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At least 91 records · Page 5Linked to original sources
PubMed1989

Peripheral vascular complications from percutaneous transluminal coronary angioplasty: a comparison with transfemoral cardiac catheterization.

The peripheral vascular complications associated with percutaneous transfemoral coronary angioplasty were compared with those that occurred during conventional transfemoral cardiac catheterization. Among 644 patients undergoing percutaneous transluminal coronary angioplasty (PTCA), 6 patients (0.9%) suffered peripheral vascular complications, whereas 35 of 2904 patients having cardiac catheterizations (1.2%) had a peripheral vascular complication. The types of complications associated with both procedures were similar and included groin hematomas, false aneurysms, arterial dissection, arterial perforation, and neurological deficits. The frequency of surgical repair of these complications also was similar in the two groups (50% required repair for a PTCA complication, 34% were repaired after a catheterization complication). The PTCA-associated complications included one myocardial infarction and one death, whereas neither of these occurred in association with a catheterization-induced vascular complication. The surgical management of five of the six PTCA complications was difficult, largely because of the size of the sheath-related puncture site and the presence of active bleeding from the associated systemic anticoagulation. PTCA carries the same risk of development of a peripheral vascular complication as found in transfemoral cardiac catheterization. Care must be taken to prevent sheath-related injury to the aorta-iliac-femoral system and hemorrhagic complications at the puncture site are of particular concern and require urgent surgical attention.

Aged↗
PubMedDate not supplied

[The puncture and catheterization of the peripheral vessels using ultrasonic scanning].

Having many-year experience with angiographic interventions, the authors examined the potentialities of ultrasonic angioscanning to monitor the implementation of endovascular interventions (EVI). During the study, they developed an original procedure of different EVI with intraoperative ultrasonic monitoring, refined the ultrasonic semiotics of the procedure, achieved positive results in preventing possible complications. The authors made indications for the procedure and rational ways of its application more concrete. They provide evidence for that the proposed procedure greatly facilitates the performance of different intravascular procedures and reduces the time (or excludes) teleradioscopy, thus lowering the radiation burden on the staff and the patient.

Adult↗
PubMed2005

[How to improve central venous catheter use in intensive care unit?].

OBJECTIVE: Central venous catheter (CVC) insertion is routinely performed in critically ill patients but causes mechanical, thrombotic, or infectious adverse events in 15% of cases. It should be possible to improve the benefit/risk ratio of central venous catheterization in intensive care unit. DATA SOURCE: We searched Pubmed using the terms: "catheterization, central venous, peripheral, adverse effects"; then "thrombosis, phlebitis, thrombophlebitis, jugular vein, femoral vein, subclavian vein, pneumothorax, haemothorax, extravasation of diagnostic and therapeutic materials". We then discuss this with a panel of intensivists in a workshop. DATA SYNTHESIS: Few data are available on the risk/benefit ratio of central vs. peripheral venous catheterization. In some cases (cardiac arrest, rapid fluid loading, parenteral nutrition) the choice is based on clear recommendations. In others (irritating drugs, pressure monitoring, peripheral access failure), the choice depends on medical and nurses daily evaluation. When CVC insertion is mandatory, it is important to implement the recommendations of the consensus conferences to prevent infectious and thrombotic complications. Mechanical complications should be improved by selecting the most appropriate insertion site, and, if unsuccessful, switching to another operator before the complications occurs. Doppler-ultrasound guidance is recommended, but is limited by the cost and training of the technique. CONCLUSION: Studies evaluating the risk/benefit ratio of CVCs versus peripheral catheters are needed to develop a venous-access strategy for ICU patients. When a CVC is mandatory, recent data are available to improve the risk/benefit ratio and can be used to build a decision algorithm.

Catheterization, Central Venous↗
PubMed1983

[Percutaneous-peripheral vena cava catheterization in intensive care of premature and newborn infants. Comparison of Shaw's silastic catheter with the customary polyvinyl catheter].

Central venous catheters inserted via peripheral veins are commonly used in neonatal intensive care. Handling of two commonly available catheters made of different materials were compared during application in 85 neonates under intensive care. Polyvinylchloride and silicone rubber were used as catheter material. Advantages of silicone rubber catheter were detected especially in very low birth weight premature infants. Successful puncture of the peripheral veins and correct positioning could be performed in a higher proportion of these babies than when using polyvinylchloride-catheters. The insertion of polyvinyl-catheters needs shorter time of manipulation and during infusion we found a significantly lower incidence of mechanical problems with the catheter.

Catheterization↗
PubMed1994

Use of a mechanical pressure device for hemostasis following cardiac catheterization.

BACKGROUND: Peripheral vascular complications that can occur after cardiac catheterization are costly and cause patient discomfort. OBJECTIVES: To determine the difference in frequency of vascular complications in a convenience sample of cardiac catheterization patients who had mechanical pressure vs digital pressure for postprocedural hemostasis. METHODS: A quasi-experimental design was used. The study group consisted of 100 patients on whom a mechanical clamp was used to effect hemostasis; the control group consisted of 100 patients who received digital pressure for hemostasis. Data from the control group were obtained retrospectively through review of cardiac catheterization charts. RESULTS: The two groups showed statistically significant differences for the number of catheters used, mean time elapsed between arterial entry and catheter removal, and compression time. There was no significant difference in complication rate between the groups. DISCUSSION: Complications including hematoma formation, arterial occlusion, ischemia and traumatic neuropathy were monitored. CONCLUSIONS: The mechanical pressure device is a safe, cost-effective alternative to digital pressure for hemostasis following cardiac catheterization. Further studies are needed to verify these results and the effectiveness of the device following other percutaneous intra-arterial procedures.

Cardiac Catheterization↗
PubMed2002

Interventional catheterization management of perioperative peripheral pulmonary stenosis: balloon angioplasty or endovascular stenting.

There is limited reported experience of catheterization therapy for peripheral pulmonary stenosis (PPS) at a surgical site in the early postoperative period. We reviewed the clinical course of patients undergoing interventional catheterization for PPS at a surgical site < 7 weeks after surgery. Successful dilation (SD) was defined as > 50% increase in predilation diameter. From 1984 to 2000, 17 patients had 19 proximal pulmonary arteries dilated 1 to 46 (median 8) days postoperatively. Median age and weight were 3.1 year and 12.7 kg. Three arteries were initially occluded. Seventeen arteries had initial BD with postintervention imaging available in 15; 8 arteries had SD. The arterial diameter increased from 3.9 +/- 2.6 to 5.5 +/- 2.8 mm (P < 0.001). Nine of these arteries had stents placed with diameter increasing to 8.7 +/- 3.7 mm (P < 0.001 compared with post-BD diameter). Stents increased the diameter in all arteries and made four of four failed BD successful. In the two most recent procedures, stents were placed without prior BD with diameter increasing from 1.3 to 9 mm and 8.2 to 14 mm. A stent was placed in 1 of 7 arteries prior to 1993 and in 10 of 12 arteries thereafter (P < 0.004). Three patients prior to 1995 had catheterization-related deaths secondary to vessel rupture after BD. BD produces SD in approximately one-half of the procedures but is associated with mortality. Stent placement increases vessel diameter substantially more than BD alone. Stents reduce the acute complication rate and avoid early reoperation in this patient group.

Adolescent↗
PubMed1998

Is routine replacement of peripheral intravenous catheters necessary?

BACKGROUND: Guidelines developed by the Centers for Disease Control and Prevention, Atlanta, Ga, recommend that peripheral intravenous catheters be changed every 3 days. However, routine replacement of central venous catheters is no longer supported in their latest update. OBJECTIVE: To evaluate the risk to patients of having peripheral intravenous catheters left in place for as long as they are clinically indicated. METHODS: This observational study in a university-affiliated, 700-bed hospital was designed to evaluate the day-specific risk (incidence density) for phlebitis, catheter infection, and obstruction with catheters remaining in place as long as clinically indicated. All consecutive patients who required peripheral intravenous catheterization for 24 hours or more were enrolled during a 10-week period. Outcome variables are phlebitis, catheter-related infections, and obstruction. Evaluated risk factors include age, sex, underlying disease, anatomical insertion site, catheter diameter, first or subsequent catheter, duration of catheterization, type of admission, hospital location, type of infusate, and antibiotic therapy. RESULTS: A total of 609 catheters that were in place for 1 to 28 days were evaluated. Phlebitis, catheter-related infection, and obstruction occurred in 19.7%, 6.9%, and 6.0% of catheters, respectively. We were unable to demonstrate an increased risk after 3 days of catheterization. The day-specific risk indicated a linear function of all outcome variables. CONCLUSIONS: The hazard for catheter-related complications--phlebitis, catheter-related infections, and mechanical complications--did not increase during prolonged catheterization. The recommendation for routine replacement of peripheral intravenous catheters should be reevaluated considering the additional cost and discomfort to the patient.

Adolescent↗
PubMed2000

Emergency vascular access.

Establishing and maintaining vascular access is often vital to the preoperative, intraoperative, and postoperative management of the small animal emergency surgical patient. Vascular access may be used for the delivery of crystalloids, colloids, blood components, medications, and anesthetic or sedative agents. It can also facilitate venous and arterial blood sampling and allow direct measurement of arterial and venous pressures. The small animal emergency and critical care veterinarian should have a thorough knowledge of vascular access techniques, including peripheral and central venous catheterization, intraosseous, and arterial access. Competence in percutaneous, percutaneous facilitative, and surgical cutdown approaches should ensure that vascular access can always be established in the critically ill patient.

Animals↗
PubMed2004

Clinical utility of rapid prescreening magnetic resonance angiography of peripheral vascular disease prior to cardiac catheterization.

PURPOSE: The presence of peripheral vascular disease, in particular iliofemoral disease, is responsible in part for vascular complications from femoral artery cannulation. We investigated whether prescreening for vascular obstructions with magnetic resonance angiography (MRA) in high-risk patients with peripheral vascular disease (PVD) would provide useful information to angiographers seeking to improve the safety and efficiency of femoral artery access at cardiac catheterization. METHODS: Twelve consecutive patients with known or suspected PVD underwent contrast-enhanced, aorto-iliofemoral MRA using a real-time BolusTrak technique. Contrast-to-noise ratios for each patient were calculated. The cardiac angiographer reviewed the MRA prior to catheterization and selected an access site. The patients' subsequent clinical course was evaluated, and a postprocedure questionnaire was completed by the angiographer to define the value of the prescreening MRA. RESULTS: No significant vascular complications occurred in these patients as defined by failure of initially chosen access site, arterial dissection, limb ischemia, pseudoaneurysm formation, hemorrhage (including retroperitoneal hematoma), or need for blood transfusion or emergency vascular surgical repair. Statistical frequency analysis of the responses in the postprocedure questionnaire demonstrated that the MR data were clinically valuable in (1) influencing the initial choice of access site; (2) influencing technical alterations to the standard access; and, (3) enhancing confidence in the selection of access site. CONCLUSIONS: MRA prescreening in patients with PVD is an effective, novel adjunct to cardiac catheterization in selected patients that improves physician confidence and influences technical choices during coronary angiography from the femoral artery approach.

Adult↗
PubMed1998

Risk factors for Enterobacter septicemia in a neonatal unit: case-control study.

Thirty cases of Enterobacter aerogenes or Enterobacter cloacae septicemia diagnosed over a 32-month period in a tertiary care neonatal unit were enrolled in a case-control study. Each case patient was matched with two controls (patients occupying the cots nearest the case patient when the latter developed septicemia). Of the 32 perinatal characteristics evaluated, 11 were identified by univariate analysis to be significantly associated with the infection. These included parents being residents of the Vietnamese refugee camps, respiratory distress syndrome, necrotizing enterocolitis, umbilical arterial catheterization, umbilical venous catheterization, bladder catheterization, mechanical ventilation, antibiotic treatment, peripheral venous catheterization, nasogastric intubation, and parenteral nutrition. Multivariate analysis, however, showed that preceding bladder catheterization and ongoing parenteral nutrition were the only independent risk factors for enterobacter septicemia. Strict aseptic technique in the preparation of parenteral nutrition fluid and avoidance of bladder catheterization are measures that may reduce the risk of enterobacter sepsis for newborns.

Bacteremia↗
PubMed1990

Use of peripheral vessels for exchange transfusion.

During a five and a half year period, exchange transfusions were performed through the peripheral vessels in 201 of the 214 infants (94%) who required either double volume or partial plasma exchange transfusions. Peripheral vessel exchange transfusion is simple, practicable, and safe with few complications. Technical difficulties in catheterizing the peripheral artery and vein may be overcome by using a 24 gauge catheter, which causes no more catheter induced haemolysis than standard umbilical catheters.

Bilirubin↗