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At least 343 records · Page 19Linked to original sources
PubMed1989

Radial artery cannulation guided by Doppler ultrasound.

A technique to enhance difficult percutaneous radial artery cannulations using Doppler ultrasound is described. A series of 12 patients (nine hypotensive and three normotensive patients with poorly palpable or absent radial pulses) was assembled and the radial arteries were cannulated using standard intravenous catheters and a hand-held Doppler ultrasound device. Localization and cannulation of the arteries was facilitated by noting the characteristic sounds using the Doppler. Eleven of the 12 patients had successful cannulation of the radial artery. In one case the artery was localized but the catheter could not be advanced. No complications were encountered. It was concluded that the use of a common Doppler ultrasound on selected patients with poor peripheral pulses may facilitate percutaneous radial artery cannulations and minimize the number of catheter punctures before successful placement.

Arteries↗
PubMed1999

Vascular access devices used during harvest of peripheral blood stem cells: high complication rate in patients with a long-term dialysis central venous catheter.

PBSC harvesting requires good quality venous access. The efficacy and complication rate of the venous access devices used during stem cell harvest in 101 consecutive patients were examined. Four different categories of venous access were used: (1) long-term dialysis central venous catheter (dCVC), (2) short-term dCVC, (3) peripheral venous cannulae (PVC), and (4) PVC and conventional central venous catheter. The number of harvest occasions per patient or harvest days per occasion were similar between the various categories of access. Complications during harvest occurred in 13 out of 48 (27%) occasions using a long-term dCVC compared to six out of 97 (6%) in the other three categories pooled together (P < 0.01). Forty-two of the 101 patients received a long-term dCVC to facilitate the harvest. The long-term dCVC was planned to stay in place and also be used as a conventional i.v. line during the following high-dose treatment. Twenty-one (50%) of the long-term dCVCs were removed due to complication. Thirteen (31%) of the long-term dCVCs were usable throughout the entire treatment period. In conclusion, we recommend that PBSC harvesting is performed through peripheral venous catheters when practically possible, otherwise via short-term dCVC.

Adolescent↗
PubMed1994

Pharmacokinetics from multiple intraosseous and peripheral intravenous site injections in normovolemic and hypovolemic pigs.

OBJECTIVES: To examine: a) the rate and extent of delivery of radioactive tracers to the central circulation from the tibial, medial malleolar, distal femoral, and humeral intraosseous sites, as well as from a peripheral intravenous site; and b) the end-tidal CO2 response to injected sodium bicarbonate at these sites. DESIGN: Prospective, descriptive study. SETTING: Animal laboratory at a university medical center. SUBJECTS: Twenty anesthetized and mechanically ventilated piglets were cannulated with 18-gauge bone marrow needles at intraosseous sites and 22-gauge Teflon catheters in peripheral veins. A 22-gauge angiocath was placed in the right carotid artery of each subject. Drug kinetics were studied in the normovolemic and hypovolemic (acute bleeding of 25 mL/kg) states. INTERVENTIONS: Sodium bicarbonate (1 mEq/kg) was injected into each of the three intraosseous and one intravenous sites with simultaneous monitoring of end-tidal CO2. A 10-min period for stabilization was allowed between injections. Aliquots of 99mtechnetium were injected at randomly selected sites and blood samples were obtained at 1.5-sec intervals via carotid artery for radioactive counts. Experiments were repeated after withdrawal of 25 mL/kg of blood. MEASUREMENTS AND MAIN RESULTS: Assessment by end-tidal CO2 monitoring after 1-mEq/kg injections of bicarbonate demonstrated a mean initial end-tidal CO2 increase at 12.8 secs and a mean maximal end-tidal CO2 increase of 8 torr (1.06 kPa), with no significant site differences noted. Radioactive tracer injections were detected in the carotid artery after 15.4 secs in normovolemic animals and after 21.4 secs in hypovolemic animals, with no significant site differences detected. The proportion of injected tracer at 2, 5, 10, 20, 30, and 40 mins identified no significant differences between various intraosseous and intravenous sites. CONCLUSIONS: Our study demonstrated similar rapid transit and proportion of bicarbonate and radioactive tracers, reaching the central circulation from multiple intraosseous sites and a peripheral intravenous site. This finding suggests that adjustments in drug dosage may not be required, using various intraosseous locations as an alternative to peripheral intravenous drug therapy.

Animals↗
PubMedDate not supplied

Vital signs for your cardiovascular services.

Current trends and "best practice" operating statistics can be vital to the success of today's cardiovascular programs. The findings from a recently published survey entitled, "Trends in Cardiovascular Programs: A National Benchmarking Study", provide the administrator with immediate and current knowledge of best ways to manage cardiovascular services to succeed in a competitive market. Study results provide some interesting and valuable information regarding non-invasive cardiology, cardiac catheterization, and peripheral vascular angiography program administration and provide insight into issues of cost, quality, and cardiovascular program concerns, interests and needs.

Angiography↗
PubMed1982

Surgical catheterization of heptic-portal and peripheral circulations and maintenance in pharmacokinetic studies.

A surgical procedure for the chronic catheterization of mongrel dogs was presented with a detailed account of the use and maintenance of these catheters. The methodology allowed for a direct determination of the capacity of the liver to the intact animal to metabolize drugs. The technique permitted the investigator to study the oxidation of drugs by the liver in a specific concentration range and assessment of the first-pass effect of the liver when many drugs are administered via the oral route. The dogs were prepared and use in the drug pharmacokinetic studies for periods up to 24 days.

Animals↗
PubMedDate not supplied

Controversial issues in the care and maintenance of vascular access devices in the long-term/subacute care client.

The aging population provides a unique challenge for the initiation and maintenance of infusion therapy. This article will highlight three common but controversial issues that have been observed by this author in the long-term/subacute care realm of infusion therapy: 1) the failure to maintain a sterile dressing over the catheter insertion site; 2) the use of heparin to maintain patency of the peripheral infusion device; and 3) the routine replacement of peripheral i.v. catheters. Several factors that contribute to the controversies will be discussed, along with some associated negative and positive outcomes.

Anticoagulants↗
PubMedDate not supplied

Transcatheter arterial embolization for hepatocellular carcinoma with portal vein thrombosis.

In order to evaluate the possible benefits of transcatheter arterial embolization (TAE) in hepatocellular carcinoma (HCC) patients with peripheral portal vein thrombosis, 96 consecutive HCC cases with peripheral portal vein thrombosis were analysed. Of them, 35 cases received TAE and 61 cases did not. Most (77.8%) of the TAE-treated cases showed decreased alpha-fetoprotein (AFP) levels after treatment, but 57.1% of them suffered another rise in AFP levels and subsequently died. One patient (2.8%) developed progressive jaundice after TAE and died within 1 month, while four of the non-TAE cases died within 1 month after diagnosis. In general, TAE is safe for HCC patients with peripheral portal vein thrombosis. In addition, using Cox's regression model for multivariate survival analysis, serum total bilirubin (< or =, > 2 mg/dL; P = 0.0254), AFP (< or = 3155 ng/mL, > 3155 ng/mL; P = 0.0002) and treatments (TAE, non-TAE; P = 0.0059) were found to affect their prognosis. There was significant difference in survival between TAE and non-TAE groups, the 6 month, 1 year and 2 year survival rates were 91.4 versus 62.3%, 51.4 versus 26.2% and 17.1 versus 4.9% (P = 0.0017). The median survival times of TAE and non-TAE groups were 10.3 versus 3.7 months, respectively. Though TAE only provided palliative treatment, it did prolong survival in HCC patients with peripheral portal vein thrombosis.

Aged↗
PubMed1991

Why flush peripheral intravenous cannulae used for intermittent intravenous injection?

We aimed to investigate whether regular flushing of peripheral intravenous cannulae used for intermittent injections with heparin-saline, in a unit for acute medicine for the elderly, reduced the incidence of complications necessitating cannula removal. We wanted to see if this could also prolong the time that cannulae may remain functional in situ. In a prospective, open study, 50 consecutively inserted cannulae were flushed regularly and a subsequent 50 consecutive cannulae were not flushed. The incidence of complications necessitating removal was not significantly different between the two groups (18% flushed, 22% unflushed). Overall, only 5% of cannulae were removed because of blockage. Heparin-saline flushes did not significantly increase the time that cannulae remained in situ. Antibiotic use was found to be associated with an increased rate of complications necessitating cannula removal. We found no significant advantage in heparin-saline flushing of peripheral intravenous cannulae used for intermittent administration of medications.

Aged↗
PubMedDate not supplied

The successful use of a non-open-ended PICC line.

This paper illustrates how the use of a non-open-ended, peripherally inserted central catheter' (PICC) solved the problem of increasingly difficult venous access for a young patient undergoing treatment for Hodgkin's lymphoma.

Adult↗
PubMed1998

[Prospective 3-month study of intravascular catheter complications in HIV-infected patients: relation between phlebitis and infection].

BACKGROUND: The aim of this study was to evaluate the etiology of phlebitis (chemical or infectious) and the prevalence of infections related to intravascular catheters (IRIC) in patients with HIV infection admitted to a 22-bed Infectious Disease Unit with a high rate of HIV infection. MATERIAL AND METHODS: A 3-month prospective study from November 1, 1994 to January 31, 1995 was carried out following a formula for data collection of all the intravenous catheters used during that time period. Cultures of the catheters withdrawn on Wednesdays and those with signs of phlebitis were performed. RESULTS: One hundred fifty-two intravenous catheters in 71 patients with HIV infection with a mean age of 37 years (range: 21-73) and mean hospital stay of 10.2 days were reported. During the study period 42 phlebitis were produced, of which 37 catheters (7 central and 30 peripheral) were processed. Of the 37 phlebitis processed, 29 (78.9%) were considered to be of physiochemical origin. Of the 21 catheters withdrawn Wednesday, 18 were processed, 8 with phlogotic signs, 2 with IRCI, equivalent to 1.9 IRCI/100 days of catheterization. During the study period no local or severe systemic infections related to the catheter were reported. Staphylococcus epidermidis was the organism involved in all the cases of IRCI. CONCLUSIONS: Despite the high number of immunosuppressed patients in related to HIV infection, a greater incidence of IRCI was not found in these patients. The most frequent cause of phlebitis by catheter was of chemical origin.

Adult↗
PubMed2005

Comparison of contamination rates of catheter-drawn and peripheral blood cultures.

The aim of this study was to assess the sensitivity and specificity of catheter-drawn and peripheral blood cultures. Paired blood culture samples collected over a 44-month period from a 280 bed Brisbane metropolitan hospital were analysed, using standard clinical and microbiological criteria, to determine whether blood culture isolates represented true bacteraemias or contamination. Catheter-collected cultures had a specificity of 85% compared with 97% for peripheral cultures. In only two instances (0.2%) was the diagnosis of clinically significant bacteraemia made on the basis of catheter culture alone. This study concluded that catheter-collected samples are not a good test for true bacteraemia, and that peripheral cultures are more reliable when the results of the paired cultures are discordant.

Bacteremia↗
PubMed2004

The use of the Angioseal device for femoral artery closure.

BACKGROUND: As vascular surgeons perform increasing numbers of percutaneous catheter-based procedures, they will need to become familiar with varying methods of femoral artery closure. Few studies on closure devices have included significant numbers of patients with peripheral arterial disease. It is the purpose of this study to determine whether the Angioseal device (St. Jude Medical) is a satisfactory method of achieving femoral artery puncture site hemostasis in these patients. METHODS: The records of all patients undergoing Angioseal closure of femoral artery puncture by a single vascular surgeon were reviewed. Indication, type of intervention, and size of the vascular sheath employed were recorded. Times to mobilization and discharge were determined. Patients were seen before discharge and 1, 4, and 12 weeks after the procedure, and at 3- month intervals thereafter. Complications including hemorrhage, pseudoaneurysm, infection, and vessel occlusion were noted. RESULTS: Between February 1, 2002, and August 31, 2003, 220 Angioseal collagen plugs were deployed in 188 patients. Attempts were made to deploy Angioseal devices in 92% of patients undergoing percutaneous procedures during this time period. One hundred forty-four procedures were diagnostic and 74 procedures included 76 therapeutic interventions. One hundred forty-four 5F sheaths, 47 6F sheaths, and 29 7F sheaths were employed during the procedures. Time to mobilization and discharge was 58 +/- 19 minutes and 102 +/- 31 minutes in patients undergoing diagnostic studies, 68 +/- 22 minutes and 146 +/- 42 minutes following interventions using 6F sheaths, and 127 +/- 18 minutes and 219 +/- 37 minutes when interventions were performed using 7F sheaths. No patient developed a major hematoma or infection following the use of an Angioseal. There were 2 complications related to device deployment. One patient developed a 1.4-cm false aneurysm at the femoral artery puncture site that resolved spontaneously. A second patient required operation for vessel occlusion when an Angioseal was deployed in a markedly diseased femoral artery. These adverse events occurred early in our experience. CONCLUSIONS: The Angioseal provides a secure method of achieving hemostasis following femoral artery puncture. It is easy to deploy, has a high level of patient satisfaction, and allows for early ambulation and hospital discharge. When simple guidelines are observed, the device can be safely used in the great majority of patients with peripheral vascular disease. It offers considerable advantages over the traditional method of manual compression.

Aged↗
PubMed2003

Peripherally inserted veno-venous ultrafiltration for rapid treatment of volume overloaded patients.

BACKGROUND: Veno-venous ultrafiltration may benefit patients with acute or chronic circulatory volume overload. Use of conventional systems, however, may be cumbersome, requiring physician placement of a double-lumen central venous catheter and use of a dedicated dialysis technician and apparatus. METHODS: A simplified peripheral ultrafiltration system including a miniaturized disposable circuit was evaluated in patients with volume-overload states. Separate intravenous catheters (16-18 G) for withdrawal and return of blood (blood flow <or= 40 mL/min, ultrafiltrate <or= 500 mL/h) were placed by nonphysician personnel in upper extremity veins. Twenty-five treatments of up to 8 hours were performed in 21 patients. RESULTS: The primary endpoint of greater than 1 L fluid removal in less than 8 hours was achieved in 23 of 25 treatments. On average, 2611 +/- 1002 mL (maximum 3,725 mL) of ultrafiltrate was removed per treatment (treatment period 6:43 +/- 1:47 hours:minutes). Patient weight decreased from 91.9 +/- 17.5 to 89.3 +/- 17.3 kg (P <.0001) after ultrafiltration. No major adverse events occurred. CONCLUSIONS: Rapid removal of extracellular and intravascular fluid volume excess can be safely achieved via peripherally inserted ultrafiltration without the need for central venous catheter placement.

Catheterization, Peripheral↗
PubMed1992

Peripheral angiography and angioplasty.

This paper reviews recent developments in diagnostic and therapeutic interventional procedures for the peripheral arteries reported from February 1991 to January 1992. Topics discussed include endovascular metallic stents, atherectomy catheters, and intravascular ultrasound.

Angiography↗
PubMedDate not supplied

Complications related to intravenous midline catheter usage. A 2-year study.

The introduction of the Landmark midline catheter (Menlo, Co., CA) brought an alternative to central line catheter placement for prolonged intravenous access. The study was initiated in 1993 to observe for complications, including hypersensitivity-like reactions. The authors hypothesized this i.v. modality would decrease the need for central i.v. lines and accompanying complications. At the time of catheter insertion, the i.v. team nurses completed a survey form that included demographics, underlying disease, and risk factors for infection. The catheter tip was cultured at the time of removal. In the second phase of the study, the authors focused specifically on hypersensitivity-like reactions. During a 2-year period, 248 patients had 334 midline catheters. Patient ages ranged from 23 to 98 years (mean age, 65 years). The bacteremia rate was 0.3%; the colonization rate was 0.9%. Factors associated with infection/ colonization included: length of time in place, chemotherapy, and lack of antibiotic administration. In the second phase of the study, during which an additional 170 catheters were placed in 131 patients, no hypersensitivity-like reactions were noted. The midline catheter appears to be a safe method of i.v. fluid administration for patients with limited peripheral vein access who need extended i.v. therapy.

Adult↗