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PubMed1999

Long-term results after recanalisation of chronic iliac artery occlusions by combined catheter therapy without stent placement.

OBJECTIVES: to evaluate the long-term outcome after recanalisation of chronic iliac artery occlusions by combined catheter therapy without stent placement. DESIGN: retrospective study. MATERIAL AND METHODS: between 1979 and 1995 75 consecutive patients were treated (53 men, 22 women; mean age 63.1+/-13.7 years; mean length of the occluded segment 6.9+/-3.5 cm). The indication for treatment was incapacitating claudication (n=55) or chronic critical ischaemia (n=20). At follow-up clinical data, pulse volume and pressure measurements were recorded and duplex-sonography and/or angiography performed, if clinically indicated. RESULTS: mean follow-up was 7. 2+/-4.1 years. The primary clinical success rate was 64% at 12 months, 57% at 4 years and remained stable for up to ten years. The secondary clinical success rate after 12 months was 83% and remained stable at 81% for up to 10 years. Peripheral embolisation as complication of the intervention occurred in 18 patients (24%) and was treated by percutaneous thromboembolectomy in 15 patients during the same procedure. In the remaining three patients no intervention was necessary. One patient had to undergo surgery for a groin haematoma. CONCLUSIONS: recanalisation of segmental chronic iliac artery occlusions by catheter therapy without stent placement has favourable long-term results comparable to primary stent placement. Randomised controlled studies are required to determine the appropriate role of catheter therapy alone and primary or selective stenting for iliac artery occlusions.

Angiography↗

PubMed2000

Multi-centre research surveillance project to reduce infections/phlebitis associated with peripheral vascular catheters.

A surveillance project was undertaken on 37 surgical wards by infection control nurses with the aim of reducing phlebitis/infections associated with peripheral vascular catheters, and to identify risk factors. Data on 2934 catheters in situ longer than 24h was collected in two separate surveillance periods and results were fed back after each surveillance period. Four significant risk factors were identified; what the catheters were used for, the duration the catheters were in situ, the surveillance period (the first surveillance period had a higher phlebitis rate than the second) and whether an infusion pump was used. Logistic regression analysis showed that each of these had a significant effect after adjusting for the effects of the other three factors.

Catheterization, Peripheral↗

PubMed2002

[Catheter induced septicaemia].

The most serious catheter-related infections, such as septicaemia are associated with the central venous catheters rather than the peripheral catheters. The main sources of microorganisms are the patient's skin and hospital environment. Bacteria can gain access to blood via the external or the internal catheter surfaces. A number of approaches for the prevention of sepsis associated with catheters have been proposed, with limited success. Beside the careful aseptic techniques, the development of antibacterial polymers offers the greatest potential for further reduction of risk of catheter-related sepsis. However, there is evidence suggesting that an appropriate training of staff in the management and care of catheters is fundamental to achieve a reduction in the incidence of catheter-related infections.

Asepsis↗

PubMed2004

Safety and efficacy of the POP technique for restoring patency to occluded PIC catheters.

Peripheral-inserted central catheters (PICCs) offer a successful alternative to peripheral venipuncture for long term medication therapy. When catheters become occluded, the nurse must intervene to avoid delayed or missed treatments. Pharmacological interventions are costly and not without risks. The purpose of this exploratory study was to test a mechanical percussive POP technique to restore patency. Thirty PICC catheters were clotted with human blood and incubated for 8 hours in a 35 degrees saline bath. Using the percussive POP technique, a 10-mL syringe with 1 mL of saline restored patency in 86% of the occluded catheters. The safety and effectiveness of the POP technique in vitro was established.

Biomechanical Phenomena↗

PubMed1995

[Pharmacological routes of administration in circulatory collapse].

A review of different ways of injecting drugs during cardiopulmonary resuscitation (CPR) and during states of shock is presented. On the basis of this review, central or peripheral intravenous injection is recommended as first choice. If a peripheral vein is used, the drug injection should be followed by infusion of a large volume of normal saline to facilitate the entry of the drug into the central circulation. In case of endotracheal intubation, several drugs can be injected into the tracheal tube. Atropine, lidocaine and naloxone are shown to be effective when given by this route. Adrenalin is probably not effective when injected endotracheally. Intraosseous injection of drugs, crystalloids and colloids is an alternative in all states except for hypovolaemic shock due to lower infusion rates. Intracardiac injection of drugs during CPR is recommended as a last resort.

Cardiopulmonary Resuscitation↗

PubMed2002

Flow-rate measurements and models for colloid and crystalloid flows in central and peripheral venous line infusion systems.

The resuscitation fluids, including crystalloids and colloids, were tested in an experimental module with 16-gauge central and peripheral catheters. Infusion pressures were ranged from the gravity driving 10 kPa (75 mmHg) to the pressurized driving 50 kPa (375 mmHg). The experiment results were correlated to obtain the empirical friction factors and the loss factors for the components commonly used in a fluid resuscitation system. The modified Bernoulli equation with the correlated friction factors and loss factors for the components were used to evaluate the pressure and flow relationship in the fluid resuscitation system with peripheral and central catheters. Fair agreements were observed from the comparison of the predictions of the total driving pressure and test results from water, crystalloid and colloid solutions. The modified Bernoulli equation is, therefore, applicable to evaluate the pressure-flow relationship for efficient fluid resuscitations. The coefficients of flow (F) and the square of flow (F2) for the binominal model are varied with the changes of geometry and size of the infusion components, fluid properties and the units of parameters. These coefficients for the fluids and catheters tested in this study were also listed for reference.

Blood Flow Velocity↗

PubMedDate not supplied

Effect of two different short peripheral catheter materials on phlebitis development.

One of the most common causes of phlebitis in hospitalized patients is intravenous catheters. The material of the catheter is a determining factor in the development of phlebitis, as are factors such as age, gender, and medical diagnosis of the patient. The aim of this study, conducted in the coronary care unit of a 384-bed hospital in Ankara, Turkey, was to determine the effect of two different short peripheral catheters on phlebitis development caused by i.v. treatment. Overall, 255 patients constituted the study sample (130 with Teflon, 125 with Vialon catheters). Both groups were followed up for phlebitis development for 6 days. The total phlebitis rate was 36.8%, with almost half of the patients (49.2%) in the Teflon catheter group and 24.0% of patients in the Vialon catheter group. A significant statistical relationship was found between phlebitis rate and variables such as gender, catheter material, and indwelling time. The results of the study demonstrate that Vialon catheters are associated with less risk of catheter-induced phlebitis than are Teflon catheters.

Adult↗

PubMed1990

Peripheral vascular occlusions: mechanical recanalization with a metal laser probe after guide wire dissection.

Fourteen patients underwent recanalization of occlusions of the iliac or femoral artery. Subintimal passage of the guide wire and catheter occurred and was confirmed on angiograms obtained after administration of contrast medium. Recanalization of the true lumen was impossible, despite repeated attempts. Rather than abandon the procedure, the authors advanced a 2.5-mm laser probe to the occlusion, and the lumen was successfully reentered without the application of laser energy in 12 patients. The authors believe this technique is useful in traversing arterial occlusions after a standard guide wire technique has failed. The development of a wire and catheter with similar properties might allow the more widespread use of this technique.

Arterial Occlusive Diseases↗

PubMed2002

Effect of contrast agent viscosity and injection flow velocity on bolus injection pressures for peripheral venous injection in first-pass myocardial perfusion studies.

Myocardial perfusion imaging using Gd contrast agents is typically performed with bolus injections of the contrast agent using a power injector to provide for consistent and sufficiently rapid injection rates for all patients. For protocols in which a peripheral venous injection is called for (e.g. antecubital vein) injection catheters of 18 ga are used where vessel geometry permits. In some patients, particularly women with smaller veins, 20 and 22 ga catheters are used. The effect of catheter size and pressure tubing length can result in high injection pressures that occasionally cause leakage or connector failure. The viscosity of the contrast agent also impacts injection pressure. In this study, a simulation of the injection pathway was constructed with time resolved pressures measured at two points in the pathway. Pressure drops were calculated for a typical MR perfusion injection protocol.

Catheterization, Peripheral↗

PubMed1990

Inferior petrosal sinus sampling: evidence of a stimulatory effect of oCRH on GH secretion in Cushing's disease.

Preoperative localization of ACTH-secreting microadenomas has been performed in 9 patients with Cushing's disease by using bilateral and simultaneous venous sampling of the inferior petrosal sinuses. In addition to ACTH and PRL we determined GH levels after oCRH stimulation in order to confirm the possible occurrence of unilateral GH increases, as recently observed by us in one patient. A central-to-peripheral and an intersinus gradient of ACTH concentration was observed in all patients examined before and/or after oCRH stimulation. In 7 patients central-to-peripheral and side-to-side PRL gradients were recorded in basal conditions: in 5 of these patients a unilateral oCRH-induced PRL increase was observed. Six out of the 7 patients with unilateral PRL increases also showed an intersinus GH gradient in basal conditions (ratio greater than or equal to 1.5); in 5 of them a clearcut oCRH-induced GH increase was observed. A peripheral oCRH-induced GH and PRL increase was not observed in any of the patients. The observation of a paradoxical oCRH-induced GH increase in the inferior petrosal sinus with the higher ACTH concentration is of speculative and clinical interest; whether it reflects co-secretion of hormones by the tumour or hormone release by non-tumourous cells via paracrine mechanism is still to be clarified. The unilateral GH increase could represent an additional signal of the presence and localization of an ACTH-secreting tumour.

Adolescent↗

PubMed2002

Placement of a vena cava filter with an antecubital approach.

RATIONALE AND OBJECTIVES: The authors performed this study to evaluate the use of an antecubital venous approach for inferior vena cava (IVC) filter placement. MATERIALS AND METHODS: An IVC filter was placed in 26 patients (15 men, 11 women) in whom the antecubital vein was the preferred access site. An antecubital vein was accessed with ultrasound guidance and used for IVC filter placement. This same access site was used to place a peripherally inserted central catheter (PICC) in 17 of the 26 patients. Access was obtained via the basilic vein in 15 patients (58%), brachial vein in eight (31%), and cephalic vein in three (12%). RESULTS: The IVC filter was successfully placed in the infrarenal vena cava in all 26 patients (100%) by using an antecubital vein for access. All filters deployed appropriately without complication. No complications occurred during PICC placement. CONCLUSION: The IVC filter can be safely placed via an antecubital vein. When clinically necessary, this site can provide convenient access for the PICC placement.

Catheterization, Peripheral↗

PubMedDate not supplied

A descriptive study of peripheral intravenous catheters in patients admitted to a pediatric unit in one Australian hospital.

Over a 5-month period, 496 peripheral intravenous catheters (PIVs) inserted into neonates, infants, and children were prospectively studied. Data were collected on demographic patient characteristics, PIV indications for use, dwell time, and reasons for removal, together with nursing actions. The results showed that most PIVs were removed within 72 hours. In 6.6% of cases, some degree of phlebitis was present at PIV removal. The risk of phlebitis increased when the PIV remained in place longer, the child was younger, or medication was administered. The greatest risk was age, with neonates being 5(1/2) times more likely to have some degree of phlebitis than non-neonates.

Adolescent↗

PubMed1994

Accelerated onset of vecuronium neuromuscular block with pulmonary arterial administration.

The purpose of this study was to determine the onset times of vecuronium neuromuscular block administered into either the central circulation or a peripheral vein. One hundred and twenty adult patients with a pulmonary artery (PA) catheter were randomly divided into one of three groups with respect to the routes of vecuronium administration (n = 40 in each group). Anaesthesia was induced with midazolam 2.5 mg iv and fentanyl 10-50 micrograms.kg-1 iv and maintained with intermittent doses of fentanyl 50 micrograms iv and nitrous oxide 60-70% in oxygen. After immobilization of the forearm in a splint, the ulnar nerve was stimulated supramaximally every 12 sec. The resulting force of the evoked thumb twitch was recorded (Myograph 2000, Biometer, Denmark). The times from the injection to the first depression of twitch response (latent onset) in patients given vecuronium 0.08 mg.kg-1 into the pulmonary artery, the right atrium, and a peripheral vein on the hand were 58.0 +/- 19.5, 71.5 +/- 17.1, and 82.4 +/- 18.0 sec (mean +/- SD), respectively. The latent onset of neuromuscular block occurred sooner in patients given vecuronium into the central vein than when administered into a vein on the hand (P < 0.01). In comparing the patients given vecuronium into the central vein, the onset times to 95% twitch depression (onset) were 152.3 +/- 40.7 and 168.2 +/- 35.5 sec. The onset of block was found to be faster when vecuronium was administered into the pulmonary artery than into the right atrium (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Recurrence of stenoses following balloon angioplasty and Simpson atherectomy of the femoro-popliteal segment. A randomised comparative 1-year follow-up study using colour flow duplex.

The results of balloon angioplasty (BA) and atherectomy (AT) with the Simpson atherocath, were compared in a randomised prospective study. Thirty-one patients were randomised to one of these methods for the treatment of symptomatic stenotic or occlusive lesions in the superficial femoral and popliteal arteries. One patient died after randomisation but before the procedure, thus 30 patients were available for analysis. All patients had intermittent claudication and BA was used in 14 and AT in 16 limbs. A surveillance protocol included colour flow duplex scanning of the femoro-popliteal arteries after 6 weeks and then at 3-monthly intervals during the 1st year and every 6 months thereafter. The average duration of follow-up was 9.7 months. For confirmation intra-arterial digital subtraction angiography (DSA) was performed in all patients at 1 year following the intervention, when clinical symptoms occurred or when colour flow duplex indicated greater than 49% restenosis. Three small dissections were the only postoperative complications and residual stenoses greater than 20% diameter reduction (DR) were observed in two patients following BA and in two after AT. Improvement of clinical category according to the "Standards for evaluating results of interventional therapy for peripheral vascular disease" occurred in 13 of 14 BA patients and in 15 of 16 AT patients. Follow-up results were expressed as cumulative patency and clinical success. Endpoints for patency were recurrence of the stenosis at the treated segment or new lesions in different segments and endpoints for clinical success were a drop in clinical category (symptoms, ankle pressure indices and post-exercise ankle pressures). One-year patency (no restenosis greater than 49% DR) was 77% in patients with BA and 25% in patients with AT (p = 0.017).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed2005

Ethanol embolization of arteriovenous malformations: interim results.

PURPOSE: To assess retrospectively the interim results and the complications of ethanol embolization treatment of arteriovenous malformations (AVMs). MATERIALS AND METHODS: Institutional review board approval was obtained for a retrospective review of patient medical and imaging records. Informed consent was not required by the institutional review board. Written consent for the procedure was obtained from all patients after a discussion about the advantages and risks of the procedure. After a general anesthetic was administered, 40 patients (16 male, 24 female; age range, 9-53 years) with inoperable AVMs in the body and extremities underwent staged ethanol embolizations (range, 1-24; median, 3). Pulmonary artery pressure and arterial blood pressure were monitored as ethanol was injected. Ethanol embolizations (50%-100% ethanol mixed with nonionic contrast material) were performed by using transcatheter and/or direct puncture techniques. Ten patients underwent additional coil deployment during ethanol embolization. Clinical follow-up (range, 2-48 months; mean, 14.6 months; median, 12 months) was performed in all patients, and results from imaging follow-up (range, 0-48 months; mean, 8.4 months; median, 6 months) were available from the last treatment session in 28 patients. Therapeutic outcomes were established by evaluating the clinical outcome of symptoms and signs, as well as the degree of devascularization at follow-up angiography. RESULTS: One hundred seventy-five ethanol embolizations were performed in 40 patients. Sixteen (40%) of 40 patients were cured, 11 (28%) had partial remission, seven (18%) had no remission, and one (2%) experienced aggravation. Treatment failed in five patients (12%). Ethanol embolization was considered effective (cure, 16 patients; partial remission, 11 patients) in 27 patients (68%). Eleven patients will need further treatment sessions for residual AVMs. Twenty-one patients (52%) experienced complications. Twenty-seven minor complications (skin and transient peripheral nerve injuries) (27 [15%] of 175 procedures) occurred in 18 (45%) of 40 patients. All minor complications were healed with wound dressing and observation. Five major complications (five [3%] of 175 procedures) occurred in five (12%) of 40 patients, and four patients recovered completely. CONCLUSION: Ethanol embolization has the potential for cure in the management of AVMs of the body and extremities but with acceptable risk of minor and major complications.

Adolescent↗

PubMed2003

A case of anterior interosseous nerve syndrome after peripherally inserted central catheter (PICC) line insertion.

Palsies involving the anterior interosseous nerve comprise less than 1% of all upper extremity nerve palsies. Patients often present initially with acute pain in the proximal forearm, lasting several hours to days. The pain subsides, to be followed by paresis or total paralysis of the pronator quadratus, flexor pollicis longus and the radial half of the flexor profundus, either individually or together. Patients with a complete lesion will have a characteristic pinch deformity. We report a case of anterior interosseous syndrome in a 42-year-old male. The patient was admitted initially for chronic osteomyelitis of the left calcaneum. He had a peripherally inserted central catheter (PICC) line inserted into a brachial vein for the administration of intravenous antibiotics, and developed anterior interosseous nerve palsy as a complication of this procedure. The catheter was subsequently removed and a new line was placed on the other side, and his neurological deficit has been improving since. This case highlights the potential hazards of venupuncture or arterial puncture of the brachial vein or artery respectively, even under controlled conditions with the benefit of ultrasound guidance. It also serves as a reminder to look out for the complications of these common procedures, and to be able to react appropriately when they arise.

Adult↗

PubMed2003

Extravasation of hyperalimentation into the liver parenchyma from a peripherally inserted central catheter.

A neonate receiving hyperalimentation through a peripherally inserted central catheter (PICC) had acute abdominal distension and respiratory distress. She was found to have extravasated a 9-cm x 9-cm pocket of hyperalimentation into the liver parenchyma, most likely caused by arterial placement of the PICC. She had severe anasarca and markedly decreased synthetic liver function. After 3 weeks of intensive care, she began to diurese. Her respiratory status subsequently improved, she started feeding, and her liver function test results returned to normal. This case shows the remarkable regenerative capacity of the neonatal liver and provides a rationale for conservative management of this rare but morbid PICC complication.

Catheterization, Peripheral↗

PubMed1989

Risk factors associated with intravascular catheter infections in burned patients: a prospective, randomized study.

A prospective, controlled study of 101 intravascular catheter sites was undertaken to determine the importance of tubing manipulation and skin contamination in the etiology of catheter infection in burned patients. Catheters in place for 3 days were randomized to have the tubing changed every 24 or 48 hours. Catheters were removed at 72 hours and the tips cultured by the semi-quantitative technique of Maki. Hubs were cultured (by swab culture) at times of tubing change and at the time of catheter removal. Skin cultures of the area surrounding the catheter were done at the time of insertion and removal. Catheter tip infection was defined as 15 or more colony forming units. Positive cultures were found in 25.7% of the cases, and were most often due to Pseudomonas species (33%) and coagulase-negative Staphylococcus (29%). Infections occurred in 35% of arterial catheters, 27% of central, and 12% of peripheral venous catheters. No benefit was observed from changing the administration tubing at 24 hours vs. 48 hours. Hub cultures were positive 30% of the time at 24 hours, 39% at 48 hours and 41% at 72 hours. Although the isolated organisms correlated with tip cultures, false positive rates varied from 8 to 62%. Discriminant analysis showed no relationship between catheter infection and burn size or day postburn; however, the incidence of catheter infection correlated inversely with the distance of the catheter insertion site from the burn wound (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗