Eficacia del uso de Nobecutan en los vendajes compresivos radiales poscateterismo cardíaco / Impact of Nobecutan use for radial compressive bandage after cardiac catheterization

El cateterismo cardiaco es un procedimiento que consiste en la introducción de un catéter por un acceso arterial (femoral, radial, braquial, cubital) que se lleva hasta el corazón para su estudio anatómico y funcional, grandes vasos y arterias coronarias. En nuestro centro, en la actualidad, se utiliza el acceso arterial radial como primera elección. Cuando finalizamos el estudio se retira el catéter y hay que comprimir el punto de punción por el que hemos realizado la prueba. La hemostasia de la arteria radial tras el cateterismo la realizamos mediante vendaje compresivo con Tensoplast®. Nuestra experiencia previa en el uso de Nobecutan® aerosol en los vendajes compresivos femorales nos hizo extender su uso al nuevo acceso vascular radial. En nuestro estudio, queremos mostrar la eficacia del uso de Nobecutan®, para la protección cutánea de la zona de punción donde se coloca el vendaje compresivo radial. Los resultados muestran una reducción de la lesión dermatológica tras la retirada del vendaje, sobre todo en los pacientes bajo tratamiento antiagregante y en los que hayan presentado lesión dermatológica secundaria al rasurado en la zona de punción (AU)

Cardiac catheterization consists in the introduction of a catheter through a peripheral arterial access (radial, femoral, brachial or cubital approach) directed to the heart, in order to study its anatomy or function, the presence coronary artery disease, and perform coronary interventions if indicated. Radial artery is our first option approach for cardiac catheterization. Once the study is finished, the catheter is removed from the arterial access and the puncture site is compressed to obtain hemostasis with a Tensoplast® compressive bandage. Based in our previous experience with the use of Nobecutan® aerosol in femoral bandage, we decided to extend it to the radial access. Our goal is to explore the Nobecutan® impact in puncture site cutaneous protection, where radial bandage is placed. Results show a reduction in dermatological lesion rate after removing the bandage, especially in patients under antiplatelet therapy and in those with previous dermatological lesion secondary to skin shaving rounding puncture site (AU)

Encuesta sobre el manejo perioperatorio de la hemostasia y transfusión en el trasplante hepático / Survey of hemostasis management and transfusion in liver transplantation

Objetivo. Conocer el manejo de la hemostasia y la práctica transfusional entre los anestesiólogos españoles en el ámbito del trasplante hepático. Método. Se elaboró un cuestionario dirigido a los facultativos especialistas en anestesiología y reanimación de todos los centros que realizan trasplante hepático en España. Los datos requeridos hacían referencia a los 12 meses previos a su distribución, desde el 1 de enero al 31 de diciembre de 2011. Resultados. Se recogieron datos de los 24 centros. Solo el 46% respondieron disponer de protocolos o guías de actuación para el manejo de la hemostasia. El 83% de los centros respondieron conocer el porcentaje de pacientes transfundidos, pero solo el 57% conocía la media de hemoderivados. La mitad respondió estar nada satisfecho con el manejo realizado. La tromboelastometría fue utilizada como método adicional de monitorización en el preoperatorio solo en el 8% de los centros y en un tercio durante el intraoperatorio. El 46% de los centros realizó corrección preoperatoria de los déficits de coagulación basados en test convencionales. En cuanto al consumo de hemoderivados, en el 57% de los centros la media de transfusión de concentrados de hematíes fue ≤ 4. El consumo de plasma fresco congelado fue muy variable, mientras que en el 100% de los centros se consumieron menos de 4 pools de plaquetas por paciente. Conclusiones. Existe una amplia variabilidad en el manejo de la hemostasia y en la práctica transfusional entre los centros españoles. No existen guías de manejo perioperatorio o no son utilizadas ampliamente. Las medias de hemoderivados transfundidos siguen siendo elevadas. Se aprecia un descenso en los centros que utilizan los nuevos métodos de monitorización (AU)

Objective. To determine the management of haemostasis and transfusion practice in the field of liver transplantation in Spain. Methods. A questionnaire was developed for physicians in anaesthesiology of all centres performing liver transplantation in Spain. The information required made reference to the 12 months prior to its distribution, from January 1 to December 31, 2011. Results. Data were collected from 24 centres in which liver transplantation is performed in Spain. Only 46% reported that they had protocols or practice guidelines for the management of haemostasis, and 83% of hospitals responded that they knew the percentage of transfused patients, but only 57% knew the mean transfusion. Regarding the degree of satisfaction with the management of haemostasis/coagulation, 50% said they were not satisfied. Thromboelastometry was used as an additional method of preoperative monitoring in only 8% of the centres and intra-operatively in one-third. Less than half (46%) of the centres performed preoperative correction of coagulation deficits based on conventional tests. The mean number of packed red cells used was ≤ 4 in 57% of centres. Consumption of fresh frozen plasma was highly variable, while 100% of centres consumed less than 4 pools of platelets per patient. Conclusions. There is a wide variability in the management of haemostasis and transfusion practice among Spanish centres. There are no guidelines or they are not widely used. The mean use of transfused blood products remain high. There was a decrease in centres using new methods of monitoring (AU)

Wire vascular closure device: evaluation of an evidence-based protocol for post-endovascular procedure patients.

Vascular closure devices (VCDs) can shorten the time to hemostasis, ambulation and discharge and improve patient comfort.(1) An evidence-based practice (EBP) project was initiated to assess impact of a shortened postoperative compression and bed rest protocol on patients undergoing arteriotomy using a wire vascular closure device (WVCD). Following protocol development, a post-implementation evaluation was initiated to assess selected outcomes including compression and bed rest time, complication rate and possible related variables. Following implementation of the new protocol, clinicians were able to shorten both compression and bed rest times by 50%, and Post-Anesthesia Care Unit (PACU) length of stay decreased to a maximum of 5 hours.

[Surgical debridement of wounds]. / La détersion chimrrgicale des plaies.

Surgical debridement is a surgical procedure which requires specific preparation. It involves a technique of surgical excision, combined with a basic procedure, lavage, to eliminate the metalloproteinases, and bleeding control.

Tratamento endovascular de hemorragia secundária a lesão da artéria esplênica na pancreatite aguda: relato de caso / Endovascular treatment of hemorrhage due to splenic artery injury in acute pancreatitis: case report

A lesão arterial esplênica é uma rara complicação relacionada a situações como trauma, lesão iatrogênica e pancreatite. Hemostasia pode ser feita por identificação do foco do sangramento através de cateterismo seletivo seguido por embolização do ramo sangrante. Relata-se caso clínico de um paciente portador de pancreatite biliar que apresentou, durante procedimento de necrosectomia, hemorragia decorrente da ruptura da artéria esplênica, sendo, então, tratado com sucesso por embolização supersseletiva.

Splenic artery injury is a rare complication related to trauma, iatrogenic injury, and pancreatitis. Hemostasis can be made by identification of the vascular lesion through selective catheterism followed by embolization of the bleeding vessel. We report a case of a patient with biliary pancreatitis, who presented hemorrhage due to rupture of the splenic artery during a necrosectomy procedure and was successfully treated with selective embolization.

A new approach to esophageal varices: endoscopic variceal ligation.

Bleeding from esophageal varices is a devastating complication of portal hypertension and is associated with a high mortality rate. The management goals for this group of patients are to achieve hemostasis in the acute phase, reduce variceal size, reduce the potential of rebleeding and eliminate varices with a follow-up program. For the past two decades, the gold standard of treatment has been endoscopic sclerotherapy but at the expense of many complications, which often cause serious morbidity. Endoscopic variceal ligation was developed as an alternative to endoscopic sclerotherapy. The experience to date shows that the goals of therapy can be achieved with fewer complications than those associated with sclerotherapy.