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PubMed1988

[A safe method for infraclavicular puncture of the subclavian vein].

Investigations of 25 human cadavers, using various anatomical techniques, led to the development of a safe and simple method of subclavian venipuncture. This method was tested with special regard to possible complications. The authors describe the guidelines for the choice of the point where the skin has to be penetrated as well as of the point towards which the needle has to be directed. While the latter is situated a little beyond the spinous process of the seventh cervical vertebra, the other is determined as follows: the distance between the acromion and the sternoclavicular joint is divided into three parts, and the junction between the medial and central third of this distance is marked on the skin. Starting from this point a vertical is dropped towards the line between the acromion and the sternal angle. The point of intersection between this line and the vertical is where the cannula penetrates the skin. After a distance of between 2.5 and 4.5 cm the top of the needle reaches the subclavian vein. Even if the vessel is pierced through and through, no complication such as pneumothorax, laceration of arteries, lesions of the adjacent nerves, etc., can occur. Using this method the authors performed catheterization of the subclavian vein in 200 patients, and there were no complications at all.

Acromion↗

PubMedDate not supplied

Successful placement of an adult sternal intraosseous line through burned skin.

Obtaining vascular access can be difficult in the critical adult patient. This can be especially true in a severely burned patient, where the usual insertion site may be involved in the burn injury. We present a case in which a sternal intraosseous line was placed through a full-thickness injury, in a patient in full arrest, who subsequently underwent a successful cardiac resuscitation.

Atropine↗

PubMed1992

Accidental injuries and blood exposure to cardiothoracic surgical teams.

A survey was undertaken over a 15-week period (62 working days) to find out the incidence and common mechanism of accidental injuries and blood exposure in cardiothoracic surgical teams. Two hundred and seventy events were reported: 70% glove penetrations, 18% skin punctures, 4% non-bleeding skin lesions and 8% lacerations with bleeding. Eye splashes occurred in 14% of the cases. The risk to the team was higher for cardiac surgery (1.6) than for thoracic surgery (0.5) and endoscopy (0.01). Most of the events were self-inflicted by experienced personnel. The surgeon's left index finger was most frequently injured, and the majority of the injuries were caused by needles followed by wire injuries during sternal closure. Prevention should be directed towards a safer technique for sternal closure, and protection of the surgeon's hands, especially his left index finger, should be found. Eye protection with goggles should become routine. This study demonstrates that open heart procedures carry a high risk of injury and frequent exposure to blood increasing the risk to the surgical team of acquiring viral infections (hepatitis-B and HIV) from the patients.

Accidents, Occupational↗

PubMed1989

Brachial plexus lesions following cardiac surgery with median sternotomy and cannulation of the internal jugular vein.

There are many possible complications after cannulation of the internal jugular vein (IJV) including injury to the brachial plexus. Neurologic injuries can also occur from sternal splitting. The present study looked at the incidence of brachial plexus lesions after cardiac surgery with and without IJV cannulation. Over 12 months, 815 patients were studied after all types of cardiac surgery. In one half of the group, cannulation of the IJV was avoided when possible. Reducing the incidence of IJV catheterization did not lower the overall incidence of brachial plexus lesions (1.8% to 1.4%). However, there was a higher incidence of neurologic lesions in patients with IJV catheters (3.0% to 0.8%) during the entire study period. All 13 plexus lesions were in the C8-T1 distribution, and seven of the patients had a Horner's syndrome on the same side. No posterior first rib fractures could be detected by radiographs. The brachial plexus lesions were transient but the Horner's syndromes were longer-lasting. It is concluded that the injuries are due to compression and traction of the plexus due to stretching and possibly from hematoma formation from the IJV punctures.

Adult↗

PubMed1992

Pericardiocentesis: a 20 patients study.

Emergency pericardiocentesis, guided by a two-dimensional echocardiography, was performed on twenty patients with symptomatic pericardial effusion of various types and causes. There were fourteen men and six women. The underlying causes were: primary lung cancer (6 cases), metastatic cardiac tumors (3 cases), tuberculosis (4 cases), complicated interventional procedures with cardiac chamber or vessel perforations (2 cases), dissecting aortic aneurysm (1 case), systemic lupus erythematous (1 case), idiopathic pericarditis (1 case), bacterial pericarditis (1 case), and myxedema heart disease (1 case). Seventeen cases were performed through the left xipho-sternal approach and 3 cases through the apical approach. None of the patients died as a result of these procedures. A two-dimensional echocardiogram is useful in diagnosing cardiac tamponade as well as in guiding pericardiocentesis, and obtaines highly positive results (20/20). The positive rate of pericardial fluid cytology for malignant cells was 89% (8/9), however, pericardial fluid cultures or direct smear for tuberculosis were negative (0/4). In cancer patients, the mean survival time following pericardiocentesis was 4.2 months (range, 1-7.8 months). We concluded that neoplastic involvement of the pericardium is the most frequent cause of symptomatic pericardial effusion. Pericardiocentesis assisted by a two-dimensional echocardiogram is safe and easy. In addition, pericarditis caused by TB is still significant and must be considered in every case in our nation.

Adult↗