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La traqueotomía percutánea por dilatación es un procedimiento que se realiza en las unidades de paciente crítico, implica la disección roma de los tejidos pretraqueales, seguida de la dilatación de la tráquea sobre la guía y la inserción de la cánula traqueal mediante la técnica de Seldinger. En las últimas décadas, la evidencia sugiere que, en manos de médicos capacitados, es al menos tan segura como la traqueotomía quirúrgica, con similar incidencia de complicaciones. La selección adecuada de pacientes y el uso de herramientas de seguridad complementarias, como broncoscopio o ultrasonido, disminuyen las tasas de falla y complicaciones. Siendo contraindicaciones absolutas para traqueotomía percutánea por dilatación una anatomía anormal, tumor maligno en el sitio de traqueostomía, coagulopatías o vía aérea difícil. La guía mediante broncoscopia permite la evaluación de la profundidad del tubo endotraqueal, confirma la posición de la aguja en el eje de la tráquea y la adecuada inserción del cable guía y dilatador. Entre sus desventajas destacan que, el sitio de punción está sujeto a sesgo y no puede guiar con precisión la aguja en la penetración de la tráquea. La traqueotomía percutánea guiada por ultrasonido es una alternativa validada en unidades, donde no se cuente con broncoscopia. Es un método rápido, seguro, que permite la identificación de estructuras anatómicas, vasculatura cervical, permite identificar el sitio de la punción y guía la inserción de la aguja en la tráquea. Esta técnica presenta altas tasas de éxito al primer intento, reduciendo significativamente el número de punciones.
Percutaneous dilation tracheostomy is a procedure performed in critical patient units. It involves blunt dissection of the pretracheal tissues followed by dilation of the trachea over the guidewire and insertion of the tracheal cannula using the Seldinger technique. In recent decades, evidence suggests that in the hands of trained physicians it is at least as safe as surgical tracheostomy, with a similar incidence of complications. The proper selection of patients and the use of complementary safety tools such as bronchoscope or ultrasound reduce failure rates and complications. Being absolute contraindications for PDT abnormal anatomy, malignant tumor at the tracheostomy site, coagulopathies, or difficult to treat airway. Bronchoscopy guidance allows evaluation of the depth of the endotracheal tube, confirms the position of the needle in the axis of the trachea and the proper insertion of the guide wire and dilator. Among its disadvantages are that the puncture site is subject to slant and cannot accurately guide the needle into the trachea. In addition, it requires Critical Patient Units with bronchoscope and trained personnel. Ultrasound-guided percutaneous tracheotomy is a validated alternative in units where bronchoscopy is not available. It is a fast, safe method that allows the identification of anatomical structures, cervical vasculature, identifies the puncture site and guides the insertion of the needle into the trachea. With high first-attempt success rates, significantly reducing the number of punctures.
Subject(s)
Humans , Tracheotomy/methods , Dilatation/methods , Trachea/diagnostic imaging , Ultrasonography, Doppler, Color/methodsABSTRACT
Los accesos venosos centrales son técnicas de uso regular en el ámbito hospitalario, es por ello que la investigación tiene como Objetivo: Establecer la incidencia de complicaciones asociadas a la colocación de accesos venosos centrales en pacientes atendidos en el Hospital Militar Universitario "Dr. Carlos Arvelo". Métodos: estudio prospectivo, de selección intencional de pacientes en el ámbito hospitalario que presenten complicaciones asociadas a la canalización de accesos venosos centrales; a los cuales se les aplicó un cuestionario donde se registraron, además de datos demográficos y clínicos, los resultados del funcionamiento del acceso venoso central. Al séptimo día se retiró o se recambió el acceso venoso central y se tomó muestra para cultivo y antibiograma de la punta de catéter. Los datos fueron tabulados, analizados en gráficos y tablas. Resultados: Uno de los principales hallazgos fueron las complicaciones infecciosas en un 65.93 % y producto de complicaciones mecánicas un 34.05 % del grupo de estudio. Las complicaciones infecciosas fueron atribuibles en su mayoría a Staphylococcus aureus (27,39 %), Pseudomona sp (21,91 %), Stenotrophomonas maltophilia (16,44%), Burkholderia cepacia (10,95 %) y Klebsiella pneumonia (5,48 %). En cuanto al porcentaje de éxito de las intervenciones se encontró que el promedio de intentos fue de 5 con una desviación estándar de ± 3 intentos y una duración promedio menor a 30 minutos en 90 de los casos representando el 76,27 % y duración mayor de 30 minutos en 28 casos representando 23,7 %. Conclusiones: Los accesos venosos yugulares internos fueron los procedimientos más frecuentes seguido de los accesos subclavios, sin predilección de lateralidad alguna. Al revisar los hallazgos se puede evidenciar que la punción arterial se convierte en la complicación mecánica más frecuente produciendo hematomas y equimosis con un alto porcentaje de intentos superiores a 30 minutos o un número de intentos mayores a tres, así como las complicaciones infecciosas generadas por el Staphylococcus aureus y sin que dichas complicaciones se encontraran asociadas al tipo de abordaje estudiado, tiempo de intervención u otros factores de carácter demográfico(AU)
Central venous accesses are a technique of regular use in the hospital environment, that is why the objective of this research is: to establish the incidence of complications treated at the University Military Hospital "Dr. Carlos Arvelo". Methods: prospective study, of intentional selection of patients in the hospital setting who present complications associated to the cannulation of central venous accesses; to whom a questionnaire was applied where, in addition to demographic and clinical data, the results of the central venous access operation were registered. On the seventh day, the central venous access was removed or replaced and a sample was taken for culture and antibiogram of the catheter tip. Data were tabulated, analyzed in graphs and tables. Results: One of the main findings was infectious complications in 65.93 % and mechanical complications in 34.05 % of the study group. Infectious complications were mostly attributable to Staphylococcus aureus (27.39 %), Pseudomona sp (21.91 %), Stenotrophomonas maltophilia (16.44 %), Burkholderia cepacia (10.95 %) and Klebsiella pneumonia (5.48 %). Regarding the percentage of success of the interventions, it was found that the average number of attempts was 5 with a standard deviation of ± 3 attempts and an average duration of less than 30 minutes in 90 of the cases representing 76.27 % and duration greater than 30 minutes in 28 cases representing 23.7 %. Conclusions: Internal jugular venous accesses were the most frequent procedures followed by subclavian accesses, with no predilection for laterality. When reviewing the findings, it can be evidenced that arterial puncture becomes the most frequent mechanical complication producing hematomas and ecchymosis with a high percentage of attempts longer than 30 minutes or a number of attempts longer than three, as well as infectious complications generated by Staphylococcus aureus and without these complications being associated to the type of approach studied, time of intervention or other demographic factors(AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Vascular Access Devices , Central Venous Catheters , Patients , Pseudomonas , Staphylococcus aureus , Stenotrophomonas maltophilia , Catheter-Related Infections , Catheters , Hospitals , Infections , Klebsiella pneumoniaeABSTRACT
Objective: To investigate the success rate and safety of modified Seldinger technique (MST) in implementing jugular vein catheterization under ultrasound-guided. Methods: 300 patients who prepared to receive jugular vein catheterization were divided into observation group (n=150 ) and control group (n=150). The patients of observation group were implemented jugular vein catheterization by using MST under ultrasound-guided, and that of control group were implemented conventional technique to achieve jugular vein catheterization. The effect of jugular vein catheterization, complication and satisfaction of patients between the two groups were compared and researched. Results: The success rates of catheterization in one time and total catheterization of observation group were significantly higher than that of control group (t=4.925, t=4.623, P<0.05). The puncture time of observation group was significantly lower than that of the control group (t=10.432, P<0.05). The incidences of bleeding at puncture point, phlebitis, catheter-related infection, and blocked catheter of the observation group were significantly lower than those of the control group (t=5.684, t=5.556, t=4.623, t=4.624, P<0.05), respectively. For puncture, the satisfaction of patients of observation group was significantly higher than that of control group (Z=-2.734, P<0.05). Besides, the incidence of venous thrombosis and unplanned extubation of the observation group was not significant difference with that of the control group. Conclusion:The jugular vein catheterization by using MST under ultrasound-guided can significantly increase the success rate of catheterization, reduce puncture complications and enhance satisfaction of patient.
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Objective To investigate the clinical effect of adopting B-type ultrasound guided peripherally inserted central catheter (PICC) in the patients with lung cancer.Methods Two hundreds and ninety-five cases of lung cancer undergoing PICC in our hospital from January 2011 to May 2016 were selected as the research subjects and divided into the observation group (151 cases) and control group (144 cases) according to the PICC methods.PICC in the observation group adopted the B-type guided modified Seldinger technique,while the control group adopted the conventional method.The venous thrombus occurrence situation in the two groups was comparatively analyzed.Results (1) The platelet count (PLT),plasma D dimer (D-D) and thromboxane B2 (TXB2),endothelin (ET),6-keto-prostaglandin F1 alpha (6-keto-PGF1α) before PICC had no signigicant difference between the two groups (P>0.05).PLT,D-D,TXB2 and ET at 12,24 h after PICC in the observation group and control group were gradually increased,while plasma 6-keto-PGF1α was gradually decreased,the intra-group difference among different time points had statistical significant (P<0.05).PLT and plasma D-D,TXB2 and ET in the observation group were significantly lower than those in the control group,while keto-PGF1α was significantly higher than that in the control group,the difference between the two groups was statistically significant(P<0.05).(2)The incidence rate of venous thrombosis in the observation group was significantly lower than that in the control group,the difference was statistically significant between the two groups (P<0.05).Conclusion Adopting B-type ultrasound guided modified Seldinger technique for PICC in the patients with lung cancer has much lower incidence rate of venous thrombosis.
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Objective To share our experience in the placement of a peripherally inserted central cathe -ter ( PICC) in critically ill patients intensive care unit ( ICU) .Method The clinical data of a critically ill pa-tient placed with PICC from neurosurgery department were collected and analyzed .Result A 78-year-old male patient diagnosed with type I respiratory failure , aspiration pneumonia , hypertension , and cerebral infarction sequelae successfully received ultrasound-guided modified Seldinger puncture technique for PICC and was trea-ted with intravenous nutrition after repeatedly vascular puncturing failure .Conclusion PICC placement is an effective method for patients in ICU to protect the peripheral vein and lower the incidence of catheter related in -fections.
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Background: The modification in technique is useful for successful right-sided internal jugular vein (IJV) cannulation on the same side even after intra-arterial puncture without using ultrasound guidance in adult patients. Materials and Methods: This study was carried out in total 160 adult patient from American Society of Anesthesiologists Grade II to III patients male (n = 95) and female (n = 65) who underwent cardiac surgery where cannulation was done on right sided by triple lumen catheter (7 French) using Seldinger technique. Results: Majority of patients were cannulated successfully by Seldinger technique with single or double attempt except for five patients in which arterial puncture occurred. All five patients were cannulated successfully on the same side with this modified technique without any significant major complications. They were managed by application of blocker at the end of arterial needle puncture without removing it. In our routine practice, we were used to removing this needle and applying compression for few minutes to prevent hematoma formation after an arterial puncture. In this study, cannula was used as a marker or guideline for the relocation of IJV on the same side and recannulation was performed by changing the direction of needle on same side lateral to the previous one and without going towards the same direction to prevent the arterial puncture again. Conclusion: Most simple and useful modified technique for institutes where the complications are most common with trainee doctors and in hospitals where there is no advanced facility like ultrasound-guided cannulation available. By this modification, it will be time saving, very comfortable, and user-friendly technique with high success rate.
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Objective To explore the application of ultrasound- guide modified Seldinger technique for upper arm PICC insertion in infant patients. Methods Use the ultrasound-guide modified Seldinger technique to inserted PICC for 27 infant patients. Results All 27 cases were inserted successfully, success rate of the one puncture reached 92.6%. Conclusions By adequate preparation for infants, effective immobilization and good cooperation of operators, and combined with techniques which prevent PICC misplacement, overcome the shortcoming of bad vessel and non-compliance of infant patients, develop the advantage of ultrasound, could improve the rate of successful catheterization of upper arm PICC insertion in infant patients, and protect the vessels.
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Objective To investigate training of the ultrasound-guided modified Seldinger technique(MST)for cannulation of PICC.Method Twenty-nine nurses trained with the traditional training on ultrasound-guided MST during December 2009 to December 2011 were set as control group and another 29 nurses trained with the systematic training during December 2011 to December 2013 were as experiment group.The training effect were compared between the two groups after 2 months training.Results The theoretical knowledge in the experiment group was improved significantly compared with the control group. Moreover, the success rate of catheterization in the experiment group was 100.0%,significantly higher than that in the control group(both P<0.01).Conclusion Systematic training system is more effective than the traditional training.It can improve the nurses’technical and theoretical knowledge on ultrasound-guided MST for PICC.
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Objective To investigate the effect of ultrasound technology combined with Seldinger technique in the catheteration of peripherally inserted central catheter(PICC).Methods One thousand and eight malignant tumor patients undergoing PICC catheteration were divided into two groups:those with visible or palpable bouncy vein as the control group(n=540)and those with invisible or impalpable elbow vein as the experiment group(n=468).The control group were treated with PICC catheteration into the elbow vein as normal control group and in the experiment group the catheteration was done into the lower part of the upper arm of the basilic vein or brachial vein as the puncture point under the guidance of ultrasound with Seldinger technique.The two groups were compared in terms of success rate of one time puncturing, success rate of one time catheterization and postoperative phlebitis,venous thrombosis and catheter related infection rate.Result There were no significant difference in the success rate for one time puncturing,while the success rate of one time catheterization in the experiment group was significantly higher than that in the control group and the mechanical phlebitis,venous thrombosis,catheter related infection rate in the experiment group were significantly lower than those in the control group(P<0.001).Conclusion Ultrasound technology combined with Seldinger technique for PICC catheterization can obtain high success rate,lower postoperative complications and provide high security.
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Objective To investigate the role of modified Seldinger technique combined with vascular ultrasonography in the placement of peripherally inserted central catheters (PICC) in patients with breast cancer undergoing postoperative chemotherapy.Methods Totally 120 patients with breast cancer undergoing postoperative chemotherapy were equally divided into the observation group and the control group using the table of random number.In the observation group,PICC were placed using the modified Seldinger technique combined with vascular ultrasonography; in the control group,the PICC were placed using the traditional blind puncture technique.The success rate of first puncture,success rate of first placement,and the incidences of mechanical phlebitis and thrombosis were compared between two groups.Results The success rate of first puncture,success rate of first placement,and the incidences of mechanical phlebitis were 91.67％,100％,and 3.33％,respectively,in the observation group and 76.67％,86.67％,and 45％,respectively,in the control group (P =0.0061,P =0.0434,and P ＜ 0.0001).However,no significant difference was found on the incidence of thrombosis between the two groups (P =0.1187).Conclusion Modified Seldinger technique combined with vascular ultrasonography is efficient and safe for PICC placement for patients with breast cancer undergoing postoperative chemotherapy.
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ObjectiveTo investigate the applicability and superiority of modified Seldinger technique (MST).MethodsTotally 108 patients receiving peripherally inserted central catheter (PICC) through vascular ultrasound combined with MST technology were enrolled as MST group and another 108 patients receiving PICC using traditional direct vision method as control group.The first puncture success rate,PICC succesa rate,catheterization time required,and early complication rate were compared between these two groups.ResultsThe first puncture success rate was 88.89％ in MST group and 72.22％ in control group (P=0.002) ; the catheterization success rate was 82.41％ in MST group and 57.41％ in control group ( P =0.000).In the MST group,there were two cases where the catheter within neck was ectopic ( P =0.003 ),two cases experienced bleeding at the puncture sites (P =0.017),three cases had phlebitis (P =0.001 ),and one case suffered from catheter blockage (P=0.010).In the eontrol group,the corresponding numbers were 13,10,18,and 9.However,the time required for PICC showed no significant difference between these two groups (P=0.685).In the MST group,15 cases were catheterized in less than 15 minutes,72 cases between 15 and 25 minutes,and 21 cases for more than 25 minutes.In the control group,12 cases were catheterized in less than 15 minutes,70 cases between 15 and 25 minutes,and 26 cases for more than 25 minutes.ConclusionPICC through MST can be more effective in positioning the targeting blood vessels,increasing the success rate of catheter insertion,reducing various tissue damages,and lowering potential complications.
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Objective To investigate the common problems and countermeasure of using ultrasound-guided modified Seldinger technique in peripherally inserted central catheter (PICC) placement Method The clinical data of 140 patients who underwent PICC placement using ultrasound-guided modified Seldinger technique were retrospectively analyzed. Results The success rate of catheterization was 98. 6% among these 140 patients,with 135 (96. 4% ) succeeded after a single attempt and 5 (3. 6% ) after 2 attempts. Besides, 7. 1% (n = 10) had difficulty in inserting the guide wire, 3. 6% (n =5) had difficult catheteration, 2. 1% (n =3) met resistance when inserting catheter into ipsilateral subclavian vein, 2. 1 % (n = 3 ) experienced dystopia of inserting catheter into internal jugulular vein, and 1.4% (n = 2) experienced the bending of PICC in the superior vena cava and axillary vein. All of these problems were handled successfully. Conclusions The common problems of PICC placement include puncture failure, difficulty in inserting guide wire, and difficult catheteration. A good knowledge of these problems will help increase the success rate.
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J-guide wires have been widely used for central venous catheterization with the popularity of the Seldinger technique. However, many adverse sequelae of central venous catheterization have been reported. We report two cases of J-guide wire breakage during central venous catheterization. Venipuncture by a steel needle was easily achieved in each case. However, insertion of a J-guide wire was difficult to perform, and pulling out the guide wire from the steel needle was more difficult, which caused breakage of the core and the uncoiling of the spring coil of the guide wire. The tip of the guide wire was not cut off, and there were no complications. With the removal of the guide wire, weak resistance was felt that which was not supposed to be sufficient to cut off the guide wire. It was assumed that an inherent fault in the manufacturing process of the guide wire could lead to this type of breakage.
Subject(s)
Catheterization, Central Venous , Central Venous Catheters , Needles , Phlebotomy , SteelABSTRACT
Intubation of an double-lumen endotracheal tube (DLT) in either a normal or a difficult airway may be more difficult than the intubation of a single-lumen endotracheal tube (ETT). A 72-year-old man undergoing right upper lobectomy could not be intubated with either a 37 Fr or a 35 Fr DLT after induction of anesthesia due to an inability to visualize the glottis. Difficult intubation had not been foreseen, but inspection through the laryngoscope revealed a Cormack grade III condition. Following two attempts to place the DLT, fibroptic bronchoscopy also proved unsuccessful. We intubated a 8.0 mm ETT with OELM (optimal external laryngeal manipulation) and followed this by inserting an infusion set catheter into the ETT as a guiding stylet. The ETT was then withdrawn with the catheter in situ in the trachea, and a 35 Fr DLT successfully introduced. After removing the catheter, the position of the DLT was corrected by fibroptic bronchoscopy. No further complication occurred and surgery was finished satisfactory. We achieved successful DLT intubation using the modified Seldinger technique with an infusion set catheter through an intubated ETT in a patient with an unanticipated difficult airway.