Name: povidone iodine rectal preparation at time of prostate needle biopsy is a simple and reproducible means to reduce risk of procedural infection
Uploaded: 2015-09-21T14:00:00.000+00:00
Duration: 5 min 32 s
Description: Watch this Scientific Journal Video about Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection at JoVE.com

The authors acknowledge the Carefusion Foundation for support via a clinical excellence grant of this work titled &#8220;Prospective evaluation of procedural povidone iodine rectal preparation to reduce infectious complications following ultrasound guided prostate needle biopsy.&#8221;

Este estudio relacionado paciente fue aprobado por la junta de revisión institucional (IRB) para la investigación humana. 1. Preparación para el paciente y Posicionamiento <ol><li> Llevar al paciente a la sala de procedimiento y colocarlos en su lado derecho o izquierdo con las rodillas flexionadas hacia el pecho. </li><li> Realice un tiempo de espera quirúrgica mediante el cual el paciente, procedimiento quirúrgico, y la indicación son revisados ​​y confirmados. </li><li> Cuando se indica, administrar sedación intravenosa a través del servicio de anestesia. </li></ol> 2. Realizar un examen rectal digital (DRE) <ol><li> Lugar tamaño guantes apropiados en ambas manos. </li><li> Inserte dedo enguantado después de la lubricación en la bóveda rectal y examinar la próstata para palpar posibles zonas sospechosas que necesitan atención enfocada durante la ecografía transrectal. 10 </li></ol> 3. Creación de povidona yodada Preparación rectal (PIRP) <ol><li> Verter 15 ml de una 10%solución de yodo povidona disponible en el mercado en un lebrillo estéril. </li><li> Añadir 5 ml de un gel de lidocaína 1% disponible comercialmente para esta cuenca. </li><li> Mezclar el contenido durante 15 s para crear una suspensión de povidona yodada. </li></ol> 4. Administración primaria de PIRP <ol><li> Use un hisopo rectal estéril para la cultura de la bóveda rectal. </li><li> Abre un 4 cm x 4 cm de gasa estéril, sumergirse en el lodo de yodo povidona, y luego insertar en la bóveda rectal. Sólo una pequeña cola de gasa se deja que emana del ano. </li><li> Deja la gasa en su lugar durante 2 min después de lo cual se retira y se desecha. </li></ol> 5. Administración Secundaria de PIRP <ol><li> Use un hisopo ginecológico desechable para pintar la zona perianal con la solución PIRP. </li><li> Inserte este hisopo ginecológica en la bóveda rectal a una distancia de 3 cm del ano. </li><li> Para maximizar aún más la exposición de la mucosa rectal para PIRP, limpiar la vau rectallt de una manera similar al menos tres veces. </li><li> Permitir que la solución de povidona yodada se seque durante 2 -. 3 min antes de proceder con la ecografía transrectal estándar y posterior biopsia 11 Esto es esencial ya que los efectos bactericidas de la PIRP requieren la solución a secar en la mucosa expuesta. </li><li> Use un hisopo rectal estéril para la cultura de la bóveda rectal. </li></ol> 6. La ecografía transrectal y biopsia <ol><li> Inserte la sonda de ultrasonido a través del recto. </li><li> Efectuar las mediciones de la próstata y la posterior biopsia de la manera estándar consistente con todas las prácticas urológicas. 11,12 </li></ol>

<ol>
	<li>Nam, R. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Increasing+hospital+admission+rates+for+complications+after+transrectal+ultrasound+guided+prostate+biopsy.">Increasing hospital admission rates for complications after transrectal ultrasound guided prostate biopsy.</a> J Urol. 189, S12-S17 (2013).</li><li>Feliciano, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+incidence+of+fluoroquinolone+resistant+infections+after+prostate+biopsy+are+fluoroquinolones+still+effective+prophylaxis.">The incidence of fluoroquinolone resistant infections after prostate biopsy are fluoroquinolones still effective prophylaxis.</a> J Urol. 179 (3), 952-955 (2008).</li><li>Kehinde, O., Al-Maghrebi, M., Sheikh, M., Anim, J. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+ciprofloxacin+and+amikacin+prophylaxis+in+the+prevention+of+septicemia+after+transrectal+ultrasound+guided+biopsy+of+the+prostate.">Combined ciprofloxacin and amikacin prophylaxis in the prevention of septicemia after transrectal ultrasound guided biopsy of the prostate.</a> J Urol. 189 (3), 911-915 (2013).</li><li>Taylor, A. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Targeted+antimicrobial+prophylaxis+using+rectal+swab+cultures+in+men+undergoing+transrectal+ultrasound+guided+prostate+biopsy+is+associated+with+reduced+incidence+of+postoperative+infectious+complications+and+cost+of+care.">Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care.</a> J Urol. 187 (4), 1275-1279 (2012).</li><li>Gyorfi, J. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Peri+procedural+povidone+iodine+rectal+preparation+reduces+microorganism+counts+and+infectious+complications+following+ultrasound-guided+needle+biopsy+of+the+prostate.">Peri procedural povidone iodine rectal preparation reduces microorganism counts and infectious complications following ultrasound-guided needle biopsy of the prostate.</a> World J Urol. 32 (4), 905-909 (2014).</li><li>Park, D. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Control+of+infective+complications+of+transrectal+prostate+biopsy.">Control of infective complications of transrectal prostate biopsy.</a> Surg Infect Larchmt. 15 (4), 431-436 (2014).</li><li>Park, D. S., Oh, J. J., Lee, J. H., Jang, W. K., Hong, Y. K., Hong, S. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simple+use+of+the+suppository+type+povidone+iodine+can+prevent+infectious+complications+in+transrectal+ultrasound+guided+prostate+biopsy.">Simple use of the suppository type povidone iodine can prevent infectious complications in transrectal ultrasound guided prostate biopsy.</a> Adv Urol. , (2009).</li><li>AbuGhosh, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+randomized+trial+of+povidone+iodine+prophylactic+cleansing+of+the+rectum+before+transrectal+ultrasound+guided+prostate+biopsy.">A prospective randomized trial of povidone iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy.</a> J Urol. 189 (4), 1326-1331 (2013).</li><li>Gerber, G. S., Brendler, C. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+the+Urological+Patient:+History,+Physical+Exam,+and+Urinalysis.">Evaluation of the Urological Patient: History, Physical Exam, and Urinalysis.</a> Campbell Walsh Urology. , (2015).</li><li>Hodge, K. K., McNeal, J. E., Terris, M. K., Stamey, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Random+systematic+versus+directed+ultrasound+guided+transrectal+core+biopsies+of+the+prostate.">Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate.</a> J Urol. 142 (1), 71-74 (1989).</li><li>Donoghue, P. M., McSweeney, S. E., Jhaveri, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Genitourinary+imaging:+current+and+emerging+applications.">Genitourinary imaging: current and emerging applications.</a> J Postgrad Med. 56 (2), 131-139 (2010).</li></ol>

The authors have nothing to disclose.

Infecciones siguientes ETR PNB son secundarios a la translocación de bacterias bóveda rectal en la próstata altamente vascular. Basándose en este principio, hemos explorado el simple método de utilización de un tema antiséptico tal como povidona yodada para reducir los recuentos de colonias de microorganismos antes de la biopsia con aguja de próstata. Nuestra experiencia pone de relieve una reducción del 4,3% al 0,6% (p = 0,02) con el uso de este régimen PIRP en el momento de la biopsia. Además, la hipótesis...

El cáncer de próstata es el cáncer más común en hombres y la segunda causa principal de mortalidad relacionada con el cáncer. En 2014, aproximadamente 233.000 casos serán diagnosticados en los Estados Unidos, con casi 30.000 hombres sucumbir a esta malignidad. 1 Si bien el antígeno prostático específico (PSA) en sangre y un examen rectal digital (DRE) desempeñan un papel esencial en la detección del cáncer de próstata, transrectal ecografía biopsia con aguja de próstata guiada (ETR PNB) es el medio más común para obtener un diagnóstico histológico del tejido. ETR PNB consiste en insertar una sonda de ultrasonido en el recto del paciente y luego generalmente aceptado 12-14 biopsias de la zona periférica de la próstata se encuentra justo delante. Cada biopsia con aguja requiere la aprobación de una aguja de 18 G a través de la pared del recto hasta la próstata altamente vascular. Por lo tanto, el riesgo teórico de sangrado e infección debido a la translocación bacteriana existe después del procedimiento. Ningunotheless, el post-procedimiento de tasa de complicaciones actuarial se ha mantenido históricamente bajo. La profilaxis antibiótica antes de la ETR PNB se prescribe habitualmente con antibióticos a base de quinolonas son los agentes más frecuentemente utilizados. A pesar de la profilaxis adecuada, la investigación contemporánea implica un aumento de las complicaciones infecciosas post-biopsia. 2 Además, los estudios han atribuido este aumento de las complicaciones infecciosas después de la ETR PNB a la aparición de microorganismos resistentes a quinolonas en particular E. coli. 3 Esta creciente tasa de resistencia a quinolonas sugiere la necesidad de regímenes de profilaxis alternativos para procedimientos ETR PNB. Con este fin, varias vías diferentes están bajo investigación. Un enfoque implica la administración de un antibiótico intravenosa o intramuscular en el momento de la biopsia en conjunción con una quinolona oral. 4 Si bien esta estrategia puede reducir los eventos siguientes sepsis TRUS PNB,una limitación principal de este enfoque es el potencial para desarrollar aún más los organismos resistentes a esta familia de antibióticos. Otra metodología recientemente investigado incorpora el uso de un hisopo rectal pre-biopsia para evaluar a los pacientes colonizados con flora rectal resistentes a las quinolonas. 5 Si se detectan tales organismos, un régimen antibiótico &quot;selectivo&quot; se podría emplear basado en el perfil de sensibilidad de las bacterias resistentes identificado cepa. Si bien la metodología es elegante, el proceso real de la obtención de este tipo de hisopos, selectivamente el cultivo en un medio selectivo quinolona, ​​y la adaptación de los antibióticos requiere a partir de entonces una infraestructura clínica y de laboratorio que pueden faltar en muchas de las prácticas clínicas. La administración de un tema antiséptica para reducir la bóveda rectal recuentos de colonias de microorganismos antes de la biopsia puede presentar una estrategia alternativa para limitar las infecciones TRUS PNB. Iodone povidona es un agente barato, fácilmente disponible que esse ha documentado que los recuentos bacterianos reducidos cuando se aplica a los sitios quirúrgicos. Aplicaciones en las dos cirugías ginecológicas y colorrectales son bien conocidos. Por lo tanto, el uso de yodo povidona como una preparación rectal presentaría un método producible, simple, y rentable a las infecciones TRUS PNB reducirse sin necesidad de preparación adicional antes de la biopsia. Con respecto a la literatura urológica, previamente trabajo ha observado una reducción en infecciones clínicas siguientes ETR PNB. 6.9 Este video muestra la técnica de PIRP para resaltar la facilidad y simplicidad de integrar en las prácticas clínicas. Todos los pacientes sometidos a ecografía transrectal PNB fueron vistos inicialmente en una clínica de urología de la especialidad para la remisión o evaluación inicial para la detección del cáncer de próstata. Esta evaluación implicó una revisión de antígeno del paciente prostático específico (PSA) y el rendimiento de un examen rectal digital (DRE). Anormalidad ya sea del PSA o DRE impulsó recomendaciónun PNB ETR. El procedimiento ETR PNB se discutió con todos los pacientes y los riesgos asociados, incluyendo infección, sangrado, y retención urinaria se aclararon. Todos los pacientes recibieron tres días de la profilaxis con antibióticos orales, ya sea con un medicamento a base de las quinolonas (por ejemplo, ciprofloxacina) o trimetoprim-sulfametoxazol (Bactrim) antes de la biopsia.

<table><tbody><tr><td>Povidone Iodine Solution, 10% Topical Microbicide Antiseptic, 8 fl oz.</td><td>Equate</td><td>4067979</td><td></td></tr><tr><td>4 x 4 sterile gauze pads, white</td><td>Dukal Corporation</td><td>DKL1412</td><td></td></tr><tr><td>disposable gynecologic swab&amp;nbsp;</td><td>numerous vendors</td><td></td><td></td></tr><tr><td>1% lidocaine gel&amp;nbsp;</td><td>numerous vendors</td><td></td><td></td></tr></tbody></table>

povidone iodine rectal preparation at time of prostate needle biopsy is a simple and reproducible means to reduce risk of procedural infection

Una sola institución y los estudios basados ​​en la población destacan que las complicaciones infecciosas siguientes biopsia ecografía transrectal de próstata guiada aguja (ETR PNB) están aumentando. Estas infecciones son en gran parte atribuible a quinolonas microorganismos resistentes que colonizan la bóveda rectal y son trasladadas en el torrente sanguíneo durante el procedimiento de la biopsia. Una preparación rectal povidona yodada (PIRP) en el momento de la biopsia es un método simple, reproducible para reducir los recuentos de colonias de microorganismos rectales y por lo tanto las infecciones resultantes siguientes TRUS PNB. Todos los pacientes se administran tres días de tratamiento antibiótico oral antes de la biopsia. La técnica PIRP implica inicialmente la colocación del paciente en la forma estándar para una TRUS PNB. Tras el examen rectal digital, 15 ml de una solución al 10% de povidona yodada comercialmente disponible se mezcla con 5 ml de 1% de la jalea de lidocaína para crear suspensión. A 4 cm x 4 cm gasa estéril es soaked en esta suspensión y luego insertado en la bóveda rectal durante 2 min después de lo cual se retira. A partir de entonces, un hisopo de algodón ginecológico desechable se utiliza para pintar tanto en la zona perianal y la bóveda rectal a una distancia de 3 cm del ano. Después se deja que la solución de yodo povidona secar durante 2 - 3 min antes de proceder con la ecografía transrectal estándar y posterior biopsia. Esta técnica PIRP ha sido en la práctica en nuestra institución desde marzo de 2012, con una reducción asociada de las infecciones post-biopsia del 4,3% al 0,6% (p = 0,02). La principal ventaja de este régimen de profilaxis es su simplicidad y reproducibilidad con el uso de un agente fácilmente disponibles, de bajo costo para reducir las infecciones. Además, la técnica evita la exposición de los pacientes a los antibióticos sistémicos adicionales con potencial de propagación adicional de organismos resistentes a múltiples fármacos. El uso de PIRP en ETR PNB, sin embargo, no es aplicable para los pacientes con yodo o los mariscos unllergies.

Esta técnica PIRP ha sido en la práctica desde enero de 2012 (hasta el presente) con 165 pacientes que han sido inscritos en esta medida de mejora de la calidad. En este momento, sólo un paciente (0,6%) ha experimentado una complicación infecciosa en la forma de sepsis sistémica. Este paciente fue colonizado con una resistente E. múltiples fármacos coli cepa. Hisopos rectales tras la administración de PIRP en este paciente señalaron que la bóveda rectal todavía fue colonizado con bacterias 2...

Watch this Scientific Journal Video about Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection at JoVE.com

Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

Here, we present a protocol for use at the time of transrectal ultrasound guided prostate needle biopsy (TRUS PNB) that is a simple and cost-effective means to reduce infections following the procedure.

Povidona yodada Preparación rectal al momento de la próstata Biopsia con aguja es un medio simple y reproducible para reducir el riesgo de infección Procesal

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy ...

povidone-iodine-rectal-preparation-at-time-prostate-needle-biopsy-is

Research

JoVE Journal

Medicine

31.9K vistas.  Penn State Milton S. Hershey Medical Center. Here, we present a protocol for use at the time of transrectal ultrasound guided prostate needle biopsy (TRUS PNB) that is a simple and cost-effective means to reduce infections following the procedure.

Video: Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

PRP as a New Approach to Prevent Infection: Preparation and In vitro Antimicrobial Properties of PRP

Implant-associated infection is becoming more and more challenging to the healthcare industry worldwide due to increasing antibiotic resistance, transmission of antibiotic resistant bacteria between animals and humans, and the high cost of treating infections.
In this study, we disclose a new strategy that may be effective in preventing implant-associated infection based on the potential antimicrobial properties of platelet-rich plasma (PRP). Due to its well-studied properties for promoting healing, PRP (a biological product) has been increasingly used for clinical applications including orthopaedic surgeries, periodontal and oral surgeries, maxillofacial surgeries, plastic surgeries, sports medicine, etc.
PRP could be an advanced alternative to conventional antibiotic treatments in preventing implant-associated infections. The use of PRP may be advantageous compared to conventional antibiotic treatments since PRP is less likely to induce antibiotic resistance and PRP's antimicrobial and healing-promoting properties may have a synergistic effect on infection prevention. It is well known that pathogens and human cells are racing for implant surfaces, and PRP's properties of promoting healing could improve human cell attachment thereby reducing the odds for infection. In addition, PRP is inherently biocompatible, and safe and free from the risk of transmissible diseases.
For our study, we have selected several clinical bacterial strains that are commonly found in orthopaedic infections and examined whether PRP has in vitro antimicrobial properties against these bacteria. We have prepared PRP using a twice centrifugation approach which allows the same platelet concentration to be obtained for all samples. We have achieved consistent antimicrobial findings and found that PRP has strong in vitro antimicrobial properties against bacteria like methicillin-sensitive and methicillin-resistant Staphylococcus aureus, Group A Streptococcus, and Neisseria gonorrhoeae. Therefore, the use of PRP may have the potential to prevent infection and to reduce the need for costly post-operative treatment of implant-associated infections.

PRP as a New Approach to Prevent Infection: Preparation and In vitro Antimicrobial Properties of PRP

Implant-associated infection is a significant clinical complication. This study describes an approach using platelet-rich plasma (PRP) to prevent implant-associated infections, presents the protocol for preparing PRP with constant platelet concentration, and reports the newly identified antimicrobial properties of PRP and related protocols for examining such antimicrobial properties in vitro.

PRP como un nuevo enfoque para prevenir la infección: Preparación y<em&gt; In vitro</em&gt; Propiedades antimicrobianas de PRP

Implant-associated infection is becoming more and more challenging to the healthcare industry worldwide due to increasing antibiotic resistance, ...

Investigación

Inmunología e Infección

In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses

Optical coherence tomography (OCT) is the optical equivalent of ultrasound imaging, based on the backscattering of near infrared light. OCT provides real time images with a 15 &#181;m axial resolution at an effective tissue penetration of 2-3 mm. Within the OCT images the loss of signal intensity per millimeter of tissue penetration, the attenuation coefficient, is calculated. The attenuation coefficient is a tissue specific property, providing a quantitative parameter for tissue differentiation. 
Until now, renal mass treatment decisions have been made primarily on the basis of MRI and CT imaging characteristics, age and comorbidity. However these parameters and diagnostic methods lack the finesse to truly detect the malignant potential of a renal mass. A successful core biopsy or fine needle aspiration provides objective tumor differentiation with both sensitivity and specificity in the range of 95-100%. However, a non-diagnostic rate of 10-20% overall, and even up to 30% in SRMs, is to be expected, delaying the diagnostic process due to the frequent necessity for additional biopsy procedures. 
We aim to develop OCT into an optical biopsy, providing real-time imaging combined with on-the-spot tumor differentiation. This publication provides a detailed step-by-step approach for percutaneous, needle based, OCT of renal masses.

In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses

Optical coherence tomography (OCT) is a high resolution imaging technique that allows analysis of tissue specific optical properties providing the means for tissue differentiation. We developed needle based OCT, providing real-time imaging combined with on-the-spot tumor differentiation. This publication describes a method for percutaneous, needle based OCT of renal masses.

En Vivo, percutánea, Aguja Based, tomografía de coherencia óptica de las masas renales

Optical coherence tomography (OCT) is the optical equivalent of ultrasound imaging, based on the backscattering of near infrared light. OCT provides real ...

Medicina

Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser

The occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem with a high incidence in the aging male population. Although it is not a life-threatening disease, BPH causes problems that seriously impact the quality of life. Here, we introduce a new technique called photoselective vaporesection of the prostate (PVRP) in treating BPH, which can be seen as a variation of photoselective vaporization of the prostate (PVP). This procedure presents several advantages compared to the PVP technique including less laser energy loss, less intraoperative complications as well as more tissue resection rate.

Here we present a protocol to perform Photoselective Vaporesection of the Prostate (PVRP) for benign prostatic hyperplasia (BPH) treatment.

Vaporesection fotoselectiva de la próstata a través de un láser de cristal Triborate litio de disparo final

The occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem with a high incidence in the aging ...

Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy

Here, we present a protocol to perform targeted prostate biopsy using a magnetic resonance imaging-ultrasound (MRI/US) fusion system. Prostate cancer has traditionally been diagnosed via transrectal ultrasound (TRUS) biopsy. Though considered the gold standard, TRUS is unable to visualize most prostate cancer lesions and therefore requires sampling of the entire prostate. This biopsy method often undergrades prostate cancer and fails to detect up to 35% of cancers on initial biopsy. Prostate MRI has been shown to have excellent sensitivity in the detection of cancerous lesions, and advancements in MRI technology during the last decade have led to the development of targeted biopsy. In targeted biopsy, a software platform overlays MRI data onto live TRUS images to create a fused MRI/US three-dimensional model of the prostate. Regions suspicious for malignancy on MRI are contoured by a radiologist, uploaded into the fusion system, and then displayed within the live MRI/US fused model. The urologist is then able to directly biopsy these targets. When compared to conventional TRUS biopsy, MRI/US fusion technology has been demonstrated to improve the detection of clinically significant cancer while reducing insignificant cancer detection. This technology, therefore, has the potential to diagnose prostate cancer primarily in men who would benefit from treatment.

Presented herein is a protocol to perform targeted biopsy of the prostate using an MRI-ultrasound fusion system.

Uso de resonancia magnética-ecografía fusión para lograr biopsia dirigida de la próstata

Here, we present a protocol to perform targeted prostate biopsy using a magnetic resonance imaging-ultrasound (MRI/US) fusion system. Prostate cancer has ...

Use of Magnetic Resonance Imaging and Biopsy Data to Guide Sampling Procedures for Prostate Cancer Biobanking

Previous methods for biobanking prostate tissue, following radical prostatectomy, generally involved random sampling. In order to increase efficiency, and enable a greater range of downstream applications, a more targeted method of sampling prostate tissue was developed. Here we use both magnetic resonance imaging (MRI) and biopsy data to target specific areas of the organ for sampling. The method involves use of a previously published prostate slicing device which removes a 5 mm transverse slice from a predetermined region of the prostate, followed by the removal of 6 mm punch biopsies from predetermined areas of this slice. These samples can be stored frozen or fixed for biobanking purposes, or used fresh immediately with 70% confidence of tumor content, as compared with 10% confidence from the random sampling approach. This enables the use of all standard downstream techniques such as genomics, proteomics or histological work, but also work that requires fresh tissue such as live tissue imaging or ex vivo culture.

This method involves utilization of clinical diagnostic data for prostate cancer patients in order to guide sampling procedures, when biobanking tissue following radical prostatectomy. This overcomes issues with previously published methods around efficiency and availability of fresh tissue for a wider range of downstream applications.

Uso de imágenes de resonancia magnética y datos de biopsia para guiar los procedimientos de muestreo para la biobanca del cáncer de próstata

Previous methods for biobanking prostate tissue, following radical prostatectomy, generally involved random sampling. In order to increase efficiency, and ...

Focal Laser Ablation of Prostate Cancer: An Office Procedure

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually similar to a fusion biopsy and is performed under local anesthesia in a clinic setting; treatment time is usually less than one hour. Laser insertion is guided by ultrasound; lesion targeting is via magnetic resonance imaging-ultrasound (MRI/US) fusion, as in targeted prostate biopsy. Real-time ablation monitoring is achieved utilizing a thermal probe adjacent to the laser fiber. The video demonstrates procedure planning, patient preparation, various steps during the procedure, and treatment monitoring. Safety, feasibility, and efficacy of this approach have been established during a previous trial. Outpatient FLA under local anesthesia is an option for management of intermediate risk prostate cancer.

This article presents and describes an outpatient treatment for prostate cancer using focal laser ablation. Laser catheter placement is guided by MRI-ultrasound fusion imaging in a fashion similar to prostate needle biopsy. Treatment is monitored in real-time with a thermal probe, placed adjacent to the laser fiber.

Ablación focal del laser del cáncer de próstata: Un procedimiento de la oficina

In this article, we describe and illustrate an outpatient procedure for focal laser ablation (FLA) of prostate cancer (PCa). The procedure is conceptually ...

Micro-Ultrasound Guided Transperineal Prostate Biopsy: A Clinic-Based Procedure

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound guided transperineal technique performed under local anesthesia, which maintains accuracy, keeps patients comfortable, has low adverse events, and minimizes the need for disposables. Prior micro-ultrasound-guided transperineal techniques required general or spinal anesthesia. The key steps described in the protocol include (1) the placement of the local anesthesia, (2) micro-ultrasound imaging, (3) and the visualization of the anesthetic/biopsy needle while uncoupled from the insonation plane. A retrospective review of 100 patients undergoing this technique demonstrated a 68% clinically significant cancer detection rate. Pain scores were prospectively collected in a subset of patients (N = 20) and showed a median procedural pain score of 2 out of 10. The 30 day Grade III adverse event rate was 3%; one of these events was probably related to the prostate biopsy. Overall, we present a simple, accurate, and safe technique for performing a micro-ultrasound-guided transperineal prostate biopsy.

This manuscript outlines the steps for performing a micro-ultrasound-guided transperineal prostate biopsy under local anesthesia.

Prostate cancer is the most common solid malignancy in men and requires a biopsy for diagnosis. This manuscript describes a freehand micro-ultrasound ...

A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound

Traditional transrectal ultrasound (TRUS)-guided prostate biopsy has limited sensitivity and specificity, particularly for detecting early-stage prostate cancer, due to a lack of precise lesion targeting. An improved cognitive fusion-guided prostate biopsy method has been developed to enhance lesion targeting by integrating three parameters of prostate multiparametric MR (mpMRI) images into TRUS images. Prostate mpMRI measurement is initially performed to obtain three key parameters: the rotation angle (&#945;), the distance from the rectal wall (X), and the distance from the prostate apex (Y). These parameters are then cognitively applied in real-time, TRUS-guided prostate needle biopsy to detect target lesions. This improved transperineal cognitive fusion biopsy method enhances diagnostic accuracy, improves reproducibility, and reduces reliance on operator experience. Clinical application in 423 patients demonstrated a prostate cancer detection rate of 73.5%, with 62.9% classified as clinically significant cancers. Compared with equipment-intensive methods such as MRI-ultrasound fusion biopsy, this approach is cost-effective, practical, and well-suited for broader clinical adoption. Additionally, the method&#39;s flexibility supports integration with other imaging techniques, such as 68Ga-PSMA PET/CT, further improving detection rates for patients with high-risk prostate cancer.

Prostate biopsy is the gold standard diagnostic method for prostate cancer. Cognitive fusion-guided prostate biopsy, which combines transrectal ultrasound with pre-measured MRI parameters, improves biopsy accuracy and enhances the detection rate of clinically significant prostate cancer.

Biopsia de próstata guiada por fusión cognitiva mediante resonancia magnética multiparamétrica y ecografía transrectal

Traditional transrectal ultrasound (TRUS)-guided prostate biopsy has limited sensitivity and specificity, particularly for detecting early-stage prostate ...

Peripheral Intravenous Catheter Insertion

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
The purpose of peripheral intravenous catheter (PIV) insertion is to infuse medications, perform intravenous (IV) fluid therapy, or inject radioactive tracers for special examination procedures. Placing a PIV is an invasive procedure and requires the use of an aseptic, no-touch technique. 
Common IV venipuncture sites are the arms and hands in adults and the feet in children. According to the Intravenous Nurses Society (INS), the feet should be avoided in the adult population because of the risk of thrombophlebitis. Venipuncture sites should be carefully assessed for contraindications, such as pain, wounds, decreased circulation, a previous cerebral vascular accident (CVA), dialysis fistulas, or a mastectomy on the same side. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. The cephalic vein has been associated with nerve damage when used for IV placements. The most distal site available on the hand or arm is preferred so that future venipuncture sites may be used if infiltration or extravasation occurs.
This video will demonstrate the insertion of a PIV, including the preparation and attachment of an IV extension set. Although a PIV securement device is used here to stabilize the IV catheter, according to INS recommendations, some facilities may not elect to purchase these devices, and the alternate chevron or U-shaped taping method may also be used.

Peripheral Intravenous Catheter Insertion: No Touch Technique

Inserción del catéter venoso periférico

Source: Madeline Lassche, MSNEd, RN and Katie Baraki, MSN, RN, College of Nursing, University of Utah, UT
The purpose of peripheral intravenous catheter ...

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Hand hygiene

Asepsis is the practice of preventing or breaking the chain of infection. The nurse employs aseptic techniques to prevent the spread of microorganisms and reduce the risk of diseases. Hand hygiene is the cornerstone of aseptic techniques and is classified into medical and surgical asepsis. Medical asepsis includes hand hygiene and the use of gloves. Surgical asepsis, or the sterile technique, refers to practices that render and keep objects and areas free of microorganisms.
Hand washing consists of a fast, vigorous rubbing motion across all parts of the hands, with lathered surfaces, followed by 15 seconds of washing under water. Handwashing works by mechanically removing microorganisms from the hands and rinsing them with water. Microorganisms are not killed by handwashing. There are three techniques of hand washing.
Hand washing 
By performing hand hygiene at the right moments and using appropriate techniques, hands become clean and safe as infectious organisms are not transmitted to yourself or others. Using handwashing products that contain an antimicrobial or antibacterial ingredient is recommended in any setting where the risk for infection is high, such as:
<ul>
	<li>&#8226; When hands are visibly soiled with blood and body fluids</li>
	<li>&#8226;&#160;Before eating and after toileting</li>
	<li>&#8226;&#160;When exposed to spore-forming microorganisms.</li>
</ul>
Antiseptic hand wash
An antiseptic hand rub is used to decrease the number of microorganisms present on hand surfaces by applying an antiseptic hand rub. Ethanol-based hand antiseptics containing 70% to 90% alcohol appear to be the most effective against common pathogens found on the hands.
All healthcare workers must practice proper hand hygiene at all times, including:
<ul>
	<li>&#8226;&#160;Just before touching a patient</li>
	<li>&#8226;&#160;Before performing an aseptic task or working with invasive devices</li>
	<li>&#8226;&#160;Before switching from a soiled to a clean body site on a patient</li>
	<li>&#8226;&#160;After contacting a patient or their immediate surroundings</li>
	<li>&#8226;&#160;Following exposure to blood, bodily fluids, or contaminated surfaces (with or without glove use)</li>
	<li>&#8226;&#160;Immediately following glove removal</li>
</ul>
Antiseptic hand rub or surgical hand antisepsis 
Surgical hand antisepsis is an antiseptic hand wash or hand-rub technique that is an integral part of the preparation for surgery by surgical personnel. Its purpose is to eliminate transient microorganisms and reduce resident hand flora. The most currently used antiseptics are chlorhexidine (CHG) and povidone-iodine (PVI). These agents are applied with a sponge and brush. This technique involves coating the elbow to the fingers and can take up to three minutes, depending on hospital protocol.

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Asepsis is the practice of preventing or breaking the chain of infection. The nurse employs aseptic techniques to prevent the spread of microorganisms and ...

Povidona yodada Preparación rectal al momento de la próstata Biopsia con aguja es un medio simple y reproducible para reducir el riesgo de infección Procesal

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