Application of ultrasonic guidance in radial artery catheterization / 中国基层医药

Objective@#To study the effect of ultrasonic guidance in radial artery catheterization.@*Methods@#From January 2017 to January 2018, 100 patients who received surgical treatment in Taizhou Central Hospital of Zhejiang Province and needed puncture and catheterization anesthesia during operation were randomly divided into control group (n=50) and observation group (n=50) according to digital table method.The control group adopted the traditional touch pulse method, while the observation group was guided by ultrasound.The first puncture success rate, the second puncture success rate, puncture time, puncture times, the vital sign index, incidence of adverse events, pain score, comfort score were compared between the two groups.@*Results@#The first puncture success rate (80%) and the second puncture success rate (100%) of the observation group were higher than 62% and 88% of the control group (χ2=3.934, 6.383, all P<0.05). The single puncture time [(59.85±8.31)s] and total puncture time [(107.14±35.37)s] of the observation group were shorter than those of the control group (t=5.766, 6.398, all P<0.05), and the puncture times [(1.27±0.54) times] of the observation group was less than that of the control group (t=5.689, P<0.05). After puncture, the heart rate [(73.79±2.46)times/min] and average arterial pressure [(96.75±6.76)mmHg] of the observation group were all lower than those of the control group (t=5.058, 4.635, all P<0.05). The total incidence of adverse events such as subcutaneous hematoma and arterial wall penetration in the observation group (4%) was lower than that in the control group (18%) (χ2=5.005, P<0.05). The pain scores at puncture and after puncture of the observation group [(1.53±0.71)points, (1.28±0.60)points] were lower than those of the control group (t=5.545, 6.233, all P<0.05). The comfort scores at puncture and after puncture of the observation group [(91.25±9.64)points, (97.31±11.37)points] were higher than those of the control group (t=6.147, 6.226, all P<0.05).@*Conclusion@#Ultrasonic guidance can effectively improve the puncture efficiency, reduce the fluctuation of vital signs, pain, reduce the adverse events during puncture, and make the patients feel more comfortable.

An institutional experience in insertion of hemodialysis catheter and peritoneal dialysis catheter for children with end stage renal disease

Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are major health care problems worldwide even in Pediatric population. The etiology of CKD in children with ESRD is varied. Most of them are started on peritoneal dialysis or hemodialysis before being considered for renal transplantation.The aims and objective of this study was to analyzed the patient group, methodology, results and outcomes of hemodialysis catheter insertion and continuous ambulatory peritoneal dialysis (CAPD) catheter insertion for children with ESRD. The etiology of ESRD in children with CKD is also reviewed.Methods: All children with ESRD who underwent CAPD catheter and haemodialysis catheter insertion over a period of 5 years were included in the study. CAPD catheters were inserted by open and laparoscopic assisted methods. The procedures were done without image guidance due to logistical constraints in a limited resource scenario. Analysis of all relevant case records, operative notes and postoperative events were done.Results: A total of 40 patients who underwent CAPD and hemodialysis catheter insertions were analysed. The primary cases (no previous insertion of dialysis catheter) included 29 and secondary cases (history of previous insertion of dialysis catheter) were 7. Re-insertions (of the same type of dialysis catheter) were 2 in each group. No significant complications occurred in either group.Conclusions: Dialysis catheters for ESRD in Paediatric population can be inserted safely even without image guidance and with very few complications.

Comparison between marked versus unmarked introducer needle in real‑time ultrasound‑guided central vein cannulation: A prospective randomized study.

Introduction: Introducer needle tip is not clearly visible during the real‑time ultrasound (US)‑guided central vein cannulation (CVC). Blind tip leads to mechanical complications. This study was designed to evaluate whether real‑time US‑guided CVC with a marked introducer needle is superior to the existing unmarked needle. Methodology: Sixty‑two critically ill patients aged 18–60 years of either sex were included in the study. The patients were randomized into two groups based on whether a marked or unmarked introducer needle was used. Both groups underwent real‑time US‑guided CVC by a single experienced operator. Aseptically, introducer needle was indented with markings spaced 0.5 cm (single marking) and every 1 cm (double marking). This needle was used in the marked group. Approximate depths (centimeter) of the anterior and posterior wall of the internal jugular vein, anterior wall of the internal carotid artery, and lung pleura were appreciated from the midpoint of the probe in short‑axis view at the level of the cricoid cartilage. Access time (seconds) was recorded using a stopwatch. A number of attempts and complications such as arterial puncture, hematoma, and pneumothorax of either procedure were compared. Results: Both marked needle and unmarked needle groups were comparable with regard to age, gender, severity scores, platelet counts, prothrombin time, and distance from the midpoint of the probe to the vein, artery, and pleura and skin‑to‑guide wire insertion access time. However, an average number of attempts (P = 0.03) and complications such as hematoma were significantly lower (P = 0.02) with the marked introducer needle group. Pneumothorax was not reported in any of the groups. Conclusion: Our study supports the idea that marked introducer needle can further reduce the iatrogenic complications of US‑guided CVC.

The application of EKG location method in the cardiac veins catheter tip location in the tumor patients / 中国基层医药

Objective To discuss the electrocardiogram(EKG)positioning method to the guiding role of determining the pipe length and the accuracy of operative localization in central venous catheterization procedure. Methods Chose 32 cases of tumor patients who had center venipunture.Use the catheter taken EKG data when cath-etering,and then given validation using postoperative chest X -ray or fluoroscopy.Judgment the sensitivity,specificity and disposable catheters success rate of the EKG positioning method.Results In the 32 cases of cancer patients, 30 patients had characteristic P waves,when the chest X -ray confirmed the superior vena cava or the junction with the right atrium,one case into the right atrium,when one case of non -P -wave in the subclavian after intravenous discounts tune into the tube after it confirmed the superior vena cava.Conclusion EKG positioning method with high accuracy in the deep venous catheter in the catheter tip positioning applications.The clinical applications are feasible.

Modified Peritoneal Dialysis Catheter Insertion: Comparison with a Conventional Method

PURPOSE: The conventional trocar and cannula method in peritoneal dialysis (PD) catheter insertion has its limitation in clinical setting. The aim of this study was to compare a modified method for percutaneous PD catheter insertion with the conventional method, and demonstrate advantages of the modified method. MATERIALS AND METHODS: Patients at a single center who had percutaneous PD catheters inserted by nephrologists from January 2006 until September 2012, using either a modified method (group M) or the conventional trocar and cannula method (group C), were retrospectively analyzed, in terms of baseline characteristics, complications experienced up to 3 months after the procedure, and the suitability of the procedure for patients. RESULTS: Group M included 82 subjects, while group C included 66 cases. The overall early complication rate in group M (1.2%) was significantly lower than that in group C (19.7%) (p<0.001). The catheter revision rate during timeframe for early complications was significantly lower in group M (0%) than in group C (6.1%) (p=0.024). When comparing Procedure time (1 h 3 min+/-16 min vs. 1 h 36 min+/-19 min, p<0.01), immediate post-procedural pain (2.43+/-1.80 vs. 3.14+/-2.07, p<0.05), and post-procedure days until ambulation (3.95+/-1.13 days vs. 6.17+/-1.34 days, p<0.01), group M was significantly lower than group C. There was no significant difference in total hospitalization period (14.71+/-7.05 days vs. 13.86+/-3.7 days). CONCLUSION: Our modified PD catheter insertion method shows its advantages in early complication rate, early complications revision rate, and the patients' conveniences.

Use of optimized ultrasound axis along with marked introducer needle to prevent mechanical complications of internal jugular vein catheterization.

Internal jugular vein (IJV) catheterization is a routine technique in the intensive care unit. Ultrasound (US) guided central venous catheter (CVC) insertion is now the recommended standard. However, mechanical complications still occur due to non‑visualization of the introducer needle tip during US guidance. This may result in arterial or posterior venous wall puncture or pneumothorax. We describe a new technique of (IJV) catheterization using US, initially the depth of the IJV from the skin is measured in short‑axis and then using real time US long‑axis view guidance a marked introducer needle is advanced towards the IJV to the defined depth measured earlier in the short axis and the IJV is identified, assessed and cannulated for the CVC insertion. Our technique is simple and may reduce mechanical complications of US guided CVC insertion.

A Case of Leukemia Cutis at the Site of a Prior Catheter Insertion

Leukemia cutis is the cutaneous involvement of leukemic neoplastic cells. It is an uncommon feature of systemic leukemia, and is associated with a poor prognosis. A 20-year-old man presented with a solitary, 2 cm dome- shaped, firm, erythematous nodule on the right medial malleolus that was present for 3 months. The patient had a history of venous catheter insertion at the right medial malleolus area 3 months previously. The history was significant for acute lymphoblastic leukemia (ALL) for 4 years; an allogenic bone marrow transplantation was performed 3 years earlier. The histologc examination of the lesion revealed diffuse infiltration of leukemic cells in the dermis and subcutis. Herein we report a case of leukemia cutis at the site of a prior catheter insertion in a patient with ALL

Effects of Distraction using Operating Doll on Preschool Children's Pain during an IV Catheter Insertion / 아동간호학회지

PURPOSE: The purpose of this study was to investigate the effect on pain of distraction with an operating doll in preschool children(3-6 years old) during an IV catheter insertion. METHOD: The research design was a nonequivalent control group posttest design, and the participants were 22 children in the experimental group, and 23 children in the control group. The children were hospitalized for enteritis and pharyngitis in a university hospital. The subjective pain was measured using FACES Pain Rating Scale by self report, and the pain behavior responses were scored using Procedure Behavior Check List by observing a film of the entire procedure, and changes in pulse and oxygen saturation as the physiological pain responses were measured by pulse oximeter. Data were analyzed with the SPSS Win 10.0 program. RESULT: The degree of subjective pain, pain behavior responses, and changes in pulse during IV catheter insertion were significantly lower in the experimental group. But there was no significant difference in O2 saturation between the two groups. CONCLUSION: Distraction using an operating doll was effective in decreasing pain during inserting the IV catheter in preschool children.

Intestinal Obstruction Due to Incarcerated Hernia at CAPD Catheter Insertion Site

Patients who have undergone peritoneal dialysis can frequently experience abdominal wall complications, such as hernia due to increased intraabdominal pressure and peritoneal leakage. However, no case of incarcerated abdominal wall hernia through catheter insertion site of CAPD has yet been reported Recently the authors experienced a case of intestinal obstruction due to an incarcerated hernia at the catheter insertion site of CAPD. We report this case and present a literature review.

Continuous Infraclavicular Brachial Plexus Block Using Retrograde Insertion of an Epidural Catheter with Stylet through the Axilla / 대한마취과학회지

BACKGROUND: The continuous infraclavicular brachial plexus block (BPB) has many merits compared to other approaches. However, due to complications and the discomfort felt by patients during the procedure, it has not gained much in popularity. We assumed that the neurovascular sheath is one compartment and placed the catheter deeply into the sheath, as used in the infraclavicular approach, through the axilla. METHODS: Patients scheduled for surgery were paired according to their diagnoses and sites of surgery. Thirty-two patients were randomly chosen and divided into two groups. Selander's continuous axillary BPB was performed in the axillary group. In the infraclavicular group, we inserted an epidural catheter with a stylet deeper into the site just medial to the coracoid process using a C-arm and nerve stimulator. RESULTS: In the infraclavicular group, sensory and motor block of the musculocutaneous nerve and the quality of BPB was superior to those of the axillary group (P < 0.05). The average depth of the catheter from the skin was 14 +/-1.5 cm. CONCLUSIONS: Continuous infraclavicular BPB can cause no more discomfort as Selander's continuous axillary approach. Furthermore, it may improve the quality of block and reduce the amount of local anesthetic used.