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;

Questo studio relativo paziente è stato approvato dal comitato di revisione istituzionale (IRB) per la ricerca umana. 1. Preparazione del paziente e Posizionamento <ol><li> Portare il paziente alla suite procedura e metterli sul loro lato destro o sinistro con le ginocchia flesse al petto. </li><li> Eseguire un timeout chirurgica per cui il paziente, procedura chirurgica, e le indicazioni sono rivisti e confermati. </li><li> Quando indicato, somministrare sedazione endovenosa tramite il servizio di anestesia. </li></ol> 2. Eseguire un esame rettale digitale (DRE) <ol><li> Luogo dimensioni guanti idonei su entrambe le mani. </li><li> Inserire dito guantato dopo la lubrificazione in rettale della prostata ed esaminare a sentire per le potenziali aree sospette che necessitano di attenzione focalizzata durante ecografia transrettale. 10 </li></ol> 3. Creazione di Povidone Iodio rettale Preparazione (PIRP) <ol><li> Versare 15 ml di 10%disponibile in commercio soluzione povidone iodio in una bacinella sterile. </li><li> Aggiungere 5 ml di un 1% gel di lidocaina disponibile in commercio per questo bacino. </li><li> Mescolare il contenuto per 15 secondi per creare un impasto povidone iodio. </li></ol> 4. Gestione primaria del PIRP <ol><li> Utilizzare un tampone rettale sterile cultura rettale. </li><li> Aprire un 4 cm x 4 cm di garza sterile, immergere nella povidone iodio liquami, e quindi inserire nel caveau rettale. Solo una piccola coda di garza è lasciato emana dall&#39;ano. </li><li> Lasciare la garza in posizione per 2 minuti dopo di che viene rimosso ed eliminato. </li></ol> 5. Amministrazione secondaria di PIRP <ol><li> Usare un tampone ginecologica usa e getta per dipingere la zona perianale con la soluzione PIRP. </li><li> Inserire questo tampone ginecologica nella rettale ad una distanza di 3 cm dall&#39;ano. </li><li> Per massimizzare ulteriormente l&#39;esposizione della mucosa rettale per PIRP, tamponare la vau rettolt in modo simile almeno tre volte. </li><li> Lasciare la soluzione di iodio povidone asciugare per 2 -. 3 min prima di procedere con transrettale standard successiva biopsia 11 Ciò è essenziale in quanto gli effetti battericidi del PIRP richiedono la soluzione ad asciugare sulla mucosa esposta. </li><li> Utilizzare un tampone rettale sterile cultura rettale. </li></ol> 6. Ecografia transrettale e biopsia <ol><li> Inserire la sonda ecografica per via rettale. </li><li> Effettuare misurazioni della prostata e la successiva biopsia in modo standard in linea con tutte le pratiche urologici. 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.

Infezioni seguenti TRUS PNB sono secondari a traslocazione di batteri rettale nella prostata altamente vascolare. Sulla base di questo principio, abbiamo esplorato il semplice metodo di utilizzo di un argomento antisettico come povidone iodio per ridurre microrganismi colonia conteggi prima di ago biopsia della prostata. La nostra esperienza mette in evidenza una riduzione dal 4,3% al 0,6% (p = 0,02) con l&#39;uso di questo regime PIRP al momento della biopsia. Inoltre, si ipotizza che la riduzione del 97% in microrgani...

Il cancro alla prostata è il tumore più comune negli uomini e la seconda causa di mortalità per cancro-correlata. Nel 2014, circa 233.000 casi saranno diagnosticati negli Stati Uniti con quasi 30.000 uomini soccombere a questa neoplasia. 1 Mentre l&#39;antigene prostatico specifico (PSA) esame del sangue e l&#39;esame digitale rettale (DRE) svolgono un ruolo essenziale nello screening del cancro alla prostata, transrettale ecografia prostatica guidata agobiopsia (TRUS PNB) è il mezzo più comune per ottenere una diagnosi istologica dei tessuti. TRUS PNB comporta l&#39;inserimento di una sonda ad ultrasuoni nel retto del paziente e quindi generalmente accettato 12-14 biopsie della zona periferica della prostata situato anteriormente. Ogni agobiopsia richiede il passaggio di un 18 G ago attraverso la parete rettale nella prostata altamente vascolare. Pertanto, il rischio teorico di sanguinamento e infezione dovuta a traslocazione batterica esiste dopo la procedura. Nessunotheless, il post-procedura di tasso di complicanze attuariale ha storicamente rimasto basso. La profilassi antibiotica prima TRUS PNB è regolarmente prescritti con antibiotici chinolonici basato Benessere degli agenti più frequentemente utilizzati. Nonostante un&#39;adeguata profilassi, la ricerca contemporanea implica un aumento delle complicanze infettive dopo biopsia. 2 Inoltre, gli studi hanno attribuito questo aumento delle complicanze infettive dopo TRUS PNB alla nascita di chinolonici microrganismi resistenti particolarmente E. coli. 3 Questo tasso crescente di resistenza ai chinoloni suggerisce la necessità di regimi di profilassi per le procedure alternative TRUS PNB. A tal fine, diverse strade sono sotto indagine. Un approccio prevede la somministrazione di un antibiotico per via endovenosa o intramuscolare al momento della biopsia in combinazione con un chinoloni orale. 4 Mentre questa strategia può ridurre gli eventi sepsi seguenti TRUS PNB,un limite principale di questo approccio è la possibilità di sviluppare ulteriormente organismi resistenti a questa famiglia antibiotico. Un&#39;altra metodologia recentemente studiato incorpora l&#39;uso di un pre-biopsia tampone rettale per pazienti schermo colonizzata da flora rettali resistenti ai chinoloni. 5 Se vengono rilevati tali organismi, un regime antibiotico &quot;targeting&quot; potrebbe essere impiegato in base al profilo di sensibilità del batterici resistenti identificato sforzo. Mentre la metodologia è elegante, il processo vero e proprio di ottenere tali tamponi, selettivamente coltura su un terreno selettivo chinolone, e sartoria antibiotici richiede successivamente una infrastruttura clinica e di laboratorio che possono essere carente in molte pratiche cliniche. La somministrazione di un argomento antisettico per ridurre rettale microrganismo colonia conta prima di biopsia può presentare una strategia alternativa per limitare le infezioni TRUS PNB. Povidone iodone è un poco costoso agente, prontamente disponibili, che èdocumentato per la conta batterica ridotti quando applicato a siti chirurgici. Applicazioni in entrambi gli interventi del colon-retto e ginecologici sono ben noti. Pertanto, l&#39;uso di povidone iodio come preparazione rettale presenterebbe un metodo producibile, semplice e conveniente per la riduzione delle infezioni TRUS PNB, senza necessità di una preparazione supplementare prima di biopsia. Con riferimento alla letteratura urologica, precedentemente lavoro ha osservato una riduzione delle infezioni cliniche seguenti TRUS PNB. 6-9 Questo video dimostra la tecnica di PIRP per evidenziare la facilità e la semplicità di integrarsi nella pratica clinica. Tutti i pazienti sottoposti a TRUS PNB sono stati inizialmente visti in una clinica urologia specialità di rinvio o di valutazione iniziale per lo screening del cancro alla prostata. Questa valutazione ha comportato una revisione di antigene del paziente prostatico siero specifico (PSA) e le prestazioni di un esame rettale digitale (DRE). Anomalie sia del PSA o DRE spinto raccomandazioneun PNB TRUS. La procedura TRUS PNB è stato discusso con tutti i pazienti e dei rischi associati, tra cui infezioni, sanguinamento, e ritenzione urinaria sono state chiarite. Tutti i pazienti hanno ricevuto tre giorni di profilassi antibiotica per via orale o con un farmaco a base chinoloni (cioè, Ciprofloxacina) o trimetoprim-sulfametossazolo (Bactrim) prima 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

Istituzione singola e studi basati sulla popolazione evidenziano che le complicanze infettive seguenti transrettale ecoguidato ago biopsia della prostata (TRUS PNB) sono in aumento. Tali infezioni sono in gran parte attribuibile al chinoloni microrganismi resistenti che colonizzano la volta rettale e si trasferiscano nel sangue durante la procedura di biopsia. Una preparazione iodio povidone rettale (PIRP) al momento della biopsia è un metodo semplice e riproducibile per ridurre rettali conta delle colonie di microrganismi e le infezioni quindi risultanti seguenti TRUS PNB. Tutti i pazienti vengono somministrati tre giorni di terapia antibiotica per via orale prima di biopsia. La tecnica consiste PIRP posizionando inizialmente il paziente in modo standard per un TRUS PNB. Dopo esame rettale digitale, 15 ml di una soluzione al 10% di povidone iodio disponibile in commercio viene miscelato con 5 ml di 1% lidocaina gel per creare slurry. A 4 cm x 4 cm garza sterile è soaked in questo slurry e poi inserito nel rettale per 2 minuti, dopo di che viene rimosso. Successivamente, un tampone di cotone monouso ginecologica viene utilizzato per dare sia la zona perianale e rettale ad una distanza di 3 cm dall&#39;ano. La soluzione di iodio povidone viene poi lasciato asciugare per 2-3 minuti prima di procedere con ecografia transrettale norma e successiva biopsia. Questa tecnica PIRP è stato in pratica presso il nostro istituto dal marzo del 2012, con una riduzione associato di infezioni post-biopsia dal 4,3% al 0,6% (p = 0,02). Il vantaggio principale di questo regime di profilassi è la sua semplicità e riproducibilità con uso di un facilmente disponibile, agente economico per ridurre le infezioni. Inoltre, la tecnica evita esporre i pazienti a antibiotici sistemici supplementari con potenziale ulteriore propagazione di organismi resistenti a più farmaci. L&#39;utilizzo di PIRP a TRUS PNB, tuttavia, non è applicabile per i pazienti con iodio o crostacei unllergies.

Questa tecnica PIRP è stato in pratica dal gennaio del 2012 (fino ad oggi), con 165 pazienti che hanno stati arruolati in questa misura il miglioramento della qualità. In questo momento, solo un paziente (0,6%) ha registrato una complicazione infettiva in forma di sepsi sistemica. Questo paziente è stato colonizzato da un resistente E. multi-farmaco coli. Tamponi rettali in seguito alla somministrazione di PIRP in questo paziente ha osservato che la volta del retto era ancora colonizzato da 2,1 x 10...

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.

Povidone Iodio rettale Preparazione al momento della prostata ago biopsia è un semplice e riproducibile significa ridurre il rischio di infezione procedurale

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 Views.  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 come un nuovo approccio per prevenire l&#39;infezione: Preparazione e<em&gt; In vitro</em&gt; Proprietà antimicrobiche di PRP

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

Ricerca

Immunologia e infezioni

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.

In Vivo, percutanea, Ago Based, Optical Coherence Tomography di masse renali

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.

Fotoselettive Vaporesection della prostata tramite un Laser di cristallo Triborate litio fine-infornamento

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 della fusione di MRI-ultrasuono per raggiungere mirata biopsia della prostata

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 di dati magnetici e di biopsia per guidare le procedure di campionamento per il biobanking sul cancro alla prostata

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.

Ablazione laser focale del cancro alla prostata: una procedura d'ufficio

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.

Una biopsia prostatica guidata dalla fusione cognitiva mediante risonanza magnetica multiparametrica ed ecografia transrettale

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

Inserimento del catetere endovenoso periferico

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

Didattica

JoVE Science Education

Competenze cliniche

Competenze infermieristiche

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.

Igiene delle mani

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

Povidone Iodio rettale Preparazione al momento della prostata ago biopsia è un semplice e riproducibile significa ridurre il rischio di infezione procedurale

Riepilogo

Esplora Altri Video

PLAYLIST