A 48-year-old man who had undergo aortal valve surgery 1 week previously became hemodynamically precarious in the intensive care whole. His doctor decided to insert a Swan–Ganz catheter ( SGC ) ( Edwards Lifesciences, Tokyo, Japan ) without fluoroscopic guidance. The SGC was inserted via the right internal jugular vein vein and advanced into the right ventricle, but it could not be advanced into the pneumonic artery. After repeated attempts, the doctor pulled back the SGC, but it could not be retrieved. x-ray interrogation showed knot formation in the SGC, and the patient was referred to us. first, a raw 5-Fr sheath was placed in the correct internal jugular vein, and a 0.014-inch guidewire ( Cruise ; Asahi Intecc, Tokyo, Japan ) was passed through the kernel of the knot. A 6-mm balloon ( Rx-Genity ; Kaneka, Tokyo, Japan ) was inflated to expand the knot diameter ; however, the ravel was not completely untie. A 10-mm-diameter Amplatz Goose Neck trap ( Medtronic, Dublin, Ireland ) was then advanced to the distal end of the SGC along with the Cruise wire. ultimately, we grasped the tip of the SGC and pulled it back, causing untying of the knot and successful removal of the SGC. several interventional radiological strategies to remove knotted catheters have been reported, including dilating the ravel by large-diameter balloons [ 1 ], covering the knot with a larger sheath, and pulling the catheter goal back through the knot following balloon dilatation [ 2 ], which is the basis of our procedure and might be the most promise. however, this method acting has a hypothesis of creating another nautical mile by passing the trap from the faulty side as shown in Fig. 1 e2 and 4. rotational angiography is required to check whether the trap is on the lapp side as the point of the SGC, although the ravel is likely to tilt to a prefer fish for the correct path ( Fig. 1 degree fahrenheit ). sufficient ravel dilation by adequately size balloons is besides important to avoid migrating the unharmed knotted catheter without untying. surgical removal is required in some situations. If the knot is identical bombastic or multiple knots exist, pulling the catheter can cause vascular trauma. Furthermore, intracardiac structures may be injured if the knot is entrapped in the chordae tendineae or heart valves [ 3 ].
Fig. 1a Knot formation in the Swan–Ganz catheter. b Balloon dilation loosened the slub. c The tap was pulled back by the snare passing through the nautical mile. d 1–4 conventional diagram of the procedure. e 1–4 The snare must be on the lapp side as the gratuity of the Swan–Ganz catheter. f Rotational angiography showed whether the snare drum was on the correct way ( bolshevik line ) or not ( blasphemous line ). fortunately, the knot was tilted, which enabled the snare to follow the decline path easily
I am broadly interested in how human activities influence the ability of wildlife to persist in the modified environments that we create.
Specifically, my research investigates how the configuration and composition of landscapes influence the movement and population dynamics of forest birds. Both natural and human-derived fragmenting of habitat can influence where birds settle, how they access the resources they need to survive and reproduce, and these factors in turn affect population demographics. Most recently, I have been studying the ability of individuals to move through and utilize forested areas which have been modified through timber harvest as they seek out resources for the breeding and postfledging phases. As well I am working in collaboration with Parks Canada scientists to examine in the influence of high density moose populations on forest bird communities in Gros Morne National Park. Many of my projects are conducted in collaboration or consultation with representatives of industry and government agencies, seeking to improve the management and sustainability of natural resource extraction.