Vygon India

Accounting for nearly 10 million deaths worldwide in 2020 alone, cancer remains one of the leading causes of death, and with the recent spread of Covid-19, cancer care has undoubtedly faced tremendous disruptions. Despite the advancement in cancer diagnostics technologies, and treatments, the instability arising from the pandemic has inflicted a major setback to the healthcare system.

The incidence of cancer amongst Covid-19 patients was observed at a rate of 6% with a much higher mortality rate than usual.[1] More than 3/4th of the patients undergoing cancer treatment had experienced some delay in their treatment due to Covid-19.[2] However, to overcome this setback and minimize all the future ones, it is important to develop a robust healthcare eco-system by ensuring reliable access to medical devices and diagnostic technologies.

In the oncology field, Vascular Access Devices (VAD) is the go-to tool for doctors to deliver chemotherapy in cancer patients, by gaining easy access to their bloodstream. Typically, a VAD is recommended in patients requiring mid-term to long-term intravenous treatment involving recurring infusions of caustic drugs or hyperosmolar fluids in chemotherapy, TPN administration, blood sampling, infection, or acute pain therapies.

With increasing cancer incidences worldwide, the need for an efficient, comfortable, and less intensive long-term treatment method rises. This is where a chemo port comes to the rescue of both the clinician and the patient – the patient by saving them the pain and discomfort from several jabs, risk of infections and skin irritations, and the clinician by saving them the time needed to prepare the area before pricking a new needle into the skin every time.

1 in 9 Indians will develop cancer during their lifetime (0-74 yrs of age). Cancer Statistics 2020: Report from National Cancer Registry Programmer, India

What is an Implantable Port and who needs one? A chemo port also called an implantable port, is a totally implantable venous access device, wherein a catheter is linked to a port body and placed subcutaneously in the patient, allowing permanent central venous access for delivering long-term intravenous therapy, usually more than 3 months, like chemotherapy, antibiotics, parenteral nutrition, pain management, fluids, and blood sampling.

Ports are indicated in cases usually requiring central venous access for more than 3 months, when vesicant drugs, drugs with osmolarity > 600 mOsm/L (INS 2006) or 500 mOsm/L, parenteral nutrition with osmolarity > 800 mOsm, or drugs with pH > 9 or pH < 5 need to be administered. [1]

Although not all chemo patients get ports inserted, it is often requested by some because they allow more normalcy in their everyday lives by increasing the aesthetic appearance and requiring limited maintenance. For instance, the patients can swim, sleep on their stomachs, or take a shower hassle-free with a port in (assuming that the surgery is performed right). It is the best option for patients that have poor venous access and when administering certain chemotherapy drugs that are too caustic to be delivered into the peripheral vein.

Where are Implantable Ports placed? The implantable port should sit snugly in the junction between the superior vena cava and the right atrium of the heart. Naturally, the most preferred insertion pathway is the venous access routes, superior vena cava in particular, through the jugular vein, subclavian vein, axillary vein, or cephalic vein. In cases where the superior vena cava is inaccessible, the inferior vena cava is used through the femoral vein.

What are the Implantable Port Indications and Contraindications?

What is Vygon’s take on this? As vascular access experts, Vygon works closely with clinicians and patients to provide products that combine the ideal dwell time with ease of use, effectiveness, and value for money. Vygon’s range of ports is specifically designed as a one-stop central venous access device for both pediatric and adults with a great focus on patient comfort while delivering secure, long-term intermittent IV therapy.

Vygon’s Hybrid implantable port, Polysite, is a hybrid combination of titanium and polyoxymethylene (POM) that are large and lightweight prove to be much much safer than other full plastic ports in the market as the risk of particulate formation from the Huber needle scratching the Titanium reservoir base is negligible. It has a titanium reservoir with a residual volume <1ml and an extremely smooth surface that ensures less dead space for infections.

When aesthetics and patient comfort are of the utmost importance to the patients, Vygon’s low-profile full titanium port Sitimplant and hybrid ports are the ideal go-to options. Sitimplant has a round base for better stability and durability. Vygon’s range of ports has wide applicability from adult to pediatric patients having both high and/or normal BMI. Adding to their benefits, they are MRI-compatible** and CT-compatible. **tests realized according to ASTM F 2052-06e1 standard

Owing to its ergonomic shape, the ports have high ease of insertion into the skin pocket and the Silicone septum can be easily located by palpation. All Vygon ports are available with a variety of insertion kit accessories, including 22G Huber needle, to ensure the right placement is achieved at the very first time using any preferred technique. Both Polysite and Sitimplant come with an extensive range of Silicone and PUR catheters of different gauges that may be preconnected or not, using a radioopaque connection ring.

Neonatal Hypothermia is a medical condition where the axillary body temperature drops to a potentially dangerous level, below 36.5 ֯C (97.7 ֯F), anything below the normal neonate body temperature range of 36.5֯ C to 37.5 ֯C (97.7 ֯F – 99.5 ֯F), as defined by World Health Organisation. This continual inability to produce sufficient body heat may be attributed to a multitude of reasons involving prolonged exposure to cold temperatures, which is detrimental to the baby’s health, progressively increasing the chances of neonatal morbidity and mortality.

A study conducted on 500 neonates in Nepal, showed that 85% of them were hypothermic (body temperature < 36 ֯C) 2 hours after delivery.[1]

Previous studies revealed that with every 1 ֯C fall in neonate’s body temperature the risk of sepsis increases by 11% and chances of death increase by a startling 28%. [2]

Incidence of Hypothermia on admission to NICU from the delivery room was found to be :

≥ 56% for infants < 750g

≥ 25% for infants ≤ [3]

Factors of Neonatal Hypothermia:

Some of the main factors that drastically increase the chances of Neonatal Hypothermia are,

Preterm babies

Low birth weight

Sepsis

Poor transporting conditions

Low environment temperatures (AC rooms, wet linen, etc.)

Causes of Neonatal Hypothermia: Physical Characteristics of preterm infants and Environmental Factors

The inherent physical characteristics of preterm infants that impairs the thermoregulatory mechanism are:

Large body surface area to weight ratio

Incapacity to shiver to generate heat

Inadequate stores of subcutaneous insulating fat

Negligible capacity to generate heat (Brown adipose tissue)

Underdeveloped epidermal barrier

High respiratory rate, etc.

The environmental factors that are responsible for the incidence of Neonatal Hypothermia are:

Symptoms of Neonatal Hypothermia:

Rectal temperature < 95 ֯ F (35 ֯ C)

Pale, cold skin (may turn blue in Acrocyanosis)

Difficulty in breathing

Weak/excessive cry

Lethargic

Poor feeding

Some of the complications of neonatal hypothermia include Respiratory Distress Syndrome, hypoxia, sepsis, cardiac arrest, and, in the worst case, even death.

Neonatal mortality is defined as the death of a neonate within 28 days from birth and we can unquestionably conclude that neonatal hypothermia is a crucial indicator of neonatal wellbeing, and survival rate.

Hence this necessitates the need for prevention and interventional measures to rewarm the neonate at the earliest, without neglecting the telltale signs.

Prevention Strategy:

One such highly effective method of preventing heat loss is using Vygon’s NeoHelp, a sterile double polyethylene layered suit to swaddle the baby, immediately after delivery (before resuscitation), implementable on both, term, and preterm babies. NeoHelp has exclusive features like an adjustable hood, complete transparency, a central Velcro opening, and a pre-shaped foam cushion in the back all designed to provide an occlusive effect. It is simple, easy-to-use, convenient, and eliminates all kinds of heat losses from the baby.

According to UNICEF, such interventions can reduce neonatal morbidity or mortality by a good 18-24%. [6]

Children are the world’s most valuable resource and its best hope for the future.

– John F.Kennedy

and with every baby lost we lose an indispensable part of our future. 

Surfactant is a substance that reduces the surface tension at the interfaces of two liquids, between a gas and a liquid or between a liquid and a solid. Detergents, soaps, paints, adhesives, motor oils, etc are all examples of commonly used surfactants in daily life. Now, another such lesser talked about surfactant is the one naturally occurring in the alveoli of human lungs – pulmonary surfactant, preventing alveoli from collapsing.

The respiratory system is the system that tirelessly works to help us breathe, comprising an integrated network of lungs, bronchi, bronchioles, pharynx, larynx, nose, and mouth.

The basic fundamental unit of the respiratory system is the alveoli, where the main exchange of oxygen and carbon dioxide takes place between the lungs and the blood. The alveoli are tiny, hollow cup-shaped air sacs making up the entirety of the lungs, having very thin walls surrounded by many blood capillaries.

The mean total number of alveoli in an adult human being is 480million located at the end of the bronchioles. [2]

Now, these alveolar walls have a thin layer of water lining their inner surfaces which are formed when water vapor condenses during gas exchange while breathing and this water film creates a strong force at their surface, called surface tension; an intrinsic property of the water molecules to pull each other together to form a sphere (as water tends to form drops). So, it would naturally lead to collapsing of the alveoli into a sphere, ultimately causing problems in breathing.

According to Laplace’s Law, the pressure that facilitates the lungs’ collapse is directly proportional to surface tension and inversely proportional to the alveolar radius.

[P = 2T/r]

where P = pressure on alveolus, T = surface tension, r = alveolar radius

This implies the smaller the radius the higher will be the collapsing pressure and vice-versa; and as alveoli are small in radius to promote a higher surface area to volume ratio in the lungs, they would have a much higher collapsing pressure.

To counteract this high surface tension, our body provides an easy fix. The alveolar type II cells of the lungs secrete a phospholipoprotein fluid, pulmonary surfactant, that lowers the surface tension at this air-water interface and keeps the alveoli wide open to allow efficient breathing, whilst maintaining the structural integrity of alveoli.

Role of pulmonary surfactant

Reduces collapsing pressure of alveoli, and ultimately the lungs

Provides high compliance to allow the lungs to expand and extend to accommodate more air

Regulates the sizes of different alveoli providing stability

Provides immune protection from infectious agents like bacteria, etc

Surfactant Production and Consequent Complications in Neonate

Fetal lung development starts from the 3rd -17th week of gestation and continues 1 – 3 years postnatally. The surfactant production first begins and is detectable in the amino fluid between the weeks 25 – 36 (until birth) [3] [4]

However, usually before 32 weeks of gestation, the fetal lungs are immature and underdeveloped and birth before this progressively increases the chances of respiratory

difficulties due to lack of surfactant and respiratory alveoli. [4] Therefore, preterm infants are at a greater risk of developing morbidities, the most common being Neonatal Respiratory Distress Syndrome, which can lead to hypoxia and other serious complications.

In Europe, RDS is observed for about 90% of babies born at 24wks of gestation and for 80% of babies born at 28wks of gestation.

[5]

What Parameters to Consider When Choosing a Hemodynamic Monitoring System

A hemodynamic monitoring system is crucial in the assessment of cardiac performance and hemodynamic parameters, especially in critically ill patients. It is now proven that measuring cardiac output and its underlying causes is vital in helping the clinician to interpret patient condition and finally choose the right treatment plan. However, there is no dearth of these monitors of varying prices in the market, and choosing the right one can become a little difficult. An ideal hemodynamic system should provide continuous, real-time values while being easy-to-handle, reliable, and finds broad implantation, especially in pediatrics and critical care. But most importantly, it should be economical without compromising on its efficacy and sensitivity. Let us first review one of the popular hemodynamic monitors available in the market – Hemosphere Advanced Platform. It is a unique all-in-one platform integrating the best of all worlds – cold bolus thermodilution, Vigilance technology, and different Pulse Contour Methods (PCM) algorithms.

A hemodynamic monitoring system is crucial in the assessment of cardiac performance and hemodynamic parameters, especially in critically ill patients. It is now proven that measuring cardiac output and its underlying causes is vital in helping the clinician to interpret patient condition and finally choose the right treatment plan. However, there is no dearth of these monitors of varying prices in the market, and choosing the right one can become a little difficult.

An ideal hemodynamic system should provide continuous, real-time values while being easy-to-handle, reliable, and finds broad implantation, especially in pediatrics and critical care. But most importantly, it should be economical without compromising on its efficacy and sensitivity.

Let us first review one of the popular hemodynamic monitors available in the market – Hemosphere Advanced Platform. It is a unique all-in-one platform integrating the best of all worlds – cold bolus thermodilution, Vigilance technology, and different Pulse Contour Methods (PCM) algorithms.

It can be implemented using different dedicated disposables, the Swan-Ganz Pulmonary Artery Catheter, FloTrac sensor, and Acumen IQ sensor. Swan-Ganz PAC, deemed as the Gold standard, despite being highly invasive, risky, and cumbersome, performs accurate hemodynamic profiling of both, adult and pediatric patients (>5kg), after external calibration by cold bolus thermodilution.

Using FloTrac (BP transducer) in conjunction with any arterial catheter is a minimally invasive system based on an uncalibrated PCM algorithm deriving cardiac output from a pre-estimated patient database continuously measures hemodynamic parameters every 20s. However, the algorithm exhibits proven limitations endangering the accuracy and reliability of the system.

The third new dedicated transducer, the Acumen IQ sensor, unlocks the “Acumen Hypotension Index” software on the Hemosphere monitor, which has the exclusive ability to predict the likelihood of a Hypotensive event (Hypotensive Predictive Index, HPI) of a patient while displaying the standard hemodynamic parameters simultaneously at the rate of 20s.

Despite its limitation of displaying non-real-time and imperfect values under certain conditions, this open platform holds future scope of including potential technologies.

Now, let us see how the most advanced system, MostCare Up, offered by Vygon, is spearheading the hemodynamic monitoring market.

Vygon’s MostCare Up is the only minimally invasive hemodynamic monitor that can follow in real-time, every beat and even the slightest hemodynamic variations in the patient, powered by the patented algorithm of PRAM (Pressure Recording Analytical Method) that evaluates the cardiac output, without any prior calibration or anthropometric database, with maximum accuracy at a sampling rate of 1000Hz that expedites the detection of the dicrotic notch at every beat.

MostCare Up’s supremacy is attributed to its consistent triumphs over existing limitations of other monitors with its exclusive features; it finds strong validation and wide applicability in critical care patients with IABP, Arrhythmia, septic, and pediatric patients of all weight and ages and is implementable on any peripheral or femoral artery using no dedicated and/or change of disposable. Besides high flexibility, transferability, and adaptability, it provides ease of use to the operator and displays a string of exclusive variables barring the standard ones. It is a preferred option as it is adaptable to the current system with no additional accessory and has a provision to even maintain arterial BP on the existing monitor.

Although the Endless version of MostCare Up requires no consumables, the On-Demand version requires dedicated Timecards for stipulated durations (24hrs, 1mth, 6mth) or one-time Patient cards (1, 10, 50 nos) for activation of the system, thus proving to be highly economical when used as per requirement.

As Vygon firmly believes in equipping medical professionals with simple yet quality and reliable medical products to facilitate premium healthcare to all, we hoped to give an objective insight into two of the most in-demand hemodynamic monitors to help you decide if it is worth your investment.

A hemodynamic monitor is used to facilitate the doctor in monitoring the cardiac performance and tissue perfusion in organs. It is crucial for critically ill patients who are often hemodynamically unstable (or at risk of becoming unstable) owing to hypovolemia, cardiac dysfunction, or alterations of vasomotor function, which may further lead to organ dysfunction, deterioration into multi-organ failure, and eventually death.

Invasive hemodynamic monitoring is a cornerstone in critical care patients in operating rooms (OT) & intensive care units (ICU). The assessment of cardiac output using a pulmonary artery catheter has long been considered the clinical gold standard, followed by Echocardiography and TTE. However, several concerns have been raised regarding its invasiveness, dependency on user, discontinuity, and associated complications.

Surpassing all these limitations, Vygon’s MostCareUp stands invincible in the sea of other monitors, with its supreme features, highest precision and reliable quality coupled with easy handling and wide adaptability at a pocket-friendly cost.

But what makes Vygon’s MostCareUp the most sought for hemodynamic monitor?

MostCareUp monitor is a minimally invasive, highly sophisticated, versatile, accurate and reliable system that is simple to use and handle, capable of deriving the cardiac output from the arterial waveform.

MostCareUp is the only minimally invasive hemodynamic monitor that can follow in real-time, every beat and even the slightest hemodynamic variations in the patient, powered by the patented algorithm of PRAM (Pressure Recording Analytical Method) that evaluates the cardiac output, without any prior calibration or anthropometric database, having good validations against Gold standard methods.

Simple: Unlike other existing monitors, no prior external calibration is required, comprising of an immediate intuitive, customizable interface displaying a broad set of information on vital elements like the preload, afterload, contractility and efficiency.

Easy, quick, flexible connections: It provides constant monitoring with accurate and rapid results. Thanks to its modern flexible connections and setup, real-time can be obtained, saved and transferred for subsequent analysis.

Versatile: Besides its wide adaptability to different patients and clinical environments, the monitor can be optimized for defining the best hemodynamic settings for patients of all age groups unique to their cardiovascular systems. Moreover, any femoral or peripheral artery can be used, and it is easily transferable between two patients.

Innovative: Not only does it display the systemic variables (systolic pressure, diastolic pressure, mean pressure and heart rate) and standard haemodynamic variables (cardiac output, stroke volume, systemic vascular resistance, dynamic fluid responsiveness variables, oxygen delivery, dP/dtmax as an index of contractility), but also exclusive variables like CCE as an index of efficiency and cardiovascular coupling, dicrotic pressure and Ea. A patented dynamic filter is responsible for producing quality pressure signals of the highest accuracy, consistently.

Reliable: MostCareUp works on the minimally invasive latest PRAM technology which allows continuous and sensitive monitoring, capable of responding to every minute hemodynamic variations in the patient. Its abject precision is achieved by deriving all the information from a beat-by-beat analysis of the arterial waveform, independent of pre-estimates and calibration. Unlike other monitors with a sampling rate of 100Hz, this has a sampling rate of 1000Hz which increases its reliability.

Cost-Effective & Convenient: It can be implemented on multiple patients without the need for any disposable or added elements. Its On-Demand and Endless system version is adaptive to all uses, allowing the operator to choose the best method of use at his discretion, thereby incurring reasonable operating cost, in comparison to other monitors that require high operating costs.

With hemodynamic monitoring, Vygon aims to enable medical professionals in preventing and/or treating organ failures by providing life-saving healthcare services to critical care patients. Vygon diligently believes in valuing every life and ensures the wellbeing of every patient by improving their way of life through its quality medical devices and technologies.