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PubMed1988

Catheterization and angioplasty of the nonopacified peripheral autogenous vein bypass graft.

Nonopacified lower extremity vein bypass grafts may not be thrombosed. Catheterization of these grafts should be performed whenever possible. If graft patency is demonstrated, vein graft angioplasty may restore flow without fibrinolytic therapy. In two cases of nonthrombosed nonopacified grafts, graft patency was demonstrated by catheterization of the grafts, and normal blood flow was restored by percutaneous transluminal angioplasty.

Aged↗
PubMed2002

Lithium dilution cardiac output measurement: a clinical assessment of central venous and peripheral venous indicator injection.

OBJECTIVE: The lithium indicator dilution technique has been shown to measure cardiac output (CO) accurately by using central venous injection of lithium chloride (Li-CCO). This study aimed to compare the measurement of CO by using peripheral venous administration of lithium chloride (Li-PCO) with Li-CCO. DESIGN: Prospective, observational human study. SETTING: Surgical intensive care unit. PATIENTS: Thirty-one patients were studied after major surgery. All patients had arterial, central, and peripheral venous catheters. A total of 24 patients had pulmonary artery catheters. MEASUREMENTS: Serial measurements of Li-CCO and Li-PCO were made during hemodynamically stable conditions. CO was also measured using thermodilution (TDCO) when a pulmonary artery catheter was present. Data were analyzed by linear regression, the generalized estimating equation, and the comparison method described by Bland and Altman. MAIN RESULTS: There were 93 Li-CCOs, 93 Li-PCOs, and 216 TDCOs recorded. The ranges of COs were similar: Li-CCO, 2.36-11.52 L/min (mean, 5.22 L/min; n = 31); Li-PCO, 1.63-9.99 L/min (mean, 5.22 L/min; n = 31), and TDCO, 3.28-10.4 L/min (mean, 5.75 L/min; n = 24). There was good linear correlation between Li-CCO and Li-PCO (R2 =.845). The mean difference for Li-CCO-Li-PCO was very small and insignificant (p =.97), and the limits of agreement were acceptable (mean difference +/- sd, 0.0005 +/- 0.64 L/min). The mean difference for Li-CCO-Li-PCO was smaller if the peripheral injection site was proximal rather than distal to the wrist (p =.053). Li-PCO and Li-CCO values were lower than simultaneously obtained TDCO measurements (Li-PCO-TDCO, -0.538 +/- 0.95 L/min, p =.003; Li-CCO-TDCO, -0.526 +/- 0.67 L/min, p =.0001). CONCLUSIONS: Li-PCO gives a measurement that agrees well with Li-CCO. Accuracy of Li-PCO is probably improved if a proximal arm vein is used. Li-PCO provides accurate measurements of CO without the risks of pulmonary artery or central venous catheterization.

Cardiac Output↗
PubMedDate not supplied

Peripheral intravenous cannulation and patient consent.

As nurses enhance their skills by taking on more tasks previously carried out by doctors, the need arises to be aware of consent. All nurses must have the capacity to ensure safe professional practice; consent is only one aspect of the enhanced role. The author reviews this issue through an exploration of peripheral intravenous cannulation.

Catheterization, Peripheral↗
PubMedDate not supplied

Management of peripheral intravenous therapy.

Practice profiles are reflective pieces written by nurses in practice and based on continuing professional development articles. This week Frances Murray discusses peripheral intravenous therapy.

Catheterization, Peripheral↗
PubMed2006

Peripheral venous pressure as a predictor of central venous pressure during orthotopic liver transplantation.

STUDY OBJECTIVE: To assess the reliability of peripheral venous pressure (PVP) as a predictor of central venous pressure (CVP) in the setting of rapidly fluctuating hemodynamics during orthotopic liver transplant surgery. DESIGN: Prospective clinical trial. SETTING: UCLA Medical Center, main operating room-liver transplant surgery. PATIENTS: Nine adult patients with liver failure undergoing orthotopic liver transplant surgery. INTERVENTIONS: A pulmonary artery catheter and a 20-g antecubital peripheral intravenous catheter dedicated to measuring PVP were placed in all patients after standard general endotracheal anesthesia induction and institution of mechanical ventilation. MEASUREMENTS: Peripheral venous pressure and CVP were recorded every 5 minutes and/or during predetermined, well-defined surgical events (skin incision, venovenous bypass initiation, portal vein anastamosis, 5 minute post graft reperfusion, abdominal closure). Pulmonary artery pressure and cardiac output (via thermodilution) were recorded every 15 and 30 minutes, respectively. MAIN RESULTS: Peripheral venous pressure (mean +/- SD) was 11.0 +/- 4.5 mmHg vs a CVP of 9.5 +/- 5.0; the two measurements differed by an average of 1.5 +/- 1.6 mmHg. Peripheral venous pressure correlated highly with CVP in every patient, and the overall correlation among all nine patients calculated using a random-effects regression model was r = 0.95 (P < 0.0001). A Bland-Altman analysis used to determine the accuracy of PVP in comparison to CVP yielded a bias of -1.5 mmHg and a precision of +/-3.1 mm Hg. CONCLUSION: Our study confirms that PVP correlates with CVP even under adverse hemodynamic conditions in patients undergoing liver transplantation.

Adult↗
PubMed1996

Myocardium is a major source of proinflammatory cytokines in patients undergoing cardiopulmonary bypass.

Proinflammatory cytokines, such as tumor necrosis factor-alpha, interleukin-6, and interleukin-8, and anti unflammatory cytokines, such as interleukin-10, may play an important role in patient responses to cardiopulmonary bypass. We sought to define whether the myocardium and the lungs serve as important sources of these cytokines under conditions of cardiopulmonary bypass. Ten patients (age 64 +/- 3 years, mean +/- standard error of the mean) undergoing elective coronary artery bypass grafting were monitored with an arterial catheter, a coronary sinus catheter, and pulmonary artery catheter. Plasma levels of tumor necrosis factor-alpha, interleukin-6, interleukin-8, and interleukin-10 were measured simultaneously in peripheral arterial blood, coronary sinus blood, and mixed venous blood before heparin administration, 1 minute before aortic crossclamping, 5 minutes after aortic declamping, and at 0.5, 1, 1.5 and 2 hours after aortic declamping. The durations of cardiopulmonary bypass and aortic crossclamping were 114 +/- 9 and 64 +/- 5 minutes, respectively. Levels of tumor necrosis factor-alpha and interleukin-6 were significantly higher in coronary sinus blood than in arterial blood after aortic declamping. Tumor necrosis factor-alpha and interleukin-6 levels were also higher in mixed venous blood than in arterial blood within 1 hour after declamping. There were no significant differences among the three sampling sites with respect to interleukin-8 and interleukin-10 levels. In one patient who had postoperative myocardial infarction, however, interleukin-8 levels were three times as high as in coronary sinus blood than in arterial blood. These data indicate that the myocardium is a major source of tumor necrosis factor-alpha and interleukin-6 in patients undergoing cardiopulmonary bypass. The lungs may consume rather than release proinflammatory cytokines in the early phase of reperfusion. The source under these conditions of the antünflammatory cytokine interleukin-10 remains to be determined.

Aged↗
PubMed2006

Intraoperative peripherally inserted central venous catheter central venous pressure monitoring in abdominal aortic aneurysm reconstruction.

Numerous studies have found no clinically significant benefit to the perioperative use of pulmonary artery catheters (PACs), and peripherally inserted central venous catheters (PICCs) have been reported to measure central venous pressure (CVP) accurately. The objective of this study was to determine whether the dynamic shifts in preload associated with elective reconstruction of abdominal aortic aneurysms (AAAs) are accurately reflected by CVP measurements from open-ended PICCs compared to CVP measurements from concomitant indwelling PACs. This is a retrospective review of prospectively collected data. PICCs and PACs were placed preoperatively in five patients undergoing elective AAA reconstruction. CVP measurements were recorded every 15 min during the operation. Bland-Altman statistical analysis was used to determine the degree of agreement in data collected by the two measurement devices. Seventy-three paired measurements of CVP from concomitant indwelling PICCs and PACs obtained from five patients undergoing elective AAA reconstruction revealed PICC measurements to be higher than PAC measurements by 0.6 mm Hg (overall correlation coefficient 0.92). The difference between the two measurement devices was expected to be <3.4 mm Hg at least 95% of the time. The findings of this pilot study indicate that PICCs are an effective method for CVP monitoring in situations of dynamic systemic compliance and preload, such as those observed during elective AAA reconstruction.

Aged↗
PubMedDate not supplied

Long-term closed chest partial and total cardiopulmonary bypass by peripheral cannulation for severe right and/or left ventricular failure, including ventricular fibrillation. The use of a percutaneous spring in the pulmonary artery position to decompress the left heart.

The authors report that total cardiopulmonary bypass (CPBP) for severe heart failure can be safely maintained for several days through peripheral cannulation alone. In two healthy sheep under general anesthesia, the authors cannulated the right external jugular vein and the right subclavian artery. A special spring was attached to a 7F Swan-Ganz catheter and positioned at the level of the pulmonary artery (PA) valve, rendering it partially incompetent. The extracorporeal circuit included a venous reservoir, a roller pump, a membrane lung, and a blood pulsator set at 25 beats/min. Ventricular fibrillation was induced with 110 VAC. Extracorporeal blood flow was raised to 100-120 ml/kg min. Mechanical pulmonary ventilation was changed to 5% CO2 in room air. During bypass, the wedge pressure (WP) averaged 9-13 mmHg, PA pressure 7-13 mmHg, and central venous pressure 1-9 mmHg. After 38 and 48 hr respectively the hearts were defibrillated with DC shock. There was total heart failure with no ejection from right or left. We continued with TCPBP. The right heart recovered after 1 and 3 hr respectively. After 7 and 5 hr, respectively, there was some aortic ejection. By 11 and 4 hr, respectively, the sheep were off bypass and on room air, with return to baseline cardiac function. Throughout the recovery the WP averaged 4-8 mmHg. At autopsy, all hearts were soft and normal in appearance. Histologic examination of the lungs and the heart was unremarkable. The authors conclude that the PA spring readily decompressed the LV. Ventilating lungs with 5% CO2 in air during CPBP sustained excellent lung function.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗