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PubMed1999

[Peripheral ischemia and persistent sciatic artery--interdisciplinary management].

Persistent sciatic artery as a rare entity results from lack of regression of the femoral artery blood supply of the leg and is often combined with an abnormally developed superficial femoral artery. We describe the case of a complete, persistent sciatic artery with peripheral ischemia caused by thrombo-embolism from buttock aneurysmal formation. Combined therapy of catheter fibrinolysis, followed by proximal and distal ligation of sciatic artery and peripheral bypass procedure, restored regular leg perfusion.

Aged↗
PubMedDate not supplied

Securing methods for peripheral cannulae.

The use of a sterile transparent dressing (Venigard, Consolidated Medical Equipment, London) was compared to the use of a non-sterile tape (Mefix, Molnlycke, Sweden) for securing peripheral cannulae in paediatric patients. Children from all medical specialties were prospectively randomised into one of two groups. The failure of a cannula (defined as the removal of the cannula before treatment was completed) was plotted against duration in each of the two groups. Statistical tests (life table analysis) suggested no significant difference (p = > 0.05). The authors conclude that the use of a sterile transparent dressing secures peripheral cannula as effectively as non-sterile tape.

Bandages↗
PubMedDate not supplied

Experience with double-lumen umbilical venous catheters in the low-birth-weight neonate.

Reliable vascular access can be problematic in sick low-birth-weight neonates. Umbilical venous catheters are one form of vascular access that can be used in this population. A retrospective review of experience with umbilical venous catheters in our neonatal intensive care unit from January 1989 through December 1991 was conducted. This included 128 patients: 70 with single-lumen (Gesco Umbilicath II) and 58 with double-lumen (Becton-Dickinson Careflow) catheters. Birth weight, gestational age, catheter life span, complications, and number of punctures for peripheral intravenous lines were analyzed. The mean birth weight, gestational age, and catheter life span did not differ significantly between catheter types. The incidence of catheter-related sepsis did not differ significantly (two single-lumen, three double-lumen) and occurred only in neonates with a catheter life span greater than 10 days. The number of intravenous punctures was significantly decreased in those neonates with double-lumen umbilical venous catheters (p < 0.0001). We conclude that in sick low-birth-weight infants the use of double-lumen umbilical venous catheters entails no greater risk than the use of a single-lumen umbilical venous catheter and may reduce iatrogenic stress associated with the starting of peripheral intravenous lines.

Catheterization, Peripheral↗
PubMed1997

A comparison of transparent polyurethane and dry gauze dressings for peripheral i.v. catheter sites: rates of phlebitis, infiltration, and dislodgment by patients.

BACKGROUND: Before a meta-analysis by Hoffman et al was published, polyurethane dressings were used at insertion sites for peripheral i.v. catheters at our institution. On the basis of the results of the meta-analysis, we began to use gauze dressings. The change from polyurethane dressings to gauze dressings limited direct observation of the i.v. insertion site, and i.v. catheters were anecdotally reported not to be anchored as securely as before. OBJECTIVES: The purpose of this study was to compare the effects of the use of transparent polyurethane dressings and gauze dressings at insertion sites for peripheral i.v. catheters on the frequency of phlebitis, infiltration, and catheter dislodgment by patients. METHODS: Two hundred twenty-nine patients were randomized to receive either gauze (n = 121) or transparent polyurethane (n = 108) dressings, and observations were recorded. RESULTS: The frequency of catheter dislodgment by the patient was significantly higher (P < .05) in patients with the gauze dressing (15%) than in patients with the transparent polyurethane dressing (6%). A trend toward lower frequencies of phlebitis (1.8% vs 3.3%) and infiltration (17.6% vs 20.7%) was noted in the patients with the transparent polyurethane dressings. DISCUSSION: The clinical advantages of the transparent polyurethane dressings lie in the ease of direct visualization of the i.v. insertion site and the securement of the i.v. catheter. CONCLUSION: At our institution, given the decreased disruption of the i.v. therapy with the transparent polyurethane dressings and the lack of differences in the rates of phlebitis or infiltration with the two types of dressings, we prefer to use transparent polyurethane rather than gauze dressings at insertion sites for peripheral i.v. catheters.

Catheterization, Peripheral↗
PubMed1994

Invasive candidiasis in the ICU--pathogenesis and management strategy.

How should new and old antifungals be used in the management of invasive candidiasis in ICU patients? A pathogenesis-based management strategy for invasive candidiasis is outlined. Colonisation of the catheterised bladder by Candida species should be eliminated to prevent invasion from the urinary tract. Invasion from the peritoneum (in the patient with a perforated bowel) should be treated promptly to prevent local vascular invasion. Empirical therapy is recommended for treatment of suspected disseminated candidiasis, 'pulmonary' candidiasis and vascular-access candidiasis. Dose and duration of therapy are decided according to clinically determined patient/disease categories and modified according to information from laboratory results. Short-term low-dose regimens are suitable for peritoneal candidiasis that is recognised early, and for vascular-access candidiasis, provided the source-catheter can be removed.

Antifungal Agents↗
PubMed1996

Parents and procedures: a randomized controlled trial.

INTRODUCTION: Previous work has shown that parents prefer to be present when their children undergo common invasive procedures, although physicians are ambivalent about parental presence. PURPOSE: To determine the effect of a parent-focused intervention on the pain and performance of the procedure, anxiety of parents and clinicians, and parental satisfaction with care. POPULATION: Children younger than 3 years old undergoing venipuncture, intravenous cannulation, or uretheral catheterization. SETTING: Pediatric emergency department of Boston City Hospital. DESIGN: Randomized controlled trial with three groups; parents present and given instructions on how to help their children; parents present, but no instructions given; and parents not present. INTERVENTION: The parents were instructed to touch, talk to, and maintain eye contact during the procedure. RESULTS: A total of 431 parents was randomized to the intervention (N = 153), present (N = 147), and not present (N = 131) groups. The groups were equivalent with respect to measured sociodemographic variables and parents' previous experience in the pediatric emergency department. No differences emerged with respect to pain (3-point scale measured by parent and clinician, and analysis of cry); performance of the procedure (number of attempts, completion of procedure by first clinician, time); clinician anxiety; or parental satisfaction with care. Parents who were present were more likely to rate the pain of the children as extreme/severe (52%) in comparison to clinicians (15%, kappa .07, poor agreement) and were significantly less anxious than parents who were not present. CONCLUSION: Overall, the intervention was not effective in reducing the pain of routine procedures. Parental presence did not negatively affect performance of the procedure or increase clinician anxiety. Parents who were present were less anxious than those who were not present. CLINICAL IMPLICATION: In general, parents have indicated that they want to be present when their children undergo procedures. The results of this study challenge the traditional belief that parental presence negatively affects our ability to successfully complete procedures. We should encourage parents who want to be present to stay during procedures.

Adult↗
PubMed2000

Peripheral nerve injury from intravenous cannulation: a case report.

The following is a case report of a patient who had an intravenous (i.v.) catheter inserted into her cephalic vein and thereafter sustained an injury to the superficial branch of the radial nerve. When an i.v. catheter penetrates a nerve, it can cause temporary or permanent damage. After sustaining an injury, a nerve will regenerate in an attempt to reconnect with the fibers it once innervated. Recovery from nerve damage may take only weeks or a year or more. Some patients, however, may sustain lifelong damage depending on the severity of the needle stick to the nerve. To avoid injury to peripheral nerves when inserting i.v. catheters, a few recommendations should be followed. First, if inserting an i.v. catheter in the cephalic vein, be conscious of the proximity of the superficial peripheral nerves. Second, if a paresthesia is elicited when inserting an i.v. catheter, withdraw the catheter immediately. Third, if a patient complains of paresthesias or numbness near the i.v. site, remove the i.v. catheter immediately. Fourth, limit the amount of probing after inserting the catheter into the skin. Finally, if nerve damage is suspected from a peripheral i.v. cannulation, consult a hand specialist promptly.

Catheterization, Peripheral↗