MedWorm: Arterial Puncture

A case report of an accidental vertebral arterial puncture videotaped during central venous catheterization in a child undergoing a ventricular septal defect repair.

Paediatric Anaesthesia — Sun, 05 Feb 2012 17:48:31 +0100

Authors: Kayashima K, Habe K PMID: 22272682 [PubMed - in process] (Source: Paediatric Anaesthesia)

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A case report of an accidental vertebral arterial puncture videotaped during central venous catheterization in a child undergoing a ventricular septal defect repair

Pediatric Anesthesia — Thu, 26 Jan 2012 12:13:26 +0100

(Source: Pediatric Anesthesia)

Experience and Opinions of 4th Year Medical Students in Acquiring Competence With Basic Procedural Skills

Journal of Surgical Research — Sat, 14 Jan 2012 22:29:02 +0100

Introduction: The Association of American Medical Colleges has identified key procedural skills that graduating medical students should acquire. Despite this educational goal, there is data to show that students are unprepared to perform even basic medical procedures upon graduation from medical school. Our aim was to characterize the experience and opinions of graduating students in acquiring these skills and elucidate predictors of competence. Methods: 156 graduating medical students were queried via online survey as to their experience, actual level of competence and desired level of competence for nine procedural skills (Foley catheter insertion, nasogastric tube insertion, venipuncture, intravenous catheter insertion, arterial puncture, basic suturing of lacerations, endotracheal intu...

[Percutaneous mandibular nerve block using neuro-stimulation guiding through the sigmoid indentation in facial surgery.]

Revue de Stomatologie et de Chirurgie Maxillo-Faciale — Fri, 13 Jan 2012 05:00:00 +0100

DISCUSSION: The complications with this technique, such as failure or arterial puncture, are rare and limited if a nerve stimulator is used. Patient's comfort is improved by intravenous remifentanil sedation in target control infusion mode, associated to prior use of prilocaine and lidocaine cutaneous cream. PMID: 22244733 [PubMed - as supplied by publisher] (Source: Revue de Stomatologie et de Chirurgie Maxillo-Faciale)

Trans-radial embolization of epistaxis in patients with end-stage liver disease

Neuroradiology — Thu, 29 Dec 2011 06:42:45 +0100

Conclusion Trans-radial embolization for epistaxis was a safe and effective method for the patient with end-stage liver disease and resultant severe coagulopathy. Content Type Journal ArticleCategory Interventional NeuroradiologyPages 1-4DOI 10.1007/s00234-011-0999-zAuthors Satoshi Tateshima, Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA 90095-7437, USAMichael Froehler, Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA 90095-7437, USARyan Cramer, Division of Interventional Neuroradiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA 90095-7437, USASachin Rastogi, Division of I...

Delayed Airway Obstruction after Internal Jugular Venous Catheterization in a Patient with Anticoagulant Therapy

Clinical and Developmental Immunology — Wed, 21 Dec 2011 23:54:28 +0100

Delayed onset of neck hematoma following central venous catheterization without arterial puncture is uncommon. Herein, we present a patient who developed a delayed neck hematoma after repeated attempts at right internal jugular venous puncture and subsequent enoxaparin administration. Progressive airway obstruction occurred on the third day after surgery. Ultrasound examination revealed diffuse hematoma of the right neck, and fibreoptic examination of the airway revealed pharyngeal edema. After emergent surgical removal of the hematoma, the patient was extubated uneventfully. (Source: Clinical and Developmental Immunology)

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Oral sucrose to decrease pain associated with arterial puncture in infants 30 to 36 weeks' gestation: a randomized clinical trial.

Advances in Neonatal Care — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSION: : This study found a significant reduction in the crying subscale of the Neonatal Infant Pain subscale immediately after the introduction of an arterial needle in neonates receiving a 24% sucrose solution, compared with those who did not receive sucrose solution. While prior studies found a similar reduction in pain scores after heel and venipuncture needlesticks, this is the first study evaluating a high concentration of oral sucrose to blunt the pain associated with an arterial puncture. PMID: 22123473 [PubMed - in process] (Source: Advances in Neonatal Care)

Use of Real-Time Ultrasound Guidance for the Placement of Hemodialysis Catheters: A Systematic Review and Meta-analysis of Randomized Controlled Trials

American Journal of Kidney Diseases — Wed, 23 Nov 2011 01:11:39 +0100

Conclusions: Use of real-time Doppler ultrasound guidance has benefits with respect to several important clinical outcomes, and its routine use in the insertion of hemodialysis catheters is strongly recommended. (Source: American Journal of Kidney Diseases)

Ultrasound use for the placement of haemodialysis catheters.

Cochrane Database of Systematic Reviews — Sun, 20 Nov 2011 22:06:03 +0100

CONCLUSIONS: Use of real-time 2-D Doppler ultrasound guidance has significant benefits with respect to the number if catheters successfully inserted on the first attempt, reduction in the risk of arterial puncture and haematomas and the time taken for successful vein puncture. PMID: 22071820 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)

Use of Angio‐Seal Closure Device When the Arteriotomy Is Above or Below the Common Femoral Artery

Clinical Cardiology — Sun, 06 Nov 2011 04:00:00 +0100

Conclusions:Although not approved for placement in areas above or below the femoral artery, off‐label use of the Angio‐Seal arteriotomy closure may be safely performed when patient characteristics are favorable. © 2011 Wiley Periodicals, Inc.The authors have no funding, financial relationships, or conflicts of interest to disclose. Neither author has a conflict of interest with St. Jude Medical or with the Angio‐Seal device. (Source: Clinical Cardiology)

Arterial Thrombosis After Using Angio-Seal

Annals of Vascular Surgery — Thu, 27 Oct 2011 11:40:48 +0100

Percutaneous closure systems of arterial puncture sites are being used more and more in modern endovascular practice. In this article, we report five cases of thrombotic complications following Angio-Seal deployment which required to be treated in our department between June 2004 and January 2006. We carried out a computerized literature review using “vascular closure” as a keyword and elected 106 articles published between 1992 and 2007. The analysis of this literature review showed that the rate of percutaneous closure complications was similar to the rate of manual compression complications, which is still the reference method. The complications associated with the use of these systems were more complex and more often required surgical repair. The severity and frequency of these com...

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The effect of skin entry site, needle angulation and soft tissue compression on simulated antegrade and retrograde femoral arterial punctures: an anatomical study using Cartesian co-ordinates derived from CT angiography

Surgical and Radiologic Anatomy — Wed, 05 Oct 2011 05:46:34 +0100

Conclusions Use of dogmatic access techniques is predicted to result in an unacceptably high rate of dangerous high and low punctures. Puncture angle and geometry can be severely affected by patient obesity. The combination of fluoroscopy to identify entry point, ultrasound-guidance to identify the femoral bifurcation and soft tissue compression to improve puncture geometry are critical for safe femoral arterial access. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00276-011-0880-0Authors Matthew D. B. S. Tam, Norwich Radiology Academy, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UB UKMark Lewis, Norwich Radiology Academy, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UB UK Journal Su...

Nurse-led central venous catheter insertion—Procedural characteristics and outcomes of three intensive care based catheter placement services

International Journal of Nursing Studies — Mon, 26 Sep 2011 04:00:00 +0100

Conclusion: This study has demonstrated safe patient outcomes with nurse led CVC insertion as compared with published data. Nurses who are formally trained and credentialed to insert CVCs can improve organisational efficiencies. This study adds to emerging data that developing clinical roles that focus on skills, procedural volume and competency can be a viable option in health care facilities. (Source: International Journal of Nursing Studies)

Femoral artery occlusion with a percutaneous arterial closure device after a routine coronary angiogram: a case report and literature review.

Annals of the Royal College of Surgeons of England — Thu, 01 Sep 2011 04:00:00 +0100

Authors: Hussain T, Al-Hamali S Abstract Groin vessels are most commonly used to obtain vascular access for angiography because of their size and accessibility. Haemostasis at the puncture site can be achieved with manual compression alone or by using a vascular closure device. We highlight the case of a 68-year-old woman who developed acute claudication in the right leg after a routine diagnostic coronary angiogram when an Angio-Seal(™) device had been employed to close a relatively low arterial puncture. On exploring the common femoral artery, fragments of the device were found occluding the bifurcation. A patch angioplasty was carried out and the patient's claudicant symptoms improved. The Angio-Seal(™) device has a polylactide and polyglycolide polymer anchor, a collagen pl...

Retinal Oxygen Saturation in Patients with Systemic Hypoxemia [Retina]

Investigative Ophthalmology — Wed, 06 Jul 2011 23:00:00 +0100

Conclusions. When compared to arterial blood gas analysis of blood samples drawn by arterial puncture, the gold standard in the field, fundus oximetry was found to be in good overall agreement with the arterial blood samples. Blood flow measurements will be needed to determine whether the systemic hypoxia is completely compensated, as suggested by oxygen extraction being comparable between the two groups. (Source: Investigative Ophthalmology)

Ultrasound-guided puncture of the femoral artery for total percutaneous aortic aneurysm repair.

Diagnostic and Interventional Radiology — Tue, 14 Jun 2011 23:00:00 +0100

CONCLUSION: Ultrasound-guided puncture of the common femoral artery for percutaneous closure of the access site has a high technical success rate and a very low complication rate. The addition of ultrasound guidance decreases the difficulty of the procedure and helps to avoid some of its complications. PMID: 21674453 [PubMed - as supplied by publisher] (Source: Diagnostic and Interventional Radiology)

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A pre-rotational simulation-based workshop improves the safety of central venous catheter insertion: Results of a successful internal medicine house staff training program.

Chest — Wed, 08 Jun 2011 23:00:00 +0100

CONCLUSIONS: Implementation of a pre-rotational workshop significantly improved the safety of CVC insertion, especially for CVCs placed by inexperienced operators. We suggest that simulation-based training with ultrasound instruction should be conducted if house staff are responsible for CVC placement. PMID: 21659429 [PubMed - as supplied by publisher] (Source: Chest)

Endovascular Management of Type B Aortic Dissection After Attempted Central Venous Catheterization

Annals of Vascular Surgery — Mon, 30 May 2011 04:00:00 +0100

A 41-year-old woman, status postmastectomy for breast cancer had an attempted 8-F left subclavian vein chemotherapy port placed in her. She developed severe upper back pain radiating to the left shoulder. A computed tomographic scan and angiography revealed catheter placement in the left subclavian artery and a type B aortic dissection. A thoracic stent–graft was used to treat the aortic dissection. While removing the catheter, a covered stent was deployed to seal the arterial puncture and a balloon-expandable stent was placed over a persistent subclavian dissection. This case illustrates an example of the feasibility of endovascular management to treat serious iatrogenic access complications. (Source: Annals of Vascular Surgery)

Iatrogenic vertebral artery pseudoaneurysm due to central venous catheterization.

Baylor University Medical Center Proceedings — Thu, 31 Mar 2011 23:00:00 +0100

Authors: Momiy J, Vasquez J Central venous lines have become an integral part of patient care, but they are not without complications. Vertebral artery pseudoaneurysm formation is one of the rarer complications of central line placement. Presented is a rare case of two pseudoaneurysms of the vertebral and subclavian artery after an attempted internal jugular vein catheterization. These were successfully treated with open surgical repair and bypass. Open surgical repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudoaneurysms has been described with promising outcomes, but long-term results are lacking. Ultimately, the best treatment of these iatrogenic injuries should start with prevention. Well-documented techniques to minimize mechanical complic...

Clinical review and analysis of complications of totally implantable venous access devices for chemotherapy

Medical Oncology — Sat, 05 Mar 2011 16:50:14 +0100

Abstract Since the first implant of totally implantable venous access device (TIVAD), performed by Niederhuber and colleague in 1982, the systems have increasingly been used in the field of oncology. We analyzed the clinical reviews and complications of TIVAD in an effort to achieve optimal management. We retrospectively studied 442 cases with TIVAD device at our hospital and we report the results. Four hundred and forty-two TIVAD were placed in the right subclavian vein in 345 cases, the left subclavian vein in 93 cases, the right jugular vein in 2 cases, the left jugular vein in 1 case, and the right femoral vein in 1 case. The immediate complications were 28 cases in malposition of the catheter, 10 cases of arterial puncture, and 2 cases of pneumothorax. The late compli...

Management of acute lower limb ischemia associated with the Angio-Seal arterial puncture closing device [Institutional report - Vascular general]

Interactive CardioVascular and Thoracic Surgery — Wed, 23 Feb 2011 00:00:00 +0100

Arterial percutaneous closure devices (APCD) could lead to severe vascular complications, like acute lower limb ischemia. The aim of this study was to evaluate retrospectively our personal series of acute lower limb ischemia following the use of APCD. From January 2004 to June 2009 the Angio-Seal percutaneous closure devices was deployed in 198 patients. Eight (4%) acute lower limb ischemia required urgent surgical repair. The device was removed in all cases. A thromboembolectomy was performed in five patients (62.5%) and in three (37.5%) an endarterectomy with patch closure was carried out (two saphenous vein and one Dacron). Limb salvage rate was 87.5%. We compared Angio-Seal complications group (A) with the 190 patients in which the Angio-Seal was successfully used without complications...

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Arterial Injury Complicating Subclavian Central Venous Catheter Insertion

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 11 Feb 2011 05:00:00 +0100

INADEQUATE PLACEMENT of a subclavian venous catheter in the subclavian artery is a well-known complication. Three cases of accidental arterial puncture occurred with the implantation of subclavian venous catheters, 2 of which involved the subclavian artery leading to percutaneous treatment; and the other involved the aortic arch, resulting in surgical management, are described. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

Influence of shoulder position on central venous catheter tip location during infraclavicular subclavian approach

British Journal of Anaesthesia — Fri, 11 Feb 2011 00:00:00 +0100

Conclusions The neutral shoulder position minimizes the number of needle passes and the incidence of catheter misplacement during the infraclavicular approach of the right subclavian vein catheterization. (Source: British Journal of Anaesthesia)

Arterial Puncture for Blood Gas Analysis

New England Journal of Medicine — Wed, 02 Feb 2011 22:00:12 +0100

New England Journal of Medicine, Volume 364, Issue 5, February 2011. (Source: New England Journal of Medicine)

Effects of Mean Arterial Pressure and Needle Size on Arterial Sampler Filling Time.

Respiratory Care — Fri, 21 Jan 2011 00:00:00 +0100

Conclusion Lower blood pressures increased sampler filling times. Measuring filling time may enable therapists to confirm successful arterial punctures in adult patients. Confirming successful arterial puncture prior to the time of analysis would expedite appropriate patient care decisions. PMID: 21255497 [PubMed - as supplied by publisher] (Source: Respiratory Care)

Percutaneous Salvage of Thrombosed Immature Arteriovenous Fistulas

Seminars In Dialysis — Sat, 01 Jan 2011 00:00:00 +0100

This study investigates the efficacy, functionality, and cost associated with the use of percutaneous techniques for the salvage of thrombosed immature fistulas. Over a 2‐year period and from a population of 18,000 patients on hemodialysis, 140 consecutive patients with thrombosed immature fistulas underwent attempts at salvage via thrombectomy procedures. All fistulas had thrombosed following access creation and had never been used for hemodialysis. Multiple approaches were utilized to gain access to the fistula, including trans‐fistula cannulation, distal arterial puncture, and proximal retrograde venous access. Thrombectomy was performed via balloon maceration and aspiration. Accelerated maturation was achieved through sequential angioplasty of diffusely stenotic veins and eliminati...

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Comparison and agreement between venous and arterial gas analysis in cardiopulmonary patients in Kashmir valley of the Indian subcontinent

Annals of Thoracic Medicine — Tue, 28 Dec 2010 00:00:00 +0100

Conclusion: Peripheral venous blood gas assessment in conjunction with finger pulse oximetry can obviate the routine use of arterial puncture in patients requiring ABG analysis. (Source: Annals of Thoracic Medicine)

Ultrasound-guided arterial puncture.

Respiratory Care — Wed, 01 Dec 2010 00:00:00 +0100

Authors: Haynes JM, Mitchell H PMID: 21122184 [PubMed - in process] (Source: Respiratory Care)

Bringing Forward Reperfusion with Oxygenated Blood Perfusion beyond Arterial Occlusion during Endovascular Procedures in Patients with Acute Ischemic Stroke [INTERVENTIONAL]

American Journal of Neuroradiology — Wed, 17 Nov 2010 00:00:00 +0100

CONCLUSIONS: In this small series, oxygenated blood delivered through a microcatheter positioned distal to the site of occlusion was feasible and safe. Until final recanalization is achieved, MOB injections may generate intermittent reperfusion for up to 2 hours. (Source: American Journal of Neuroradiology)

Carina as a useful and reliable radiological landmark for detection of accidental arterial placement of central venous catheters

Journal of Clinical Monitoring and Computing — Sat, 23 Oct 2010 15:47:23 +0100

Abstract Central venous catheters are commonly used in the management of critically ill patients. Their insertion can be challenging in hemodynamically unstable patients and in those with altered thoracic anatomy. Although ultrasound guided insertion can reduce this problem, this facility may not be available in all locations and in all institutions. Accidental arterial puncture is one of the very serious complications that can occur during central venous catheter insertion. This is usually detected clinically by bright color and projectile/pulsatile flow of the returning blood. However, such means are known to be misleading especially in hypoxic and hemodynamically unstable patients. Other recognized measures used to identify arterial puncture would be blood gas analysis ...

Ultrasound-guided central venous catheterization in cancer patients improves the success rate of cannulation and reduces mechanical complications: A prospective observational study of 1,978 consecutive catheterizations

BioMed Central — Mon, 18 Oct 2010 23:00:00 +0100

Conclusions: This study represents the largest published series of consecutive patients with cancer undergoing CVC insertion under US guidance; this procedure allowed the completion of the therapeutic program for 1,930/1,978 (97.6%) of the catheters inserted. The absence of pneumotorax and other major complications indicates that US guidance should be mandatory for CVC insertion in patients with cancer. (Source: BioMed Central)

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Incidence of posterior vessel wall puncture during ultrasound-guided vessel cannulation in a simulated model.

Accident and Emergency Nursing — Fri, 01 Oct 2010 00:00:00 +0100

CONCLUSIONS: This study found a high incidence of inadvertent PVWP during simulated US-guided vessel cannulation in this model. PMID: 21069895 [PubMed - in process] (Source: Accident and Emergency Nursing)

Management of Inadvertent Iatrogenic Subclavian Artery Injury With an Extravascular Bio-Inert Sealant

Journal of Vascular Surgery — Tue, 31 Aug 2010 23:00:00 +0100

Inadvertent arterial puncture is a complication of placement of central catheters; this can lead to arterial occlusion, embolism, pseudoaneurysm formation, vessel laceration, or dissection. To prevent the occurrence of these complications, the central catheter has to be removed, but direct pressure is not an adequate option in the subclavian artery. The management of this complication does not have a standard accepted treatment. (Source: Journal of Vascular Surgery)

Prospective study to determine possible correlation between arterial and venous blood gas values.

Acta Anaesthesiologica Taiwanica — Tue, 31 Aug 2010 23:00:00 +0100

CONCLUSION: Venous blood gas values are an acceptable alternative to arterial blood gas values in patients undergoing lumbar disc surgery. PMID: 20864062 [PubMed - in process] (Source: Acta Anaesthesiologica Taiwanica)

Percutaneous Closure and “Push‐Pull” Technique to Repair Arterial Lead and Sheath Placement Complicating Cardiac Resynchronization Therapy

Pacing and Clinical Electrophysiology : PACE — Tue, 31 Aug 2010 23:00:00 +0100

We describe the use of a “push‐pull” technique within an arterial setting to allow removal of the lead, while maintaining access through the same puncture to allow an arterial‐closure device to then seal the artery at this site. As a result of this percutaneous approach, the patient avoided the need for a vascular surgical procedure. (PACE 2010; 1–3) (Source: Pacing and Clinical Electrophysiology : PACE)

Bringing Forward Reperfusion with Oxygenated Blood Perfusion beyond Arterial Occlusion during Endovascular Procedures in Patients with Acute Ischemic Stroke [INTERVENTIONAL]

American Journal of Neuroradiology — Thu, 26 Aug 2010 00:00:00 +0100

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Finding on a chest radiograph: A dangerous complication of subclavian vein cannulation

Indian Journal of Critical Care Medicine — Mon, 09 Aug 2010 12:32:41 +0100

Nataraj Madagondapalli Srinivasan, Akshay KumarIndian Journal of Critical Care Medicine 2010 14(2):95-96Cannulation of the subclavian vein has its inherent risks. Post procedure chest radiograph is one of the investigations done to rule out immediate complications. Unless the clinician is aware as to what to look for in the radiograph, some of the dangerous complications can be overlooked. Accidental subclavian artery cannulation is identified immediately by color and jet of the blood. Also the position of the catheter tip has to be confirmed by obtaining the arterial pressure tracing using a pressure transducer. Non availability of Doppler ultrasound and pressure transducer are limiting factors for immediate confirmation of proper catheter placement. Also, in patients with severe hypotens...

Efficacy of bacterial ribosomal RNA-targeted reverse transcription-quantitative PCR for detecting neonatal sepsis: a case control study

BioMed Central — Wed, 28 Jul 2010 23:00:00 +0100

Conclusions: This RT-PCR technique is useful for sensitive detection of pathogens causing neonatal sepsis, even in cases with negative results by blood culture. (Source: BioMed Central)

50 Years Ago in The Journal of Pediatrics: Chemical Stimuli of Respiration in the Early Neonatal Period

The Journal of Pediatrics — Fri, 16 Jul 2010 06:28:03 +0100

Reardon HS, Baumann ML, Haddad EJ. J Pediatr 1960;57:151-70 As neonatologists, we take for granted our ability to rapidly measure and interpret blood gases to take appropriate therapeutic action. That was not the case 50 years ago when Reardon et al published their extensive characterization of blood gases during the first hours of neonatal life. To generate these normative data, sampling occurred via the umbilical vein, umbilical artery, and temporal artery, which today would be an unacceptable location for arterial puncture. Of even greater historical interest is their comment that the site of laboratory measurement was several miles from the patients, necessitating storage of samples in an ice bath for as long as 5 hours, which, again, would be frowned on today. (Source: The Journal of...

Vascular changes at the puncture segments of arteriovenous fistula for hemodialysis access

Journal of Vascular Surgery — Sun, 11 Jul 2010 23:00:00 +0100

Conclusion: Puncture of arteriovenous fistula using a buttonhole technique resulted in a consistent vascular dilatation and moderately high incidence of intimal thickness, but no significant luminal stenosis was found. (Source: Journal of Vascular Surgery)

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Intelligent model-based advisory system for the management of ventilated intensive care patients: Hybrid blood gas patient model

Computer Methods and Programs in Biomedicine — Wed, 07 Jul 2010 07:39:47 +0100

Abstract: Arterial blood gas (ABG) analyses are essential for assessing the acid–base status and guiding the adjustment of mechanical ventilation in critically ill patients. Conventional ABG sampling requires repeated arterial punctures or the insertion of an arterial catheter causing pain, haemorrhage and thrombosis to the patients. Less invasive and non-invasive blood gas analysers, with a technology still in transition, have offered some promise in the recent years. SOPAVent (Simulation of Patients under Artificial Ventilation) is a five compartment blood gas model which captures the basic features of respiratory physiology and gas exchange in the human lungs. It uses ventilator settings and routinely monitored physiological parameters as inputs to produce steady-state estimates of th...

Ultrasound-guided percutaneous insertion of 2.7 Fr tunnelled Broviac lines in neonates and small infants

Pediatric Surgery International — Mon, 14 Jun 2010 14:27:00 +0100

Teaching Technical Skills to Medical Students During a Surgery Clerkship: Results of a Small Group Curriculum

Journal of Surgical Research — Mon, 07 Jun 2010 00:00:00 +0100

Conclusions: These results suggest that a small group technical skills curriculum facilitates learning of specific technical skills and appears to increase participation in all of the skills taught and assessed. This may be one strategy to introduce students to technical skills during the surgery clerkship and improve participation of these skills in the hospital setting. (Source: Journal of Surgical Research)

Early ST-segment recovery after primary percutaneous coronary intervention accurately predicts long-term prognosis after acute myocardial infarction

American Heart Journal — Mon, 31 May 2010 23:00:00 +0100

Background: Several ancillary studies reported on the prognostic value of ST-segment recovery (STR) with measurement at 30 to 240 minutes after primary percutaneous coronary intervention (PCI). We determined the long-term prognostic value of early STR, assessed at the end of primary PCI, in unselected patients after ST-segment elevation myocardial infarction (STEMI).Methods: We analyzed 12-lead electrocardiograms, recorded in the catheterization laboratory before arterial puncture and at the time of the end of PCI, from 2,124 STEMI patients who underwent primary PCI at our institution between 2000 and 2007. ST-segment recovery was categorized as complete (≥70%), partial (30%-70%), or absent ( (Source: American Heart Journal)

Four cases of inadvertent arterial cannulation despite of ultrasound guidance

The American Journal of Emergency Medicine — Fri, 30 Apr 2010 23:00:00 +0100

We read with great interest the publication by Stone et al in the recent issue of the journal about the ultrasound detection of guidewire position for avoiding arterial guidewire placement. They demonstrated that guidewire visualization within the jugular vein predicted venous catheter placement with a sensitivity and specificity of 100% and 100%, respectively, in all 20 adult patients. As the author discussed, the use of real-time ultrasound guidance decreases complication, especially arterial puncture . We are also confirming the venous placement of the wire in all cases using ultrasound sonography. (Source: The American Journal of Emergency Medicine)

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Brachial Approach for Coronary Angiography and Intervention: Totally Obsolete, or a Feasible Alternative When Radial Access is Not Possible?

Annals of the Academy of Medicine, Singapore — Fri, 30 Apr 2010 23:00:00 +0100

Conclusion: Brachial artery puncture and catheterisation may be a viable, safe and effi cient alternative to the transfemoral approach in a centre that is experienced with the arm approach, when radial access is not possible. PMID: 20535426 [PubMed - in process] (Source: Annals of the Academy of Medicine, Singapore)

ED technicians can successfully place ultrasound-guided intravenous catheters in patients with poor vascular access

The American Journal of Emergency Medicine — Sun, 25 Apr 2010 23:00:00 +0100

Conclusions: Emergency department technicians can be taught to successfully place US-guided IVs in patients with difficult venous access. Teaching this skill to ED technicians increases the pool of providers available in the ED to obtain access in this patient population. (Source: The American Journal of Emergency Medicine)

The Effectiveness of Ultrasonography-Guided Suprascapular Nerve Block for Perishoulder Pain.

Orthopedics — Thu, 15 Apr 2010 23:00:00 +0100

This study analyzed the effectiveness of suprascapular nerve block under ultrasonographic guidance in patients with perishoulder pain. Patients with perishoulder pain were enrolled in the study and were randomly divided into 2 groups. In the first group of 25 patients (12 men and 13 women), nerve block was applied under ultrasonographic guidance. Mean patient age in this group was 55.1 years. In the control group, 25 patients (11 men and 14 women) underwent nerve block without ultrasonographic guidance; mean patient age was 51.6 years. Degree of pain was assessed using a visual analog scale (VAS) and shoulder function was evaluated using the Constant shoulder score (CSS) before the nerve block, immediately following the procedure, and 1 month after the procedure. There was no statistically...

Ultrasound-Guided Radiological Placement of Central Venous Port via the Subclavian Vein: A Retrospective Analysis of 500 Cases at a Single Institute

CardioVascular and Interventional Radiology — Wed, 14 Apr 2010 06:50:18 +0100

In conclusion, US-guided RP of a CVP via the SCV is highly appropriate, based on its high technical success rate and the limited number of AEs. Content Type Journal ArticleCategory Clinical InvestigationDOI 10.1007/s00270-010-9841-yAuthors Noriaki Sakamoto, National Cancer Center Hospital Division of Diagnostic Radiology Tsukiji 5-1-1, Chuo-ku 104-0045 Tokyo JapanYasuaki Arai, National Cancer Center Hospital Division of Diagnostic Radiology Tsukiji 5-1-1, Chuo-ku 104-0045 Tokyo JapanYoshito Takeuchi, National Cancer Center Hospital Division of Diagnostic Radiology Tsukiji 5-1-1, Chuo-ku 104-0045 Tokyo JapanMasahide Takahashi, National Cancer Center Hospital Division of Diagnostic Radiology Tsukiji 5-1-1, Chuo-ku 104-0045 Tokyo JapanMasakatsu Tsurusaki, National Cancer Center Hospit...

Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty

American Heart Journal — Wed, 31 Mar 2010 23:00:00 +0100

Conclusions: The use of VCDs is associated with a significantly shorter time to hemostasis and thus may shorten recovery. However, the use of VCDs is associated with a somewhat increased risk of infection, lower limb ischemia/arterial stenosis/device entrapment in the artery, and need of vascular surgery for arterial complications. Further studies are needed to get more conclusive results, particularly in patients at high risk of femoral puncture-related complications. (Source: American Heart Journal)

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Ultrasonography: A novel approach to central venous cannulation

Indian Journal of Critical Care Medicine — Wed, 17 Mar 2010 16:11:54 +0100

Conclusion: USG-guided CVC is thus easier, quicker, and safer than landmark approach. (Source: Indian Journal of Critical Care Medicine)

Increased Use of Percutaneous Technique for Totally Implantable Venous Access Devices. Is It Real Progress? A 27-Year Comprehensive Review on Early Complications

Annals of Surgical Oncology — Wed, 10 Mar 2010 16:00:51 +0100

Conclusions Despite the increased use of percutaneous technique for TIVADs’ implantation, surgical cutdown, because of its safety, remains the best approach to avoid possible fatal immediate complications. Content Type Journal ArticleCategory Medical OncologyDOI 10.1245/s10434-010-1005-4Authors Isidoro Di Carlo, University of Catania Department of Surgical Sciences, Organ Transplantation, and Advanced Technologies Catania ItalyElia Pulvirenti, University of Catania Department of Surgical Sciences, Organ Transplantation, and Advanced Technologies Catania ItalyMaurizio Mannino, University of Catania Department of Surgical Sciences, Organ Transplantation, and Advanced Technologies Catania ItalyAdriana Toro, University of Catania Department of Surgical Sciences, Organ ...

Comparison of the Usefulness of N-Terminal Pro-Brain Natriuretic Peptide to Other Serum Biomarkers as an Early Predictor of ST-Segment Recovery After Primary Percutaneous Coronary Intervention

The American Journal of Cardiology — Mon, 22 Feb 2010 00:00:00 +0100

Data on the ability of serum biomarkers to predict microvascular obstruction by ST-segment recovery after primary percutaneous coronary intervention (PCI) is largely absent. Therefore, we determined the association between 5 serum biomarkers, obtained before emergency coronary angiography, and immediate ST-segment recovery in patients who had undergone primary PCI for ST-segment elevation myocardial infarction. We measured N-terminal pro-brain natriuretic peptide (NT-pro-BNP), cardiac troponin T, creatinine kinase-MB fraction, high-sensitivity C-reactive protein, and serum creatinine from blood samples obtained through the arterial sheath at the start of primary PCI. Serial 12-lead electrocardiograms were recorded in the catheterization laboratory before arterial puncture and at the end of...

Direct Hepatic Artery Puncture for Transarterial Therapy in Liver Cancer

Journal of Vascular and Interventional Radiology : JVIR — Fri, 22 Jan 2010 00:00:00 +0100

In the treatment of liver malignancies, therapies such as bland embolization, chemoembolization and radioembolization require access to the hepatic artery by means of conventional transfemoral or brachial catheterization. Challenging vascular anatomy can impede selective access to tumoral vessels, preventing the safe and effective delivery of embolic material. Direct percutaneous hepatic arterial puncture under ultrasonographic guidance may be an alternative method to obtain intrahepatic arterial access for the purposes of hepatic arteriography and delivery of therapeutic agents. In this case series, the authors describe the use of direct hepatic artery puncture to successfully perform two radioembolization procedures and one bland embolization procedure. (Source: Journal of Vascular and I...

Patient acceptance of whole-body magnetic resonance angiography: A prospective questionnaire study.

Acta Radiologica — Thu, 21 Jan 2010 00:00:00 +0100

Conclusion: Patient acceptance of WB-MRA is superior to that of DSA in patients with PAD, with the majority of patients preferring WB-MRA. PMID: 20092370 [PubMed - as supplied by publisher] (Source: Acta Radiologica)

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Is nerve stimulation needed during an ultrasound-guided lateral sagittal infraclavicular block?

Acta Anaesthesiologica Scandinavica — Mon, 18 Jan 2010 00:00:00 +0100

The objective of the study was to evaluate the influence of ultrasound (US) guidance alone vs. neurostimulation (NS) and US (NSUS) guidance techniques on block performance time and block success rate for the lateral sagittal infraclavicular block (LSIB). In a randomized and prospective manner, 110 adult patients scheduled for distal upper limb surgery were allocated to the US or the NSUS groups. In the US group, a local anesthetic (LA) was administered only with US guidance to produce a 'U'-shaped distribution around the axillary artery. In the NSUS group, LA was administered under US guidance only after electrolocation of one of the median, ulnar or radial nerve-type responses. A total of 30 ml of LA (10 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml) was administered in bo...

[Spontaneous resolution of a pseudoaneurysm following arterial puncture.]

Anales de Pediatria — Wed, 09 Dec 2009 00:00:00 +0100

Authors: Parrilla Parrilla J, Fernández Elías M, Montero Valladares C, Alonso Salas MT, Loscertales Abril M PMID: 20005191 [PubMed - as supplied by publisher] (Source: Anales de Pediatria)

Management of Iatrogenic Injuries of the Supra-aortic Arteries

Journal of Cardiothoracic and Vascular Anesthesia — Fri, 20 Nov 2009 00:00:00 +0100

ALTHOUGH IATROGENIC VASCULAR injuries are relatively rare, the incidence is increasing, most likely as a result of increasing utilization of percutaneous techniques. Acute iatrogenic injuries of supra-aortic arteries occur less frequently compared with injuries of the femoral arteries but may have more serious consequences. Various medical procedures may cause iatrogenic injury to the supra-aortic arteries, but the most frequent cause is an inadvertent central venous catheter puncture. Arterial puncture occurs in approximately 0.5% to 3.7% of all central venous catheterizations, with a higher incidence after internal jugular compared with subclavian central venous approaches. Certainly, these injuries typically occur in the sickest of patients, and their comorbidities often make management...

Acute leg ischemia secondary to embolization of an Angio-Seal device.

Diagnostic and Interventional Radiology : The Turkish Society of Radiology — Tue, 10 Nov 2009 00:00:00 +0100

Authors: Adusumilli S, Mah J, Richardson A Angio-Seal is a vascular closure device designed for repairing arterial puncture sites used for various endovascular procedures. It has a better safety and efficacy profile compared to manual compression in the previous studies. However, there are significant complications that may arise from the use of Angio-Seal like infections, aneurysm formation, and vessel occlusion. Our case is a demonstration of one such complication. We conclude with a dicussion of the present literature available with regards to the Angio-Seal device. PMID: 19908180 [PubMed - as supplied by publisher] (Source: Diagnostic and Interventional Radiology : The Turkish Society of Radiology)

Surgical treatment of arterial ischemia associated with the use of the angioseal vascular closure device.

VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases — Sun, 01 Nov 2009 00:00:00 +0100

Conclusions: Surgical repair is effective, although, generally, it is not restricted to a simple thrombectomy, requiring the use of different arterial repair techniques. PMID: 19998253 [PubMed - in process] (Source: VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases)

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Ultrasound detection of guidewire position during central venous catheterization

The American Journal of Emergency Medicine — Mon, 26 Oct 2009 00:00:00 +0100

Conclusions: Ultrasound reliably detects the guidewire during CVC placement and visualization of the wire before dilation and catheter insertion may provide an additional measure of safety during ultrasound-guided CVC placement. (Source: The American Journal of Emergency Medicine)

Acute transient thyroid swelling after catheterization of the subclavian vein

Critical Care — Tue, 06 Oct 2009 23:00:00 +0100

In this report, we present a remarkable case of acute diffuse edematous swelling of the thyroid gland as an unexpected and rare complication after attempted subclavian vein catheterization. Acute thyroid swelling rarely occurs after fine needle aspiration, and to our knowledge, we are the first to describe acute thyroid swelling after central venous catheter insertion. (Source: Critical Care)

Comparison of Combat Gauze and TraumaStat in Two Severe Groin Injury Models

Journal of Surgical Research — Sat, 26 Sep 2009 23:00:00 +0100

Conclusions: These findings indicated that CBG and TMS were similarly effective in improving hemostasis. These two fabric-like dressings showed easy application and removal, leaving a clean wound for surgical repair. (Source: Journal of Surgical Research)

Use of the Starclose Device for Closure of Inadvertent Subclavian Artery Punctures

Annals of Vascular Surgery — Mon, 31 Aug 2009 23:00:00 +0100

Discussion: Based on our limited experience, we feel that this method can be performed safely and expeditiously not only in the operating room but also at the bedside. (Source: Annals of Vascular Surgery)

Comparison of 10 hemostatic dressings in a groin puncture model in swine

Journal of Vascular Surgery — Wed, 26 Aug 2009 12:56:59 +0100

Conclusions: The findings indicated that the efficacy of Woundstat, Celox, X-Sponge, and ACS+ were similar and superior in improving survival, hemostasis, and maintenance of mean arterial pressure in an actively bleeding wound caused in this severe vascular injury model.Clinical Relevance: Major improvements have been made in the development of novel dressings with hemostatic properties to control heavy bleeding in noncompressible areas. Hemostatic dressings offer promise in the military and civilian surgical environment for hemorrhage control in difficult situations. This animal-based study identified dressings with good absorption and good clotting abilities that ranked superior in terms of control of rebleeding. Also, these dressings might be beneficial in well-attended or remote surgic...

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Radial artery pseudoaneurysm after a single arterial puncture for blood-gas analysis: a case report

Cases Journal — Mon, 20 Jul 2009 23:00:00 +0100

We report a case of a radial artery pseudoaneurysm complicating a single arterial puncture for blood-gas analysis that was treated with excision of pseudoaneurysm and suture of the defect of wall of radial artery. The puncture for continuous blood pressure monitoring and serial blood gas analysis have been reported in critically ill patients, but, to the best of our knowledge, there are no cases reported of pseudoaneurysm after a single arterial puncture for blood-gas analysis. In the reported case we think that the main cause of the pseudoaneurysm onset was an incorrect compression and/or a too much short time of compression of the radial artery after the puncture. Minor sequelae and rare complications may be minimized by careful attention to detail in the performance of such procedures a...

Popliteal artery embolization with the Mynx closure device

Catheterization and Cardiovascular Interventions — Sun, 12 Jul 2009 23:00:00 +0100

We report a case of popliteal artery emobilization after using an extravascular water soluble plug-mediated vascular puncture closure device. © 2009 Wiley-Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

Use of Simulation-Based Education to Improve Outcomes of Central Venous Catheterization: A Systematic Review and Meta-Analysis

Academic Medicine — Thu, 25 Jun 2009 10:14:10 +0100

Conclusions: Despite some limitations in the literature reviewed, evidence suggests that simulation-based education for CVC provides benefits in learner and select clinical outcomes. (Source: Academic Medicine)

Ultrasound-Guided Central Venous Cannulation in Bariatric Patients

Obesity Surgery — Thu, 25 Jun 2009 07:15:50 +0100

Conclusions The use of ultrasound guidance may increase the success rate and decrease the incidence of complications associated with central venous cannulation. The advantages of this approach is visualization of the anatomical structures at puncture site prior to skin puncture and the ability to track needle and guide-wire placement during the procedure. With its high accuracy in detecting catheter misplacement, bedside ultrasonic examination combined with intraatrial electrocardiogram may further decrease morbidity associated with misplaced central venous catheters. Content Type Journal ArticleCategory ResearchDOI 10.1007/s11695-009-9902-yAuthors Claudia Brusasco, University of Genoa Section of Anesthesia and Intensive Care Medicine—DICMI Largo Rosanna Benzi 2 1...

The Anatomic Relationship between the Common Femoral Artery and Common Femoral Vein in Frog Leg Position Versus Straight Leg Position in Pediatric Patients

Academic Emergency Medicine — Wed, 10 Jun 2009 04:00:00 +0100

Conclusions: A significant percentage of children have FAs that overlap their FVs. This overlap may be responsible for complications such as FA puncture with CVL placement. Ultrasound-guided techniques may decrease these risks. Placing children in the frog leg position increases the diameter of the FV visualized on ultrasound. ACADEMIC EMERGENCY MEDICINE 2009; 16:1[ndash]6 © 2009 by the Society for Academic Emergency Medicine (Source: Academic Emergency Medicine)

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Fluoroscopy vs. Traditional guided femoral arterial access and the use of closure devices: A randomized controlled trial

Catheterization and Cardiovascular Interventions — Mon, 08 Jun 2009 23:00:00 +0100

Conclusion: The angiographic suitability for VCD was not different between FG and TALG groups. Fluoroscopy decreased the number of low arteriotomies. The time to sheath insertion, number of arterial punctures needed to obtain access, and the incidence of complications were also similar. © 2009 Wiley-Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

A randomized study of a new landmark-guided vs traditional para-carotid approach in internal jugular venous cannulation in infants.

Paediatric Anaesthesia — Thu, 30 Apr 2009 23:00:00 +0100

CONCLUSIONS: Compared with traditional para-carotid approach, the new landmark-guided approach for access of the IJV during teaching central catheterization significantly reduced carotid arterial puncture, provided a higher success rate and minimized procedure time in infants aged 3-12 months. PMID: 19453580 [PubMed - in process] (Source: Paediatric Anaesthesia)

In Response to “A Modified ‘Over-the-Needle' Technique for Arterial Cannulation”

Journal of Cardiothoracic and Vascular Anesthesia — Sun, 26 Apr 2009 23:00:00 +0100

I would like to comment on the letter to the editor from Koshy et al regarding a technique for arterial puncture in adult patients. Radial artery cannulation, in fact, can be difficult in cases involving small children; patients with hypotension, changes in cardiac output, or anatomic changes of the artery; and a lack of experience of the physician. The Seldinger technique may help specifically when the cannula cannot be advanced into the arterial lumen. However, this technique increases cost, and it does not solve the main problem, which is the puncture of the artery. Ultrasound is also of great help, but it is not always available. (Source: Journal of Cardiothoracic and Vascular Anesthesia)

[Original articles] Evaluation of a method for converting venous values of acid-base and oxygenation status to arterial values

Emergency Medicine Journal — Mon, 23 Mar 2009 04:00:00 +0100

Conclusion: Arterial pH and Pco2 can be calculated precisely from peripheral venous blood in a broad patient population. The method has potential for use as a screening tool in emergency medical departments and in medical and surgical wards to assess a patient’s acid-base and oxygenation status prior to sampling arterial blood or to help in the decision to refer the patient to the ICU. In departments where arterial blood gas values are used to monitor patients (eg, pulmonary medicine), the method might reduce the number of arterial samples taken by replacing them with peripheral venous blood samples, thus reducing the need for painful arterial punctures. (Source: Emergency Medicine Journal)

Management of Subclavian Arterial Injuries following Inadvertent Arterial Puncture during Central Venous Catheter Placement.

Journal of Vascular and Interventional Radiology : JVIR — Wed, 21 Jan 2009 05:00:00 +0100

Authors: Abi-Jaoudeh N, Turba UC, Arslan B, Hagspiel KD, Angle JF, Schenk WG, Matsumoto AH Subclavian artery injuries after central venous catheter placement constitute a rare but potentially fatal complication. In this case series, the authors describe several endovascular treatment options in the management of iatrogenic subclavian arterial injuries resulting from inadvertent arterial placement of central catheters. PMID: 19167239 [PubMed - as supplied by publisher] (Source: Journal of Vascular and Interventional Radiology : JVIR)

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[Pharyngeal hemorrhaging due to iatrogenic false aneurysm : Complication after cannulation of the internal jugular vein.]

Der Anaesthesist — Thu, 25 Dec 2008 05:00:00 +0100

Authors: Kreckel V, Langwara H Catheterization of the internal jugular vein is used for temporary access to the central vein in patients with acute or chronic renal failure. The most frequent problem is the arterial puncture and accidental placement of the large catheter in an artery. This case report describes a rare secondary complication by accidental catheterization of the right common carotid artery after intended dual lumen catheter insertion into the right internal jugular vein. A false aneurysm with pharyngeal hemorrhaging developed 2 weeks after the puncture. The diagnosis was made using colour-Doppler ultrasound and the aneurysm was treated with vascular surgery. PMID: 19107451 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)

Where's the Point?

Pediatric News — Mon, 01 Dec 2008 05:00:00 +0100

DR. WILKOFF practices general pediatrics in a multispecialty group practice in Brunswick, Maine. Write to Dr. Wilkoff at our editorial offices (pdnews@elsevier.com). If you have given more than a thousand intramuscular injections, you have probably hit bone at least once or twice. This is not the “Eureka!” kind of discovery that one gets from striking oil or seeing that crimson flashback from a successful and intentional arterial puncture. Pricking the periosteum is more of a fingernails-on-the-blackboard moment. Even if somehow you managed to ignore the bone-chilling vibrations that traveled up the syringe, the patient's response told you that going too deep is a bad thing. (Source: Pediatric News)

Risk predictors of retroperitoneal hemorrhage following percutaneous coronary intervention.

The American Journal of Cardiology — Thu, 27 Nov 2008 09:31:07 +0100

In conclusion, this large prospective cohort study identified CRI, but not VCD use, as an independent predictor for RPH and peripheral vascular disease. PMID: 19026298 [PubMed - in process] (Source: The American Journal of Cardiology)

Incidents and complications of totally implanted vascular access devices in children : a prospective study.

Patient Safety in Surgery — Thu, 13 Nov 2008 05:00:00 +0100

CONCLUSION: Prospective recording of TIVA insertion in children reveals a significant number of early incidents and complications, mainly associated with the percutaneous puncture technique. We found no infection in this series. Results of a longer follow-up in the same population are pending. PMID: 19014527 [PubMed - as supplied by publisher] (Source: Patient Safety in Surgery)

Modified Trapdoor Exposure for Open Repair of Brachiocephalic Artery Branch Injury: Case Report

Vascular and Endovascular Surgery — Sun, 09 Nov 2008 05:00:00 +0100

We describe 2 cases of successful open surgical repair of iatrogenic cervicothoracic arterial injuries secondary to central venous catheterization. In both patients, a novel transmanubrial approach was incorporated to expose and control the brachiocephalic artery. (Source: Vascular and Endovascular Surgery)

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The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic cardiac catheterisation

International Journal of Evidence-Based Healthcare — Wed, 05 Nov 2008 05:00:00 +0100

The objective of this review was to present the best available evidence for the optimal length of bed rest after trans-femoral diagnostic cardiac catheterisation. The main outcome of interest was the incidence of bleeding and haematoma formation following varying periods of bed rest.Search strategy We searched the following databases: CINAHL, Medline, Cochrane Library, Current Contents, EBSCO, Web of Science, Embase, British Nursing Index, Controlled clinical trials database, Google Scholar. Reference lists of relevant articles and conference proceedings were searched. We also contacted key organisations and researchers in the field.Selection criteria All randomised and quasi-randomised controlled trials that compared the effects of different lengths of bed rest following trans-femoral dia...

Prediction of arterial blood gas values from arterialized earlobe blood gas values in patients treated with mechanical ventilation

Indian Journal of Critical Care Medicine — Wed, 29 Oct 2008 07:42:30 +0100

Conclusions: Arterialized earlobe blood gas can accurately predict the ABG values of pH, PCO 2 , BE, and HCO 3 - for patients who do not require regular continuous blood pressure measurements and close monitoring of arterial PO 2 measurements. (Source: Indian Journal of Critical Care Medicine)

Safety and Effectiveness of Repeat Arterial Closure Using the AngioSeal Device in Patients with Hepatic Malignancy.

Journal of Vascular and Interventional Radiology : JVIR — Wed, 22 Oct 2008 04:00:00 +0100

CONCLUSIONS: The repeat use of the AngioSeal closure device is safe and effective in patients with hepatic malignancy undergoing regional oncologic interventional procedures. PMID: 18951046 [PubMed - as supplied by publisher] (Source: Journal of Vascular and Interventional Radiology : JVIR)

Point-of-Care Bedside Gas Analyzer: Limited Use of Venous pCO2 in Emergency Patients

The Journal of Emergency Medicine — Sun, 19 Oct 2008 23:00:00 +0100

Conclusions: There is significant variability in the arteriovenous difference of pCO2 readings, hence, arterial punctures are still needed to specifically determine the arterial pCO2. (Source: The Journal of Emergency Medicine)

Prospective clinical evaluation of a new manometer syringe that distinguishes pressures below 30 and above 50 mmHg.

Journal of Clinical Anesthesia — Mon, 01 Sep 2008 04:00:00 +0100

CONCLUSIONS: Certofix PresSure Check provides a unique way of testing whether a catheter is placed in a low or high pressure system. It can be used for identifying inadvertent arterial punctures. PMID: 18929281 [PubMed - in process] (Source: Journal of Clinical Anesthesia)

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Pain and tactile stimuli during arterial puncture in preterm neonates.

Pain — Mon, 25 Aug 2008 04:00:00 +0100

Authors: Gaspardo CM, Chimello JT, Cugler TS, Martinez FE, Linhares MB The purpose of this study was to assess the behavioral and physiological reactivity of preterm neonates during different phases of a blood collection procedure involving arterial puncture. The sample consisted of 43 preterm and very low birth weight neonates with a postnatal age of 1 to 21 days who were hospitalized in the Neonatal Intensive Care Unit. The neonates were evaluated during the whole blood collection procedure. The assessment was divided into five consecutive phases: Baseline (BL); Antisepsis (A), covering the period of handling of the neonate for antisepsis prior to puncture; Puncture (P); Recovery-Dressing (RD), covering the period of handling of the neonate for dressing until positioning for rest in ...

Long-term outcomes of peripheral arm ports implanted in patients with colorectal cancer

International Journal of Clinical Oncology — Fri, 15 Aug 2008 06:45:58 +0100

Conclusion Peripheral arm ports can be maintained with excellent short-and long-term outcomes. Peripheral arm ports are considered to be a good alternative to central venous ports implanted in the chest in patients with MCRC. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10147-008-0766-2Authors Junichiro Kawamura, Kyoto University Department of Surgery, Graduate School of Medicine 54 Shogoin Kawahara-cho, Sakyo-ku Kyoto 606-8507 JapanSatoshi Nagayama, Kyoto University Department of Surgery, Graduate School of Medicine 54 Shogoin Kawahara-cho, Sakyo-ku Kyoto 606-8507 JapanAkinari Nomura, Kyoto University Department of Surgery, Graduate School of Medicine 54 Shogoin Kawahara-cho, Sakyo-ku Kyoto 606-8507 JapanAtsushi Itami, Kyoto University Department ...

Complications Associated With the Arterial Puncture Closure Device--Angio-Seal

Vascular and Endovascular Surgery — Wed, 30 Jul 2008 04:00:00 +0100

Conclusion The Angio-Seal device should not be used for closure of the superficial femoral artery and in patients with severe arteriosclerosis. The application of arteriography as well as the use of ultrasound-guided puncture is advisable. In all cases, surgical intervention was successful and an adequate therapy for management of complications. (Source: Vascular and Endovascular Surgery)

Anaesthesia for arterial puncture in the emergency department: a randomized trial of subcutaneous lidocaine, ethyl chloride or nothing.

European Journal of Emergency Medicine — Wed, 09 Jul 2008 09:33:34 +0100

Page: 218DOI: 10.1097/MEJ.0b013e3282f4d19bAuthors: France, James E. a; Beech, Fiona J.M. b; Jakeman, Nicola a; Benger, Jonathan R. c (Source: European Journal of Emergency Medicine)

Success of Ultrasound-guided Peripheral Intravenous Access with Skin Marking.

Academic Emergency Medicine — Wed, 09 Jul 2008 04:00:00 +0100

Conclusions: LAMP did not improve success of USGPIVA in variably experienced operators. Experience was associated with higher rates of success for USGPIVA. PMID: 18637084 [PubMed - as supplied by publisher] (Source: Academic Emergency Medicine)

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Local Anesthesia in Arterial Puncture: Nurses' Knowledge and Attitudes.

Archivos de Bronconeumologia — Tue, 01 Jul 2008 04:00:00 +0100

CONCLUSIONS: Local anesthesia is used very little in arterial puncture. Knowledge about how to perform arterial blood extraction for blood gas analysis is insufficient and needs to be improved among both nurses and nursing students. Nonetheless it is noteworthy that most of those surveyed indicated a preference for receiving local anesthesia if they were to undergo the procedure. These data should be taken into consideration when training nurses to perform arterial puncture. PMID: 18727888 [PubMed - as supplied by publisher] (Source: Archivos de Bronconeumologia)

Ultrasound-guided supraclavicular vs infraclavicular brachial plexus blocks in children.

Paediatric Anaesthesia — Mon, 09 Jun 2008 04:00:00 +0100

Conclusions: (i) Ultrasound-guided supraclavicular and infraclavicular brachial plexus blocks are effective in children. (ii) There has been no pneumothorax in 40 US-guided supraclavicular brachial plexus blocks performed by anaesthesiologists already trained in US-guided regional anaesthesia using an IP technique in children >/=5 years old. (iii) In this study, the supraclavicular approach of the brachial plexus was faster to perform than the infraclavicular one. PMID: 18544144 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)

Emergency Femoral Hemodialysis Catheter Placement Complicated by Prevesical Hematoma

The Journal of Emergency Medicine — Mon, 05 May 2008 23:00:00 +0100

We report herein a patient with femoral vein perforation and prevesical hematoma. (Source: The Journal of Emergency Medicine)

An observational study of emergency department intern activities.

Med J Aust — Mon, 05 May 2008 04:00:00 +0100

CONCLUSIONS: The ED exposes interns to a broad range of activities. With the anticipated increase in intern numbers, dilution of the emergency medicine experience may occur, and requirements for supervision may increase. Substitution of ED rotations may deprive interns of a valuable learning experience. PMID: 18459922 [PubMed - as supplied by publisher] (Source: Med J Aust)

A potentially fatal complication during subclavian vein catheterization in an infant with congenital heart disease-puncture to pulmonary artery directly: a case report.

Journal of Clinical Anesthesia — Thu, 01 May 2008 04:00:00 +0100

We report an arterial puncture directly to the pulmonary artery in infant during subclavian vein catheterization. PMID: 18502370 [PubMed - in process] (Source: Journal of Clinical Anesthesia)

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Validity of venous blood gas analysis for diagnosis of acid-base imbalance in children admitted to pediatric intensive care unit.

World Journal of Pediatrics : WJP — Thu, 01 May 2008 04:00:00 +0100

CONCLUSIONS: VBG can be used instead of ABG in some diseases such as respiratory distress syndrome, neonatal sepsis, renal failure, pneumonia, diabetic ketoacidosis and status epilepticus, but in other diseases such as neonatal seizure, shock, congestive heart failure and congenital heart diseases, ABG is preferable and must not be replaced by VBG. These results may be used for the formulation of future guidelines for PICU. PMID: 18661766 [PubMed - in process] (Source: World Journal of Pediatrics : WJP)

Kontinuierliche Nierenersatztherapie in der Behandlung des akuten Nierenversagens: Geschichte und Entwicklung

Intensivmedizin und Notfallmedizin — Mon, 07 Apr 2008 05:32:34 +0100

Abstract Acute renal failure (ARF) is a frequent complication in patients with multiple organ failure and sepsis leading to a significant increase of mortality in these critically ill patients (50– 70%). While for years, ARF was considered an unavoidable complication of multiple organ failure and thus not essential for the progress, various studies in recent years have shown an independent and fundamental influence of ARF and therefore its therapy on the survival of the patient. In the late 1970s continuous forms of treatment were introduced into the intensive care units. The first form of this treatment option was continuous arteriovenous hemofiltration (CAVH), primarily developed for the treatment of overhydrated patients resistant to diuretics. Using pump driven for...

ExoSeal vascular plug gets good reviews in ECLIPSE study

News-Medical News Feed — Wed, 02 Apr 2008 23:40:00 +0100

A new bioabsorbable plug that seals the arterial puncture site used for threading catheters into the body during diagnostic angiography and interventional procedures significantly shortens bleeding time and enables patients to get up and walk around far sooner than when manual compression is applied to the groin. (Source: News-Medical News Feed)

Bioabsorbable Plug Gets Good Reviews In ECLIPSE Study

Cardiovascular / Cardiology News From Medical News Today — Wed, 02 Apr 2008 13:00:00 +0100

Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies

Annals of Oncology — Wed, 27 Feb 2008 05:00:00 +0100

Central venous catheters (CVCs) have considerably improved the management of patients with hematological malignancies, by facilitating chemotherapy, supportive therapy and blood sampling. Complications of insertion of CVCs include mechanical (arterial puncture, pneumothorax), thrombotic and infectious complications. CVC-related thrombosis and infections are frequently occurring complications and may cause significant morbidity in patients with hematological malignancies. CVC-related thrombosis and infections are related and can therefore not be seen as separate entities. The incidence of symptomatic CVC-related thrombosis had been reported to vary between 1.2 and 13.0% of patients with hematological malignancy. The incidence of CVC-related bloodstream infections varies between 0.0 and 20.8...

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Accuracy of Physical Examination and Intra-Access Pressure in the Detection of Stenosis in Hemodialysis Arteriovenous Fistula.

Seminars in Dialysis — Fri, 01 Feb 2008 05:00:00 +0100

Authors: Campos RP, Chula DC, Perreto S, Riella MC, do Nascimento MM Both physical examination (PE) and intra-access pressure (IAP) measurements have been used in the identification of stenosis in an arteriovenous access. The aim of this study was to evaluate the accuracy of PE and IAP in the diagnosis of arteriovenous fistula (AVF) stenosis. A total of 84 patients were enrolled in the study (54% men, mean age of 50.7 +/- 12.7 years and mean AVF patency of 24.9 +/- 7.8 months, 52% radiocephalic). Abnormalities of pulse and thrill were used as the diagnostic tools for the detection of stenosis using the physical examination. For IAP, stenosis was suspected when the ratio between IAP at the arterial puncture site and the mean blood pressure was <0.13 or >0.43. The diagnosis of sten...

Sonographically guided venous puncture and fluoroscopically guided placement of tunneled, large-bore central venous catheters for bone marrow transplantation—high success rates and low complication rates

Supportive Care in Cancer — Wed, 16 Jan 2008 15:49:47 +0100

Conclusion Percutaneous implantation of large-lumen, tunneled, central venous catheters can be achieved with a high technical success rate and a low complication rate under combined sonographic and fluoroscopic guidance. In cases of mechanical complications, catheter rescue by interventional techniques is possible in the vast majority of cases. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s00520-007-0378-9Authors Bernhard Gebauer, Charité, Universitätsmedizin Berlin Department of Radiology Campus Virchow-Klinikum, Augustenburger Platz 1 13353 Berlin GermanyUlf Martin Karl Teichgräber, Charité, Universitätsmedizin Berlin Department of Radiology Campus Virchow-Klinikum, Augustenburger Platz 1 13353 Berlin GermanyMichael Werk, Charité, Universit...

Nerve Injuries Related to Vascular Access Insertion and Assessment.

Journal of Infusion Nursing — Tue, 20 Nov 2007 01:24:51 +0100

Nerve injury related to the insertion of peripheral IV catheters, venipuncture for blood collection, and the insertion of peripherally inserted central catheters is the most commonly reported insertion complication. Nurses who insert peripheral and central vascular access devices are responsible, both clinically and legally, to have a working knowledge of the vascular, arterial, and nerve anatomy of the upper extremity. Nerve compression injury is related to large infiltrations and extravasations that can cause compartment syndrome. A hematoma can develop when inadequate pressure is applied to vascular and arterial puncture sites and can result in nerve compression injury. These injuries are preventable when nurses select appropriate sites for insertion of vascular access devices, assess I...

Emergent treatment of an Iatrogenic arterial injury at femoral puncture site With Symbiot® self-expanding PTFE-covered coronary stent-graft

Australasian Radiology — Wed, 07 Nov 2007 06:33:29 +0100

We report an intracranial stenting procedure complicated by active bleeding from the femoral puncture site because of high arterial puncture. The patient was treated by placement of two PTFE-covered self-expanding coronary stent-grafts. To our ... (Source: Australasian Radiology)

Iatrogenic stenosis following suture-mediated closure device

Australasian Radiology — Wed, 07 Nov 2007 06:33:27 +0100

Australasian Radiology, Volume 51, Issue s4, Page B319-B323, December 2007. SUMMARY The use of percutaneous closure devices post arterial punctures has been introduced to reduce time to haemostasis, reduce haemorrhage, improve patient comfort and reduce time to ambulation. Their increased use has been a result of larger access ... (Source: Australasian Radiology)

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Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies.

Ann Oncol — Wed, 24 Oct 2007 04:00:00 +0100

Authors: Boersma RS, Jie KS, Verbon A, van Pampus EC, Schouten HC Central venous catheters (CVCs) have considerably improved the management of patients with hematological malignancies, by facilitating chemotherapy, supportive therapy and blood sampling. Complications of insertion of CVCs include mechanical (arterial puncture, pneumothorax), thrombotic and infectious complications. CVC-related thrombosis and infections are frequently occurring complications and may cause significant morbidity in patients with hematological malignancies. CVC-related thrombosis and infections are related and can therefore not be seen as separate entities. The incidence of symptomatic CVC-related thrombosis had been reported to vary between 1.2 and 13.0% of patients with hematological malignancy. The incid...

Effect of radix paeoniae rubra on expression of p38 MAPK/iNOS/HO-1 in rats with lipopolysaccharide-induced acute lung injury.

Chinese Journal of Traumatology — Mon, 01 Oct 2007 04:00:00 +0100

CONCLUSIONS: The high expression of MAPK plays an important role in lipopolysaccharide-induced acute lung injury. Protective effect of RPR on lipopolysaccharide-induced acute lung injury may be related to the inhibition of the abnormal high expression of p38 MAPK/iNOS/HO-1. PMID: 17919363 [PubMed - indexed for MEDLINE] (Source: Chinese Journal of Traumatology)

[Best evidence topic reports] Capillary blood gases as an alternative to arterial puncture in diabetic ketoacidosis

Emergency Medicine Journal — Thu, 27 Sep 2007 04:00:00 +0100

(Source: Emergency Medicine Journal)

Prospective Study of Elective Bilateral Versus Unilateral Femoral Arterial Puncture for Uterine Artery Embolization

CardioVascular and Interventional Radiology — Fri, 14 Sep 2007 19:53:15 +0100

Abstract The purpose of this study was to assess the effect of elective bilateral femoral arterial punctures for uterine artery embolization (UAE) of symptomatic fibroids on fluoroscopy and procedural time, patient dose, and ease of procedure. We conducted a prospective study of UAE with either the intention to catheterize both uterine arteries using a single femoral puncture (n = 12) or elective bilateral arterial punctures from the outset (n = 12). The same two operators undertook each case. Main outcome measures were total procedure time, fluoroscopy time, dose-area product (DAP), and total skin dose. A simulation was then performed on an anthropomorphic phantom using the mean in vivo fluoroscopy parameters to estimate the ovarian dose. Bilateral UAE w...

Correlation Between Peripheral and Central Venous Pressures in Children with Congenital Heart Disease

Pediatric Cardiology — Thu, 13 Sep 2007 06:56:42 +0100

In conclusion, although CVP measured from a peripheral intravenous catheter in infants and children with congenital heart disease is not as accurate as the measurement in adults, the aforementioned linear regression equation based on measurement of PVP gives a reliable estimate of CVP. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00246-007-9067-1Authors H. Amoozgar, Shiraz University of Medical Sciences, Nemazee Hospital Division of Pediatric Cardiology Shiraz 71937-11351 IranN. Behniafard, Shiraz University of Medical Sciences, Nemazee Hospital Division of Pediatric Cardiology Shiraz 71937-11351 IranM. Borzoee, Shiraz University of Medical Sciences, Nemazee Hospital Division of Pediatric Cardiology Shiraz 71937-11351 IranG. H. Ajami, Shiraz University of Medical Scienc...

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Ultrasound-Guided Versus Landmark-Guided Femoral Vein Access in Pediatric Cardiac Catheterization

Pediatric Cardiology — Thu, 13 Sep 2007 06:56:42 +0100

Conclusions Ultrasound-guided access to the femoral vein minimizes the complication of inadvertent arterial puncture as compared with the landmark-guided approach. Content Type Journal ArticleCategory OriginalDOI 10.1007/s00246-007-9066-2Authors S. Iwashima, Hamamatsu University School of Medicine Department of Pediatrics Handayama 1-20-1 Hamamatsu City 431-3192 JapanT. Ishikawa, Hamamatsu University School of Medicine Department of Pediatrics Handayama 1-20-1 Hamamatsu City 431-3192 JapanT. Ohzeki, Hamamatsu University School of Medicine Department of Pediatrics Handayama 1-20-1 Hamamatsu City 431-3192 Japan Journal Pediatric CardiologyOnline ISSN 1432-1971Print ISSN 0172-0643 (Source: Pediatric Cardiology)

[Subintimal angioplasty for superficial femoral artery occlusions: first experience in Kaunas University of Medicine Hospital]

Medicina (Kaunas) — Mon, 13 Aug 2007 13:32:06 +0100

CONCLUSIONS: Subintimal angioplasty of occluded superficial femoral artery is a safe and minimally invasive procedure with a high initial technical success rate, low complication rate, and good early results, and in case of failure, subsequent surgery can be performed. PMID: 17637515 [PubMed - in process] (Source: Medicina (Kaunas))

Subintimal angioplasty for superficial femoral artery occlusions: first experience in Kaunas University of Medicine Hospital.

Medicina (Kaunas) — Sat, 21 Jul 2007 00:31:22 +0100

CONCLUSIONS. Subintimal angioplasty of occluded superficial femoral artery is a safe and minimally invasive procedure with a high initial technical success rate, low complication rate, and good early results, and in case of failure, subsequent surgery can be performed. PMID: 17637515 [PubMed - as supplied by publisher] (Source: Medicina (Kaunas))

The safety and efficacy of the Angio-Seal closure device in diagnostic and interventional neuroangiography setting: a single-center experience with 1,443 closures

Neuroradiology — Wed, 27 Jun 2007 08:03:53 +0100

Conclusion Our experience in a relatively large series of patients shows that the use of the Angio-Seal STS vascular closure device is safe and effective in patients undergoing cerebral diagnostic angiography and neurointerventional procedures with an acceptable rate of complications, although the complication rate was higher in the group of patients who received heparin and/or antiplatelet medication. Content TypeJournal Article JournalNeuroradiologyOnline ISSN 1432-1920Print ISSN 0028-3940 (Source: Neuroradiology)

[Short reports] A quality control programme for acute myocardial infarction management in out-of-hospital critical care medicine

Emergency Medicine Journal — Wed, 20 Jun 2007 04:00:00 +0100

This study, conducted over two time periods, aimed to evaluate the effectiveness of the diffusion of data, implementation of correctives measures and updated protocols in reducing time to reperfusion in acute myocardial infarction (AMI) management in the out-of-hospital setting. Mean (SD) time to hospital admission and to arterial puncture improved (58 (13) vs 67 (18) min, p = 0.03; and 82 (16) vs 95 (29) min, p = 0.02). The study, performed according to quality control programme methodology, showed that the chronology of AMI management could be improved by appropriate interventions and monitoring of intervention times. (Source: Emergency Medicine Journal)

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[Nociceptive cancer pain in adult patients: statement about guidelines related to the use of antinociceptive medicine.]

Annales Francaises d'Anesthesie et de Reanimation — Sun, 17 Jun 2007 06:56:18 +0100

CONCLUSION: Oral immediate or controlled release morphine is the most common and effective pain treatment for most patients with nociceptive cancer pain but rotation with other opioids or alternative routes of administration must be discussed quickly if pain persits or if adverse effects occur. PMID: 17560755 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

Thrombin Injection for Acute Hemorrhage Following Angiography

CardioVascular and Interventional Radiology — Tue, 29 May 2007 07:08:11 +0100

We report the use of ultrasound-guided thrombin injection that prevented any immediate need for surgery in 2 cases of uncontrolled bleeding following femoral arteriography. Clinical presentations and treatment are reported, together with a review of the literature. Content TypeJournal Article JournalCardioVascular and Interventional RadiologyOnline ISSN 1432-086XPrint ISSN 0174-1551 (Source: CardioVascular and Interventional Radiology)

US-guided placement of central vein catheters in patients with disorders of hemostasis.

European Journal of Radiology — Thu, 03 May 2007 04:00:00 +0100

CONCLUSION: US-guided placement of central vein catheters in patients with disorder of hemostasis is safe with high technical success and low complication rates. US guidance for central venous catheterization should be the preferred method in this group of patients, if available in the hospital setting. PMID: 17482407 [PubMed - as supplied by publisher] (Source: European Journal of Radiology)

Mechanical complications and malpositions of central venous cannulations by experienced operators

Intensive Care Medicine — Wed, 07 Mar 2007 07:43:10 +0100

Conclusions??Even experienced operators cause a?considerable number of early mechanical complications and malpositions. After two unsuccessful cannulation attempts failure and associated complications are very likely. Content TypeJournal Article JournalIntensive Care MedicineOnline ISSN 1432-1238Print ISSN 0342-4642 (Source: Intensive Care Medicine)

CT Angiography of Lower Extremity Vascular Bypass Grafts.

Techniques in Vascular and Interventional Radiology — Fri, 01 Dec 2006 05:00:00 +0100

Authors: Toomay SM, Dolmatch BL Over the past several years computed tomography (CT) technology has advanced to such a degree that CT angiography (CTA) has become the study of choice at our institution for imaging lower extremity vascular bypass grafts. CTA quickly provides anatomic information about the state of the graft and identifies virtually all forms of bypass graft failure and related complications. Furthermore, detailed vascular anatomy is seen beyond the graft and affords sufficient anatomic detail for surgical revision without the need for other angiographic studies. Although catheter angiography, duplex-ultrasound, magnetic resonance angiography, and nuclear medicine studies all continue to play some role in the evaluation of vascular grafts, they are more often used as pro...

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Current Trends in the Management of Iatrogenic Cervical Carotid Artery Injuries

Vascular and Endovascular Surgery — Thu, 12 Oct 2006 06:00:00 +0100

This study was undertaken to elicit the opinion of experts regarding the management of iatrogenic injury to the carotid artery. A text questionnaire was transmitted by electronic mail to members of the Western Vascular Society concerning management of iatrogenic injury to the cervical carotid artery. Participants were asked to submit information regarding practice status and their preferred choices for the management of different clinical scenarios. The scenarios were: (1) large bore sheath (> 8.5F) cannulation of the carotid artery in anesthetized patients, (2) large bore sheath cannulation of the carotid artery in an awake patient, (3) delayed recognition of a misplaced sheath by > 4 hours, and (4) arterial puncture was recognized after only the entry needle (16-gauge) was introduc...

Techniques for Managing Complications of Arterial Closure Devices

Vascular and Endovascular Surgery — Thu, 12 Oct 2006 06:00:00 +0100

According to data reported by the American Heart Association, more than 5 million diagnostic and therapeutic catheterizations are performed each year in the United States. The number of catheterizations has tripled since 1979. It has been estimated that complications related to the access site result in more than 75,000 surgical procedures annually. Thus, improved management of the access site itself is essential to achieve the greater goals of improved care and reduced cost. Manual compression directly over the site of arterial puncture usually results in adequate hemostasis but has several significant drawbacks. Manual compression is uncomfortable for the patient, is fatiguing and time-consuming for staff, and necessitates several hours of costly in-hospital observation. In addition, it ...

[Iatrogenic arterial pseudo aneurysms in Behçet's disease. Two cases]

Journal des Maladies Vasculaires — Mon, 01 May 2006 04:00:00 +0100

We report two exceptional localizations of iatrogenic pseudo aneurysms due to accidental arterial puncture, involving respectively the internal carotid artery and the humeral artery. We discuss the clinical characteristics and therapeutic modalities of this complication. PMID: 16733441 [PubMed - indexed for MEDLINE] (Source: Journal des Maladies Vasculaires)

Mechanical Complications of Central Venous Catheters

Journal of Intensive Care Medicine — Tue, 17 Jan 2006 07:00:00 +0100

We analyzed 385 consecutive central venous catheter (CVC) attempts over a 6-month period. All critically ill patients 18 years of age or older requiring a CVC were included. The rate of mechanical complications not including failure to place was 14%. Complications included failure to place the CVC (n = 86), arterial puncture (n = 18), improper position (n = 14), pneumothorax (n = 5 in 258 subclavian and internal jugular attempts), hematoma (n = 3), hemothorax (n = 1), and asystolic cardiac arrest of unknown etiology (n = 1). Male patients had a significantly higher complication rate than female patients (37% vs 27%, P = .04). The subclavian approach had a higher complication rate than the internal jugular or the femoral approach (39% vs 33% vs. 24%, P = .02). The complication rate increase...

An improved technique for gaining radial artery access in endovascular interventions.

Cardiovascular Revascularization Medicine — Sun, 01 Jan 2006 05:00:00 +0100

We present a simple technique to avoid time loss and potential dangerous maneuvers for catheterization of the radial artery in endovascular interventions. If any difficulties are encountered when advancing the guide wire after the arterial puncture using standard transradial kits, we found it useful to routinely use a 60-mm polyethylene radial pressure line catheter like the Leader Cath (Vygon, Ecquen, France), which is more flexible and less traumatic than short catheters and are usually available in the standard hydrophilic transradial kit. With the 20-gauge needle within the arterial lumen, it is sufficient to advance the guide wire 3 or 4 cm, followed by the insertion of the radial pressure line catheter for administering a vasodilator cocktail. The contrast injection through the cathe...

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Pseudoaneurysm of the brachial artery in two infants following accidental arterial puncture.

VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases — Mon, 01 Aug 2005 04:00:00 +0100

We present two infants with brachial artery pseudoaneurysm in the antecubital region following accidental arterial puncture. PMID: 16184841 [PubMed - indexed for MEDLINE] (Source: VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases)

Central vein catheterization of dialysis patients with real time ultrasound guidance.

The Journal of Vascular Access — Sat, 01 Jan 2000 05:00:00 +0100

Authors: Gallieni M Internal jugular vein cannulation has become a routinary and clinically important aspect of medical care in critically ill patients. The landmark-guided technique usually affords rapid and easy vascular access, but it is not always successful and may be complicated by arterial puncture, hematoma, pneumothorax. A prospective, descriptive study is reported on the use and success of ultrasound-assisted central vein catheterization in dialysis patients who had an indication for internal jugular vein catheterization. Data were collected prospectively on number of punctures, needle passes, and success rates. Over a 6-year period, there were 220 attempts at internal jugular catheterization in 205 patients and ultrasound guidance was used in 210 of the 220 (95%) attempts. I...