will usually be on multiple antipsychotic drugs for many years and may lead to delayed awakening, cardiovascular instability, arrhythmias and sudden cardiac death during general anaesthesia. This case report is about the perioperative anaesthetic management of an elderly schizophrenic patient undergoing removal of femur implant. This article will explore important drug interactions and available options for a successful anaesthesia.

Matched MeSH terms: Device Removal/adverse effects; Device Removal/methods

Stent dislodgement in left anterior descending coronary artery and successful deployment with two parallel wires and a small balloon

Ngow H

Kardiol Pol, 2009 Sep;67(9):1040-2 discussion 1043.

PMID: 19838965

Coronary artery stent dislodgement during angioplasty is a rare complication. Stent dislodgement was more frequent in the past when stents were manually crimped onto the balloon. Newer and improved balloon-mounted stents with better radio-opacity have reduced the incidence of stent dislodgement but do not completely eliminate it. We report a case of balloon-mounted stent dislodgement in the proximal left anterior descending (LAD) coronary artery prior to deployment. This patient however was successfully treated with re-wiring of the artery with two parallel wires and the stent's reposition prior to deployment with the help of a small balloon.

Matched MeSH terms: Device Removal/instrumentation; Device Removal/methods

Fulltext Infective endocarditis and the pacemaker: cardiac implantable electronic device infection

Yew KL

Med J Malaysia, 2012 Dec;67(6):618-9.

PMID: 23770958 MyJurnal

We are seeing more implantation of cardiac device such as pacemakers and defibrillators and also cardiac implantable electronic device infection. The infection may affect just the pocket site or progress to deeper infection and bacteraemia. Inadequately treated infection may lead to right sided endocarditis, cardiotomy for pacemaker explantation and increased cost and length of stay in the hospital. We report a Staphylococcal infection of a pacemaker system, its successful medical and surgical management.

Matched MeSH terms: Device Removal

Fulltext Removal of failed dental implant with application of concentrated growth factor (CGF): a case report

Nurul Ain Mohamed Yusof, Mohd Salman Masri, Erni Noor

Compendium of Oral Science, 2018;5(1):46-53.

MyJurnal

Introduction: High survival rates of dental implants were commonly reported even after 10 years of follow up. Nevertheless, complications and failure may occur and the implant would need to be removed. In recent years, the use of autogenous blood products in dental surgery has increased due to its ability to aid the healing of the soft and hard tissues. Clinical case: The case demonstrated the utilisation of concentrated growth factor (CGF) from the patient’s blood for healing following conservative removal of a failed dental implant. Subsequently, the patient showed satisfactory recovery without any infections and clinical complaints. Conclusion: This explantation procedure, together with the use of CGF, may prevent the normal bone resorption and accelerate soft tissue healing. As it is biological in nature having originated from the patient’s blood, it is more readily accepted by the tissues and the risk of infection is low.

Matched MeSH terms: Device Removal

Fulltext eComment: Trans-pericardial extra-anatomic aortic bypass for coarctation of the aorta

Sachithanandan A, Badmanaban B

Interact Cardiovasc Thorac Surg, 2011 Jul;13(1):100.

PMID: 21697404 DOI: 10.1510/icvts.2010.265264A

Matched MeSH terms: Device Removal*

Effect of local anesthesia and intravenous sedation on pain perception and vasovagal reactions during femoral arterial sheath removal after percutaneous coronary intervention

Kiat Ang C, Leung DY, Lo S, French JK, Juergens CP

Int J Cardiol, 2007 Apr 4;116(3):321-6.

PMID: 16904773

There is no consensus with respect to the use of analgesia during femoral arterial sheath removal after percutaneous coronary intervention (PCI). We performed a randomized controlled trial to assess the impact of intravenous sedation and local anesthesia during femoral sheath removal after PCI on patient comfort and the incidence of vasovagal reactions.

Matched MeSH terms: Device Removal/adverse effects*

Spontaneous knot formation impeding the removal of a silicone urethral catheter

Mustafa NA, Lope RJ, Cheah FC

Arch. Dis. Child. Fetal Neonatal Ed., 2006 Jul;91(4):F287.

PMID: 16790731

Matched MeSH terms: Device Removal/methods

A simple method for removal of a broken intramedullary nail

Sivananthan KS, Raveendran K, Kumar T, Sivananthan S

Injury, 2000 Jul;31(6):433-4.

PMID: 10831741

The removal of broken implanted intramedullary nails secondary to re-fracture or non-union is challenging. In 12 cases a simple and safe method has been used to remove broken implants.

Matched MeSH terms: Device Removal/methods*

Techniques for successful early retrieval of the Micra transcatheter pacing system: A worldwide experience

Afzal MR, Daoud EG, Cunnane R, Mulpuru SK, Koay A, Hussain A, et al.

Heart Rhythm, 2018 06;15(6):841-846.

PMID: 29427820 DOI: 10.1016/j.hrthm.2018.02.008

BACKGROUND: Experience with retrieval of the Micra transcatheter pacing system (TPS) is limited because of its relatively newer technology. Although abandonment of the TPS at end of life is recommended, certain situations such as endovascular infection or device embolization warrant retrieval.

OBJECTIVE: The purpose of this study was to report the worldwide experience with successful retrieval of the Micra TPS.

METHODS: A list of all successful retrievals of the currently available leadless pacemakers (LPs) was obtained from the manufacturer of Micra TPS. Pertinent details of retrieval, such as indication, days postimplantation, equipment used, complications, and postretrieval management, were obtained from the database collected by the manufacturer. Other procedural details were obtained directly from the operators at each participating site.

RESULTS: Data from the manufacturer consisted of 40 successful retrievals of the Micra TPS. Operators for 29 retrievals (73%) provided the consent and procedural details. Of the 29 retrievals, 11 patients underwent retrieval during the initial procedure (immediate retrieval); the other 18 patients underwent retrieval during a separate procedure (delayed retrieval). Median duration before delayed retrieval was 46 days (range 1-95 days). The most common reason for immediate retrieval was elevated pacing threshold after tether removal. The most common reasons for delayed retrieval included elevated pacing threshold at follow-up, endovascular infection, and need for transvenous device. Mean procedure duration was 63.11 ± 56 minutes. All retrievals involved snaring via a Micra TPS delivery catheter or steerable sheath. No serious complications occurred during the reported retrievals.

CONCLUSION: Early retrieval of the Micra TPS is feasible and safe.

Matched MeSH terms: Device Removal/methods*

Comparison between the use of LMA™ and SLIPA™ in patients undergoing minor surgeries

Wan Rahiza, W.M., Nurlia, Y., Abd Rahman, I., Esa, K., Nadia, M.N., Raha, A. R.

Journal of Surgical Academia, 2012;2(1):8-13.

MyJurnal

Supraglottic airway devices have been used as safe alternatives to endotracheal intubation in appropriate types of surgery. This was a prospective, randomised, single blind study comparing the use of LMA™ and SLIPA™ in terms of ease of insertion, haemodynamic changes and occurrence of adverse effects (e.g. blood stains on the device upon removal and sore throat). A total of 62 ASA I or II patients, aged between 18 to 70 years were recruited for this study. Patients were randomised into two groups; LMA™ and SLIPA™ group. Following induction of anaesthesia, an appropriate sized LMA™ or SLIPA™ was inserted after ensuring adequate depth of anaesthesia. Anaesthesia was maintained with oxygen, nitrous oxide and sevoflurane. The ease of insertion was graded and haemodynamic changes were recorded at 2 minute intervals up to 10 minutes after insertion of the airway devices. The presence of blood stains upon airway device removal at the end of surgery and incidence of sore throat was also recorded. No difficult insertion was experienced in either of these devices. Insertion was either easy [LMA™ 87.1% versus SLIPA™ 80.6% (p = 0.49)] or moderate [LMA™ 12.9% versus SLIPA™ 19.4% (p = 0.16)]. Throughout the study period, the haemodynamic changes that occurred in both groups were not statistically different. Traces of blood were noted on the surface of the device in 9.7% of patients in the SLIPA™ group versus 6.5% of patients in the LMA™ group. The incidence of sore throat was recorded in 12.9% versus 19.4% of patients in the SLIPA™ and the LMA™ groups respectively. These findings were not statistically significant. In conclusion, this study showed no significant differences between the use of LMA™ and SLIPA™ in terms of ease of insertion, haemodynamic changes and adverse effects in patients undergoing minor surgical procedures.

Matched MeSH terms: Device Removal

Fulltext The 50% and 95% effective doses of desflurane for removal of the classic laryngeal mask airway in spontaneously breathing anaesthetised adults

Hui MT, Subash S, Wang CY

Anaesthesia, 2011 Apr;66(4):274-7.

PMID: 21401540 DOI: 10.1111/j.1365-2044.2011.06620.x

The 50% and 95% effective doses of desflurane for removal of the classic laryngeal mask airway after suction of the upper airway, in anaesthetised spontaneously breathing adult patients, are not known. To determine these, we studied 38 healthy patients, aged between 18 and 44 years. The target desflurane concentration in each individual patient was determined by the Dixon up-and-down method. When the predetermined target end-tidal desflurane concentration reached steady state, we kept a constant end-expiratory partial pressure between the alveolus and the brain for 10 min before attempting to remove the classic laryngeal mask airway after suctioning the upper airway. The initial desflurane target concentration was set at 6% and up-down desflurane increments were 0.1%. This continued until there were at least six crossover pairs. From the probit analysis, the 50% effective dose of desflurane was 5.29% (95% CI 5.132-5.379%) and the 95% effective dose was 5.55% (95% CI 5.429-6.394%).

Matched MeSH terms: Device Removal/methods

Retained Endoscope: An Unexpected but Serious Complication of Hemospray®

Yii RSL, Chuah KH, Poh KS, Lau PC, Ng KL, Ho SH, et al.

Dig Dis Sci, 2022 01;67(1):344-347.

PMID: 33491164 DOI: 10.1007/s10620-021-06835-4

Matched MeSH terms: Device Removal/methods*

Fulltext "Fishing for lines": removal of endovascular catheters from the cardiovascular system

Wong AR, Suhaimi H, Ridzuan MA, Rizal MM, Saedah A

Singapore Med J, 2009 Oct;50(10):e358-61.

PMID: 19907875

We present two infants whose endovascular lines were accidentally cut or fractured, and had to be retrieved via transcatheter means in the cardiac catheterisation laboratory. The first case was a two-month-old infant with transposition of the great arteries, requiring an emergency balloon atrial septostomy. An indwelling vascular catheter that was placed in the right femoral vein was accidentally cut and had migrated into the inferior vena cava, before being retrieved. The second case was a one-week-old neonate who presented with pneumonia at birth, and had a long intravenous catheter placed in the left saphenous vein, which became fractured, and subsequently migrated into the heart. This case presented as a pulmonary embolus with haemodynamic instability, as the catheter had partially obstructed the right ventricular outflow tract. This was later retrieved via transcatheter means.

Matched MeSH terms: Device Removal*

Impact of interventional nephrology on outcome and penetration rate of a CAPD program

Wong CM, Ng KP, Keng TC, Lim SK, Tan SY

Perit Dial Int, 2011 3 24;31(2):194-6.

PMID: 21427247 DOI: 10.3747/pdi.2009.00237

Matched MeSH terms: Device Removal/statistics & numerical data

Retained haemodialysis-catheter guidewire in the head and neck: a multidisciplinary team approach

Xiao Hong C, Abd Wahab S, Azman M

BMJ Case Rep, 2020 Oct 27;13(10).

PMID: 33109696 DOI: 10.1136/bcr-2020-236484

Penetrating foreign body in the head and neck can be catastrophic from injury to the constellation of vascular and neural structures in the neck. Early recognition and prompt surgical intervention is imperative to save lives. Herein, we present an unusual case of iatrogenic foreign body-a coiled guidewire embedded in the deep neck space. The complications, radiological investigation and multidisciplinary surgical management are further discussed.

Matched MeSH terms: Device Removal/methods

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