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2.
J. bras. nefrol ; 42(1): 38-46, Jan.-Mar. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1098336

ABSTRACT

ABSTRACT Introduction: The vascular access cannulation technique varies among clinics, and guidelines on vascular access give little importance to cannulation techniques. The objective of this study was to evaluate the cannulation technique and to determine which factors are associated with each detail of the technique. Material and methods: The vascular access cannulation was evaluated in 260 patients undergoing hemodialysis. The type and anatomical location of the vascular access, the cannulation technique, direction, gauge, and distance between needles, besides bevel direction and needle rotation were registered. Results: The arteriovenous fistula was the most frequent vascular access (88%), the most used cannulation technique was area (100%), the needle direction was anterograde in most cases (79.5%), and the mean distance between the tips of needles was 7.57±4.43 cm. For arteriovenous grafts, the proximal anatomical location (brachial artery) and cannulation with 16G needles in anterograde position were more predominant. For arteriovenous fistulas, the distal anatomical location (radial artery) and cannulation through 15G needles were more common. Cannulation of vascular access in retrograde direction was associated with a greater distance between needles (13.2 ± 4.4 vs 6.1 ± 3 cm, p < 0.001). Kt/V was higher when the distance between needles was higher than 5 cm (1.61 ± 0.3 vs. 1.47 ± 0.28, p < 0.01). Conclusions: The vascular access cannulation technique depends on the vascular access characteristics and expertise of cannulators. Clinical trials are required for the formulation of guidelines for vascular access cannulation.


RESUMO Introdução: A técnica de canulação do acesso vascular varia entre instituições de saúde, e as diretrizes sobre o acesso vascular dão pouca importância às técnicas de canulação. O objetivo deste estudo foi avaliar a técnica de canulação e determinar quais fatores estão associados a cada detalhe da técnica. Material e métodos: A canulação do acesso vascular foi avaliada em 260 pacientes em hemodiálise. Foram registrados o tipo e localização anatômica do acesso vascular, a técnica de canulação, a direção, a bitola e a distância entre as agulhas, além da direção do bisel e da rotação da agulha. Resultados: A fístula arteriovenosa foi o acesso vascular mais frequente (88%), a técnica de canulação mais utilizada foi a área (100%), a direção da agulha foi anterógrada na maioria dos casos (79,5%) e a distância média entre as pontas das agulhas foi de 7,57 ± 4,43 cm. Para enxertos arteriovenosos, a localização anatômica proximal (artéria braquial) e a canulação com agulhas 16G em posição anterógrada foram mais predominantes. Para as fístulas arteriovenosas, a localização anatômica distal (artéria radial) e a canulação através de agulhas 15G foram mais comuns. A canulação do acesso vascular na direção retrógrada foi associada a uma maior distância entre as agulhas (13,2 ± 4,4 v.s. 6,1 ± 3 cm, p < 0,001). O Kt / V foi maior quando a distância entre as agulhas foi superior a 5 cm (1,61 ± 0,3 vs. 1,47 ± 0,28, p < 0,01). Conclusões: A técnica de canulação do acesso vascular depende das características do acesso vascular e da experiência dos "canuladores". Ensaios clínicos são necessários para a formulação de diretrizes para a canulação do acesso vascular.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Catheterization/instrumentation , Catheterization/methods , Arteriovenous Fistula , Renal Dialysis/methods , Needles , Brazil , Blood Vessel Prosthesis , Risk , Cross-Sectional Studies , Treatment Outcome , Vascular Access Devices
5.
Rev. bras. cir. cardiovasc ; 34(2): 213-221, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-990580

ABSTRACT

Abstract Objective: To investigate whether axillary artery cannulation has supremacy over innominate artery cannulation in thoracic aortic surgery. Methods: A comprehensive search was undertaken among the four major databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing axillary to innominate artery cannulation in thoracic aortic surgery. Databases were evaluated and assessed up to March 2017. Results: Only three studies fulfilled the criteria for this meta-analysis, including 534 patients. Cardiopulmonary bypass time was significantly shorter in the innominate group (P=0.004). However, the innominate group had significantly higher risk of prolonged intubation > 48 hours (P=0.04) than the axillary group. Further analysis revealed no significant difference between the innominate and axillary groups for deep hypothermic circulatory arrest time (P=0.06). The relative risks for temporary and permanent neurological deficits as well as in-hospital mortality were not significantly different for both groups (P=0.90, P=0.49, and P=0.55, respectively). Length of hospital stay was similar for both groups. Conclusion: There is no superiority of axillary over innominate artery cannulation in thoracic aortic surgery in terms of perioperative outcomes; however, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing optimal arterial cannulation site.


Subject(s)
Humans , Male , Female , Aorta, Thoracic/surgery , Axillary Artery/surgery , Catheterization/methods , Brachiocephalic Trunk/surgery , Postoperative Complications , Catheterization/adverse effects , Catheterization/mortality , Treatment Outcome , Hospital Mortality
6.
Rev. latinoam. enferm. (Online) ; 27: e3125, 2019. graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1004251

ABSTRACT

Objetivos durante a punção venosa periférica, recomenda-se o uso de um garrote acima do local da punção para potencializar a distensão venosa. Dadas as suas características e o uso em ambientes clínicos, os garrotes podem representar uma fonte de disseminação de micro-organismos. Entretanto, os resultados de estudos científicos nessa área estão dispersos na literatura. Esta revisão de escopo tem como objetivo mapear as evidências disponíveis a respeito das práticas dos profissionais de saúde no que concerne ao uso do garrote durante a punção venosa periférica e à contaminação microbiológica associada. Método revisão de escopo de acordo com a metodologia do Instituto Joanna Briggs. Dois revisores independentes analisaram a relevância dos estudos, extraíram e sintetizaram dados. Resultados quinze estudos foram incluídos na revisão. Em geral, os garrotes foram reutilizados sem processos de descontaminação recorrentes. Verificou-se que os profissionais compartilham esses dispositivos entre si e os usaram continuamente por períodos entre duas semanas e sete anos e meio. Conclusão as práticas de enfermagem relacionadas ao uso do garrote durante a punção venosa periférica não são uniformes. A reutilização de garrotes pode colocar em risco a segurança do paciente se o reprocessamento (limpeza e desinfecção/esterilização) não for adequado, dado o tipo de material do garrote e a microbiota encontrada. Novos estudos são necessários para avaliar o impacto de vários tipos de práticas de reprocessamento na descontaminação de garrotes e na segurança do paciente.


Objectives during peripheral venipuncture, health professionals are recommended to use a tourniquet above the puncture site in order to potentiate venous distension. Given its characteristics and use in clinical settings, tourniquets may represent a source of microorganism dissemination. However, the results of scientific studies in this area are scattered in the literature. This scoping review aims to map the available evidence on health professionals' practices related with tourniquet use during peripheral venipuncture and associated microbiological contamination. Methods scoping review following the Joanna Briggs Institute methodology. Two independent reviewers analyzed the relevance of the studies, extracted and synthesized data. Results fifteen studies were included in the review. Overall, tourniquets were reused without being subject to recurring decontamination processes. It has been found that practitioners share these devices among themselves and use them successively for periods between two weeks and seven and half years. Conclusion nursing practices related to tourniquet use during peripheral venipuncture are not standard. Reuse of tourniquets may jeopardize the patient's safety if reprocessing (cleaning and disinfection/sterilization) is not adequate, given the type of tourniquet material and microbiota found. New studies are needed to assess the impact of various types of reprocessing practices on tourniquet decontamination and patient safety.


Objetivos durante la punción venosa periférica, se recomienda el uso de un garrote arriba del sitio de la punción para potenciar la distensión venosa. Dadas sus características y uso en ambientes clínicos, los garrotes pueden representar una fuente de diseminación de microorganismos. Sin embargo, los resultados de estudios científicos en esta área están dispersos en la literatura. Esta revisión de alcance tiene como objetivo mapear las evidencias disponibles acerca de las prácticas de los profesionales de salud en lo que concierne al uso del garrote durante la punción venosa periférica y la contaminación microbiológica asociada. Método revisión de alcance de acuerdo con la metodología del Instituto Joanna Briggs. Dos revisores independientes analizaron la relevancia de los estudios, extrajeron y sintetizaron datos. Resultados quince estudios se incluyeron en la revisión. En general, los garrotes fueron reutilizados sin procesos de descontaminación recurrentes. Se verificó que los profesionales comparten estos dispositivos entre sí y los utilizaron continuamente por períodos entre dos semanas y siete años y medio. Conclusión las prácticas de enfermería relacionadas al uso del garrote durante la punción venosa periférica no son uniformes. La reutilización de garrotes puede poner en riesgo la seguridad del paciente si el reprocesamiento (limpieza y desinfección/esterilización) no es adecuado, dado el tipo de material del garrote y la microbiota encontrada. Nuevos estudios son necesarios para evaluar el impacto de varios tipos de prácticas de reprocesamiento en la descontaminación de garrotes y en la seguridad del paciente.


Subject(s)
Humans , Professional Practice , Catheterization/methods , Central Venous Pressure/physiology , Disinfection/instrumentation , Equipment Contamination/prevention & control , Portugal , Health Personnel , Phlebotomy/methods
7.
Braz. j. med. biol. res ; 52(3): e8055, 2019. tab, graf
Article in English | LILACS | ID: biblio-989464

ABSTRACT

This study aimed to investigate the clinical characteristics, prognosis, and factors for survival of patients who underwent early-start peritoneal dialysis (PD) within 24 h after catheter insertion three years after PD. This study was conducted from January 1, 2013 to December 31, 2017. All adult patients who were diagnosed with end-stage renal disease (ESRD) and underwent PD for the first time within 24 h after catheter insertion in our hospital were included. All patients with PD were followed-up until they withdrew from PD, switching to hemodialysis, were transferred to other medical centers, underwent renal transplantation, died or were lost to follow-up, or continued to undergo dialysis until the end of the study period. The follow-up observation lasted three years. The number of eligible patients was 110, and switching to hemodialysis and death were the main reasons for patients to withdraw from PD. The 1-, 2-, and 3-year technical survival rates of patients were 89.1, 79.1, and 79.1% respectively, while the 1-, 2- and 3-year survival rates were 90, 81.8, and 81.8%, respectively. The Charlson comorbidity index, age, hemoglobin, serum albumin, diabetic nephropathy, chronic glomerulonephritis, and hypertensive renal damage were independent risk factors that affected the prognosis of PD patients. Under the condition of ensuring the quality of the PD catheter insertion, early-start PD within 24 h after catheter insertion is a safe treatment approach for ESRD patients.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Catheterization/methods , Catheters, Indwelling , Peritoneal Dialysis/methods , Kidney Failure, Chronic/therapy , Prognosis , Time Factors , Catheterization/mortality , Body Mass Index , Proportional Hazards Models , Multivariate Analysis , Risk Factors , Age Factors , Peritoneal Dialysis/mortality , Kaplan-Meier Estimate , Kidney Failure, Chronic/mortality
8.
J. bras. pneumol ; 45(4): e20180137, 2019. tab, graf
Article in English | LILACS | ID: biblio-1012569

ABSTRACT

ABSTRACT Objective: To present a case series of pulmonary arteriovenous malformations (PAVMs), describing the main clinical findings, the number/location of pulmonary vascular abnormalities, the clinical complications, and the treatment administered. Methods: This was a retrospective observational study evaluating patients with PAVM divided into two groups: hereditary hemorrhagic telangiectasia (HHT); and idiopathic PAVM (iPAVM). Results: A total of 41 patients were selected for inclusion, but only 33 had PAVMs. After clinical evaluation, 27 and 6 were diagnosed with HHT and iPAVM, respectively. In the HHT group, the mean age was 49.6 years and 88.9% were female. In that group, 4 patients had an SpO2 of < 90% and the most common clinical finding was epistaxis. In the iPAVM group, the mean age was 48.1 years and 83.3% were female. In that group, 3 patients had an SpO2 of < 90%. Computed tomographic pulmonary angiography showed that most of the PAVMs were in the lower lobes: 56.4% in the HHT group and 85.7% in the iPAVM group. Embolization was performed in 23 patients (in both groups). At this writing, 10 patients are scheduled to undergo the procedure. One of the patients who underwent embolization was subsequently referred for pulmonary resection. Conclusions: In both of the PAVM groups, there was a predominance of women and of fistulas located in the lower lobes. Few of the patients had respiratory symptoms, and most had an SpO2 > 90%. The treatment chosen for all patients was percutaneous transcatheter embolization.


RESUMO Objetivo: Apresentar uma série de casos de malformações arteriovenosas pulmonares (MAVP) e descrever os principais achados clínicos, a quantidade e localização das MAVP, as complicações clínicas e os tratamentos realizados. Métodos: Estudo retrospectivo observacional que avaliou pacientes com MAVP divididos em dois grupos: telangiectasia hemorrágica hereditária (THH) e MAVP idiopática (MAVPi). Resultados: Foram avaliados 41 pacientes, sendo 33 pacientes portadores de MAVP. Após a avaliação clínica, 27 e 6 foram diagnosticados com THH e MAVPi, respectivamente. No grupo THH a média de idade foi de 49,6 anos e 88,9% eram do sexo feminino. Desses pacientes, 4 tinham SpO2 < 90% e o achado clínico mais frequente era epistaxe. No grupo MAVPi a média de idade foi de 48,1 anos, sendo que 83,3% eram do sexo feminino. Desses, 3 tinham SpO2 < 90%. Após a realização de angiotomografia de tórax observou-se que a maior parte das MAVP se situava nos lobos inferiores, totalizando 56,4% e 85,7% nos grupos THH e MAVPi, respectivamente. O tratamento por embolização foi realizado em 23 pacientes nos dois grupos, enquanto 10 aguardavam o procedimento até o momento da escrita deste estudo. Um paciente submetido à embolização foi encaminhado para ressecção pulmonar. Conclusões: Em ambos os grupos de pacientes com MAVP observou-se uma predominância de mulheres e de fístulas localizadas nos lobos inferiores. A maioria era assintomático respiratório com SpO2 > 90%. O tratamento de escolha para todos foi a embolização percutânea por cateter.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Arteriovenous Malformations/etiology , Arteriovenous Malformations/therapy , Arteriovenous Malformations/diagnostic imaging , Pulmonary Artery/abnormalities , Pulmonary Artery/diagnostic imaging , Telangiectasia, Hereditary Hemorrhagic/complications , Catheterization/methods , Angiography/methods , Echocardiography , Radiography, Thoracic/methods , Retrospective Studies , Treatment Outcome , Embolization, Therapeutic/methods , Septal Occluder Device , Computed Tomography Angiography
9.
Rev. gaúch. enferm ; 40(spe): e20180232, 2019. graf
Article in Portuguese | LILACS, BDENF | ID: biblio-978509

ABSTRACT

Resumo OBJETIVO Descrever o processo de implantação da lista de verificação de segurança cirúrgica em laboratório de cateterismo (LC). MÉTODO Estudo descritivo do tipo relato de experiência das estratégias de segurança desenvolvidas nos últimos seis anos em hospital universitário da região Sul do Brasil. RESULTADOS Foram incorporadas na prática assistencial as seis metas internacionais de segurança do paciente (MISP) em consonância com o programa de acreditação hospitalar pela Joint Comission International (JCI), por meio de um processo contínuo com caráter educativo. A lista de verificação foi adaptada considerando as características da unidade e os procedimentos realizados. CONCLUSÕES A implantação da lista de verificação proporcionou a promoção da segurança do paciente, maior integração da equipe, avanços na comunicação entre os profissionais e no registro das informações da assistência em sala.


Resumen OBJETIVO Describir el proceso de implantación de la lista de verificación de seguridad quirúrgica en un laboratorio de cateterismo (LC). MÉTODO Estudio descriptivo del tipo relato de experiencia sobre las estrategias de seguridad desarrolladas en los últimos seis años en un hospital universitario de la región Sur de Brasil. RESULTADOS Se incorporaron en la práctica asistencial las seis metas internacionales de seguridad del paciente (MISP) en consonancia con el programa de acreditación hospitalaria por la Joint Comission International (JCI), a través de un proceso continuo con carácter educativo. La lista de verificación fue adaptada considerando las características de la unidad y los procedimientos realizados. Conclusión: La implantación de la lista de verificación proporcionó la promoción de la seguridad del paciente, una mayor integración del equipo, avances en la comunicación entre los profesionales y en el registro de las informaciones de la asistencia en sala.


Abstract OBJECTIVE To describe the process of implanting the surgical safety checklist in a catheterization laboratory (CL). METHOD Descriptive case report study about the safety strategies developed in the last six years in a university hospital in the southern region of Brazil. RESULTS The six international patient safety goals (IPSG) were incorporated into the care practice in accordance with the hospital's Joint Comission International (JCI) accreditation program, through a continuous process of educational nature. The checklist was adapted considering the characteristics of the unit and the procedures performed. CONCLUSION The implementation of the checklist provided the promotion of patient safety, greater staff integration, advances in communication among professionals and the recording of in-room care information.


Subject(s)
Humans , Universities , Catheterization/standards , Checklist , Patient Safety , Surgical Procedures, Operative/standards , Catheterization/methods , Forms as Topic
10.
Int. j. cardiovasc. sci. (Impr.) ; 31(6): 562-568, nov.- dez. 2018. tab, graf
Article in English | LILACS | ID: biblio-979704

ABSTRACT

Background: In coronary procedures, although the radial approach protects patients from hemorrhagic complications, it is technically more complex than the femoral approach. Objectives: To test the hypothesis that the radial approach is the procedure of choice in ACS patients due to the high risk of bleeding; and to identify independent predictors of the choice for radial access. Methods: Patients admitted for ACS who underwent invasive coronary procedure were included. We registered the type of access (femoral or radial) chosen by the physician for the first angiography; the investigators did not interfere with this choosing process. Student's t-test was used for comparisons between the CRUSADE and ACUITY scores. Predictors of radial access were compared between the groups. Statistical significance was defined by p < 0,05.Results: Radial access was chosen in 67% of 347 consecutive patients. Patients who underwent radial approach had lower risk of bleeding determined by CRUSADE (30 ± 14 vs. 37 ± 15; p < 0.001) as compared with femoral access. In multivariate analysis, four variables were identified as independent predictors negatively associated with radial access ­ age (OR = 0.98; 95%CI = 0.96 ­ 0.99), creatinine (OR = 0.54; 95%CI = 0.3 ­ 0.98), signs of left ventricular failure (OR = 0.45; 95% CI = 0.22 ­ 0.92) and previous CABG (OR = 0.022; 95%CI = 0.003 ­ 0.166). Conclusion: The propensity to choose radial over femoral access in coronary intervention was not primarily influenced by patients' bleeding risk. Predictors of this decision, identified in the study, indicated less complex patients, suggesting that the difficulty in performing the technique was a stronger determinant than its potential antihemorrhagic effect


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Radial Artery , Acute Coronary Syndrome , Femoral Artery , Percutaneous Coronary Intervention/methods , Coronary Artery Disease , Catheterization/methods , Stents , Data Interpretation, Statistical , Multivariate Analysis , Risk Factors , Angioplasty/methods , Hemorrhage/complications , Angina, Unstable
12.
Rev. Soc. Bras. Clín. Méd ; 16(3): 171-173, jul.-set. 2018. ilus.
Article in Portuguese | LILACS | ID: biblio-1047949

ABSTRACT

OBJETIVO: Descrever um modelo de treinamento de baixo custo de dissecção e acesso vascular utilizando língua bovina. MÉTODOS: Foram utilizadas dez línguas de boi para confecção de simuladores. Inicialmente, o corpo da língua foi dissecado, separando as camadas epitelial e muscular, e o pedículo vascular foi destacado da base da língua. A artéria principal da língua foi, então, cateterizada e conectada a uma seringa, sendo, em seguida, fixada à porção muscular. Após, para simular o tecido celular subcutâneo, foi confeccionada uma pasta amarela gelatinosa, que foi posicionada de modo a cobrir a extensão do pedículo vascular por inteiro. Por fim, a camada epitelial da língua foi reposicionada sob a camada muscular, por meio de sutura contínua. Para avaliar o modelo, foram observados o tempo de confecção do modelo, sua durabilidade, seu custo e o número de vezes que pôde ser usado. RESULTADOS: O tempo médio para confecção do modelo foi de 15,82±2,45 minutos, com durabilidade de 20 dias sob refrigeração. O custo médio foi de R$25,00, podendo ser utilizado, em média, por 3,8±0,63 vezes. Não houve falhas na montagem do modelo. CONCLUSÃO: O modelo de língua de boi se mostrou viável e de fácil aplicação para o treinamento de técnica cirúrgica de dissecção vascular. (AU)


OBJECTIVE: To describe a low cost training model for dissection and vascular access using a bovine tongue. METHODS: Ten bovine tongues were used to build simulators. First, the body of the tongue was dissected, with its epithelial layer being separated from the muscular layer, and the vascular pedicle was detached from the base of the tongue. The tongue main artery was then catheterized and connected to a syringe, and subsequently fixed to the muscle layer. Then, the entire vascular pedicle was covered with a yellow gelatinous paste to simulate the subcutaneous tissue. Finally, the epithelial layer was repositioned above the muscle layer through continuous suture. To evaluate the model, 4 variables were considered: 1) time for building the model, 2) its durability, 3) its cost, 4) number of times that it could be used. RESULTS: The mean time to make the model was 15.82 ±2.45 minutes, with a durability of 20 days under refrigeration. The mean cost of each model was U$10.00, and could be used about 3.8±0.63 times. There were no fails to build the model. CONCLUSIONS: The model with a bovine tongue proved to be viable and easy to be applied for training the surgical technique of vascular dissection. (AU)


Subject(s)
Animals , Catheterization/methods , Dissection/education , Simulation Training/methods , Tongue/surgery , Cattle , Clinical Competence , Models, Animal , Dissection/methods , Education, Medical/methods
13.
Rev. argent. radiol ; 82(3): 107-113, set. 2018. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-977271

ABSTRACT

Objetivo Determinar la frecuencia de las complicaciones observadas durante la trombectomía en el ictus isquémico agudo. Materiales y Métodos Se revisó de forma retrospectiva las trombectomías realizadas en nuestra institución cuando los ictus isquémicos tuvieron una indicación de tratamiento endovascular. Se registraron los diferentes dispositivos utilizados en ese periodo de tiempo y si presentaron relación con el desarrollo de las complicaciones inmediatas mediante arteriografía. Resultados De un total de 228 casos, se registraron complicaciones en el 16,6% de los casos. Se identificaron embolias (n » 31), hemorragias subaracnoideas (n » 2), hemorragia gangliobasal (n » 1), vasoespasmo (n » 1), disección (n » 1) y peusoaneurismas (n » 2). La embolia a nuevos territorios se presentó solo en 5 casos. Discusión El tratamiento endovascular ha demostrado ser efectivo para la recanalización en oclusión de gran vaso. El uso de dispositivos presume un riesgo por la manipulación de los vasos. Conclusión La embolia fue la complicación más frecuente. El tratamiento endovascular en el ictus genera un desenlace clínico favorable de los pacientes, al mismo tiempo, el bajo porcentaje de complicaciones que encontramos no suponen una afectación negativa en el desenlace final.


Purpose To determine the complications we observed during thrombectomy in acute ischemic stroke. Materials and Methods We reviewed retrospectively thrombectomies performed in our institution when endovascular treatment for stroke was done. The different devices used in this period of time were recorded and we determined if these were related to the development of immediate complications duringthe procedure visualized in arteriography. Results We had 228 cases, complications were found in 16.6% of the cases. Embolisms (n » 31), subarachnoid hemorrhages (n » 2), gangliobasal hemorrhage (n » 1), vasospasm (n » 1), dissection (n » 1) and peusoaneurysms (n » 2) were identified. 5 embolisms happened to new territories during thrombectomy. Discussion Endovascular treatment has been shown to be effective for recanalization in large vessel occlusion. The use of devices presumes a risk for the manipulation of the vessels. Conclusion Embolism was the most frequent complication. The endovascular treatment in the acute stroke produces a favorable clinical outcome of the patients and we found a low percentage of complications that would not suppose a negative affectation in the final outcome.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Thrombectomy/methods , Stroke/complications , Stroke/diagnostic imaging , Skull/diagnostic imaging , Spain , Vascular Diseases/complications , Catheterization/methods , Catheterization/statistics & numerical data , Carotid Artery, Internal/diagnostic imaging , Tomography, X-Ray Computed , Stents/statistics & numerical data , Retrospective Studies , Multicenter Study , Thrombectomy/statistics & numerical data , Embolism , Hemorrhage
14.
Int. j. cardiovasc. sci. (Impr.) ; 31(4)jul.-ago. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-910455

ABSTRACT

As cardiopatias congênitas são importantes causas de morbimortalidade infantil e, em cerca de 50% dos casos, é necessária a intervenção cirúrgica no primeiro ano de vida. Estima-se alto défice de procedimentos na Região Norte do Brasil.Analisar o tempo de espera para realização de tratamento eletivo cirúrgico e/ou intervencionista de crianças portadoras de cardiopatias congênitas em um centro de referência cardiológico, e fazer considerações sobre as cardiopatias e suas formas de tratamento na referida instituição. Estudo analítico, de caráter transversal do período de janeiro de 2012 a outubro de 2014, de pacientes com idade igual ou inferior a 14 anos diagnosticados com cardiopatias congênitas que estavam na fila de tratamento cardíaco eletivo cirúrgico ou percutâneo. Das 407 crianças que aguardavam por tratamento, a faixa etária mais prevalente foi a de > 2 a 6 anos (34,0%). O tempo médio de espera, em meses, foi 23,1 ± 18,3, com mediana de 19. As cardiopatias mais frequentes foram comunicação interventricular (28,98%), persistência do canal arterial (18,42%) e comunicação interatrial (11,05%). A maioria das crianças (63,4%) não pertencia à região metropolitana. As intervenções percutâneas representaram somente 27,84% do total de cateterismos e 14,85% de todos os tratamentos cardíacos. Cerca de 60% do volume de cirurgias pediátricas ocorreu em crianças sem cadastro prévio no sistema, devido ao caráter de urgência. Grande parte das crianças que aguardam por procedimento cardíaco é procedente de fora da região metropolitana e tem malformações potencialmente tratáveis por cateterismo. É necessário aumentar a capacidade operacional do único centro de referência público do Estado, além de descentralizar o atendimento em alta complexidade cardiológica da região metropolitana


Congenital heart disease is an important cause of morbidity and mortality in childhood, and in 50% of cases, surgery is required in the first year of life. A high deficit of surgical procedures is estimated in Northern Brazil. To analyze the waiting time for elective surgical treatment and/or intervention in children with congenital heart disease in a Cardiology referral center, and to make considerations about heart diseases and forms of treatment in that institution. A cross-sectional study of all patients aged less than 14 years, with a diagnosis of congenital heart disease that were waiting for elective surgical or percutaneous cardiac treatment. Among the 407 children with congenital heart defects, the most prevalent age group was > 2 to 6 years (34.0%). The average waiting time was 23.1 ± 18.3 months, with a median of 19. The most frequent heart disease was ventricular septal defect (28.98%), patent ductus arteriosus (18.42%) and atrial septal defect (11.05%). Most children (63.4%) were not from the metropolitan area. The percutaneous interventions represented only 27.84% of the catheterization procedures and 14,85% of all heart treatments. Approximately 60% of the pediatric surgeries occurred in children who were not previously registered due to urgency cases. Most of the children waiting for a cardiac procedure were not from the metropolitan area and had malformations potentially treatable by catheterization. It is necessary to increase the capacity of the single referral center in the state of Pará, as well as decentralize the high-complexity cardiological care in the metropolitan region


Subject(s)
Humans , Male , Female , Child , Child , Heart Defects, Congenital/surgery , Heart Defects, Congenital/therapy , Waiting Lists , Brazil , Cardiac Care Facilities , Catheterization/methods , Congenital Abnormalities , Cross-Sectional Studies , Data Collection , Elective Surgical Procedures/methods , Endocardial Cushion Defects/therapy , Epidemiology, Descriptive , Heart , Heart Septal Defects, Ventricular/therapy , Prevalence
15.
Int. j. cardiovasc. sci. (Impr.) ; 31(4): 374-382, jul.-ago. 2018. tab, graf
Article in English | LILACS | ID: biblio-954109

ABSTRACT

Congenital heart disease is an important cause of morbidity and mortality in childhood, and in 50% of cases, surgery is required in the first year of life. A high deficit of surgical procedures is estimated in Northern Brazil. Objective: To analyze the waiting time for elective surgical treatment and/ or intervention in children with congenital heart disease in a Cardiology referral center, and to make considerations about heart diseases and forms of treatment in that institution. Methods: A cross-sectional study of all patients aged less than 14 years, with a diagnosis of congenital heart disease that were waiting for elective surgical or percutaneous cardiac treatment. Results: Among the 407 children with congenital heart defects, the most prevalent age group was > 2 to 6 years (34.0%). The average waiting time was 23.1 ± 18.3 months, with a median of 19. The most frequent heart disease was ventricular septal defect (28.98%), patent ductus arteriosus (18.42%) and atrial septal defect (11.05%). Most children (63.4%) were not from the metropolitan area. The percutaneous interventions represented only 27.84% of the catheterization procedures and 14,85% of all heart treatments. Approximately 60% of the pediatric surgeries occurred in children who were not previously registered due to urgency cases. Conclusion: Most of the children waiting for a cardiac procedure were not from the metropolitan area and had malformations potentially treatable by catheterization. It is necessary to increase the capacity of the single referral center in the state of Pará, as well as decentralize the high-complexity cardiological care in the metropolitan region


As cardiopatias congênitas são importantes causas de morbimortalidade infantil e, em cerca de 50% dos casos, é necessária a intervenção cirúrgica no primeiro ano de vida. Estima-se alto défice de procedimentos na Região Norte do Brasil. Objetivo: Analisar o tempo de espera para realização de tratamento eletivo cirúrgico e/ou intervencionista de crianças portadoras de cardiopatias congênitas em um centro de referência cardiológico, e fazer considerações sobre as cardiopatias e suas formas de tratamento na referida instituição. Método: Estudo analítico, de caráter transversal do período de janeiro de 2012 a outubro de 2014, de pacientes com idade igual ou inferior a 14 anos diagnosticados com cardiopatias congênitas que estavam na fila de tratamento cardíaco eletivo cirúrgico ou percutâneo. Resultados: Das 407 crianças que aguardavam por tratamento, a faixa etária mais prevalente foi a de > 2 a 6 anos (34,0%). O tempo médio de espera, em meses, foi 23,1 ± 18,3, com mediana de 19. As cardiopatias mais frequentes foram comunicação interventricular (28,98%), persistência do canal arterial (18,42%) e comunicação interatrial (11,05%). A maioria das crianças (63,4%) não pertencia à região metropolitana. As intervenções percutâneas representaram somente 27,84% do total de cateterismos e 14,85% de todos os tratamentos cardíacos. Cerca de 60% do volume de cirurgias pediátricas ocorreu em crianças sem cadastro prévio no sistema, devido ao caráter de urgência. Conclusão: Grande parte das crianças que aguardam por procedimento cardíaco é procedente de fora da região metropolitana e tem malformações potencialmente tratáveis por cateterismo. É necessário aumentar a capacidade operacional do único centro de referência público do Estado, além de descentralizar o atendimento em alta complexidade cardiológica da região metropolitana


Subject(s)
Humans , Male , Female , Child , Child , Waiting Lists , Heart Defects, Congenital/surgery , Heart Defects, Congenital/therapy , Congenital Abnormalities , Brazil , Catheterization/methods , Cardiac Care Facilities , Epidemiology, Descriptive , Prevalence , Cross-Sectional Studies , Data Collection , Elective Surgical Procedures/methods , Endocardial Cushion Defects/therapy , Heart , Heart Septal Defects, Ventricular/therapy
16.
J. vasc. bras ; 17(1): f:81-l:88, jan.-mar. 2018. ilus
Article in Portuguese | LILACS | ID: biblio-905078

ABSTRACT

Nos últimos anos, balões farmacológicos surgiram como promissora alternativa terapêutica em intervenções endovasculares. Com essa tecnologia, transferem-se drogas antiproliferativas à parede arterial, sem a necessidade de implante metálico para liberação. Descreve-se o caso de um paciente com uma segunda recidiva de reestenose intra-stent renal tratada por angioplastia com balão coberto por droga, com boa evolução clínica caracterizada por adequado controle pressórico e redução de classes e dosagem dos anti-hipertensivos. Os resultados obtidos com balões farmacológicos em outros territórios e esta experiência isolada podem contribuir como sugestão para o uso desses dispositivos na reestenose intra-stent renal, com resultados iniciais satisfatórios


During recent years, drug-coated balloons (DCBs) have emerged as a promising therapeutic option. DCBs directly transfer antiproliferative drugs to the arterial wall in order to decrease myointimal hyperplasia. We describe a case of de novo renal artery in-stent restenosis (ISR) treated with drug-coated balloon angioplasty with acceptable short-term results, achieving blood pressure control using fewer antihypertensive agents. The experience and results obtained with DCBs in other territories could suggest and justify use of this technology in renal artery ISR


Subject(s)
Humans , Male , Middle Aged , Angioplasty, Balloon/methods , Renal Artery/diagnostic imaging , Stents , Angiography/methods , Aorta, Abdominal , Blood Vessels/diagnostic imaging , Catheterization/methods , Endovascular Procedures/methods
17.
J. vasc. bras ; 16(4): f:343-l:347, out.-dez. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-880938

ABSTRACT

Em todo paciente submetido a reparo endovascular do aneurisma de aorta abdominal (REVA) que se apresente subitamente com quadro de dor abdominal ou sinais de choque, a hipótese de endoleak ou vazamento, com expansão do aneurisma e ruptura deve ser aventada. Apresentamos o caso de um paciente em pós-operatório de REVA que apresentou uma neoplasia de duodeno mimetizando um endoleak


Whenever a patient who has undergone endovascular repair of an abdominal aortic aneurysm (EVAR) presents with sudden onset abdominal pains or signs of shock, the hypothesis of endoleak with aneurysm expansion and rupture should be considered. We present the case of an EVAR patient in whom a tumor of the duodenum mimicked an endoleak during the postoperative period


Subject(s)
Humans , Male , Aged, 80 and over , Aortic Aneurysm , Endoleak , Hemangiosarcoma , Angiography/methods , Aorta, Abdominal , Aortic Aneurysm, Abdominal , Catheterization/methods , Endoscopy/methods , Endovascular Procedures/methods , Vascular Surgical Procedures/methods
18.
Rev. bras. cir. cardiovasc ; 32(4): 270-275, July-Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-897925

ABSTRACT

Abstract Objective: Midline sternotomy is the preferred approach for device migration following transcatheter device closure of ostium secundum atrial septal defect. Results of patients operated for device migration were retrospectively reviewed after transcatheter closure of atrial septal defect. Methods: Among the 643 patients who underwent atrial septal defect with closure device, 15 (2.3%) patients were referred for device retrieval and surgical closure of atrial septal defect. Twelve patients underwent device retrieval and surgical closure of atrial septal defect through right antero-lateral minithoracotomy with femoral cannulation. Three patients were operated through midline sternotomy. Results: Twelve patients operated through minithoracotomy did not require conversion to sternotomy. Due to device migration to site of difficult access through thoracotomy, cardiac tamponade and hemodynamic instability, respectively, three patients were operated through midline sternotomy. Mean aortic cross-clamp time and cardiopulmonary bypass time were 28.1±17.7 and 58.3±20.4 minutes, respectively. No patient had surgical complication or mortality. Mean intensive care unit and hospital stay were 1.6±0.5 days and 7.1±2.2 days, respectively. Postoperative echocardiography confirmed absence of any residual defect and ventricular dysfunction. In a mean follow-up period of six months, no mortality was observed. All patients were in New York Heart Association class I without wound or vascular complication. Conclusion: Minithoracotomy with femoral cannulation for cardiopulmonary bypass is a safe-approach for selected group of patients with device migration following transcatheter device closure of atrial septal defect without increasing the risk of cardiac, vascular or neurological complications and with good cosmetic and surgical results.


Subject(s)
Humans , Male , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Thoracotomy/methods , Foreign-Body Migration/surgery , Septal Occluder Device/adverse effects , Heart Septal Defects, Atrial/surgery , Catheterization/methods , Cardiopulmonary Bypass/methods , Retrospective Studies , Foreign-Body Migration/complications , Treatment Outcome , Femoral Artery , Sternotomy/methods , Heart Septal Defects, Atrial/diagnostic imaging
19.
Rev. gastroenterol. Perú ; 37(3): 235-239, jul.-sep. 2017. ilus, tab
Article in Spanish | LILACS | ID: biblio-991259

ABSTRACT

RESUMEN Objetivo: Determinar la eficacia y seguridad de la técnica de doble guía en pacientes con canulación difícil durante una CPRE. Materiales y métodos: El presente estudio se realizó, entre el mes de enero del 2015 y julio del 2016. Se procedió a sintetizar la data, de éxito y complicaciones de la TDG en pacientes con canulación difícil y cuando la inserción de la guía en el conducto pancreático fue hecha involuntariamente después de una técnica estándar. Resultados: 24 pacientes sometidos a una CPRE con TDG; 17 fueron mujeres (70,8%) y 7 varones (29,2%). La edad promedio fue 65,21±16,49 años. La indicación más frecuente fue coledocolitiasis en 62,5 %, luego colangiocarcinoma, 12,5 %. El diagnóstico final post CPRE, fue coledocolitiasis en 45,8%, seguido por fibrosis de papila, 29,2%. El éxito de la técnica de la doble guía fue de 87,5%. Hubo 3 casos de canulación frustra con la TDG, dos pacientes presentaron pancreatitis post CPRE (8,3%), no hubo casos de perforaciones. Conclusiones: La TDG es una alternativa eficaz a la CPRE catalogada como de canulación difícil por técnica convencional, sea cual fuere la etiología, con un alto porcentaje de éxito técnico y con una tasa baja de pancreatitis post CPRE, semejante a la reportada en otros países.


ABSTRACT Objective: To determine the efficacy and safety of double guidewire technique in patients with difficult biliary cannulation during ERCP. Materials and methods: We conducted a retrospective cohort study of all ERCPs performed between January 2015 and July 2016. DGT was performed in patients for whom biliary cannulation was difficult and guidewire insertion into the pancreatic duct (PD) was inadvertently achieved while attempting the standard WGC technique. Results: 24 patients were enrolled with ERCP and DGT; 17 were female (70.8%) and 7 male (29.2%). The average age was 65.21±16.49 years. The most frequent indication was choledocholithiasis (62.5%), then cholangiocarcinoma (12.5%). Post ERCP diagnosis was choledocholithiasis (45.8%), and papillary fibrosis (29.2%). The success of DGT was 87.5%. Three cases of failure cannulation with the DGT were reported, two patients had pancreatitis post ERCP (8.3%), there were no cases of perforations. Conclusions: TDG, is an effective alternative to difficult biliary cannulation during ERCP with conventional methods; with a high success rate and low rate of post ERCP pancreatitis, similarly to reported in other countries.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Catheterization/methods , Cholangiopancreatography, Endoscopic Retrograde/methods , Catheterization/instrumentation , Retrospective Studies , Follow-Up Studies , Cholangiopancreatography, Endoscopic Retrograde/instrumentation , Outcome Assessment, Health Care
20.
J. bras. pneumol ; 43(3): 190-194, May-June 2017. tab, graf
Article in English | LILACS | ID: biblio-893840

ABSTRACT

ABSTRACT Objective: To evaluate the role of intrapleural positioning of a pleural catheter in early lung expansion and pleurodesis success in patients with recurrent malignant pleural effusion (RMPE). Methods: This was a retrospective study nested into a larger prospective cohort study including patients with RMPE recruited from a tertiary university teaching hospital between June of 2009 and September of 2014. The patients underwent pleural catheter insertion followed by bedside pleurodesis. Chest CT scans were performed twice: immediately before pleurodesis (iCT) and 30 days after pleurodesis (CT30). Catheter positioning was categorized based on iCT scans as posterolateral, anterior, fissural, and subpulmonary. We used the pleural volume on iCT scans to estimate early lung expansion and the difference between the pleural volumes on CT30 and iCT scans to evaluate radiological success of pleurodesis. Clinical pleurodesis success was defined as no need for any other pleural procedure. Results: Of the 131 eligible patients from the original study, 85 were included in this nested study (64 women; mean age: 60.74 years). Catheter tip positioning was subpulmonary in 35 patients (41%), anterior in 23 (27%), posterolateral in 17 (20%), and fissural in 10 (12%). No significant differences were found among the groups regarding early lung expansion (median residual pleural cavity = 377 mL; interquartile range: 171-722 mL; p = 0.645), radiological success of pleurodesis (median volume = 33 mL; interquartile range: −225 to 257 mL; p = 0.923), and clinical success of pleurodesis (85.8%; p = 0.676). Conclusions: Our results suggest that the position of the tip of the pleural catheter influences neither early lung expansion nor bedside pleurodesis success in patients with RMPE.


RESUMO Objetivo: Avaliar o papel do posicionamento intrapleural do cateter pleural na expansão pulmonar precoce e no sucesso da pleurodese em pacientes com derrame pleural maligno recorrente (DPMR). Métodos: Trata-se de um estudo retrospectivo aninhado em um estudo prospectivo de coorte maior com pacientes com DPMR recrutados em um hospital-escola universitário terciário entre junho de 2009 e setembro de 2014. Os pacientes foram submetidos a inserção de cateter pleural e, em seguida, pleurodese à beira do leito. A TC de tórax foi realizada duas vezes: imediatamente antes da pleurodese (TCi) e 30 dias após a pleurodese (TC30). Com base na TCi, a posição do cateter foi classificada em posterolateral, anterior, fissural e subpulmonar. Usamos o volume pleural na TCi para estimar a expansão pulmonar precoce e a diferença entre os volumes pleurais na TC30 e na TCi a fim de avaliar o sucesso radiológico da pleurodese. Considerou-se que a pleurodese teve êxito clínico quando não foi necessário realizar nenhum outro procedimento pleural. Resultados: Dos 131 pacientes elegíveis do estudo original, 85 foram incluídos neste estudo aninhado (64 mulheres; média de idade: 60,74 anos). A posição da ponta do cateter foi subpulmonar em 35 pacientes (41%), anterior em 23 (27%), posterolateral em 17 (20%) e fissural em 10 (12%). Não houve diferenças significativas entre os grupos quanto à expansão pulmonar precoce (mediana da cavidade pleural residual = 377 ml; intervalo interquartil: 171-722 ml; p = 0,645), sucesso radiológico da pleurodese (mediana do volume = 33 ml; intervalo interquartil: −225 a 257 ml; p = 0,923) e sucesso clínico da pleurodese (85,8%; p = 0,676). Conclusões: Nossos resultados sugerem que a posição da ponta do cateter pleural não influencia nem a expansão pulmonar precoce nem o sucesso da pleurodese à beira do leito em pacientes com DPMR.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Catheters, Indwelling , Pleural Effusion, Malignant/surgery , Pleurodesis/methods , Thoracentesis/instrumentation , Thoracentesis/methods , Ultrasonography, Interventional/methods , Catheterization/methods , Lung/physiopathology , Pleural Cavity/surgery , Pleura/pathology , Pleura/physiopathology , Prospective Studies , Reproducibility of Results , Retrospective Studies , Statistics, Nonparametric , Tomography, X-Ray Computed , Treatment Outcome
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