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At least 217 records · Page 12Linked to original sources
PubMed1990

Relationship between anesthetic procedure and contact of anesthesia personnel with patient body fluids.

We recorded the frequency with which anesthesia personnel came in contact with patient body fluids in order to provide an empirical basis for the recommendation of relevant precautions. Anesthesia personnel completed a questionnaire when performing a range of standardized procedures. The rate of contact with blood was as follows: catheterization of peripheral vein, 18%; insertion of central venous catheter, 87%; arterial puncture, 38%; lumbar puncture, 23%; catheterization of the extradural space, 34%; tracheal intubation, 4%; tracheal extubation, 9%; suction of oral cavity, pharynx, or trachea, 13%; intramuscular injection of drug, 8%; and establishment or discontinuation of drip for blood transfusion, 43%. By using protective gloves, 98% of contacts with patient blood would have been prevented. Blood contact was more frequent in the emergency ward than in the operating room (P less than 0.05). Health care workers were not able to predict when a specific procedure would imply that contact with patient blood would occur. We recommend that specific precautions be adopted for the various procedures and discuss precautions that could have prevented contact with body fluid.

Anesthesiology↗
PubMed1999

Pain during insertion of peripheral intravenous catheters with and without intradermal lidocaine.

Phase 1 of this study evaluated the perception of pain in 50 patients undergoing peripheral venous catheter insertion without the use of a local anesthetic. Phase 2 evaluated perceived pain in 50 patients who received intradermal lidocaine before the i.v. catheter was inserted. The researchers found that lidocaine injected intradermally before placement of an i.v. catheter resulted in significantly lower self-reported pain perceptions (p < 0.01). No additional time (determined in intervals of 15 minutes) was required for the study group. Based on these findings, the hospital policy was modified so that intradermal lidocaine would be offered to all patients requiring peripherally inserted i.v. catheters.

Anesthetics, Local↗
PubMedDate not supplied

Midline catheters: the middle ground of intravenous therapy administration.

Evangelical Community Hospital at Lewisburg, Pennsylvania, is a small community hospital with 110 beds. This organization sought a device to bridge between the short peripheral catheter and the peripherally inserted central catheter. The midline catheter provided an answer to this dilemma. However, a literature search for midline catheters yielded only four published articles, and only one of these was related to outcomes. The drugs used and the type of patients treated at Evangelical Community Hospital provided a challenge for the infusion therapist. This article examines the management of the patients who fell into a midlength of stay, and for whom both the short peripheral catheter and the peripherally inserted central catheter were inappropriate.

Algorithms↗
PubMed1991

Peripheral intravenous cannulation.

The placement of intravenous cannulas can be a difficult task, especially when treating a hypovolaemic or critically ill patient. Often the physician is faced with the problem of being unable to locate a suitable vein or, even more frustrating, finding a vein but not being able to insert the cannula. The author summarises the general principles of peripheral intravenous cannulation and presents some practical tips.

Catheterization, Peripheral↗
PubMed1998

[Duplex ultrasound risk stratification of percutaneous puncture of the brachial artery for diagnostic and interventional coronary angiography].

Diagnostic and interventional heart catheterization in peripheral vascular disease often requires due to iliacal disease additional methods of arterial approach besides the Judkin's technique. The percutaneous catheterization of the brachial artery finds widespread use. A major complication linked with this method is an increased rate of thrombotic occlusions at the puncture site. Thus, we investigated in a prospective set-up the ability of duplex ultrasound to identify predictive risk factors for vascular complications. Over a period of 20 months, 8000 patients referred to heart catheterization were studied. Routine catheterization via the femoral route was contraindicated in 34 out of 8000 mostly due to severe peripheral vascular disease with multiple vascular risk factors (diabetes, hypertension, and smoking). 53 patients who had a comparable low risk-profile served as the control group. The brachial artery was examined by ultrasound duplex for vessel anatomy and diameter at the puncture site before coronary angiography. Both groups (patient and control group) showed in 15% a variable anatomy with a premature division of the brachial artery in 6% proximal of the elbow and in 9% already distal to the axillary artery. Because of reduced diameters of these variable vessels no procedure was carried out at these arms. In all cases the opposite arm was successfully used instead, because the variants were always located only at one arm. The diameter of the brachial artery measured in average 5.0 +/- 0.8 mm and 4.8 +/- 0.7 mm in patients and controls, respectively. Women had a significantly smaller vessel diameter than men, measuring a difference of 0.4 and 0.6 mm, respectively (p < 0.05). For coronary angiography 6F and 7F arterial sheats were used equally, and in 32% of all cases a coronary intervention was performed. 31 (91%) procedures were carried out without complications; there was a false aneurysm in 1 patient (3%) and an occlusion of the brachial artery at the puncture site in 2 patients (6%). The occluded vessels of two diabetic women had a reduced diameter at the level of 10% of the standard distribution and an unfavorable ratio of sheat-to-vessel-diameter which lead initially to an obstruction of nearly 50% of the vessel lumen during catheterization. Screening of the brachial artery by ultrasound duplex before a percutaneous catheterization for coronary angiography and intervention showed reproducibly the variable anatomy and differences in vessel diameter, which can be risk factors for thrombotic occlusion. Important details for the location of the puncture site and the possible size of the arterial sheat can be obtained, so that coronary interventions with 7F catheter systems are still practicable. This technique is a simple and efficient method to estimate the relative risk of arterial occlusion prior to percutaneous puncture of the brachial artery, especially in a group of patients with severe atherosclerosis and elevated vascular risk-factors.

Adult↗
PubMed1991

Peripheral arterial occlusion in infants--a report of two cases treated conservatively.

The occlusion of major arteries in newborns is usually associated with catheterization of the umbilical vessels. It occurs very rarely instead as a primary disorder, and the cause is still unclear. We present two new cases of newborns with this type of disease, which were resolved with the only medical treatment. The literature is reviewed, and the usefulness of the different diagnostic procedures is discussed.

Arterial Occlusive Diseases↗
PubMed1991

[Approaches in parenteral nutrition].

The central venous catheter, on the one hand, and the peripheral venous cannula, on the other hand, are available as fundamental access possibilities for parenteral nutrition. While the implantation of a central venous catheter is technically tiresome and subject to a complication rate up to 5%, the peripheral venous cannulization, in general, does not represent any technical problem. However, in case of peripheral venous access, due to the local venous compatibility, not only the duration of application is generally limited to 4-6 days, but the feeding of nutritious substances as such (excepting fat emulsions) is restricted, too. This means a limitation of the applicability in temporary and acute phases of a disease, as well as its application as a supplementary therapy in the event of oral or enteral nutrition. The advantage of the central venous parenteral nutrition refers to the possibility of a long-term high-doses, and thus to a complete parenteral, nutritional therapy. It is, however, subject to an aggravating rate of thrombotic (0.5-5%) and septic complication (3-6%), so that the indication and duration of application should be looked upon very closely and critically. The low-risk alternatives of a peripheral venous parenteral nutrition should be observed more closely.

Catheterization, Central Venous↗
PubMed1996

Principles of angioplasty guidance using ultrasound.

Marker bands that cast dense shadow on X-ray are placed at crucial points on a catheter (for example on a peripheral angioplasty catheter on either side of the balloon) so that those parts of the catheter can be guided inside the body by X-ray. For catheter guidance by ultrasound, an ultrasound sensor in the mid-balloon region of an angioplasty catheter is integrated to the scanhead of an ultrasound scanner, via a catheter system interface (CSI). When the sensor in the catheter is imaged by the ultrasound scanner, the CSI injects a bright arrow corresponding to its position. This allows accurate catheter guidance using ultrasound. This paper describes the principles of ultrasound guidance of catheters and the initial clinical experience using this new catheter system (Echomark) in carrying out peripheral transluminal angioplasty.

Angioplasty↗