PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Catheterization, Peripheral”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 325 records · Page 18Linked to original sources
PubMed2005

Duration of analgesia is similar when 15, 20, 25 and 30 mL of ropivacaine 0.5% are administered via a femoral catheter.

PURPOSE: This dose-response study was designed to determine the most appropriate dose of ropivacaine 0.5% injected via an indwelling femoral catheter for perioperative peripheral analgesia for total knee replacement (TKR). METHODS: 84 patients were allocated randomly to four groups and received, via a femoral catheter, either 15, 20, 25 or 30 mL of ropivacaine 0.5% in a double-blind fashion. An anterior sciatic block with 20 mL bupivacaine 0.5% was also performed. The evolution of sensory block of femoral, obturator and lateral femoral cutaneous nerves and motor block of femoral nerve were tested every five minutes during the first 30 min. The percentage of patients with complete sensory block of both femoral and obturator nerves determined success rate. General anesthesia was then induced. After surgery, patient-controlled analgesia (PCA) with ropivacaine 0.2% was available via the femoral catheter. The interval between the initial injection and the first PCA administration determined duration of action. RESULTS: The duration of action was not different between the four solutions tested i.e., 534 +/- 379 min for 15 mL, 799 +/- 364 min for 20 mL, 624 +/- 342 min for 25 mL and 644 +/- 266 min for 30 mL. The percentage of patients with complete sensory femoral and obturator blocks was, respectively, 60%, 95%, 85% and 70% for 15, 20, 25 and 30 mL (P = 0.008/15 mL vs 20 mL). CONCLUSION: Although there is no difference in duration of analgesia, because of better sensory spread, 20 mL of ropivacaine 0.5% appears to be the most appropriate dose for peripheral analgesia after TKR.

Aged↗
PubMed2001

Changing concepts in long-term central venous access: catheter selection and cost savings.

BACKGROUND AND OBJECTIVES: Long-term central venous access is becoming an increasingly important component of health care today. Long-term central venous access is important therapeutically for a multitude of reasons, including the administration of chemotherapy, antibiotics, and total parenteral nutrition. Central venous access can be established in a variety of ways varying from catheters inserted at the bedside to surgically placed ports. Furthermore, in an effort to control costs, many traditionally inpatient therapies have moved to an outpatient setting. This raises many questions regarding catheter selection. Which catheter will result in the best outcome at the least cost? It has become apparent in our hospital that traditionally placed surgical catheters (ie, Hickmans and central venous ports) may no longer be the only options. The objective of this study was to explore the various modalities for establishing central venous access comparing indications, costs, and complications to guide the clinician in choosing the appropriate catheter with the best outcome at the least cost. METHODS: We evaluated our institution's central venous catheter use during a 3-year period from 1995 through 1997. Data was obtained retrospectively through chart review. In addition to demographic data, specific information regarding catheter type, placement technique, indications, complications, and catheter history were recorded. Cost data were obtained from several departments including surgery, radiology, nursing, anesthesia, pharmacy, and the hospital purchasing department. RESULTS: During a 30-month period, 684 attempted central venous catheter insertions were identified, including 126 surgically placed central venous catheters, 264 peripherally inserted central catheters by the nursing service, and 294 radiologically inserted peripheral ports. Overall complications were rare but tended to be more severe in the surgical group. Relative cost differences between the groups were significant. Charges for peripherally inserted central catheters were $401 per procedure, compared with $3870 for radiologically placed peripheral ports and $3532 to $4296 for surgically placed catheters. CONCLUSIONS: Traditional surgically placed central catheters are increasingly being replaced by peripherally inserted central venous access devices. Significant cost savings and fewer severe complications can be realized by preferential use of peripherally inserted central catheters when clinically indicated. Cost savings may not be as significant when comparing radiologically placed versus surgically placed catheters. However, significant cost savings and fewer severe complications are associated with peripheral central venous access versus the surgical or radiologic approach.

Catheterization↗
PubMed1993

Double-blind, randomized, controlled trial of papaverine-containing infusions to prevent failure of arterial catheters in pediatric patients.

OBJECTIVE: To test the efficacy of the continuous infusion of papaverine-containing fluids into peripheral arterial catheters for reducing the risk of catheter failure. DESIGN: Prospective, double-blind, randomized, controlled trial. SETTING: Pediatric intensive care unit in a children's hospital. PATIENTS: A total of 239 children, aged 3 wks to 18 yrs who had an arterial catheter inserted for clinical purposes. INTERVENTIONS: Patients were randomized to receive either papaverine (60 mg/500 mL) or no additive, within the infused fluids. MEASUREMENTS AND MAIN RESULTS: Data about patient demographics and potential risk factors for arterial catheter failure were collected at the time of catheter insertion, throughout the life of the catheter, and at the time of catheter removal. Catheter failure was defined as an inability to draw blood from the catheter or loss of the arterial waveform. Overall, 35 (15%) subjects had catheter failure. The risk of catheter failure was lower in patients randomized to receive papaverine (eight [7%] of 115 vs. 27 [22%] of 124; chi-square = 5.2; p = .02), and the time until failure of the catheter was longer in the papaverine group (p = .02, log-rank test). This difference persisted when controlling for potentially confounding factors. CONCLUSION: In critically ill children, infusion of papaverine-containing fluids reduces the risk of failure of peripheral arterial catheters.

Adolescent↗
PubMed1987

Parenteral nutrition via peripheral veins: a feasibility study.

Twenty patients who had undergone uncomplicated surgery of moderate severity were randomly allocated to two groups (both n = 10) who were fed using a peripheral vein for up to six days. Group I received, each day, a nutrient solution providing 10 grams of nitrogen as Perifusin (E Merck Ltd) and 1400 calories as dextrose and Intralipid (Kabivitrum Ltd) with an osmolality of 490 mosmol/kg. Group II received only 15 grams of nitrogen per day as Perifusin with an osmolality of 376 mosmol/kg. The mean (+/- s.e. mean) nitrogen balance over the study was similar in both groups, in Group I being -1.23 +/- 0.89, and in Group II being -1.05 +/- 1.08 g (P greater than 0.05 Mann-Whitney U test). The nutrient mixture given to Group I resulted in elevated levels of serum 3-hydroxybutyrate and lower levels of serum non-esterified fatty acids. These data suggest that lipolysis and ketogenesis were suppressed. There was no significant difference in serum lactate levels in either group. Venous thrombophlebitis at the infusion site was assessed daily using Maddox's criteria, with a minimal degree of inflammation occurring in either group. This preliminary study suggests that a total parenteral feeding regimen may be designed for peripheral vein infusion. Further studies are indicated.

Adult↗
PubMedDate not supplied

Peripheral parenteral nutrition: a preliminary report on its efficacy and safety.

In this preliminary study of peripheral parenteral nutrition, we compared our first nine patients fed by this method with 21 patients fed by total parenteral nutrition during the same period. We found that peripheral parenteral nutrition was as effective as total parenteral nutrition in improving physiologic function (both skeletal and respiratory muscle function). We also found that by using the protocol described here thrombophlebitis was not a significant problem. Additional study is required to ascertain the exact incidence of this and other complications. We would advocate the greater use of peripheral parenteral nutrition in suitable patients and the use of this protocol for its administration.

Adult↗
PubMed1992

Peripheral artery cannulation in newborns.

This report outlines our experience (retrospectively over a 3-year period) with peripheral artery cannulation for blood gas monitoring in 170 newborn infants. The technique for radial artery cannulation is described in detail. Recorded sites of cannulation were radial (138), posterior tibial (34), dorsalis pedis (2) and temporal (1). Only minor complications occurred which were transient ischaemia (19 cases), accidental blood loss (4 cases) and superficial abscesses (2 cases). Three other cases were suspected to have systemic infection but these were not proven. Cannulae had to be removed in 52% of cases because no blood could be withdrawn for sampling. It is concluded that peripheral artery cannulation in the newborn is a safer and more convenient procedure than umbilical artery catheterisation.

Catheterization, Peripheral↗
PubMed1990

Peripheral teflon catheters. Potential source for bacterial contamination of orthopedic implants?

To detect low numbers of bacterial cells on Teflon catheters removed from peripheral veins, 74 catheter tips were incubated in thioglycollate media for up to ten days. Fifteen (20.3%) of the catheters were found to be culture-positive. Propionibacterium acnes was isolated from seven, Staphylococcus epidermidis from six, and Staphylococcus haemolyticus and Staphylococcus hominis from one each, all common skin organisms associated with infection of implants. An increase in documentation of bacterial contamination resulted from incubating greater than 72 hours; this allowed the slower-replicating Propionibacterium acnes to grow to detectable numbers. Because of these findings and those of others, attention is focused on the peripheral vein conduit as a potential source for hematogenous seeding of implants with bacterial cells. Changing peripheral catheters within 24 hours is recommended to reduce the constant risk of occult bacteremia.

Bacteria↗
PubMed2004

Ultrasound guidance for vascular access.

The evidence that supports the general application of US guidance for venous access in the ED has reached a critical mass. The increasing familiarity of emergency physicians with US and the recent focus on patient safety and clinical outcomes has intensified attention on the capacity for US to improve patient care in the ED. US guidance can increase the safety and efficiency of venous access procedures and offers improved outcomes. The potential for these improvements is compelling, especially among certain types of ED patients such as those with difficult or complicated access. Varying levels of evidence support the use of US guidance over the traditional landmark approach for venous access in adult and pediatric populations and for central and peripheral veins. Many different techniques may be applied, depending on the clinical situation and equipment available.

Catheterization, Central Venous↗
PubMed1997

Women's perception of pain and distress during intravenous catheterization and urethral mini-catheterization.

A study was done to prospectively compare the pain and distress of urethral mini-catheterization (MC) with the pain and distress of intravenous (IV) catheterization in women. Ten-centimeter visual analog scales were used on which the left end represented "no pain" or "no distress" and the right "the worst pain imaginable" or "extreme distress." Distress was defined to include embarrassment, anxiety, or fear. A convenience sample of 40 adult women who presented to a university emergency department and were undergoing both procedures as part of their management appraised pain and distress after IV placement and urethral MC. The mean IV pain score was 4.2 cm, whereas the mean MC score was only 2.6 cm (P = .02). The IV and MC distress score means were similar (2.3 v 2.6 cm, P = .55). These results suggest that patients perceive urethral MC as less painful than IV placement. The distress scores of these two procedures did not differ and were low in both instances.

Adolescent↗
PubMed1993

Comparison of intraosseous, central, and peripheral routes of crystalloid infusion for resuscitation of hemorrhagic shock in a swine model.

Venous access is often a clinical dilemma in severely hypovolemic children. This study compares fluid resuscitation by central vein, peripheral vein, and the intraosseous route in a hemorrhagic shock model. Hampshire piglets were bled to a mean arterial pressure of 30 mm Hg. This level of shock was sustained for 30 minutes. Resuscitation was carried out with normal saline delivered at 50 mL/min by a manual pressure of 450-475 mm Hg over the ensuing 20 minutes. Bone marrow from two intraosseous-infused animals was harvested immediately after the study for histologic examination. The hemodynamic response to crystalloid resuscitation was comparable among the three groups. There was no significant difference in mean arterial pressure, central venous pressure, cardiac output, pulmonary capillary wedge pressure, mixed venous oxygen saturation, or arterial oxygen saturation. Histologically, cellular washout and necrosis were found in bone marrow immediately adjacent to the intraosseous needle infusion site. For fixed-rate infusion, intraosseous crystalloid resuscitation is as efficacious as that delivered by peripheral or central venous routes in reversing hemorrhagic shock.

Animals↗
PubMed1999

Redo cardiac surgery in a patient with severe peripheral vascular disease and pericardial adhesions using subclavian arterial cannulation and port-access technology.

Patients viewed as conventionally inoperative candidates are now given alternative surgical choices. The ability to provide new technology such as the port-access minimally invasive approach, kinetic venous assist, and specialized cannulae have made this possible. This case report discusses the ability to apply and modify this new technology to provide a successful surgical outcome in a patient with severe peripheral vascular disease and dense mediastinal adhesions.

Aged↗
PubMed1988

Flow dynamics of peripheral venous catheters during extracorporeal membrane oxygenation with a centrifugal pump.

Extracorporeal membrane oxygenation uses peripherally placed cannulas and a streamlined circuit without a venous reservoir. This study tests the flow dynamics of venous catheters connected without a reservoir directly to a centrifugal pump. During in vitro testing, a 30 cm segment of collapsible tubing interposed between the reservoir and pump simulates the vein. In five sheep, flow was measured between catheters placed in the right atrium and inferior vena cava from peripheral sites. Catheter tip design (four types) does not affect flow within a simulated vein in vitro. Maximum pump flow is independent of filling pressures (6 to 21 mm Hg) in vitro and in vivo when the catheter tip is in a tank reservoir or the right atrium. However, when the catheter tip is within a collapsible segment or in the inferior vena cava, maximal flow is significantly influenced by filling pressure (6 to 18 mm Hg) and by the ratio of catheter outer diameter to venous diameter. At all filling pressures, maximal flow in vivo is significantly reduced when this ratio is greater than 0.5. During extracorporeal membrane oxygenation, central venous pressure and catheter/vein ratio, not catheter size alone, control flow through peripheral venous catheters.

Adult↗
PubMed1993

[Technical aspects of rehydration].

Rehydration of terminally ill patients is from a technical point of view not more difficult than fluid treatment of any other patient. The difficulty lies in the balanced decision between the appropriate method on one hand and the desirability of a rehydration on the other hand. The route of choice in terms of burden for the patient as well as from a logistic point of view is the oral one. If it fails fluid can be administered via transnasal gastric tube. Percutaneous endoscopic gastrostomy and other types of gastrostomy do not provide any advantage over gastric tube for patients with imminent early mortality and those in a hospital. Subcutaneous infusions provide at least for a short time a suitable method for rehydration also and in particular for terminally ill patients. Peripheral venous catheters are suitable for rehydration, however only for a period of few days until another solution is found.

Catheterization, Peripheral↗
PubMed1998

Fine-bore cannulas for peripheral intravenous nutrition: polyurethane or silicone?

The peripheral intravenous route is being used more frequently for the administration of short- to medium-term parenteral nutritional support. Dedicated fine bore cannulas have significantly reduced the incidence of thrombophlebitis. Currently available cannulas are made of polyurethane or silicone. We present our experience with a 23G silicone cannula and a 22G polyurethane alternative. Fifty-four silicone cannulas were used with a median survival of only 3 days, compared with 7 days for 90 polyurethane cannulas (P < 0.0001). Only 22% of silicone cannulas were removed electively compared with 56% of polyurethane cannulas (P < 0.00005). The most common cause for silicone cannula removal was occlusion (48%), which occurred in only 8% of polyurethane cannulas (P < 0.00001). Polyurethane cannulas develop fewer complications and are more effective in the delivery of peripheral intravenous nutritional support.

Adult↗