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At least 829 records · Page 46Linked to original sources
PubMed2002

Risk of anaphylaxis from aprotinin re-exposure during LVAD removal and heart transplantation.

Aprotinin has been shown to reduce transfusion requirements in re-operative cardiac surgery and in implantation of long-term left ventricular assist devices (LVAD). However, it is an antigenic polypeptide and re-exposure is associated with a small incidence of anaphylaxis. This report describes 2 cases of anaphylactic response to aprotinin when the agent was employed for both the LVAD implant and for the subsequent explant and cardiac transplant. Early re-exposure to just the test dose was associated with a significant incidence of anaphylaxis.

Adult↗
PubMed1985

Comparison of three multiload IUDs: MLCu250, MLCu375 and MLAgCu250.

A comparative study was made of three differently loaded Multiload intrauterine contraceptive devices. The IUDs were used by 450 women for 3 years unless the device was removed earlier. The reasons for IUD removal (pregnancy, bleeding and/or pain, and other) were recorded, and the data analyzed after 1 year and after 3 years using the log-rank method. No statistically significant differences could be found among the three devices either in rate of pregnancy nor IUD removal for any reason.

Adult↗
PubMed1997

Does a single device prevent further slipping of the epiphysis in children with slipped capital femoral epiphysis?

All 170 patients (212 hips) treated between 1946 and 1992 for slipped capital femoral epiphysis (SCFE) with fixation in situ with a single device were reviewed to evaluate the incidence of further slipping of the epiphysis after primary treatment. In 154 hips, a smooth device without anchorage in the epiphysis was used and in 58, a device anchored in the epiphysis. In 3 hips, further slipping of the epiphysis occurred after primary treatment with no obvious cause. In 10 hips, an obvious cause for further slipping of the epiphysis was found. These 10 hips were re-operated due to the loss of epiphyseal grip in 6 hips, unsatisfactory placement of the device in 1, while in the remaining 3 hips, the device was removed before physeal closure. Twenty-six hips (12.3%) were re-operated because the device had lost its epiphyseal grip before physeal closure, and in 25 of these hips the device was smooth and had no anchorage in the epiphysis. The conclusion of this study is that a single device with anchorage in the epiphysis is stable enough to prevent further slipping of the epiphysis in hips with SCFE.

Adolescent↗
PubMed2005

Knotting of a ureteric stent in a child.

Knotting of ureteric stents is an unusual complication of their use and has not previously been reported in a child. We present a case of a 4-year-old that developed symptomatic hydronephroureter following removal of a multilength stent, which had knotted at the proximal loop. The child made a full recovery but knotting must be considered if resistance is encountered during stent removal.

Anastomosis, Surgical↗
PubMed2004

Pupillary block glaucoma secondary to posterior chamber phakic intraocular lens implantation for high myopia.

We describe a complication of posterior chamber phakic intraocular lens (PCP IOL) implantation for high myopia. Both eyes of a 44-year-old patient were treated prophylactically with a neodymium:YAG laser iridotomy before PCP IOL implantation. Bilateral PCP IOL implantation was performed uneventfully, although a peripheral iridotomy was required immediately after implantation in the right eye because of early pupillary block glaucoma. Two months later, the left eye developed pupillary block glaucoma despite apparently patent iridotomies. The PCP IOLs were subsequently removed.

Adult↗
PubMed2006

Infectious complications of implantable ports and Hickman catheters in paediatric haematology-oncology patients.

The aim of this study was to define and compare the infectious and non-infectious complications associated with Hickman catheters and implantable ports in children. The study was conducted over a three-year period in the Department of Haematology-Oncology at the Schneider Children's Medical Center of Israel. All patients who required a central venous catheter (CVC) were included in the study. For each episode of catheter-associated bloodstream infection, demographic, clinical and microbiology data were recorded. During the study period, 419 tunnelled CVCs (246 implantable ports and 173 Hickman) were inserted in 281 patients. Compared with implantable ports, Hickman catheters were associated with a significantly higher rate of bloodstream infections (4.656 vs 1.451 episodes per 1000 catheter-days), shorter time to first infection (52.31 vs 108.82 days, P < 0.001), shorter duration of catheterization (140.75 vs 277.28 days, P < 0.001), and higher rate of removal because of mechanical complications (P < 0.005). Gram-positive bacterial infections were more prevalent in the implantable port group (63.6% vs 41.6%), whereas Gram-negative rods, polymicrobial infections and mycobacterial infections were more prevalent in the Hickman group (31.4% vs 50.9%, 17% vs 36% and 0% vs 4.4%, respectively; P < 0.05 for all). Haematopoietic stem cell transplantation was identified as an independent risk factor for infection [odds ratio (OR) -1.68, P = 0.005] and for catheter removal due to complications (OR -2.0, P < 0.001). Implantable ports may be considered the preferred device for most paediatric oncology and stem cell transplantation patients.

Adolescent↗
PubMed1997

A dedicated prosthesis for open thoracostomy.

Due to our dissatisfaction with the mutilation caused by the skin-lined open thoracostomy, we have developed a dedicated prosthesis that is expected to avoid or to substitute for the classic operation. The prosthesis is a corrugated silicone tube with an oval flange at one end (to fix it internally) and a mobile ring on the other (to fix it externally). It is inserted at the bottom of the empyematic cavity after 3 cm of a rib is removed. We have used it in 20 patients whose empyema was secondary to pneumonia (12) or complications of pneumonectomy (4), lobectomy (2), decortication (1), or pleuroscopy (1). Six of those patients have already been cured and their prosthesis removed after 54 to 305 days. In 1 with a persistent postpneumonectomy bronchopleural fistula the device was removed after 299 days and the patient was submitted to a limited thoracoplasty. Six other patients still have unresolved cavities and have been using the prosthesis for 63 to 302 days. Seven patients died of their underlying disease (bilateral pneumonia, 2; acquired immunodeficiency syndrome, 2; mesothelioma, 1; heart failure and pulmonary embolism, 1; unknown, 1) after using the prosthesis for 11 to 160 days. In those patients from whom the prosthesis already has been removed, the scar looks like those commonly seen after removal of an ordinary chest tube. Based on these early favorable results we feel most encouraged to persist in this research. Nevertheless, we are aware that a larger number of patients and a longer follow-up will be necessary before we may make definitive recommendations.

Empyema, Pleural↗
PubMed1990

Spontaneous breakage of self-retaining intraprostatic stent.

An unexpected late complication was observed in a patient in whom the self-retaining intraprostatic stent was inserted. Among our 32 patients in whom the device was used, instead of a long-term indwelling catheter in high operative risk patients or in those awaiting a definitive operation, the success rate was 80%, with a 20% immediate failure rate. Spontaneous breakage of the device occurred 96 days after its insertion. This device was removed endoscopically and a new unit was inserted under sonographic guidance. After 6 months the device still functioned satisfactorily.

Aged↗
PubMedDate not supplied

Removal of urinary catheters: midnight vs 0600 hours.

In the fields of both nursing and medicine there is a dearth of published literature on the optimum time to remove indwelling urinary catheters (IDCs) following urological surgery. Tradition seems to be in favour of removing IDCs at 0600 hours despite a lack of evidence to support this practice. This study was undertaken to determine whether midnight removal of IDCs resulted in patients' resuming normal voiding patterns. A prospective clinical trial was conducted to determine the impact midnight removal of urinary catheters would have on the patients' voiding pattern, and subsequent discharge from hospital. One hundred and sixty patients were entered into the study. The patients were allocated at random to have their urinary catheter removed either at midnight or at 0600 hours. Patients who had their catheters removed at midnight passed a greater volume of urine with both their first (268 ml compared with 177 ml; P<0.0001) and second voids (322 ml compared with 195 ml; P<0.0001) than their counterparts in the 0600 group. This permitted earlier discharge from hospital. The results reported in this study support the findings of earlier research that midnight removal of IDC leads to an earlier resumption of normal voiding patterns, permits earlier discharge from hospital and appears to reduce patients' anxiety. The recommendation from this study is that there should be a change in hospital policy so that the majority of IDCs are removed at midnight.

Aged↗
PubMed2006

Hardware removal: indications and expectations.

Although hardware removal is commonly done, it should not be considered a routine procedure. The decision to remove hardware has significant economic implications, including the costs of the procedure as well as possible work time lost for postoperative recovery. The clinical indications for implant removal are not well established. There are few definitive data to guide whether implant removal is appropriate. Implant removal may be challenging and lead to complications, such as neurovascular injury, refracture, or recurrence of deformity. When implants are removed for pain relief alone, the results are unpredictable and depend on both the implant type and its anatomic location. Current literature does not support the routine removal of implants to protect against allergy, carcinogenesis, or metal detection. Surgeons and patients should be aware of appropriate indications and have realistic expectations of the risks and benefits of implant removal.

Device Removal↗
PubMed1993

Safe Medical Devices Act: management guidance for hospital compliance with the new FDA requirements.

The Safe Medical Devices Act of 1990 (Public Law 101-629) was signed by President George Bush almost three years ago on November 28, 1990. The law expanded the Food and Drug Administration's (FDA) authority to regulate medical devices and grew out of congressional concerns about the FDA's ability to quickly learn when a medical device caused an adverse patient event, and to ensure that hazardous devices are removed from hospitals and other health care facilities in a timely manner. The Safe Medical Devices Act is an extension of the Medical Device Amendments of 1976, which imposed production, distribution, and sales rules on medical device manufacturers. It gives the FDA the legal authority to directly regulate the use of medical devices in health care facilities. Among the Safe Medical Devices Act's provisions are specific requirements for hospitals, health professionals, and other users of medical devices to report patient incidents involving medical devices to the manufacturer and to the FDA if a device caused or contributed to a serious injury, death, or other "adverse experience." Adverse experiences are defined by the FDA to include concussions, fractures, burns, temporary paralysis, and temporary loss of sight, hearing, or smell. Hospitals have been required to comply with this provision of the law, called user reporting, since 1991. Hospitals are also required to participate in tracking certain medical devices whose failure could result in a serious adverse health outcome. The law requires distributors and manufacturers of specific devices to adopt a method for device tracking. Hospitals are required to cooperate with and provide device manufacturers with information about patients with permanently implantable devices and life-sustaining and life-supporting devices used outside device user facilities. The law also gives the FDA the authority to designate other devices subject to tracking if the agency determines such tracking is warranted to preserve the patient's health. This provision of the law is called device tracking. Device tracking became effective on August 29, 1993. This special report addresses some of the major questions about implementing user reporting and device tracking in hospitals. Over the past two years the FDA has issued a series of rules and regulations that have caused a great deal of confusion and misunderstanding. Some of the law's provisions are straightforward; however, some basic issues and rules--such as the definition of a reportable event--are unclear. While there are still some open questions about the reporting and tracking requirements, the following is the best information available at this time.(ABSTRACT TRUNCATED AT 400 WORDS)

Commerce↗
PubMedDate not supplied

The FemoStop compression device: utilization guidelines for the critical care nurse.

FemoStop is an exciting new femoral compression device being used on patients by critical care nurses. It is now common practice in many settings for the nurse to remove post-angioplasty and post-cardiac catheterization sheaths. In settings where physicians are primarily removing these devices, nurses must then be prepared to deal with site bleeding, post-sheath removal. FemoStop provides a means to do this. An understanding of the utilization guidelines for this product is beneficial and timesaving for busy nurses in many settings.

Angioplasty↗
PubMedDate not supplied

Preventing treatment interference: the nurse's role in maintaining technologic devices.

BACKGROUND: Treatment interference, the disruption or self-removal of technologic devices, is a primary reason for application of physical restraints in acute and critical care settings. The processes of care surrounding treatment interference and the prevention of device disruption have not been comprehensively analyzed. OBJECTIVES: To describe the processes used by critical care nurses to prevent treatment interference in critically ill older adults. METHODS: Participant observation field research was conducted in medical and intermediate medical intensive care units. Data were analyzed by using the constant comparative method and event analysis. RESULTS: Maintaining technologic devices is almost exclusively a nursing responsibility and involves the skillful assessment of patient awareness and trustworthiness and interpretation of behaviors. Critical care nurses are most protective of those devices for which accidental removal is perceived as life threatening: endotracheal tubes, arterial catheters, and central venous catheters. Nurses assess patients' cognitive status, mobility, strength, and trustworthiness, as well as device considerations such as replacement difficulty and device necessity. In addition to verbal strategies, such as explaining, nurses use distraction, deception, comfort measures, watchful family members, physical restraints, and sedation to prevent treatment interference. CONCLUSION: This analysis considers the social context of the intensive care unit, including roles and the human-technology interaction. It illustrates the tremendous responsibility that nurses assume in maintaining technologic devices. Next steps in research and policy development are also considered.

Adult↗