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Focus on peripherally inserted central catheters in critically ill patients

World Journal of Critical Care Medicine 2014年第4期3卷 80-94页

作者： Paolo Cotogni Mauro Pittiruti Anesthesiology and Intensive Care Department of Medicine S. Giovanni Battista Hospital University of Turin Department of Surgery Catholic University Hospital

Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with eac

关键词： Central venous catheters Venous access devices Ultrasound guidance Guidelines Peripherally inserted central catheters Blood stream infections Intensive care unit patients Critical care medicine Pediatrics

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Targeted Ultrasound-Guided Double catheters (Infraclavicular-Brachial Plexus, Median Nerve) Facilitate Hand Rehabilitation with Superb Analgesia and Motor Function Retention

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Open Journal of Anesthesiology 2015年第7期5卷 142-148页

作者： Ashlee E. Holman Balram Sharma Vicki E. Modest Massachusetts General Hospital Department of Anesthesia Critical Care and Pain Medicine Boston USA

A 44-year-old male who suffered a crush-degloving hand injury complicated by Complex Regional Pain Syndrome (CRPS) type I was scheduled for operative hand manipulation and inpatient physiotherapy. Preoperative placement of an ultrasound-guided infraclavicular catheter provided incomplete analgesia requiring supplemental morphine during physiotherapy sessions despite continuous infusion of 0.1% bupivacaine at 20 mL/hour. Due to the patient’s adamant refusal of replacement of the infraclavicular catheter, a second ultrasound-guided median nerve catheter was placed distally at the mid-forearm level and elicited complete sensory blockade of the hand. Dual infusions were maintained with 0.25% bupivacaine at 5 mL/hour through the median nerve catheter and 0.1% bupivacaine at 20 mL/hour through the infraclavicular catheter, and subsequent daily physiotherapy progressed productively. Continuous perineural catheter use to facilitate rehabilitation is an emerging practice that may improve overall recovery. Combination catheters, infusing local anesthetics at separate locations, can be used synergistically to preserve motor function and reach a superior analgesic endpoint.

关键词： Double Perineural catheters Infraclavicular Catheter Median Nerve Catheter Selective Sensory Blockade Motor Function Preservation

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A New Biomaterial for Urinary catheters

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Journal of Biomaterials and Nanobiotechnology 2018年第1期9卷 1-12页

作者： Roberto Santos Lima Salvador Vilar Correia Lima José Lamartine De Andrade Aguiar Eziel Cavalcanti Vasconcelos Rocha Flávia Cristina Morone Pinto Life Sciences Center Federal University of Pernambuco (UFPE) Caruaru Brazil Postgraduate Program in Surgery Department of Surgery Center for Health Sciences Federal University of Pernambuco (UFPE) Recife Brazil

Several studies argue that an ideal biomaterial for urinary catheters is utopian. Based in literature review it seems to be true. However, research advances: the biomaterial itself, new designs, new coatings, associated drugs, etc. Once implanted and interacting with urine, two old problems persist: encrustation and bacterial colonization. In this context, an extracellular product from bacterial synthesis on sugarcane molasses biomaterial has been studied in several experimental and clinical studies. Based on its high biocompatibility, the aim of this study is to evaluate its performance in an in vivo model as an endourologic prosthesis implanted in the bladder of Wistar rats. We evaluate physical, chemical and biological phenomena in comparison to an already established biomaterial, polyurethane. Even though it is not a finished product, the sugarcane biopolymer presented similar performance compared to polyurethane in several analyzed parameters and has an important characteristic: low cost.

关键词： Biomaterial Urinary catheters Encrustation

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Surface Treated catheters for Vascular Access—Useful?

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Open Journal of Nephrology 2013年第3期3卷 152-160页

作者： Rolf Bambauer Ralf Schiel Carolin Bambauer Reinhard Latza Inselklinik Heringsdorf GmbH Seeheilbad Heringsdorf Germany Institute for Blood Purification Homburg Germany Laboratorium of Medicine St. Ingbert Germany Main Hospital Darmstadt Darmstadt Germany

Background: Catheter-related infections (CRI), thrombosis, and stenosis are among the most frequent complications associated with catheters which are inserted in vessels as vascular access. These problems are usually related to the handling of the staff, the catheter materials, and the surface properties of the catheter. To mitigate such complications surface treatment process of the outer surface, such as ion beam assisted deposition is investigated in a retrospective study from 1992 to 2007, to prove if the surface treatment of the catheters is a sufficient solution. Methods: This study (1992-2007) evaluated silver coated and non-coated implanted large-bore catheters used for extracorporeal detoxification. In 159 patients, 54 patients received a silver coated catheter (Spi-Argent, Spire Corporation, Bedford, MA, USA) and 105 patients, an untreated catheter served as controls. The catheters were inserted into the internal jugular or subclavian veins. After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. They were also examined using a scanning electron microscope (SEM). Results: The silver coated catheters showed a tendency towards longer in situ time. The microbiologic examinations of the catheter tips were in both catheter types high positive, but not significant. Conclusion: The silver coated catheters showed no significant reduction in infection rate by evaluation of all collected data in this retrospective study. There was no association between both catheters in significantly reducing patient discomfort. Other surface treatments which include the outer and inner surface are necessary. New developed catheter materials such as the microdomain structured inner and outer surface, as an example, are considered more biocompatible because they mimic the structure of natural biological surface.

关键词： Surface Treated Large Bore catheters Hemodialysis Apheresis Ion Been Assisted Deposition (IBAD) Microdomain-Structered Surface (PUR-SMA Coated Catheter)

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Angle Effect to Dropping of Dew in Closed Suction catheters

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Health 2018年第6期10卷 719-729页

作者： Kazuto Doi Mayumi Doi Yukoh Yaegashi Katsuhisa Imoto Masaru Ando Junichi Kadota Department of Pathophysiology Faculty of Medicine Oita University Oita Japan Department of Clinical Pharmacology & Therapeutics Faculty of Medicine Oita University Oita Japan Department of Medical Engineering Faculty of Health Sciences Junshin Gakuen University Fukuoka Japan Department of Respiratory Medicine & Infectious diseases Faculty of Medicine Oita University Oita Japan

Intratracheal aspiration in a patient on ventilation is generally performed using a catheter. Of late, closed suction systems have been used more frequently than open systems. To remove tracheal secretions through the intratracheal tube, catheter suction is used, and the suction catheter may be of the closed- or open-type. The catheters are cleaned by flushing with sterile 0.9% saline, resulting in dropping of dew. This phenomenon is caused by some factors: influence of flow, clogging of the suction tube, problem of manipulation of flushing and angle between the intubation tube and the connection port. But this dropping has not yet been investigated. In this study, we focused at this angle and we used the test lung which is simulated machine on behalf of patient. We consider two situations adult and child, also two types of catheters Eco-Cath and Ty-care. In child case we consider elbow-type suction catheters and Y-connector type. The angle was set at 0°, 20°, 40°, 60°, and 90°, and we observed the difference between Eco-Cath and Ty-care. In adults difference is significant (p 0.001), In 90°between Tracheal intubation and Tracheotomy (p ≈ 0.26). In child difference is significant (p 0.001), In 90°between Tracheal intubation and Tracheotomy (p ≈ 0.15). In child case we observed dependency of angle on various conditions too. The relation of the angle and dew was clarified.

关键词： catheters Intratracheal Intubation Respiration Suction Tracheostomy Ventilators

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Drainage of pancreatic fluid collections in acute pancreatitis:A comprehensive overview

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World Journal of Clinical Cases 2022年第20期10卷 6769-6783页

作者： Akash Bansal Pankaj Gupta Anupam K Singh Jimil Shah Jayanta Samanta Harshal S Mandavdhare Vishal Sharma Saroj Kant Sinha Usha Dutta Manavjit Singh Sandhu Rakesh Kochhar Department of Radiodiagnosis Postgraduate Institute of Medical Education and ResearchChandigarh 160012India Department of Gastroenterology Postgraduate Institute of Medical Education and ResearchChandigarh 160012India

Moderately severe and severe acute pancreatitis is characterized by local and systemic *** complications predominate the early phase of acute pancreatitis while local complications are important in the late phase of the *** fluid collections represent the most important local *** of these collections is indicated in the setting of infection,persistent or new onset organ failure,compressive or pressure symptoms,and intraabdominal ***,endoscopic,and minimally invasive surgical drainage represents the various methods of drainage with each having its own advantages and *** methods are often *** this minireview,we discuss the indications,timing,and techniques of drainage of pancreatic fluid collections with focus on percutaneous catheter *** also discuss the novel methods and techniques to improve the outcomes of percutaneous catheter drainage.

关键词： Pancreatitis,Acute necrotizing Drainage catheters Stents Therapeutic irrigation Debridement Collections

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Transcatheter arterial embolization for traumatic injury to the pharyngeal branch of the ascending pharyngeal artery:Two case reports

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World Journal of Clinical Cases 2022年第32期10卷 12015-12021页

作者： Daisuke Yunaiyama Yuki Takara Takehiro Kobayashi Mika Muraki Taro Tanaka Mitsuru Okubo Toru Saguchi Motoki Nakai Kazuhiro Saito Kiyoaki Tsukahara Yuri Ishii Hiroshi Homma Department of Radiology Tokyo Medical University HospitalShinjuku-ku 160-0023Japan Department of Otorhinolaryngology Head and Neck SurgeryTokyo Medical University HospitalShinjuku-ku 160-0023Japan Department of Emergency and Critical Care Medicine Tokyo Medical University HospitalShinjuku-ku 160-0023Japan

BACKGROUND The ascending pharyngeal artery(APhA)comprises the pharyngeal trunk(PT)and neuromeningeal *** PT feeds the nasopharynx and adjacent tissue,which potentially connects with the sphenopalatine artery(SPA),branched from the internal maxillary artery(IMA).Due to its location deep inside the body,the PT is rarely injured by ***,we present two cases that underwent transcatheter arterial embolization(TAE)of the PT of the APhA due to trauma and iatrogenic *** SUMMARY Case 1 is a 49-year-old Japanese woman who underwent transoral endoscopy under sedation for a medical *** nasal airway was inserted as glossoptosis occurred during *** from the nasopharynx was observed during the endoscopic *** the bleeding continued,the patient was referred to our hospital for further ***-enhanced computed tomography(CT)demonstrated extravasation in the nasopharynx originating from the right Rosenmuller *** was performed and the extravasation disappeared after *** 2 is a 28-year-old Japanese woman who fell from the sixth floor of a building and was transported to our *** CT demonstrated a complex facial fracture accompanying extravasation in the left pterygopalatine fossa to the *** demonstrated an irregular third portion of the *** angiography after TAE of the IMA demonstrated extravasation from the PT of the APhA,additional TAE to the artery was *** bleeding stopped after the *** Radiologists should be aware that the PT of the APhA can be a bleeding source,which has a potential connection with the SPA.

关键词： Arteries catheters Hemorrhage Injury Trauma Case report

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Open Surgical Insertion of Tenkchoff Straight Catheter Without Guide Wire

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Chinese Medical Sciences Journal 2013年第2期28卷 117-121页

作者： Shi-feng Yang Wu-jun Xue Ai-ping Yin Li-yi Xie Wan-hong Lu Department of Nephrology First Affiliated Hospital of Medical SchoolXi'an Jiaotong University

Objective To compare the clinical outcomes of open surgical peritoneal dialysis catheter （PDC） insertion with guide wire and the outcomes of PDC insertion without guide wire. Methods Data of the patients receiving open surgical Tenkchoff straight catheter insertion in our department from January 2005 to January 2011 were retrospectively analyzed. The 117 patients in whom PDC insertion was conducted with the guidance of guide wire were enrolled into group A, and the 121 cases receiving PDC insertion without guide wire were enrolled into group B. The incidences of post-operative complications （catheter obstruction, catheter displacement, bloody dialysate, and dialysate leakage）, catheter survival, and patient survival rates were compared between the 2 groups. Results The baseline characteristics （gender, age, body mass index, prothrombin time, activated partial thromboplastin time, platelet count, serum creatinine, follow-up time, primary diseases, and outcomes） of the 2 groups were comparable （all P〉0.05）. In post-operative complications, only the incidence of early bloody dialysate showed significant difference, being 16.2% in group A and 7.4% in group B （P=0.04）. Catheter and patient survival rates were not significantly different between the two groups. Overweight patients showed a higher incidence of catheter obstruction compared with normal weight patients [16.0% （4/25） vs. 3.3% （7/213）, P=0.02], but no differences in post-operative between the 2 groups. complications were found among overweight patients Conclusions Open surgical Tenkchoff straight catheter insertion without guide wire does not lead to higher risk of post-operative complications and catheter removal. It may be an alternative option when guide wire is not available.

关键词： peritoneal dialysis catheters surgery guide wire

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Epidural abscess after multiple lumbar punctures for labour epidural catheter placement

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The Journal of Biomedical Research 2010年第4期24卷 332-335页

作者： Sundeep S.Tumber Department of Anaesthesiology and Pain Medicine University of California

Epidural catheterization is routinely used by anaesthesiologists to provide labour and post-operative analgesia. In most cases, catheter placement is without serious side effects and uneventful. However, epidural abscess is a rare complication that may result in severe morbidity. We present a case of epidural abscess after labour epidural catheter placement in a healthy 36-year-old female who presented on post-partum d 10 with complaints of fever and back pain. She was treated with intravenous antibiotics and fully recovered.

关键词： labour epidural abscess catheters analgesia

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VIRTUAL REALITY BASED THREE-DIMENSIONAL GUIDE WIRE PROPAGATION SIMULATION FOR ENDOVASCULAR INTERVENTION

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Transactions of Nanjing University of Aeronautics and Astronautics 2010年第1期27卷 62-69页

作者：周正东 Pascal Haigron Vincent Guilloux Antoine Lucas 南京航空航天大学材料科学与技术学院法国国家健康与医学研究院雷恩第一大学信号与图像处理实验室中法生物医学信息研究中心法国国家健康与医学研究院临床高新技术研究中心雷恩第一大学附属医院

The virtual reality based motion simulation of the guide wire and the catheter inside specific vascular structures can benefit a lot for the endovascular intervention. A fast and well-performed collision cancellation algorithm is proposed based on the geometric analysis and the angular propagation （AP）, and a 3-D real-time interactive system is developed for the motion simulation of the guide wire and the catheter inside the specific patient vascular. The guide wire or the catheter is modeled as the ＂multi-body＂ representation and properties are defined by its intrinsic characteristics. The motion of the guide wire or the catheter inside the vascular is guided by the collision detection and the collision cancellation algorithm. Finally, a relaxation procedure is used to achieve more realistic status. Experimental results show that the behavior of the guide wire or the catheter depends on the defined parameters. The real-time simulation can be achieved. The result shows that the simulation system is effective and promising.

关键词： catheters virtual reality guide wire multi-body model endovascular intervention

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