Meta-analysis of central and peripheral cannulation for type A aortic dissection.

BACKGROUND: Acute type A aortic dissection necessitates rapid and effective arterial cannulation techniques for optimal outcomes. This meta-analysis compares the safety and effectiveness of direct aortic cannulation (AoC) with peripheral cannulation (PC) via the femoral or axillary arteries in aortic surgery for acute type A aortic dissection. METHODS: A systematic review following PRISMA guidelines identified 10 retrospective studies encompassing 2518 patients (961 AoC, 1557 PC). Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated to analyze perioperative characteristics, short-term mortality rates, and postoperative complications including stroke and acute kidney injury. RESULTS: Short-term mortality did not significantly differ between AoC and PC (OR [95% CI] = 0.78 [0.61-1.01], p = .06). Likewise, postoperative stroke (OR [95% CI] = 0.86 [0.63-1.17], p = .33) nor acute kidney injury (OR [95% CI] = 1.11 [0.89-1.37], p = .35) showed no significant differences. AoC exhibited shorter operation time whereas there were no significant differences in aortic cross clamp time and cardiopulmonary bypass time between both groups. Our meta-regression analysis, considering the distal extent of aortic replacement, indicated that variations in aortic replacement rates did not significantly impact the observed outcomes. CONCLUSION: AoC is a viable alternative to PC for acute type A aortic dissection. While both approaches offer comparable outcomes, AoC's advantage in shorter operation time warrants thoughtful consideration in clinical practice.

Evaluation of peripheral cannulation technique among nurses in maternity and Dr. Jamal Ahmad Rashid pediatric teaching hospitals in Sulaimaniyah, Iraq.

BACKGROUND: Obedience to the excellent standards of nursing practice is the ultimate attitude to develop patient outcomes and avoid nursing process related-infections. Inserting the peripheral intravenous cannula is the utmost mutual aggressive technique achieved in nursing care for patients. Therefore, nurses must have adequate knowledge and practice to ensure the procedure's success. OBJECTIVES: To determine the peripheral cannulation technique evaluation among nurses working in the emergency departments. METHODS: This descriptive-analytical study was conducted at Maternity and Pediatric Teaching Hospitals in Sulaimaniyah, Iraq on 101 randomly selected nurses, from 14th December 2021 to 16th March 2022. Data collection was carried out through a structured interview questionnaire aimed to gather the nurses' general characteristics and an observational checklist to assess the nurses' pre, during and post practices regarding peripheral cannulation technique. RESULTS: According to general practice, 43.6% of nurses had an average level, 29.7% had a good level, and 26.7% had a poor level of practice in the evaluation of the peripheral cannulation technique. Our study also showed a positive association between socio-demographic characteristics of the studied samples with the overall level of practice regarding peripheral cannulation technique. CONCLUSIONS: Nurses were not practised peripheral cannulation technique appropriately; however, half of the nurses' had an average level of practice, although their practices were not followed the standard protocols.

Evaluation of extended-length cannula inserted using ultrasound guidance in patients with difficult IV access.

Historically, gaining peripheral intravenous (IV) access for patients with difficult intravenous access (DIVA) has been problematic and associated with increased complications, central venous access device insertion and reduced patient satisfaction. Consequently, extended-length peripheral intravenous catheters (PIVCs) have been developed, but to date no real-world data exploring their effectiveness with NHS patients has been published. This article reports on the results of introducing extended-length PIVCs, inserted using ultrasound guidance in patients with DIVA by a vascular access team. This began in 2019, across an adult tertiary hospital setting in the NHS with about 750 beds. The specialties at this hospital include, but are not limited to, emergency medicine; head and neck; vascular; diabetes and endocrinology; respiratory; care of the older person; stroke services; gastroenterology; and trauma and orthopaedics. The vascular access team recorded 1485 individual insertions between 2019 to 2022, with a mean dwell time of 6 days, a first attempt success rate of 91%, and a therapy completion rate of 75 and 78% for inpatient and outpatients respectively. Indications included administration of IV fluids, medication, blood products and access for investigations or procedures. Obtaining reliable IV access in patients with DIVA prevents treatment delays, cancelled or delayed procedures, both of which benefit patients and the healthcare organisation. The data presented in this study support the use of extended-length PIVCs in patients with DIVA and has led to the development of new referral pathways.

Alternative option for limb reperfusion cannula placement for percutaneous femoral veno-arterial ECMO.

Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is an established last line support for severe, acute cardiorespiratory failure. In the case of VA ECMO, peripheral cannulation via the femoral vessels is often advantageous when compared with the alternative central cannulation, and is associated with better clinical outcomes. One of the specific potential complications of peripheral femoral arterial cannulation for ECMO, however, is ipsilateral distal lower limb ischemia; a consideration especially when cannulating the vessel directly, as distal limb perfusion is invariably compromised by an occlusive effect of the arterial cannula within the femoral artery. The gold standard technique for lower limb reperfusion is a separate size 6-7 Fr cannula inserted proximally into the femoral artery, just below the insertion point of the ECMO return cannula, and connected directly to the ECMO circuit so that the blood flow is also directed distally to perfuse the entire limb. This functions well whether the ECMO cannula has been placed percutaneously or by surgical cut-down. Although proximal femoral arterial placement of the reperfusion cannula is the established and preferred technique, there are many technical challenges which may preclude its placement. Local haematoma or bleeding post ECMO insertion, peripheral vascular disease, constricted vasculature in severely shocked patients, or patient obesity are all common reasons why placement of the proximal reperfusion cannula may be difficult, or impossible. In such instances, our retrograde perfusion technique may maintain limb perfusion and may even be limb saving for patients on VA ECMO support.

Peripheral intravenous cannulation: protecting patients and nurses.

Peripheral intravenous cannulation is a common clinical procedure in today's healthcare setting. There are a range of different devices to choose from, and this article will consider the risk of catheter-related bloodstream infections and needlestick injuries, national and international guidelines on infection prevention and safety in intravenous access, the need for closed catheters, features of the Introcan Safety® 3 (B. Braun Melsungen AG) and research into peripheral cannulas.

Peripheral Cannulation for Cardiopulmonary Bypass in Resection of Renal Cell Carcinomas with Level 3 Tumour Thrombus.

BACKGROUND: In renal cell carcinomas with tumour thrombus involving the intrahepatic vena cava or above (Level 3+), the urologist will often require the assistance of a cardiothoracic surgeon to establish cardiopulmonary bypass to safely perform a cavotomy for complete resection - this is traditionally through a sternotomy and central cannulation approach. METHODS: We present two cases of patients with Level 3 tumour thrombus involvement, in whom resection was performed with bypass established through peripheral cannulation, thus avoiding the added morbidity of a sternotomy. RESULTS: The cases were performed without any major adverse events, with bypass times of 55 and 200minutes respectively. CONCLUSIONS: Peripheral cannulation is a useful tool in the cardiothoracic surgeon's armamentarium, whose utility should be remembered outside of its traditional setting. We describe two cases, where peripheral cannulation for CPB has been shown to be a safe and minimally invasive alternative to sternotomy for resection of locally advanced renal cell carcinomas.

Structured learning in paediatric vascular access: effects on clinical practice.

UNLABELLED: Vascular access is an essential skill requirement for many health professionals. Traditionally, in-house medical and nurse training has revealed limited paediatric vascular access experience. AIM: To critically evaluate the effectiveness of the implementation of a structured learning and assessment framework for paediatric vascular access and its impact on improving the learning experience, skill acquisition and retention of health professionals. METHODS: A two-part retrospective (group 1) and prospective (group 2) study involving 49 health professionals was undertaken. Purposive sampling was used with the study method of survey to evaluate learning experience and assess if learning had been transferred into practitioner clinical practice. RESULTS: Overall 61% of participants in group 1 were competent 12 months post training. In comparison, 57% in group 2 were competent 10 weeks post training. CONCLUSION: Findings highlight encouraging results with improvement in practitioner learning experience, skill acquisition and retention post framework implementation. RECOMMENDATIONS: A structured programme incorporating assessment is required with the use of multi-evaluation methods to evaluate education effectiveness.

Central versus peripheral cannulation for acute type A aortic dissection: A meta-analysis of over 14,000 patients.

OBJECTIVE: The optimal cannulation strategy for patients with acute type A aortic dissections (ATAAD) is unclear. METHODS: A systematic search was performed to identify all studies comparing aortic and non-aortic cannulation in patients undergoing ATAAD repair. The primary endpoint was overall survival. The secondary endpoints were operative mortality, postoperative stroke, renal failure, renal replacement therapy, paraplegia, and mesenteric ischemia. Pooled meta-analyses with aggregated and reconstructed time-to-event data were performed. RESULTS: Twenty-three studies were included (aortic: 3904; non-aortic: 10,719). Ten-year overall survival was 61.1 â€‹% and 58.4 â€‹% for aortic and non-aortic cannulation, respectively (HR 1.07; 95 â€‹% CI 0.92-1.25; p â€‹= â€‹0.38). No statistically significant difference was observed for operative mortality (p â€‹= â€‹0.10), stroke (p â€‹= â€‹0.89), renal failure (p â€‹= â€‹0.83), or renal replacement therapy (p â€‹= â€‹0.77). CONCLUSION: Patients undergoing surgery for ATAAD can undergo aortic cannulation with similar outcomes to those who undergo non-aortic cannulation.

Mechanical circulatory support in severe primary graft dysfunction: Peripheral cannulation but not earlier implantation improves survival in heart transplantation.

BACKGROUND: Primary graft dysfunction (PGD) still affects 2% to 28% of heart transplants (HT). Severe PGD requires mechanical circulatory support (MCS) and is the main cause of death early after HT. Earlier initiation has been suggested to improve prognosis but the best cannulation strategy is unknown. METHODS: Analysis of all HT in Spain between 2010 and 2020. Early (<3 hours after HT) vs late initiation (≥3 hours after HT) of MCS was compared. Special focus was placed on peripheral vs central cannulation strategy. RESULTS: A total of 2376 HT were analyzed. 242 (10.2%) suffered severe PGD, 171 (70.7%) received early MCS and 71 (29.3%) late MCS. Baseline characteristics were similar. Patients with late MCS had higher inotropic scores and worse renal function at the moment of cannulation. Early MCS had longer cardiopulmonary bypass times and late MCS was associated with more peripheral vascular damage. No significant differences in survival were observed between early and late implant at 3 months (43.82% vs 48.26%; log-rank p = 0.59) or at 1 year (39.29% vs 45.24%, log-rank p = 0.49). Multivariate analysis did not show significant differences favoring early implant. Survival was higher in peripheral compared to central cannulation at 3 months (52.74% vs 32.42%, log-rank p = 0.001) and 1 year (48.56% vs 28.19%, log-rank p = 0.0007). In the multivariate analysis, peripheral cannulation remained a protective factor. CONCLUSIONS: Earlier MCS initiation for PGD was not superior, compared to a more conservative approach with deferred initiation. Peripheral compared to central cannulation showed superior 3-month and 1-year survival rates.

Use of the Ultrasound Technique as Compared to the Standard Technique for the Improvement of Venous Cannulation in Patients with Difficult Access.

(1) Objective. We aimed to demonstrate that the use of the ultrasound-guided technique facilitates peripheral venous cannulation as compared to the standard technique in patients with difficult access at emergency services. (2) Method. A case-control study, randomized research. Variables were collected from a population with non-palpable or not visible veins, classified into size risk groups for 6 months. In the comparative analysis, the patients were divided into two groups: the cases group was composed of patients to whom the peripheral venous cannulation was performed with the ultrasound-guided technique (UST), while the control was composed of patients with whom the standard technique (ST) was performed. The ultrasound LOGIQ P5 750VA from General Electric Healthcare, with an 11 mHz linear probe, was utilized, along with peripheral venous catheters model InsyteTM AutoguardTM with gauges of 14G to 26G. (3) Results. Seventy-two cases. The use of the ultrasound decreased the time (618.34s ST, 126s UST) and the number of punctures (2.92 ST, 1.23 UST); about 25% of the patients did not have complications with the UST, as compared to 8% with the ST. The use of the ultrasound decreased the pain experienced by 1.44 points in the visual analog scale, as compared to 0.11 points with the ST. The rate of success of the first try with the UST was 76%, as compared to 16% of the ST. The gauge of the catheter increased with the UST, with successful cannulations obtained with 20G (56%) and 18G (41%) gauges. (4) Conclusions. The use of ultrasound facilitates venous cannulation according to the variables of the study. The ultrasound visualization of the vessels is associated with the selection of the catheter gauge. There was no relation between the complications and the depth of the blood vessels.

Atrial Septal Defect Closure Via Mini Thoracotomy and with Peripheral Cannulation.

BACKGROUND: Atrial septal defect is one of the most common congenital cardiac disorders requiring intervention. We compared a minimally invasive method for atrial septal defect closure that included total peripheral cannulation and an anterior mini-thoracotomy incision of 5 cm or less with a median sternotomy approach. METHODS: This was a retrospective cross-sectional study among patients with Atrial Septal Defect. The preoperative variables, intraoperative data, and postoperative outcomes of patients undergoing minimally invasive atrial septal defect closure with total peripheral cannulation and atrial septal defect closure via median sternotomy were collected and compared. RESULTS: Fifty-five patients underwent minimally invasive closure of the atrial septal defect with total peripheral cannulation and 55 patients that underwent surgery by median sternotomy were included for comparison. There were 61.81% (34) female and 38.18% (21) male in the mini-thoracotomy group while there were 52.72% (29) female and 47.27% (26) male in the median sternotomy group. The mean age at surgery was 23.4 and 28.6 years in mini-thoracotomy and median sternotomy groups of patients respectively. The most common symptom was exertional shortness of breath in both groups. The mean length of stay in the intensive care unit was 1.8 and 2.5 days in mini-thoracotomy and median sternotomy groups respectively, and the length of stay in the hospital was 4.5 days and 4.8 days in mini-thoracotomy and median sternotomy groups respectively. There was a significant association was found between the mini-thoracotomy and median sternotomy group in relation to mean size of the incision, average time for cardiopulmonary bypass, average cross-clamp time, and fluid drained on the first day after surgery. CONCLUSIONS: Atrial septal defect closure with a mini-invasive approach is safe and cost-effective with very few perioperative complications and good patient satisfaction.

Modern practice and outcomes of reoperative cardiac surgery.

OBJECTIVES: To evaluate recent practice and outcomes of reoperative cardiac surgery via re-sternotomy. Use of early versus late institution of cardiopulmonary bypass (CPB) before sternal re-entry was of particular interest. METHODS: From January 2008 to July 2017, 7640 patients underwent reoperative cardiac surgery at Cleveland Clinic. The study group consisted of 6627 who had a re-sternotomy and preoperative computed tomography scans; 755 and 5872 were in the early and late institution of CPB groups, respectively. Patients were stratified into high (n = 563) or low (n = 6064) anatomic risk of re-entry on the basis of computed tomography criteria. Weighted propensity-balanced operative mortality and morbidity were compared with surgeon as a random effect. RESULTS: Reoperative procedures most commonly incorporated aortic valve replacement (n = 3611) and coronary artery bypass grafting (n = 2029), but also aortic root (n = 1061) and arch procedures (n = 527). Unadjusted operative mortality was 3.5% (235/6627), and major sternal re-entry and mediastinal dissection injuries were uncommon (2.8%). In the propensity-weighted analysis, similar mortality (3.1% vs 4.5%; P = .6) and major morbidity, including stroke (1.8% vs 3.2%) and dialysis (0 vs 2.6%), were noted in the high anatomic risk cohort between early and late CPB groups. Similar trends were observed in the low anatomic risk cohort (mortality 3.5% vs 2.1%; P = .2). CONCLUSIONS: Reoperative cardiac surgery is associated with low operative morbidity and mortality at an experienced center. Early and late CPB strategies have comparable outcomes in the context of an image-guided, team-based strategy.

Low Consciousness in a Patient with Venous Air Embolism Introduced via Peripheral Vascular Cannulation.

INTRODUCTION: Venous air embolism is rarely seen, can be fatal and is associated mostly with large central venous catheters and mechanical ventilation. Some cases due to peripheral intravenous access have also been reported. CASE DESCRIPTION: We present a case of intracranial venous air embolism most likely secondary to peripheral cannulation. On admission, the patient was drowsy with a suddenly deteriorating Glasgow coma scale score. This case emphasizes cautious cannula insertion and close monitoring of the patient in the event of complications. CONCLUSION: Intravenous cannulation is common but care should be taken to avoid catastrophic complications. Consider air embolism as the differential diagnosis if a patient has a low level of consciousness after an intravenous cannula is inserted. LEARNING POINTS: A reduced level of consciousness in a patient should be quickly recognised and the differential diagnosis of air embolism considered.Peripheral vascular cannulation should be carefully monitored.High-flow oxygen and efficient monitoring of the patient are required.

Implementing an emergency department vascular access team: A quality review of training, competency, and outcomes.

Peripheral intravenous catheters are frequently used devices in emergency departments. Many patients now present with difficult anatomy and are labeled as difficult intravenous access patients. A common technology to address this challenge is ultrasound. While studies have examined the ability to train emergency staff, few have addressed how this should be done and the outcomes associated with such training. No studies were found with dedicated vascular access specialist teams in emergency departments. An emergency department vascular access specialist team was formed at a hospital in Bangor, Maine, United States to train, validate, and proctor clinicians with ultrasound-guided peripheral intravenous devices. A quality review of this process was compiled and determined that appropriate clinicians with dedicated training and guidance can achieve higher levels of procedural success. Furthermore, evidence substantiates that frequent practice is linked to a higher quality of care and that a significant need for such teams is present. This review examines how a team was implemented and its impact both department- and facility-wide. It is possible that hospitals benefit from the services of vascular access specialists to provide higher quality care. Successful implementation of such specialist teams requires foundational knowledge and skills in vascular access with ongoing quality measures to ensure competency and compliance with evidence-based practices.

Penetrating Heart Injury Repaired with Peripheral Cannulation: Case Report.

Heart injuries usually occur due to penetrating or blunt traumas. High mortality rates are seen in heart injuries, owing to firearms and cutting/piercing tools. Factors such as the degree of injury, its localization, and the length of time to reach the hospital influence mortality rates. Despite the increase in imaging facilities and improvements in hospital transportation in today's conditions, high mortality rates are still observed, owing to causes such as sudden blood loss, cardiac arrest, or cardiac tamponade. The present study aimed to present the successful treatment of a 46-year-old male patient with injuries to the left atrium and posterior wall of the left ventricle due to a gunshot wound using the approach of median sternotomy and peripheral cannulation.

Venous drainage for minithoracotomy approach in an adult with interrupted inferior vena cava.

For atrial septal defect closure via right minithoracotomy in an adult patient with infra-hepatic interruption of the inferior vena cava with azygos connection, an alternative venous cannulation strategy was applied. In addition to bicaval cannulations to the femoral vein and the internal jugular vein, a 20 Fr straight cannula draining the hepatic vein was added to the proximal IVC through the right atrium wall via a working port. A bloodless operative field in the right atrium was afforded with bicaval encircling. Preoperative imaging test of the continuity of the IVC was important planning cardiac surgery with peripheral cannulations.

Cannulation Strategies for Minimally Invasive Cardiac Surgery.

OBJECTIVE: Operative techniques for minimally invasive cardiac surgery (MICS) have evolved dramatically over the past decade to include a wide demographic of patients. Mastering a variety of cannulation techniques is of paramount importance in performing a safe perfusion strategy and operation. Our aim is to describe cannulation strategies utilized in various MICS procedures. METHODS: We review numerous cannulation strategies and their application in different minimally invasive procedures. RESULTS: Cannulation strategies will vary depending on the MICS procedure and other anatomical variations and obstacles. Utilizing the appropriate cannulation strategy will allow for a safe and effective operation. CONCLUSIONS: Mastering the art of cannulation will provide surgeons with a toolbox to choose from when performing MICS in a wide variety of procedures.

Effects of smelling amniotic fluid on preterm infant's pain and stress during peripheral cannulation: A randomized controlled trial.

AIM: To investigate the effect of smelling amniotic fluid on preterm infants' pain and stress caused by peripheral cannulation. METHODS: This was a randomized controlled trial. The study sample consisted of 80 preterm infants meeting the case selection criteria and infants were randomly assigned to each group. However, in addition to the infants excluded from the study, total number of the infants in all the groups was 61. Infants in the amniotic fluid group smelled amniotic fluid for 15 min before, during, and after the application of peripheral cannulation while those in the control group received routine care during the procedure. The Premature Infant Pain Profile was used to assess their pain levels, and salivary cortisol analysis was performed to evaluate stress levels. RESULTS: Preterm infants in the amniotic fluid and control groups had similar baseline characteristics. However, the pain levels of infants in the amniotic fluid group were significantly lower than of those in the control group during and after the procedure. After the procedure, cortisol levels of the infants in the amniotic fluid group were lower than of those in the control group, although this difference was not significant. CONCLUSION: The intervention of smelling amniotic fluid is a practice that can be used for reducing pain and stress of preterm infants during peripheral cannulation.

Use of vein-viewing device to assist intravenous cannulation decreases the time and number of attempts for successful cannulation in pediatric patients.

Every child who contacts a healthcare setting has a potential for intravenous cannulation (IV) procedure and related pain, fear, and distress. Many of the healthcare professionals recognize that there is a lack of intervention to prevent multiple cannulation attempts and to reduce pain and distress inflicted to children during IV cannulation. A quasi-experimental study was undertaken in pediatric patients to study the effect of a vein-viewing device (VTorch) on IV cannulation procedure. The number of cannulation attempts and time taken for successful cannulation were assessed with the use of this device (experimental group, n = 159) and compared it with the standard procedure (control group, n = 159). The effect of this device in cannulation associated pain, fear, and behavioral distress were also evaluated among these children. Using Vein-viewing device as an aid for IV cannulation significantly reduced the time taken for cannulation (P = .003) and the number of cannulation attempts (P = .03). In addition, there was a significant increase in the first-attempt cannulation success rate with the use of this device (P = .04). The use of vein-viewing device did not have any direct effect on cannulation associated pain, fear, or behavioral distress among the study participants. The results of this study may aid in improving the quality of intravenous access procedure in pediatric patients.