Comparison of Intraoperative Ultrasound-guided Versus Technique Modified Subclavian Vein Puncture During Implantation of Totally Implanted Port / 肿瘤防治研究

Objective To compare the success rate and complication rate between real-time ultrasound-guided and technique modified methods of right subclavian vein puncture in tumor patients during implantation of totally implanted port, and to evaluate their effectiveness and safety. Methods We randomly divided 260 tumor patients into ultrasound-guided group and technique modified group, and compared the success rate, pneumothorax, arterial injury, ectopic catheter, local hematoma, puncture times, pinch-off syndrome, etc. Results The success rate of primary puncture in the ultrasound-guided group was better than that in the technique modified group (96.92% vs. 86.15%, P=0.002). The overall complication of the ultrasound-guided group was lower than that of the technique modified group (0 vs. 9.23%, P < 0.001). The incidence of pneumothorax (0 vs. 3.85%, P=0.024) and accidental arterial injury (0 vs. 3.08%, P=0.044) in the ultrasound-guided group were lower than those in the technique modified group. There was no arteriovenous fistula and pinch-off syndrome in any group. Conclusion Compared with the technique modified group, the ultrasound-guided group has more advantages in puncture. Patients with vascular variability can be detected in time.

Peripheral vein puncture assisted with Eyes-On vascular imaging glasses in vulneralis shock / 中国实用护理杂志

Objective To evaluate peripheral vein puncture assisted with Eyes-On vascular imaging glasses in vulneralis shock. Methods Between February 2017 and June 2018, 110 patients in vulneralis shock were distributed to treatment group, and 128 patients between January 2016 and January 2017 were distributed to control group. Peripheral vein puncture were underwent in treatment group assisted with Eyes-On vascular imaging glasses, and with traditional operation in control group. Successful rate of first puncture, second puncture, puncture more than three times, and failure rate, operating time, rate of complications were recorded. Results Successful rate of first puncture in treatment group and control group were 97.03% (98/101) and 9.38% (12/128). There was significant difference between two groups (χ2=173.771, P=0.001). Operating time of treatment group and control group were (1.16 ± 0.41), (5.01±1.03) min, there was significant difference between two groups (t=7.693, P<0.01). In the observation group, puncture was successful while in the control group, puncture failed in 5 cases, with a failure rate of 3.91% (5/128). And there was no significant difference in failure rate of puncture (P >0.05). Regard as complications, there were no significant differences in leakage and bleeding (P>0.05), but there were significant differences in blockage and hematoma which were 5.94% (6/101), 1.98% (1/101) and 21.09% (27/128), 11.71% (15/128) ( χ2=10.510, 7.791, P<0.01). Conclusion Eyes-On vascular imaging glasses can operated easily and vein imaging directly, and nurses can independently proceed puncture quickly and effectively in vulneralis shock. Eyes-On glasses is a recommended device.

Peripheral vein puncture assisted with Eyes-On vascular imaging glasses in vulneralis shock / 中国实用护理杂志

Objective@#To evaluate peripheral vein puncture assisted with Eyes-On vascular imaging glasses in vulneralis shock.@*Methods@#Between February 2017 and June 2018, 110 patients in vulneralis shock were distributed to treatment group, and 128 patients between January 2016 and January 2017 were distributed to control group. Peripheral vein puncture were underwent in treatment group assisted with Eyes-On vascular imaging glasses, and with traditional operation in control group. Successful rate of first puncture, second puncture, puncture more than three times, and failure rate, operating time, rate of complications were recorded.@*Results@#Successful rate of first puncture in treatment group and control group were 97.03% (98/101) and 9.38% (12/128). There was significant difference between two groups (χ2=173.771, P=0.001). Operating time of treatment group and control group were (1.16±0.41), (5.01±1.03) min, there was significant difference between two groups (t=7.693, P<0.01). In the observation group, puncture was successful while in the control group, puncture failed in 5 cases, with a failure rate of 3.91%(5/128). And there was no significant difference in failure rate of puncture (P >0.05). Regard as complications, there were no significant differences in leakage and bleeding (P>0.05), but there were significant differences in blockage and hematoma which were 5.94%(6/101), 1.98%(1/101) and 21.09%(27/128), 11.71%(15/128)(χ2=10.510, 7.791, P<0.01).@*Conclusion@#Eyes-On vascular imaging glasses can operated easily and vein imaging directly, and nurses can independently proceed puncture quickly and effectively in vulneralis shock. Eyes-On glasses is a recommended device.

Clinical efficacy of improved TIPS therapy in portal hypertension with acute upper gastrointestinal bleeding / 实用放射学杂志

Objective To discuss the clinical efficacy of improved TIPS of percutaneous portal vein puncture in treatment of acute upper gastrointestinal bleeding induced by portal hypertension.Methods 28 patients with acute upper gastrointestinal bleeding underwent improved TIPS therapy in our hospital were enrolled.The clinical data,laboratory parameters and hemodynamic changes were collected and analyzed before and after operation.Results The success rate for the first time and hemostatic rate of postoperative 24 hours in all patients was 100%.2(7.14%)patients underwent mild hepatic encephalopathy.After TIPS operation,the concentration of serum albumin increased,whereas,concentration of total bilirubin and alanine aminotransferase decreased(P<0.01).Portal vein pressure (PVP)of pre-and post-operation was(41.48 ± 3.72)mmHg and(28.91 ± 2.59)mmHg,and the hepatic venous pressure gradient (HVPG)was(20.30 ± 2.76)mmHg and(8.81 ± 2.04)mmHg.PVP and HVPG were both decreased significantly after operation(P<0.01).Conclusion Improved TIPS therapy can obtain good clinical efficacy and safety for esophageal and gastric varicose bleeding in acute cirrhosis.

Pneumothorax related to subclavian vein puncture: analysis of the causes in 47 patients / 介入放射学杂志

Objective To investigate the risk factors that may induce pneumothorax resulted from subclavian vein puncture during interventional therapy for arrhythmia.Methods The clinical data of 4 351 patients with heart disease,who were admitted to Wuhan Asia Heart Disease Hospital,China,during the period from January 2010 to January 2014 to receive subclavian vein puncture for the performance of radiofrequency catheter ablation or pacemaker implantation,were retrospectively analyzed.The gender,age,presence of chronic obstructive pulmonary disease (COPD) and the shape of clavicle of patients who developed pneumothorax were analyzed,and their relationships with the occurrence of pneumothorax were evaluated.Results Of the 4 351 patients,47 patients developed pneumothorax(1.08％),their age was 12-72 years old with a mean of (47.1±18.4) years old.Among the 47 patients,37 patients were females (78.7％).The angle between clavicle and sternum ＜60°(oblique clavicle) was seen in 27 patients,coexisting COPD was seen in 2 patients.The occurrence of pneumothorax was strikingly higher in females than that in males (OR=2.7,95％ CI=1.4-5.2).In patients with oblique clavicle the risk of pneumothorax was obviously increased (OR=3.5,95％ CI=1.6-7.9) and in patients with COPD the probability of pneumothorax was remarkably increased (OR=2.3,95％CI=1.2-4.7).No special treatment was employed in 5 pneumothorax patients,and the pneumothorax was absorbed by itself.In 19 patients,the pneumothorax was relieved through thoracic puncture and suction.Closed drainage of thoracic cavity was employed in 23 patients.All patients were discharged from hospital with complete rehabilitation.Conclusion Clinically,pneumothorax has been an important clinical problem in interventional therapy.In female patients and in patients who have oblique clavicle or coexisting COPD,pneumothorax is more likely to occur when they receive subclavian vein puncture.

Application of axillary vein puncture needle technique in premature infants with low birth weight / 中国生化药物杂志

Objective To investigate the clinical effect of axillary vein puncture needle technique in the infusion of low birth weight infants.Methods The study group received axillary venipuncture indwelling needle technique, the control group was given head intravenous indwelling needle technique, compared the related anomalies incidence of two groups of low birth weight infants during intravenous infusion catheter. Results The incidence of abnormal occlusion, phlebitis, oozing of blood in preterm infants with low birth weight infants (2.13%,4.26% and 2.13%) were significantly lower than those in the control group (19.15%,27.66%,17.02%), respectively (P＜0.05). Conclusion The application of axillary vein puncture needle technique can significantly reduce the incidence of adverse reactions associated with infusion of low birth weight infants, and has positive significance in ensuring the efficacy and prognosis.

Application of axillary vein puncture needle technique in premature infants with low birth weight / 中国生化药物杂志

Objective To investigate the clinical effect of axillary vein puncture needle technique in the infusion of low birth weight infants.Methods The study group received axillary venipuncture indwelling needle technique, the control group was given head intravenous indwelling needle technique, compared the related anomalies incidence of two groups of low birth weight infants during intravenous infusion catheter. Results The incidence of abnormal occlusion, phlebitis, oozing of blood in preterm infants with low birth weight infants (2.13%,4.26% and 2.13%) were significantly lower than those in the control group (19.15%,27.66%,17.02%), respectively (P＜0.05). Conclusion The application of axillary vein puncture needle technique can significantly reduce the incidence of adverse reactions associated with infusion of low birth weight infants, and has positive significance in ensuring the efficacy and prognosis.

Effects of propfol and midazolam for sedation effect of central venous puncture / 局解手术学杂志

Objective To compare the effect of propofol and Midazolam for the vein puncture and indicators of respiratory cycle in the e-mergency center. Methods According to different anaesthetic,100 patients who needed for central venepuncture in patients,were randomly divided into Propofol group (50 cases) and Midazolam group (50 cases),given different dose input,and evaluated by RSS(Ramsay Sedation Scale,RSS) . In terms of the onset time and recovery time of consciousness,the central venous puncture were performed with all the patients. Results There was no significant difference in the process of sedation effect on respiration and circulation of the patients between 2 groups. And the differences between 2 groups with the time of reaching RSS-5 were no statistical significance,while the differences of consciousness recovery time between 2 groups were statistical significance. Conclusion The appropriate dosage and velocity of Propofol and Midazolam can quickly achieve central vein puncture,with slight influence on respiratory and circulatory system and no serious adverse reaction. But the onset time and consciousness recovery time of the Propofol which has a good controllability was shorter than those of Midazolam.

Prospective randomized comparison of single pacemaker implantation using the subclavian vein puncture versus the cephalic vein cutdown / 中国综合临床

Objective To compare the value of pacemaker implantation using the subclavian vein (SCV) puncture and thecephalic vein(CV) cutdown approach.Methods One hundred and forty-six patients were randomized into SCV group (98 patients) and CV group (48 patients).We observed the success rate,surgery duration,fluoroscopy time and complications of the two groups.Results The SCV group had significantly higher success rate,shorter duration of surgery and fluoroscopy than the CV group (success rate:100％ (98/98) vs.89％ (43/48),x2 =10.5,P ＜ 0.05 ; duration of surgery:(118 ± 35) min vs.(256 ± 75)min,t =12.12,P ＜0.01 ; duration of fluoroscopy:(15 ±5) min vs.(35 ± 10) min,t =13.08,P ＜0.01).Both groups had one case who developed compilations which were pocket hematoma and wire electrode dislocation respectively.The rate of complications was not significantly different between the two groups (P ＞ 0.05).Conclusion The SCV approach should be considered a preferable access in pacemaker implantation.

Venas superficiales de la fosa cubital: aspectos anátomo-clínicos y antropológicos / Superficial veins of the cubital fossa: anatomo-clinic and anthropologic aspects

Es bastante frecuente el acceso a las venas superficiales de la fosa cubital, siendo uno de los sitios más utilizados para punción venosa. Aunque es un procedimiento simple, es invasivo y a veces doloroso. La disposición de las venas superficiales de la región cubital ha sido descrita por numerosos autores y en diversos grupos étnicos, describiéndose variaciones y diversas padronizaciones. Las venas superficiales de la fosa cubital se han descrito formando una M, N, Y y W. Numerosos estudios, en distintas razas y grupos étnicos han demostrado similitudes y diferencias en la disposición de las venas superficiales de la fosa cubital. En 1908 Berry & Newton determinaron que en el 83% de los hombres británicos la vena cefálica del antebrazo (VCA) y la vena basílica del antebrazo (VB A) eran conectadas por la vena mediana del codo (VMCo). Okamoto (1922) en hombres japoneses, determinó 3 Tipos de padrones venosos: Tipo I donde la VCA origina la VMCo, no existe la vena cefálica accesoria del antebrazo (VCAA), y la VCA no se duplica; Tipo II, caracterizado por la duplicación de la VCA y un Tipo III, que incluye la VCAA que drena en la VCA. En hombres blancos y negros Charles (1932) señaló que la distribución más frecuente (cerca de 70% de los casos), era aquella donde la VCA y la VB A eran conectadas por la VMCo. Soller et al. (1962, 1964) en africanos de África Occidental, distinguieron tres tipos de formaciones venosas. Grupo I. Disposición clásica, tipos en M o aparentes (38,1%). Grupos II y III descritas como disposiciones de tipo embrionario constituyen el 62% de los casos. Halim & Abdi (1974) en hindúes, observaron tres tipos: 1) Tipo I. La VCA y la VBA son conectadas por la VMCo; Tipo II. La VCA drena en la VBA; la vena mediana del antebrazo (VMA) drena en la VCA. Tipo III. No existe comunicación entre la VCA y la VBA en la fosa cubital y la subdividen en Tipos IIIA y III B. Wasfi et al. (1986) describieron ...

Access of the cubital fossa to the superficial veins is very frequent, this being one of the most frequent vein puncture sites. Although it is a simple procedure, it is invasive and at times painful. The disposition of the superficial veins of the cubital area has been described by numerous authors and in diverse ethnic groups, describing many variations and various patterning. The superficial veins of the cubital fossa have been independently described, forming an M, N, Y or W. Numerous studies in different races and ethnic groups have demonstrated similarities and differences in the disposition of the superficial veins of the cubital fossa. In 1908 Berry & Newton determined that in 83% of British men the cephalic vein of the forearm (CVF) and the basilic vein of the forearm (BVF) were connected by the median cubital vein (MCV) Okamoto (1922) in Japanese men, determined 3 types of venous patterns. Type I where the CVF originates the MCV, the accessory cephalic vein (ACV) does not exist, and the (CVF) does not duplicate; Type II is characterized by the duplication of the CVF and a Type III, that includes the ACV which drains in the CVF. In white and black men Charles (1932) indicated that the most frequent distribution (nearly 70% of the cases), was that where the CVF and the BFV were connected by the MCV. Soller et al. (1962, 1964) in Africans from West Africa, distinguished three types of venous formations. Group I classic dispositions, types in M or apparent (38.1%) Groups II and III described as dispositions of the embryological type constitute 62% of the cases. Halim & Abdi (1974) observed 3 types in Hindus types: 1) Type I. The CVF and the BVF are connected by the MCV; Type II. The CVF drains in the BVF: the median vein of the forearm (MVF) drains in the CVF. Type III. There is no communication between the CVF and the BFV in the cubital fossa and it is subdivided in Types III A and III B. Wasfi et al. (1986) described ...

Avaliação do processo anti-séptico em sitio de punção venosa de doadores de sangue / Anti-septic process evaluation in veins puncture besiege of blood givers

Considerando que o sangue coletado, processado e transfundido deve apresentar o menor risco possível de contaminação, necessário se faz uma anti-sepsia com eficácia comprovada, já que pesquisas apontam falhas anti-sépticas como ponto mais crítico das contaminações bacterianas de hemocomponentes. Assim, este trabalho teve como objetivo avaliar o processo anti-séptico usado em doadores de sangue do Hemonúcleo Regional de Francisco Beltrão - PR (HRFB). Para isso foi utilizada uma metodologia que consistiu em duas coletas de microorganismos de pele de cada individuo: uma antes e outra após anti-sepsia. As amostras (165) foram divididas e avaliadas por três diferentes metodologias, colhidas com swabs estéreis embebidos em solução de cloreto de sódio a 0,9%. Os swabs foram semeados em ágar-sangue de carneiro a 5%. A incubação foi a 36º C, e a contagem foi realizada após 24 e 48 horas, respectivamente. Evidenciou-se na comparação das três metodologias que a anti-sepsia com álcool a 70%, e vigorosa fricção do algodão com técnica correta, aliada ao tempo de ação do anti-séptico sobre a pele é o ponto fundamental para a eficácia da redução de microrganismos de pele.

Considering that the collected, processed and transfused blood must present the lesser possible contamination risk, it’s necessary makes an antisepsis with proven effectiveness, since research points anti-septic imperfections as more critical point of the bacterial hemocomponents contaminations. Thus, this work had as objective to evaluate the anti-septic process used in givers of blood from the Hemonucleo Regional of Francisco Beltrao - PR (HRFB). For this, it was used a methodology that consists of two collections of skin microorganisms of each individual: one before and another one after antisepsis. The samples (165) had been divided and evaluated for three different methodologies, harvested with swabs barren absorbed in sodium chloride solution 0,9 %. The swabs had been sown in sheep agar-blood at 5 %. The incubation was at 36º C, and the counting was carried through 24 and 48 hours after, respectively. It was proven in the comparison of the three methodologies that the antisepsis with alcohol at 70%, and vigorous cotton friction with correct technique, allied to the anti-septic action time on the skin, is the basic point for the micro-organisms reduction effectivenessat skin.

Meta analysis of two approaches for central venous catheterization through deep vein puncture / 中国实用护理杂志

Objective The incidence rate of complication during central venous catheterization through internal jugular vein (IJV) and subclavian vein (SV) puncture. Methods Clinical controlled trials about IJV and SV puncture were collected and related literatures were screened according to the criteria of inclusion. The literatures underwent Meta analysis and subsequent analysis of sensitivity. Results A total of 18 literatures were included. Meta analysis indicated that statistical difference existed in the related infection rate [RR=1.74, 95%CI (1.32, 2.30)] and arterial puncture [RR=3.19, 95%CI (1.70, 5.99)], but not in the one-time-puncture success rate [RR=1.06, 95%CI (0.90, 1.24)] between IJV and SV puncture. Conclusions The rate of related infection and arterial puncture was higher by IJV than by SV puncture. But we could not confirm if any difference existed in the one-time-puncture success rate between the two methods. The results still needs evaluation by high-quality randomly controlled experiments.

Formaciones Venosas de la Fosa Cubital en el Individuo Mapuche: Estudio Bioscópico / Venous Formations in the Cubital Fossa of Mapuche: Bioscopy Study

Las venas superficiales de la fosa cubital constituyen uno de los sitios más importantes para punción venosa. La disposición de esas venas presenta numerosas variaciones y, la disposición de ellas no ha sido estudiada en el grupo étnico mapuche. Debido a esto, y considerando a este grupo como el mayor conglomerado étnico de América del Sur, efectuamos este estudio. Fueron analizadas las venas superficiales de la fosa cubital, en 300 miembros superiores (150 derechos y 150 izquierdos) de individuos de ambos sexos (30 hombres y 120 mujeres), chilenos del grupo étnico mapuche, con edades entre 15 y 84 años. El estudio fue realizado en las postas rurales adyacentes a la ciudad de Temuco. Basados en la clasificación de del Sol et al. (1988) para las formaciones venosas de la fosa cubital, obtuvimos los siguientes resultados: Tipo I (38,7%), la vena cefálica (VC) se divide en vena intermedia basílica (VIB) y vena intermedia cefálica (VIC), uniéndose a la vena basílica (VB) y vena cefálica accesoria (VCA), respectivamente. La VIB era de mayor calibre y la vena intermedia del antebrazo (VIA) drenaba, generalmente, en la VB; Tipo II (28,3%), la VC origina la vena intermedia del codo (VICo), que se une a la VB. No existe VCA, siendo la VICo de mayor calibre y la VIA drena en la VB; Tipo III (24%), no existe comunicación entre la VB y VC a nivel de la fosa cubital. La VIA drena en la VB; Tipo IV (4,3%), la VC drena en la VB y la VIA drena en la VC; Tipo V otras disposiciones, donde se incluye la M clásica (1%) que resulta de la división de la VIA. La utilización de las VIC y VC se recomienda cuando ellas tienen un calibre semejante a la VIB o a la VICo ya que los riesgos de punción de otras estructuras anatómicas importantes, como ramos anteriores del nervio cutáneo medial del antebrazo o arteria braquial, son mínimos.

The superficial veins of the cubital fossa constitute one of the most important sites for vein puncture. The availability of those veins present numerous variations, and the availability of these has not been studied in the Mapuche ethnic group. In view of the above, and considering this group as the greatest ethnic conglomerate in South America the study took place. The superficial veins of the cubital fossa were analized in 300 superior members (150 right and 150 left) in subjects of both sexes (30 men and 120 women) Chileans of the Mapuche ethnic group between 15 and 84 years of age. The study was realized in rural clinics near the city of Temuco. Based on the classification of del Sol et al. (1988) for the vein formation of the cubital fossa, the following results were obtained: type I (38.7%), the cephalic vein (VC) is divided in the intermediate basilic vein (VIB) and intermediate cephalic vein (VIC), joining thebasilic vein (VB)and accessory cephalic vein (VCA) respectively. The VIB was of a major caliber and the intermediate vein of the forearm (VIA) generally drained in the VB, Type II (28,3%), the VC originates the intermediate vein of the elbow (VICo), that joins the VB. VCA does not exist, th VICo being of a mayor caliber and the VIA drains in to VB, Type III (24%) no communication exists between the VB and VC at the level of the cubital fossa, the VIA drains into VB, Type IV (4,3%), the VC drains in the VB and VIA drins in the VC; Type V other dispositions where the classic M is included (1%) which results in the division of the VIA. The use of the VIC and VC is recommended when they have a similar caliber to that of the VIB of VICo. Because the puncture risks of other important anatomic structures, such as anterior branches of the medial cutaneous nerve of the forearm or brachial artery are minimal.

Complex Regional Pain Syndrome followed by Artery and Vein Puncture: A report of 2 cases / 대한통증학회지

No definitive etiology or risk factors have been identified that predispose individuals to developing complex regional pain syndrome (CRPS). We experienced two cases of CRPS developed after arterial and venous puncture which were done in regular medical work. A 35-years old female patient was suffered from pain and allodynia with swelling at right hand and wrist after radial artery puncture for monitoring of blood pressure during general anesthesia. A 24-years old male patient had pain and swelling with allodynia at the right fingers and arm after median cubital vein puncture for blood sampling. They did not have proper pain management as CRPS patients in the past weeks and months after their pain occurred. They were diagnosed as CRPS and started undergoing various interventional procedures, which led to improve their pain condition. Our cases suggest that CRPS could develop without any proved tissue damage in routine medical practice. In conclusion, health care workers should be educated in knowledge about the uncommon medical condition and proper consultation to pain specialist when it happens.