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Objective:To search, evaluate and summarize the evidence related to the maintenance of peripheral arterial duct flushing systems in children for clinical reference.Methods:Up To Date, BMJ, Nathional Institute for Health and Care Excellence(NICE), Chinese Medlive, Cochrane Library, Joanna Briggs Institute(JBI), CINAHL, METSTR, PubMed, Wanfang, CNKI, VIP were used to collect secondary evidence resources about management and maintenance of peripheral arterial duct flushing systems in children. After the quality evaluation of each type of literature, the evidence was extracted and summarized.Results:A total of 9 articles were included in the research. The 22 pieces of best evidence were obtained from 7 aspects, including basic requirements of children′s peripheral arterial duct flushing systems, arterial flushing method, flushing rate of injection pump system, flushing pressure of pressurized bag pump system, arterial flushing fluid, replacement and maintenance of children′s arterial catheter flushing system, and continuous improvement of arterial catheter maintenance.Conclusions:The best evidence for the establishment and maintenance of pediatric peripheral arterial duct flushing systems provides a basis for clinical decision, but practice testing is still needed.
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Abstract Objective: Several reports claim that blood pressure (BP) in the radial artery may underestimate the accurate BP in critically ill patients. Here, the authors evaluated differences in mean blood pressure (MBP) between the radial and femoral artery during pediatric cardiac surgery to determine the effectiveness of femoral arterial BP monitoring. Method: The medical records of children under 1 year of age who underwent open-heart surgery between 2007 and 2013 were retrospectively reviewed. Radial and femoral BP were measured simultaneously, and the differences between these values were analyzed at various times: after catheter insertion, after the initiation of cardiopulmonary bypass (CPB-on), after aortic cross clamping (ACC), after the release of ACC, after weaning from CPB, at arrival in the intensive care unit (ICU), and every 6 h during the first day in the ICU. Results: A total of 121 patients who underwent open-heart surgery met the inclusion criteria. During the intraoperative period, from the beginning to the end of CPB, radial MBPs were significantly lower than femoral MBPs at each time-point measured (p < 0.05). Multivariate analysis showed that longer CPB time (>60 min, odds ratio: 7.47) was a risk factor for lower radial pressure. However, discrepancies between these two values disappeared after arrival in the ICU. There was no incidence of ischemic complications associated with the catheterization of both arteries. Conclusion: The authors suggest that femoral arterial pressure monitoring can be safely performed, even in neonates, and provides more accurate BP values during CPB-on periods, and immediately after weaning from CPB, especially when CPB time was greater than 60 min.
Resumo Objetivo: Diversos relatos alegam que a pressão arterial (PA) na artéria radial poderá subestimar a PA precisa em pacientes gravemente doentes. Aqui, avaliamos diferenças na pressão arterial média (PAM) entre a artéria radial e femoral durante cirurgia cardíaca pediátrica para determinar a eficácia do monitoramento da PA da artéria femoral. Método: Realizamos uma análise retrospectiva de prontuários médicos de crianças com menos de 1 ano de idade submetidas a cirurgia de coração aberto entre 2007 e 2013. As PAs radial e femoral foram auferidas simultaneamente, as diferenças entre esses valores foram analisadas diversas vezes: após a inserção do cateter, após o início do bypass cardiopulmonar (CPB-on), após pinçamento cruzado da aorta (ACC), após a liberação do ACC, após desmame do CPB, na entrada na unidade de terapia intensiva (UTI) e a cada 6 horas durante o primeiro dia na unidade de terapia intensiva (UTI). Resultados: Um total de 121 pacientes submetidos a cirurgia de coração aberto atenderam aos nossos critérios de inclusão. Durante o transoperatório, do início ao término do CPB, as PAMs da artéria radial foram significativamente menores do que as PAMs da artéria femoral em cada ponto de medição (p < 0,05). A análise multivariada mostrou que a duração mais longa do CPB (> 60 minutos, Razão de Chance = 7,47) representou um fator de risco de pressão radial mais baixa. Contudo, as diferenças entre esses dois valores desapareceram após a entrada na UTI. Não houve incidência de complicações isquêmicas associadas à cateterização de ambas as artérias. Conclusão: Sugerimos que o monitoramento da pressão arterial femoral pode ser realizado com segurança, mesmo em neonatos, e fornece valores da PA mais precisos durante períodos de CPBon e imediatamente após o desmame do CPB, principalmente nos casos em que a duração do CPB foi superior a 60 minutos.
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Humans , Male , Female , Infant, Newborn , Infant , Cardiopulmonary Bypass , Monitoring, Intraoperative/methods , Radial Artery/physiology , Femoral Artery/physiology , Arterial Pressure/physiology , Cardiac Surgical Procedures/methods , Retrospective StudiesABSTRACT
Objective To discuss the clinical effect of normal saline flushing and heparinized saline flushing in invasive arterial blood pressure monitoring in the critical patients. Methods A total of 140 critical patients were randomly divided into the experimental group and the control group with 70 cases in each group according to the envelope method. The experimental group used normal saline for tube flushing, the control group used heparinized saline (5 U/ml) for tube flushing. The incidence of complications and coagulation index were compared between two groups. Results There was no statistically difference in the incidence of the catheter jam and local infection (P>0.05). The incidence of bleeding events was 14.3% (10/70) in the control group, which was higher than 2.9% (2/70) of the experimental group. The difference was statistically significant(χ2=4.466, P<0.05). The activated partial thromboplastin time, prothrombin time of the control group were (32.22 ± 4.22) s, (11.56 ± 2.12) s, which were longer than (29.84 ± 3.64) s, (10.66 ± 1.48) s of the experimental group. And international normalized ratio of the control group was 1.12±0.14, which was higher than 1.03±0.20 of the experimental group. The difference was statistically significant (t values were-3.573,-2.912,-3.084, P <0.05). Conclusions The normal saline flushing liquid was more safer and reliable in the invasive arterial blood pressure monitoring.
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Objective To investigate the feasibility of the upper- arm electronic sphygmomanometer for evaluating the blood pressure in patients with atrial fibrillation. Methods Consecutive hospitalized patients with atrial fibrillation for coronary angiography were selected, and the application of upper- arm electronic sphygmomanometer and mercury sphygmomanometer of blood pressure were applied and in the process of coronary angiography, the radial artery invasive blood pressure was recorded and the correlation was analyzed. Results Mercury sphygmomanometer and radial artery invasive blood pressure measurement had a good consistency on systolic blood pressure, diastolic blood pressure, pulse pressure, mean arterial pressure in atrial fibrillation patients, the differences were not statistically significant (P>0.05). Upper- arm electronic sphygmomanometer and radial artery invasive blood pressure measurement had some consistency (pulse rate range, pulse rate of 70-90 beats / min) on systolic blood pressure, diastolic blood pressure, pulse pressure, mean arterial pressure in atrial fibrillation patients, the differences were not statistically significant (P>0.05). Upper-arm electronic sphygmomanometer and mercury sphygmomanometer had some consistency (pulse rate range, pulse rate of 70-90 beats / min) on systolic blood pressure, diastolic blood pressure, pulse pressure, mean arterial pressure in atrial fibrillation patients, the differences were not statistically significant (P>0.05). The correlation between mercury sphygmomanometer and radial artery invasive blood pressure measurement were found on systolic blood pressure, diastolic blood pressure, pulse pressure, mean arterial pressure in atrial fibrillation patients (r=0.71-0.78, P<0.05),which were better than those of upper- arm electronic sphygmomanometer and radial artery invasive blood pressure measurement (r=0.53-0.70, P <0.05). Conclusions The upper- arm electronic sphygmomanometer can be used for the assessment of blood pressure in patients with atrial fibrillation.
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Objective To make a comparison between noninvasive blood pressure (NIBP) and invasive blood pressure (IBP). Method Totally 450 patients undergoing selective surgery received radial artery or dorsalispedis artery puncture and catheter under local anesthesia to figure out the difference between NIBP and IBP. Results The systolic blood pressure difference of IBP from different positions and NIBP were as follows:left radial artery group (18.20 ± 0.67, 15.27 ± 0.62) mmHg, right radial artery group (18.54 ± 0.79, 14.68 ± 0.77) mmHg, left foot dorsal artery group (41.98 ± 2.26, 40.54 ± 1.77) mmHg and right foot dorsal artery group (37.57 ± 0.01, 37.93 ± 2.90) mmHg. The noninvasive systolic blood pressure difference between left and right arms was (2.84 ± 0.45) mmHg, the noninvasive diastolic blood pressure difference (3.19 ± 0.34) mmHg, and the noninvasive mean blood pressure difference (2.85 ± 0.35) mmHg. The NIBP of right arm was higher than that of left arm. Conclusions IBP is higher than NIBP, and the invasive artery systolic blood pressure is about 20mmHg higher than noninvasive systolic blood pressure. Meanwhile we confirm that systolic blood pressure gradually rises over 30 years old, and diastolic blood pressure increases while gradually declines after 50.
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PURPOSE: Photoplethysmography (PPG) is a noninvasive optical technology that detects changes in blood volume in the vascular system. This study aimed to investigate the possibilities of monitoring the cardiovascular system status by using PPG. MATERIALS AND METHODS: Forced hemodynamic changes were induced using cardiac stimulants; dopamine and epinephrine, and PPG components were recorded by a noninvasive method at the peripheral blood vessels. The results were compared among 6 dogs. Endotracheal intubation was performed after an intramuscular injection of 25 mg/kg ketamine sulfate, and anesthesia was maintained with 2% enflurane. After stabilizing the animals for 15 min, 16 mg/mL diluted dopamine was injected into a vein for 2 min at 20 microgram/kg.min(-1) by using an infusion pump. Thereafter, the infusion pump was stopped, and 1 mg epinephrine was injected intravenously. Fluid administration was controlled to minimize preload change in blood pressure. RESULTS: After stimulant administration, systolic blood pressure (SBP) and diastolic blood pressures (DBP) increased. The direct current (DC) component, which reflects changes in blood volume, decreased while the alternating current (AC) component, which reflects changes in vascular compliance and resistance, increased. The correlation coefficient between SBP and the foot of the DC component was 0.939 (p < 0.01), while it was 0.942 (p < 0.01) for DBP and the peak of the DC component. The AC component could predict the increase in vascular resistance from a stable pulse blood volume, even with increased pulse pressure. Conclusions: These results support the possibility that PPG components may be used for easy and noninvasive measurement of hemodynamic changes in the cardiovascular system.
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Animals , Humans , Blood Pressure/physiology , Blood Pressure Monitors , Dogs/physiology , Models, Animal , Photoplethysmography/methodsABSTRACT
Objective To investigate the difference between invasive and non-invasive blood pres-sure monitoring for patients after mechanic valve replacement. Methods Invasive or non- invasive blood pressure of 40 patients after mechanic valve replacement were continuously monitored for 24 hours, and the results underwent t test. Results There was a significant difference between invasive and non-invasive blood pressure monitoring for patients within 12 hours after mechanic valve replacement, but no difference was seen between them after 12 hours. Conclusions It can provide more accurate bases by monitoring blood pressure invasively at early stage after mechanic valve replacement, and it can be replaced by non-invasive blood pressure monitoring 12 hours after mechanic valve replacement.
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Objective To find the way of predicting invasive blood pressure.Methods 47 subjects were enrolled into the study.Non-invasive blood pressure (NBP) measurements were performed by the oscillometric device.The corresponding invasive blood pressure (IBP) reading was obtained from a radial intra-arterial catheter on the same arm.The index of the blood vessel structure was measured by two-dimensional ultrasound,homodynamic parameters of carotid and radial artery were measured by using the color Doppler ultrasound.Linear relation between IBP and NBP,as well as IBP and indices measured by non-invasive methods Was analyzed by regression method. Canonical correlation analysis was also conducted to find out the potential predictive factors of invasive blood pressure. Results The regression equation was:Y=17.21-64.357X1+2.802X2+1.324X3(Yrepresents ISBP,Xl represents RRI,X2 represents RPI,X3 represents NSBP).The first canonical correlation coefficients can be explained the correlation between index measured by non-invasive methods and invasive blood pressure.Conclusion Invasive blood pressure can be predicted from non-invasive blood pressure and hemodynamic parameters.In addition to noninvasive systolic hlood pressure and radial artery resistance index.the potential predictive factors of invasive blood pressure includes explmned by non-invasive diastolic blood pressure,radial pulsating index,carotid shear rate and carotid peak systolic velocity.
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BACKGROUND: Venous regurgitation into the infusion line and subsequent occlusion frequently occurs during blood pressure (BP) measurement. The purpose of this study was to obtain the pattern and the actual range of peripheral venous pressure (PVP) change during NIBP measurement before and during enflurane anesthesia. METHODS: Adult size NIBP cuff was placed on the same arm on which IV infusion set was placed. PVP waveforms during BP measurement were recorded from 6 subjects. PVPs were measured before induction and at 30 min after induction of enflurane anesthesia (n=19). As the PVP waveform during NIBP measurement was biphasic in shape, values of baseline PVP (BEFORE), first peak (PEAK1), notch between two peaks (NOTCH), second peak (PEAK2) were measured. Timed control data were obtained from six volunteers. RESULTS: PEAK2 was always higher than PEAK1. Range of peak PVP was 12-130 mmHg (57.6 2.5 mmHg, mean S.E.) and PVP change was augmented during enflurane anesthesia (p<0.05). Enflurane anesthesia accentuated correlationship between mean arterial pressure and PVP. CONCLUSION: Our observation showed that peak PVP occurred during deflation phase and its range of variation was substantial. Changes in the pattern and the autoregulation of PVP by enflurane needs further investigation.
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Adult , Humans , Anesthesia , Arm , Arterial Pressure , Blood Pressure , Enflurane , Homeostasis , Venous Pressure , VolunteersABSTRACT
We had examined the invasive blood pressure monitoring of superficial temporal, radial and femoral artery in two eases of Takayasus syndrome with mitral regurgitation and acute renal artery infarction. Mitral valve replacement and aorto-renal bypass graft were done by using cardiopulmonary bypass and one-lung ventilation respectively, The results are ; 1) Superficial temporal artery monitoring was more reliable and less fluctuant than femoral and radial artery monitoring in blood pressure. But we dont know the relationship of adequate cerebral perfusion pressure and superficial temporal artery pressure. 2) The femoral artery pressure monitoring was not adequate when the patients had a problem with ascending and descending aorta patency. 3) We had good results in the patient management by the monitoring of superficial temporal artery pressure.
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Humans , Aorta, Thoracic , Blood Pressure Monitors , Blood Pressure , Cardiopulmonary Bypass , Femoral Artery , Infarction , Mitral Valve , Mitral Valve Insufficiency , One-Lung Ventilation , Perfusion , Radial Artery , Renal Artery , Temporal Arteries , TransplantsABSTRACT
This paper introduces the configuration, classification, present status and trend of invasive blood pressure sensor.