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Peripheral transcatheter embolization with platinum microcoils.

Embolotherapy with platinum microcoils delivered through the Tracker-18 microcatheter (Target Therapeutics, San Jose, Calif) was performed in 16 patients when peripheral superselective catheterization with standard angiographic catheters was not possible. The Tracker-18 catheter could be directed distally into small peripheral vessels for delivery of the microcoils. These microcoils, with attached fiber strands, resulted in vascular occlusion within a few minutes in all cases. Embolotherapy was technically successful in all patients. The procedures were clinically successful in 15 of 16 patients (94%), and no complications were encountered. Embolization with platinum microcoils through the Tracker-18 catheter is useful when standard methods of embolization are not possible.

Adolescent↗

Intravenous access. Part 1. Peripheral i.v.s.

The nursing care of the patient with a peripheral IV requires the implementation of the basic principles of intravenous care. Because the integrity of the skin is broken, measures are implemented to prevent the occurrence of infection. Skin preparation of the venipuncture site is important in preventing the introduction of organisms into the IV insertion site. The regular care of the insertion site and maintenance of an occlusive dressing prevent further IV site contamination. The use of peripheral IVs constructed of certain materials, the use of normal saline over heparin flush solution to maintain IV patency, and an established routine of changing IV sites at regular intervals remain controversial issues. Nurses need to keep abreast of new IV products and new research findings to better care for patients with peripheral IVs.

Catheterization, Peripheral↗

[Use of peripherally inserted multilumen catheters as an alternative to central venous access].

BACKGROUND: In the last decade alternatives to central venous lines in critically ill children have been developed. Multilumen catheters have classically been used through central venous access but there are no reports on their use as peripherally inserted central lines. PATIENTS AND METHODS: We performed a retrospective study of patients admitted to the pediatric intensive care unit in the previous 3 years who underwent catheterization with peripherally inserted central venous lines. The catheters were four French, double-lumen and 30-cm long. RESULTS: Twenty-two catheters were used in 22 children (mean age: 8.3 years; range 1.7-13.8). The catheters remained in place for a mean of 7.2 days. Ninety percent of the catheters were placed in antecubital veins. The catheters were used to administer antibiotics (59 %), other drugs (81 %), total parenteral nutrition (50 %) and blood (9 %). Central venous pressure monitoring was performed in eight patients. Complications were found in five patients (22 %): three cases of phlebitis, one catheter occlusion and one infection at the site of insertion. No significant differences were found in the complication rate between peripherally inserted catheters and 298 central venous catheters inserted in our unit in the same time period. CONCLUSIONS: Peripherally inserted multilumen catheters may be an alternative in the management of critically-ill pediatric patients.

Adolescent↗

A comparison of the effects of central v peripheral bolus injections of potassium chloride on aortic root potassium concentrations in swine.

Clinically relevant doses of potassium chloride (equivalent to 2 mEq/60 kg of body weight) were administered as rapid intravenous (IV) boluses to healthy halothane-anesthetized pigs. Potassium was given either peripherally through a standard IV ear catheter or centrally through the central venous port of a pulmonary artery catheter. Multiple injections were made in each pig, and cardiac output was varied by changing end-tidal halothane concentration. The aortic root potassium concentration was measured every three to six seconds for 90 seconds following potassium administration in each pig. Monitored variables included end-tidal halothane, end-tidal carbon dioxide, pulmonary artery pressure, mean arterial blood pressure, cardiac output, electrocardiogram, and temperature. Following both peripheral and central administration of potassium chloride, aortic root potassium increased significantly. However, the time required to achieve the peak aortic root potassium concentration was significantly less after central administration. In addition, the change in aortic root potassium concentration was greater following central administration compared with peripheral. The change in aortic root potassium concentration correlated inversely with cardiac output only after central, but not peripheral injection. Despite marked transient hyperkalemia in all animals, no electrocardiographic evidence of hyperkalemia could be demonstrated. It is concluded that small bolus doses of potassium chloride (2 mEq/60 kg) can be given safely either peripherally or centrally in normal, hemodynamically stable swine.

Animals↗