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1.
Rev. bras. enferm ; 75(5): e20210418, 2022. tab, graf
Article in English | LILACS-Express | LILACS, BDENF | ID: biblio-1360879

ABSTRACT

ABSTRACT Objective: to evidence the use of flushing to prevent complications from intravenous therapy. Methods: an integrative review in databases, using descriptors and selection criteria. Data were collected in 12 articles using an instrument and later classified, summarized and aggregated for knowledge synthesis. Results: it was evident that: the pre-filled syringe resulted in a lower occurrence of catheter obstruction; irregular flushing frequency caused advanced phlebitis; the use of Venous Arterial Blood Management Protection (VAMP) generated a lower incidence of blood infection; heparinized solution did not result in a lower central catheter failure rate; flushing volume and frequency were not predictors of catheter failure; flushing practice was not shown to be incorporated among professionals. Conclusion: there are disagreements about the volume, frequency, solution and devices used in flushing. New technologies can reduce complications such as obstruction and infection.


RESUMEN Objetivo: buscar evidencia sobre el uso del flushing para prevenir complicaciones en la terapia intravenosa. Métodos: revisión integradora de bases de datos, utilizando descriptores y criterios de selección. Los datos se recolectaron de 12 artículos utilizando un instrumento y, posteriormente, se clasificaron, resumieron y agregaron para la síntesis de conocimientos. Resultados: se evidenció que: la jeringa precargada resultó en la menor incidencia de obstrucción del catéter; la frecuencia irregular del flushing causaba flebitis avanzada; el uso del dispositivo de Venous Arterial Blood Management Protection (VAMP) resultó en una menor incidencia de infecciones sanguíneas; la solución heparinizada no dio como resultado una tasa de falla del catéter central más baja; el volumen y la frecuencia del flushing no fueron predictores de falla del catéter; no se demostró que la práctica del flushing se incorpore entre los profesionales. Conclusión: existen desacuerdos sobre el volumen, la frecuencia, la solución y los dispositivos utilizados en el flushing. Las nuevas tecnologías pueden reducir complicaciones como la obstrucción y la infección.


RESUMO Objetivo: buscar evidências sobre o uso do flushing para prevenir a ocorrência de complicações na terapia intravenosa. Métodos: revisão integrativa em bases de dados, com emprego de descritores e critérios de seleção. Os dados foram coletados em 12 artigos com utilização de instrumento e, posteriormente, classificados, sumarizados e agregados para síntese do conhecimento. Resultados: evidenciou-se que: a seringa pré-carregada resultou na menor ocorrência de obstrução do cateter; a frequência irregular do flushing ocasionou flebite avançada; o uso do dispositivo Venous Arterial Blood Management Protection (VAMP) gerou menor incidência de infecção sanguínea; a solução heparinizada não resultou em menor taxa de falha do cateter central; o volume e frequência do flushing não foram preditores de falha do cateter; a prática do flushing não se mostrou incorporada entre os profissionais. Conclusão: há divergências sobre o volume, frequência, solução e dispositivos utilizados no flushing. Novas tecnologias podem reduzir complicações, como obstrução e infecção.

2.
Rev. enferm. UERJ ; 29: e61291, jan.-dez. 2021.
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1354365

ABSTRACT

Objetivo: discorrer sobre as recomendações para prática de enfermagem mais atuais no manejo de cateter central de inserção periférica (PICC) em recém-nascidos (RNs). Conteúdo: a assistência ao RN com PICC vem sofrendo diversas alterações em relação às formas de mensuração do tamanho do cateter a ser inserido e de visualização da veia a ser puncionada, aos fatores que influenciam a escolha do sítio de inserção, ao acompanhamento da migração do cateter, à confirmação da ponta do PICC e a outros cuidados de manutenção e remoção do dispositivo. Conclusão: houve uma grande evolução do conhecimento referente ao manejo do PICC na população neonatal, mas ainda existem lacunas de conhecimento a serem exploradas. Espera-se uma melhoria da assistência ao RN que receberá um PICC.


Objective: to discuss the most current recommendations for nursing practice in the management of the peripherally inserted central catheter (PICC) in newborns (NBs). Content: care for NBs with PICCs has undergone several changes as regards measuring the size of the catheter to be inserted and visualizing the vein to be punctured, factors influencing choice of insertion site, monitoring for catheter migration, confirming PICC tip position, and other precautions for device maintenance and removal. Conclusion: knowledge of PICC management in newborns has advanced greatly, but still features gaps to be explored. Care for NBs who receive a PICC is expected to improve.


Objetivo: discutir las recomendaciones más actuales para la práctica de enfermería sobre el manejo de catéteres centrales de inserción periférica (PICC) en recién nacidos (RN). Contenido: la asistencia al RN con PICC ha sufrido varios cambios en relación con las formas de medir el tamaño del catéter a insertar y la visualización de la vena a puncionar, los factores que influyen en la elección del sitio de inserción, el seguimiento de la migración del catéter, la confirmación de la punta del PICC y otras precauciones de mantenimiento y extracción del dispositivo. Conclusión: ha habido una gran evolución del conocimiento sobre el manejo de PICC en la población neonatal, sin embargo, aún existen brechas de conocimiento por explorar. Se espera una mejora en la asistencia al RN que recibirá un PICC.

3.
Rev. enferm. UERJ ; 29: e57284, jan.-dez. 2021.
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1342436

ABSTRACT

Objetivo: analisar o uso de cateter vesical de demora em unidade de terapia intensiva. Método: estudo observacional, transversal, descritivo, documental, realizado em uma unidade de terapia intensiva no Rio de Janeiro, entre maio e agosto de 2020. Amostra por conveniência, composta por 190 prontuários de pacientes com esse dispositivo. Utilizou-se questionário relacionado à caracterização dos pacientes, critérios de inserção; boas práticas; complicações não infecciosas. Os dados foram analisados pela estatística descritiva, apresentados em frequência absoluta e relativa. Para eventos não infecciosos, foi realizado o Teste Exato de Fischer, com auxílio do programa Statistical Package for Social Sciences. Resultados: a inserção de cateter vesical de demora se deu majoritariamente no sexo feminino (123-64,7%), pacientes com média de 62,9 anos e diagnóstico de COVID 19 (97 - 51,1%). Em 134 (70,5%) dos casos, os critérios foram atendidos. Conclusão: reforça-se a importância do cumprimento de protocolos e boas práticas no uso do cateter vesical de demora.


Objective: to analyze the use of indwelling bladder catheters in an intensive care unit. Method: this descriptive, cross-sectional, documentary study was conducted in an intensive care unit in Rio de Janeiro, between May and August 2020 with a convenience sample, comprising 190 medical records of patients with such devices. A questionnaire was used to characterize the patients, insertion criteria, best practices and non-infectious complications. The data were analyzed by descriptive statistics, presented in absolute and relative frequencies. For non-infectious events, Fischer's Exact Test was performed using the Statistical Package for Social Sciences. Results: indwelling bladder catheters were inserted mostly in females (123; 64.7%), patients with mean age 62.9 years, and diagnosis of COVID 19 (97; 51.1%). In 134 (70.5%) of cases, the criteria were met. Conclusion: the findings underline the importance of compliance with protocols and good practices when using indwelling bladder catheters.


Objetivo: analizar el uso del catéter vesical de larga duración en una unidad de cuidados intensivos. Método: estudio observacional, transversal, descriptivo, documental, realizado en una unidad de cuidados intensivos en Río de Janeiro, entre mayo y agosto de 2020. Muestra de conveniencia, compuesta por 190 historias clínicas de pacientes con este dispositivo. Se utilizó un cuestionario relacionado con la caracterización de los pacientes, criterios de inserción; buenas prácticas; complicaciones no infecciosas. Los datos fueron analizados por estadística descriptiva, presentados en frecuencia absoluta y relativa. Para los eventos no infecciosos, se realizó la Prueba Exacta de Fischer, con la ayuda del programa Statistical Package for Social Sciences. Resultados: la inserción de catéter vesical de larga duración se produjo principalmente en mujeres (123- 64,7%), pacientes con media de edad de 62,9 años y diagnóstico de COVID 19 (97 - 51,1%). En 134 (70,5%) de los casos, se cumplieron los criterios. Conclusión: Se refuerza la importancia del cumplimiento de protocolos y buenas prácticas en el uso del catéter vesical de larga duración.

4.
Rev. enferm. UERJ ; 29: e61291, jan.-dez. 2021. graf
Article in Portuguese | LILACS-Express | LILACS, BDENF | ID: biblio-1365796

ABSTRACT

RESUMO Objetivo discorrer sobre as recomendações para prática de enfermagem mais atuais no manejo de cateter central de inserção periférica (PICC) em recém-nascidos (RNs). Conteúdo a assistência ao RN com PICC vem sofrendo diversas alterações em relação às formas de mensuração do tamanho do cateter a ser inserido e de visualização da veia a ser puncionada, aos fatores que influenciam a escolha do sítio de inserção, ao acompanhamento da migração do cateter, à confirmação da ponta do PICC e a outros cuidados de manutenção e remoção do dispositivo. Conclusão houve uma grande evolução do conhecimento referente ao manejo do PICC na população neonatal, mas ainda existem lacunas de conhecimento a serem exploradas. Espera-se uma melhoria da assistência ao RN que receberá um PICC.


RESUMEN Objetivo discutir las recomendaciones más actuales para la práctica de enfermería sobre el manejo de catéteres centrales de inserción periférica (PICC) en recién nacidos (RN). Contenido la asistencia al RN con PICC ha sufrido varios cambios en relación con las formas de medir el tamaño del catéter a insertar y la visualización de la vena a puncionar, los factores que influyen en la elección del sitio de inserción, el seguimiento de la migración del catéter, la confirmación de la punta del PICC y otras precauciones de mantenimiento y extracción del dispositivo. Conclusión ha habido una gran evolución del conocimiento sobre el manejo de PICC en la población neonatal, sin embargo, aún existen brechas de conocimiento por explorar. Se espera una mejora en la asistencia al RN que recibirá un PICC.


ABSTRACT Objective to discuss the most current recommendations for nursing practice in the management of the peripherally inserted central catheter (PICC) in newborns (NBs). Content care for NBs with PICCs has undergone several changes as regards measuring the size of the catheter to be inserted and visualizing the vein to be punctured, factors influencing choice of insertion site, monitoring for catheter migration, confirming PICC tip position, and other precautions for device maintenance and removal. Conclusion knowledge of PICC management in newborns has advanced greatly, but still features gaps to be explored. Care for NBs who receive a PICC is expected to improve.

5.
Estima (Online) ; 19(1): e2321, jan.-dez. 2021. tab
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1353119

ABSTRACT

Objetivo:avaliar a satisfação da pessoa com retenção urinária diante do uso de diferentes tipos de cateteres vesicais bem como comparar e analisar diferentes atributos desses após a sua utilização no cateterismo intermitente limpo (CIL). Método: estudo exploratório descritivo de corte transversal, desenvolvido em um ambulatório de referência do estado de São Paulo, no período de fevereiro a março de 2020. A amostra constituiu-se de 32 adultos cadastrados no serviço, e que adotavam o CIL como forma de esvaziamento vesical. A coleta de dados foi realizada por entrevista individual com a utilização de um questionário semiestruturado. Os dados foram analisados por estatística descritiva, inferencial e categorização das respostas para as questões abertas. Resultados: dos 32 usuários, 84% eram do sexo masculino, com média de idade de 54,16 anos, 81% realizavam o procedimento entre 1 a 5 anos, com frequência de 4 a 6 vezes ao dia (66%). A maioria dos entrevistados (73%) preferiu o cateter de poliuretano com revestimento hidrofílico, convergindo com o percentual de usuários satisfeitos com o mesmo cateter. Conclusão: a tecnologia com maior satisfação é o cateter de poliuretano com revestimento hidrofílico devido a diversos atributos, como lubrificação, firmeza, embalagem, deslizamento na uretra, manipulação, eliminação rápida da urina e conforto


Objective:to assess the satisfaction of the person with urinary retention in the face of the use of different types of urinary catheters, as well as to compare and analyze different attributes of these after their use in clean intermittent catheterization (CIC). Method: descriptive exploratory cross-sectional study, developed in a reference clinic in the state of São Paulo, from February to March 2020. The sample consisted of 32 adults registered in the service, and who adopted the CIC as a form of bladder emptying . Data collection was performed through individual interviews using a semi-structured questionnaire. Data were analyzed using descriptive, inferential statistics and categorization of responses to open questions. Results: of the 32 users, 84% were male, with a mean age of 54.16 years, 81% performed the procedure between 1 and 5 years, with a frequency of 4 to 6 times a day (66%). Most respondents (73%) preferred the hydrophilic-coated polyurethane catheter, converging with the percentage of users satisfied with the same catheter. Conclusion: the most satisfying technology is the hydrophilic-coated polyurethane catheter due to several attributes such as lubrication, firmness, packaging, urethral slip, handling, rapid urine clearance and comfort


Objetivo:evaluar la satisfacción de la persona con retención urinaria ante el uso de diferentes tipos de catéteres vesicales, así como comparar y analizar diferentes atributos de estos después de su utilización en el cateterismo intermitente limpio (CIL). Método: estudio exploratorio descriptivo de corte transversal, desarrollado en un ambulatorio de referencia del estado de San Pablo, en el período de febrero a marzo del 2020. La muestra se constituye de 32 adultos registrados en el servicio, y que adoptaban el CIL como forma de vaciamiento vesical. La recogida de datos fue realizada por entrevista individual con la utilización de un cuestionario semiestructurado. Los datos fueron analizados por estadística descriptiva, inferencial y categorización de las respuestas para las preguntas abiertas. Resultados: de los 32 usuarios, 84% eran del sexo masculino, con promedio de edad de 54,16 años, 81% realizaban el procedimiento entre 1 a 5 años, con frecuencia de 4 a 6 veces al día (66%). La mayoría de los entrevistados (73%) prefirió el catéter de poliuretano con revestimiento hidrófilo, convergiendo con el porcentual de usuarios satisfechos con el mismo catéter. Conclusión: la tecnología con mayor satisfacción es el catéter de poliuretano con revestimiento hidrófilo debido a diversos atributos, como lubricación, firmeza, embalaje, deslizamiento en la uretra, manipulación, eliminación rápida de la orina y comodidad


Subject(s)
Self Care , Urinary Bladder, Neurogenic , Urinary Catheterization , Health Education , Enterostomal Therapy
7.
Rev. enferm. Inst. Mex. Seguro Soc ; 29(3): 150-159, 04-oct-2021. tab
Article in Spanish | LILACS, BDENF | ID: biblio-1357925

ABSTRACT

Introducción: las infecciones de las vías urinarias relacionadas con la instalación de catéter vesical son de las infecciones asociadas a la atención sanitaria más comunes en México y el mundo. Representan un riesgo latente para el desarrollo de complicaciones y pueden ocasionar la muerte. Objetivo: analizar los factores de riesgo que se asocian directamente a la infección del tracto urinario en la instalación del catéter vesical. Metodología: estudio observacional, descriptivo y transversal, con muestra de 90 pacientes de un hospital de segundo nivel de atención en el que se identificaron los factores de riesgo de infección de vías urinarias asociadas a la instalación de sonda vesical. Resultados: se observó un tipo de cumplimiento de los indicadores de calidad durante la instalación de sonda vesical con frecuencia en el 52.22% de los participantes. Un tipo de cumplimiento con frecuencia en el 48.90% de los participantes durante el mantenimiento de la sonda vesical, y un tipo de cumplimiento con frecuencia del 47.78% al momento del retiro de la sonda. Los principales factores de riesgo identificados asociados a la infección del tracto urinario fueron: a) que la sonda sea instalada por un médico interno, b) una estancia mayor a 3 días en urgencias y c) que la sonda sea instalada por una enfermera general. Conclusiones: se encontraron indicadores de cumplimiento cercano al 50%, lo que se considera muy bajo en la medición de los indicadores de calidad durante la instalación, mantenimiento y retiro de la sonda vesical, incluso estos están por debajo del porcentaje nacional.


Introduction: Urinary tract infections related to the installation of a bladder catheter are the most common infections associated with health care in Mexico and the world. They represent a latent risk for the development of complications and can cause death. Objective: To analyze the risk factors that are directly associated with urinary tract infection in the installation of the bladder catheter. Methods: Observational, descriptive and cross-sectional study; with a sample of 90 patients from a second-level care hospital in which the risk factors for urinary tract infection associated with the installation of a urinary catheter were identified. Results: A type of compliance with the quality indicators was observed during the urinary catheter installation with a frequency of 52.22% of the participants. A type of compliance with a frequency of 48.90% of the participants during the maintenance of the urinary catheter, and a type of compli- ance with a frequency of 47.78% at the time of catheter removal. The main risk factors identified associated with urinary tract infection were: a) that the catheter is installed by an intern, b) a stay of more than 3 days in the emergency room, and c) that the catheter is installed by a general nurse. Conclusions: Compliance indicators were found close to 50%, which is considered very low in the measurement of quality indicators during the installation, maintenance and removal of the urinary catheter, even these are below the national percentage.


Subject(s)
Humans , Urinary Tract , Urinary Tract Infections , Cross-Sectional Studies , Urinary Catheters , Secondary Care , Mexico
8.
J. pediatr. (Rio J.) ; 97(5): 564-570, Sept.-Oct. 2021. tab, graf
Article in English | LILACS | ID: biblio-1340152

ABSTRACT

Abstract Objective: To evaluate the influence of intra-abdominal pressure on the cardiac index (CI) at different intra-abdominal hypertension grades achieved when performing an abdominal compression maneuver (ACM). Evaluating the effectiveness of the ACM in distending the left internal jugular vein (LIJV). Methods: Prospective observational study conducted in the PICU of a quaternary care teaching hospital. Participants underwent the ACM and the IAP was measured with an indwelling urinary catheter. At each IAH grade reached during the ACM, the CI was measured by transthoracic echocardiography and the LIJV cross-sectional area (CSA) was determined by ultrasonography. Results: Twenty-four children were included (median age and weight of 3.5 months and 6.37 kg, respectively). The median CI observed at baseline and during IAH grades I, II, III, and IV were 3.65 L/min/m2 (IQR 3.12−4.03), 3.38 L/min/m2 (IQR 3.04−3.73), 3.16 L/min/m2 (IQR 2.70−3.53), 2.89 L/min/m2 (IQR 2.38−3.22), and 2.42 L/min/m2 (IQR 1.91−2.79), respectively. A 25% increase in the LIJV CSA area was achieved in 14 participants (58%) during the ACM. Conclusion: The ACM significantly increases IAP, causing severe reversible impairment in the cardiovascular system and is effective in distending the LIJV in just over half of the subjects. Even low levels of HIA can result in significant cardiac dysfunction in children. Therefore, health professionals should be aware of the negative hemodynamic repercussions caused by the increased IAP.


Subject(s)
Humans , Child , Critical Illness , Intra-Abdominal Hypertension , Prospective Studies , Ultrasonography , Hemodynamics
11.
Rev. bras. ciênc. vet ; 28(2): 111-116, abr./jun. 2021. il.
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1367979

ABSTRACT

Objetivou-se no presente estudo comparar as técnicas de coleta de urina via sondagem uretral e cistocentese guiada por ultrassom, afim de verificar se o método de coleta pode influir nos resultados laboratoriais. Foram utilizados 12 cães machos, sem histórico de enfermidades, dos quais coletou-se cinco mililitros (mL) de urina via sondagem uretral e cinco mL via cistocentese guiada por ultrassom, ambas no mesmo momento. Posteriormente foi realizada a análise física (cor, odor, densidade, turbidez), química (urobilinogênio, glicose, corpos cetônicos, bilirrubina, proteína, nitrito, pH, sangue e leucócitos) e sedimentoscopia (avaliação de 10 campos de luz, objetiva de 40x). Cilindros urinários, cristais, corpúsculos gordurosos, espermatozoides, bactérias e células vesicais foram classificados qualitativamente como: ausentes (0), discretos (1), moderados (2) e intensos (3). Hemácias, leucócitos, e células de descamação foram quantificadas a partir da média dos campos analisados. As análises bioquímicas de microalbuminúria, creatinina e proteína total urinárias foram realizadas a partir do sobrenadante urinário, removido das amostras após centrifugação, e utilizados kits reagentes, conforme recomendação do fabricante, sendo a leitura em espectrofotômetro. Em todos os testes realizados os valores de p encontrados foram superiores 0,05 (p>0,05), excluindo-se a possibilidade de haver diferenças significativas dos resultados laboratoriais obtidos pelas duas formas de coleta.


The objective of this study was to compare two techniques of urine collection, urethral catheterization and ultrasound-guided cystocentesis, in order to verify if the collection method may influence the laboratory results. Twelve male dogs were used, with no history of diseases, of which five milliliters (mL) of urine were collected by urethral catheterization and five mL by both at the same time. Subsequently, the samples underwent physical analysis (color, smell, density andturbidity), chemical analysis (urobilinogen, glucose, ketone bodies, bilirubin, protein, nitrite, pH, blood and leukocytes) and sedimentoscopy (evaluation of 10 light fields, 40x objective). Urinary casts, fatty corpuscles, spermatozoa, bacteria and bladder epithelial cells were classified qualitatively as absent (0), discrete (1), moderate (2) and intense (3). Red blood cells, leukocytes and desquamation cells were quantified from the mean of the analyzed fields. The urine supernatants were obtained after centrifugation and were used for biochemical analyzes of microalbuminuria, urinary protein and creatinine. The reagent kits were used as recommended by the manufacturer and the samples were read by spectrophotometry. All tests presented p values higher than 0,05 (p>0,05), excluding the possibility of significant differences between the laboratory results of both forms of urine collection.


Subject(s)
Animals , Dogs , Urinary Catheterization/veterinary , Urinary Reservoirs, Continent/veterinary , Urinalysis/veterinary , Dogs/urine , Urine Specimen Collection/methods , Biochemical Reactions/analysis
13.
Arq. bras. cardiol ; 116(2): 305-312, fev. 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1152996

ABSTRACT

Resumo Fundamento Dados sobre o uso de ressonância magnética cardíaca (RMC) em crianças no Brasil são escassos. Objetivos Buscamos oferecer informações sobre as práticas atuais de RMC pediátricas no Brasil. Métodos Um questionário foi enviado a médicos solicitantes de RMC de todo o país, cobrindo informações sobre si próprios, sobre seus serviços de RMC, contexto clínico dos pacientes e sobre os obstáculos para a realização de RMC em crianças. Para a análise estatística, um p < 0,05 bilateral foi considerado significativo. Resultados A pesquisa obteve 142 respostas. Foi relatado que a RMC está disponível para 79% dos respondentes, dos quais 52% raramente ou nunca a utilizam. As indicações mais comuns são cardiomiopatias (84%), pós-operatório de correção de tetralogia de Fallot (81%) e malformações do arco aórtico (53%). A complexidade do exame se correlacionou à relação RMC/cirurgia (Rho = 0,48, IC 95% = 0,32-0,62, p < 0,0001) e ao número de exames de RMC (Rho = 0,52, IC 95% = 0,38-0,64, p < 0,0001). A complexidade da RMC esteve associada à sua realização por cardiologistas pediátricos (RC 2,04, IC 95% 1,2-3,89, p < 0,01). Os principais obstáculos ao uso mais frequente de RMC foram o alto custo (65%), a necessidade de sedação (60%) e o número insuficiente de profissionais qualificados (55%). Conclusão A RMC pediátrica não é usada frequentemente no Brasil. A presença de um cardiologista pediátrico a frente dos exames esteve associado ao uso de RMC em pacientes mais complexos. O treinamento de especialistas em RMC pediátrica e a educação dos médicos solicitantes são passos importantes na direção de um uso mais abrangente de RMC no Brasil. (Arq Bras Cardiol. 2021; 116(2):305-312)


Abstract Background Data on the use of cardiac magnetic resonance imaging (CMR) on children in Brazil is lacking. Objectives This study sought to provide information on current pediatric CMR practices in Brazil. Methods A questionnaire was sent out to referring physicians around the country. It covered information on the respondents, their CMR practices, the clinical context of the patients, and barriers to CMR use among children. For statistical analysis, two-sided p < 0.05 was considered significant. Results The survey received 142 replies. CMR was reported to be available to 79% of the respondents, of whom, 52% rarely or never use CMR. The most common indications were found to be cardiomyopathies (84%), status of post-tetralogy of Fallot repair (81%), and aortic arch malformations (53%). Exam complexity correlated with CMR-to-surgery ratio (Rho = 0.48, 95% CI = 0.32-0.62, p < 0.0001) and with the number of CMR exams (Rho = 0.52, 95% CI = 0.38-0.64, p < 0.0001). Further, a high CMR complexity score was associated with pediatric cardiologists conducting the exams (OR 2.14, 95% CI 1.2-3.89, p < 0.01). The main barriers to a more frequent use of CMR were its high cost (65%), the need for sedation (60%), and an insufficient number of qualified professionals (55%). Conclusion Pediatric CMR is not used frequently in Brazil. The presence of a pediatric cardiologist who can perform CMR exams is associated with CMR use on more complex patients. Training pediatric CMR specialists and educating referring providers are important steps toward a broader use of CMR in Brazil. (Arq Bras Cardiol. 2021; 116(2):305-312)


Subject(s)
Humans , Child , Brazil , Cardiac Surgical Procedures , Cardiomyopathies , Magnetic Resonance Imaging , Magnetic Resonance Imaging, Cine , Heart
14.
Rev. bras. cir. cardiovasc ; 36(1): 120-124, Jan.-Feb. 2021. graf
Article in English | LILACS | ID: biblio-1155801

ABSTRACT

Abstract Minimally invasive aortic valve replacement has gained consent due to its good results in terms of minimized surgical trauma, faster rehabilitation, pain control and patient compliance. In our experience, we have tried to replicate the conventional and gold standard approach through a smaller incision. Sparing the right internal thoracic artery, avoiding rib fractures and performing total central cannulation is important to make this procedure minimally invasive from a biological point of view too. In addition, the total central cannulation is pivotal to simplify perfusion and drainage. Moreover, a complete step-by-step procedure optimization and-when possible-the use of sutureless prosthesis help to reduce the cross-clamping and perfusion times. After more than 1000 right anterior thoracotomy (RAT) aortic valve replacements, we have found tips and tricks to make our technique more effective.


Subject(s)
Heart Valve Prosthesis , Heart Valve Prosthesis Implantation , Aortic Valve/surgery , Thoracotomy , Treatment Outcome , Sternotomy
15.
Article in Chinese | WPRIM | ID: wpr-911976

ABSTRACT

Objective:To explore the effect of the angle between sagittal part of left portal vein and ductus venous(AsLPVDV), and the diameter of ductus venous(DDV) on the success rate of umbilical venous catheterization (UVC) in neonates.Methods:This was a retrospective study including 80 neonates requireing UVC in Gansu Provincial Women and Child-care Hospital from April 2020 to January 2021. According to the results of UVC, they were grouped into the success group(successful insertion of catheter, n=76) and failure group(failed to insert, n=4), or one-time success group (successful after first insertion attempt, n=43) and non-one-time success group(successful after several attempts or failed to insert, n=37). The AsLPVDV and the DDV were measured before UVC by bedside ultrasound. For those with obstruction of catheterization were guided by pressing the abdomen in right side recumbent position under real-time ultrasound monitoring. The success rate of UVC and the differences of AsLPVDV and DDV among different groups were compared. Chi-square test, t test, or U test were adopted for the comparison among groups. Receiver operating characteristic (ROC) curve was used to evaluate the sensitivity and specificity of the AsLPVDV and the DDV in predicting the one-time success of UVC. Results:The total success rate of UVC was 95%(76/80) and the one-time success rate was 53.8%(43/80). A larger AsLPVDV and DDV were observed in the success group compared with the failure group [(142.2±8.3)° vs (133.6±3.2)°, (3.0±0.4) vs(1.8±0.4) mm, t=6.284 and 2.064, both P<0.05] as well as in one-time success group compared with the non-one-time success group [(147.5±6.2)° vs (135.2±4.7)°, (3.1±0.3) vs (2.8±0.6) mm, t=9.956 and 2.939, both P<0.05]. Area under the curve of AsLPVDV and DDV in predicting one-time success of UVC were 0.944(95% CI:0.869-0.983) and 0.811 (95% CI:0.708-0.890), respectively. The cut-off value was 140.4° for AsLPVDV and 2.9 mm for DDV, with the sensitivity of 93.0% and 90.7%, and specificity of 91.9% and 64.9%, respectively. Conclusions:The success rate of UVC is related to AsLPVDV and DDV. AsLPVDV is of high value in predicting the one-time success of UVC.

16.
Chinese Journal of Urology ; (12): 635-636, 2021.
Article in Chinese | WPRIM | ID: wpr-911085

ABSTRACT

A case of severe complications is presented that replaced the double J tubeless misguided by zebra guidewire into ileum in a patient with ureteral dermostomy, causing a ureteral ileum fistula.The result suggests improper operation of zebra guidewire could have a risk of ureteral perforation when the ureter is distorted, narrow or with inflammatory lesions.Standardized diagnosis and treatment and correct selection of guidewire can reduce the risk of ureteral perforation.

17.
Article in Chinese | WPRIM | ID: wpr-910565

ABSTRACT

Objective:To evaluate the safety and effectiveness of clinical application of " variable diameter measurable pancreatic duct" in laparoscopic pancreaticoduodenectomy (LPD).Methods:A retrospective study was conducted at the Second Hospital, Hebei Medical University Liver Surgical Team from July 2019 to July 2020 using the " HongShi single stitch" method of pancreatic duct to jejunum anastomosis on 147 patients who underwent LPD. According to the type of pancreatic duct, the patients were divided into having normal pancreatic ducts (the normal group, n=61) and those having " variable diameter measuring pancreatic duct" (the variable diameter group, n=86). The perioperative data and postoperative complications were compared and analyzed. Results:There were 89 males and 58 females, aged (56.7±1.5) years. There were no significant differences in age, gender and body mass index between groups ( P>0.05). For the variable diameter group, the diameter of the divided pancreatic stump was (3.2±0.1) mm, and the depth of internal pancreatic duct stenting was (4.7±0.2) cm. However, it could not be measured accurately in the normal group. The incidence of postoperative pancreatic fistula rate was significantly lower in the variable diameter group than the normal group [2.32% (2/61) vs. 11.47% (7/86), P=0.023]. Conclusion:The variable diameter measurement of pancreatic duct was safe and effective in choosing patients to undergo LPD.

18.
Chinese Journal of Trauma ; (12): 1112-1118, 2021.
Article in Chinese | WPRIM | ID: wpr-909984

ABSTRACT

Objective:To systematically compare the prognosis in non-compressible torso hemorrhage(NCTH)treated by resuscitative endovascular balloon occlusion of the aorta(REBOA)and resuscitation thoracotomy(RT).Methods:Data were searched form MEDLINE, EMBASE, PubMed, WanFang, CNKI and VIP databases to collect studies on the prognosis of patients with NCTH undergone REBOA and RT from inception to December 2020. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. The Meta-analysis was performed using Revman 5.3. The patients were divided into REBOA group and RT group according to the different surgical treatment methods on admission, and the prognosis of each group was evaluated. The difference of mortality rate, reoperation rate of laparotomy after operation, reoperation rate of embolization after operation and mortality rate in different operating room area were compared between the two groups. Publication bias was assessed using the Egger test.Results:A total of 2 prospective studies and 4 retrospective studies involving 2, 588 subjects were included. There were 1, 591 patients in REBOA group and 997 patients in RT group. Significant differences were observed in the mortality rate( I2=68%, OR=0.33, 95% CI 0.26-0.42, P<0.01), reoperation rate of laparotomy after operation( I2=76%, OR=1.41, 95% CI 1.11-1.77, P<0.01)and reoperation rate of embolization after operation( I2=84%, OR=0.76, 95% CI 0.59-0.99, P<0.05)between REBOA group and RT group. Subgroup analysis showed that the mortality rate in the ICU were not statistically different between the two groups( I2=83%, OR=0.69, 95% CI 0.45-1.05, P>0.05), but the mortality rate in the emergency room was lower in REBOA group than that in RT group( I2=94%, OR=0.52, 95% CI 0.38-0.70, P<0.01). Egger test showed that publication bias had little effect on the results. Conclusions:For patients with NCTH, REBOA can reduce the mortality rate and reoperation rate of embolization after operation, but increase the reoperation rate of laparotomy after operation when compared with RT. In addition, the emergency room may be a more suitable operationg room area for REBOA.

19.
Chinese Critical Care Medicine ; (12): 755-756, 2021.
Article in Chinese | WPRIM | ID: wpr-909399

ABSTRACT

In order to improve the success rate of supraclavicular deep venous catheterization and reduce mechanical complications, we present an auxillary maneuver in regard to supraclavicular subclavian catheterization basing on the relatively fixed anatomy of subclavian vein and its adjacent surroundings, furthermore, we revised the standardized procedure of supraclavicular subclavian catheterization. The maneuver is summarized in the shape of verses (verses: thumb navigation is well designed according to anatomy. Needle penetrated into vein should be parallel to coronal plane. Fine needle in position should be immobilized. Is it difficult for parallel puncture? Pressure determination is required when needle is in place. It is critical to distinguish which vessel has been inserted. Guidewire is advanced smoothly. Check blood return after expansion of skin and catheterization.). For teaching convenience, verses are considered to be more concise and memorable, as well as applicable to clinical practice, in order to provide some help for clinical teaching.

20.
Article in English | WPRIM | ID: wpr-873525

ABSTRACT

@#BACKGROUND: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the used devices, pain score, and complications between intraosseous (IO) access and central venous catheterization (CVC) in critically ill Chinese patients. METHODS: In this prospective clustered randomized controlled trial, eight hospitals were randomly divided into either the IO group or the CVC group. Patients who needed emergency vascular access were included. From April 1, 2017 to December 31, 2018, each center included 12 patients. We recorded the data mentioned above. RESULTS: A total of 96 patients were enrolled in the study. There were no statistically significant differences between the two groups regarding sex, age, body mass index, or operator satisfaction with the used devices. The success rates of the first attempt and the procedure time were statistically significant between the IO group and the CVC group (91.7% vs. 50.0%, P<0.001; 52.0 seconds vs. 900.0 seconds, P<0.001). During the study, 32 patients were conscious. There was no statistically significant difference between the two groups regarding the pain score associated with insertion. There were statistically significant differences between the two groups regarding the pain score associated with IO or CVC infusion (1.5 vs. 0.0, P=0.044). Complications were not observed in the two groups. CONCLUSIONS: IO access is a safe, rapid, and effective technique for gaining vascular access in critically ill adults with inaccessible peripheral veins in the emergency departments.

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