[Heart failure and nursing homes]. / L'insuffisance cardiaque en Ehpad.

Heart failure is a very common condition in elderly people, particularly those living away from home, in institutional care. The main objective of a study was to find out whether patients with heart failure admitted to a nursing home benefit or not from the same ultrasound assessment as the general population. The secondary objective was to analyse the management of residents with heart failure living in institutional care.

Focused ultrasound of the pleural cavities and the pericardium by nurses after cardiac surgery.

OBJECTIVES: We aimed to study the feasibility and reliability of focused ultrasound (US) examinations to quantify pericardial (PE)- and pleural effusion (PLE) by a pocket-size imaging device (PSID) performed by nurses in patients early after cardiac surgery. DESIGN: After a 3-month training period, with cardiologists as supervisors, two nurses examined 59 patients (20 women) with US using a PSID at a median of 5 days after cardiac surgery. The amount of PE and PLE was classified in four categories by US (both) and chest x-ray (PLE only). Echocardiography, including US of the pleural cavities, by experienced cardiologists was used as reference. RESULTS: Focused US by the nurses was more sensitive than x-ray to detect PLE. The correlations of the quantification of PE and PLE by the nurses and reference was r (95% confidence interval) 0.76 (0.46-0.89) and 0.81 (0.73-0.89), both p < 0.001. PE and PLE were drained in one and six (eight cavities) patients, all classified as large amount by the nurses. CONCLUSIONS: Cardiac nurses were able to obtain reliable measurements and quantification of both PE and PLE bedside by focused US and outperform the commonly used chest x-ray regarding PLE after cardiac surgery.

Correction of carotid-jugular traumatic fistula using a bovine pericardial patch / Correção de fístula traumática carotídeo-jugular com pericárdio bovino

Carotid-jugular fistulae are rare, but habitually cause morbidity and mortality. They are often linked with penetrating trauma, primarily caused by gunshots. This report describes the case of a patient who was the victim of a gunshot wound to the left cervical area, provoking a carotid-jugular arteriovenous fistula and occlusion of the common carotid artery. The fistula was corrected by ligature of the internal jugular vein and arteriorrhaphy of the left common carotid artery with a bovine pericardium patch.

A fístula carotídeo-jugular é de ocorrência rara, porém habitualmente causa morbimortalidade. Está associada frequentemente a trauma penetrante, principalmente em razão de lesão por projétil de arma de fogo. Relata-se o caso de um paciente vítima de lesão por projétil de arma de fogo na região cervical esquerda, o que provocou fístula arteriovenosa carotídeo-jugular com oclusão da artéria carótida comum. Foi realizada correção da fístula com ligadura da veia jugular interna e arteriorrafia com remendo de pericárdio bovino na artéria carótida comum esquerda.

Endovascular treatment of external iliac vein stenosis caused by graft compression after kidney transplantation / Tratamento endovascular de estenose de veia iliaca externa, em pos-operatorio de transplante renal, por compressao pelo enxerto

A 57-year old patient presented with approximately 80% stenosis of the left external iliac vein due to compression by the renal graft after kidney transplantation. The initial clinical manifestation of this vascular complication was progressive edema of the left lower limb, starting in the foot during the immediate postoperative period and reaching the thigh. Renal function also deteriorated during the first four months after transplantation. Venous Doppler ultrasound findings were suggestive of a diagnosis of extrinsic compression by the kidney graft and so phlebography was ordered, confirming stenosis of the left external iliac vein. The patient was initially treated with balloon angioplasty, but there was still residual stenosis so a stent was inserted, eliminating the stenosis. The edema reduced over time and the patient's renal function improved. While vascular complications are rare, and potentially severe, events, success rates are good if treatment is started early.

Paciente com 57 anos apresentou estenose de aproximadamente 80% de veia ilíaca externa esquerda, devido a compressão pelo enxerto renal após o transplante de rim. A complicação vascular manifestou-se clinicamente com edema em membro inferior esquerdo, de caráter progressivo, que se iniciou no pé, durante o pós-operatório imediato, e progrediu até a coxa, associando-se a deterioração da função renal durante o intervalo de quatro meses após o transplante. O diagnóstico de compressão extrínseca pelo enxerto renal foi sugerido pelo eco-Doppler venoso, sendo, então, realizada flebografia, que confirmou estenose de veia ilíaca externa esquerda. O tratamento foi realizado com angioplastia por balão, porém a estenose residual persistiu, optando-se, então, pela colocação de stent, com correção da estenose. O paciente evoluiu com regressão do edema e melhora da função renal. Embora as complicações vasculares sejam eventos raros e potencialmente graves, existe um bom percentual de sucesso com a terapêutica precoce.

Embolia de shunt carotídeo temporário para a artéria poplítea / Temporary carotid shunt embolism for popliteal artery

O deslocamento de um shunt para um ramo arterial mais distal, percorrendo um longo trajeto, é uma complicação rara. A ultrassonografia vascular pode se apresentar como uma excelente modalidade diagnóstica para identificar o sítio de embolização de corpos estranhos intravasculares. Os autores relatam um caso raro de migração de um shunt temporário, implantado na carótida comum esquerda, para artéria poplítea esquerda. Descrevem, ainda, a utilização do ecocolor doppler arterial que, além de localizar o ponto de embolização, com uma dermatografia exata, foi fundamental para que a abordagem cirúrgica transcorresse com facilidade através de uma via de acesso restrita e precisa.

The displacement of a shunt to a more distal arterial branch, along a path, is a rare complication. Vascular ultrasound can be presented as an excellent diagnostic modality for identifying the site of embolization of intravascular foreign bodies. The authors report a rare case of temporary shunt migration, implanted in the left common carotid artery, to left popliteal artery. The authors also describe the use of arterial vascular ultrasound to find the point of embolization, with an exact dermatography, that was essential to an easily surgical approach through a restrict and precise access way.

Tratamento alternativo para pseudoaneurisma femoral pós-cateterismo / Alternative treatment for postcatheterisation femoral false aneurysm

A incidência de pseudoaneurisma após cateterismo via femoral varia entre 0,1 a 2,0 por cento em procedimentos diagnósticos e 5 por cento em terapêuticos. São descritos tratamentos para pseudoaneurismas desde o método conservador até a intervenção com cirurgia convencional. Nos casos de pseudoanerismas de tamanho médio, o tratamento não invasivo, com compressão com duplex scan ou injeção de trombina/fator de coagulação XIII, é o de escolha. Neste artigo, relatamos dois casos de pseudoaneurisma pós-cateterismo terapêutico, em que foi realizado tratamento combinado utilizando-se técnicas endovascular e de cirurgia aberta. A associação dessas duas modalidades terapêuticas possibilitou a redução de perdas sanguíneas comparando-se à cirurgia convencional isolada, além de minimizar o trauma cirúrgico e reduzir o tempo de internação.

The incidence of femoral postcatheteriation pseudoaneurysm ranges from 0.1 to 2.0 percent in diagnostic procedures to 5 percent in therapeutic procedures. There are several treatment options for pseudoaneurysms, from conservative management to conventional surgical intervention. For medium-sized pseudoaneurysms, ultrasound-guided compression repair or percutaneous injection of thrombin/coagulation factor XIII are the treatments of choice. In this paper, we describe two cases of post-therapeutic catheterization pseudoaneurysm, in which endovascular and conventional surgery were combined. The association of these two modalities of treatment decreased blood loss in comparison with conventional surgery alone, besides reducing surgical trauma and hospital stay.

La punción del acceso vascular en hemodiálisis es una necesidad, el método Buttonhole una opción / Vascular access puncture in haemodialysis is a necessity. The buttonhole method is an option

Introducción. La técnica de punción del acceso, además de influir en la supervivencia de éste, es motivo de ansiedad y disconfort para el paciente. Existen tres técnicas de punción: escalera, área de punción y Buttonhole. Estudios realizados sobre esta última la asocian con disminución de dolor y de las complicaciones asociadas a la punción. Objetivo Introducción del método de punción Buttonhole en nuestra Unidad. Metodología Estudio descriptivo observacional, realizado en nuestra unidad de hemodiálisis. Se han incluido en este estudio todos los pacientes de hemodiálisis portadores de fístula arterio-venosa sana y no protésica. La muestra será de 35 pacientes randomizados aleatoriamente con un periodo de seguimiento de 6 meses. Previamente al inicio del estudio enfermería se formó en la técnica y se creó un protocolo de punción específico. Cada hemodiálisis se recogen todas las variables a analizar en una hoja de registro. Se aplica estadística descriptiva para las variables. t de Student para la diferencia entre medias y x2 y prueba exacta de Fisher para la de proporciones, considerando significativo p<0.05. Análisis de la supervivencia Kaplan-Meier. Paquete estadístico SPSS 14.0. Resultados La sensación de dolor durante la punción y el tiempo de hemostasia han disminuido significativamente en todos los pacientes. Durante el periodo del estudio no se ha producido ninguna complicación. Conclusiones La técnica Buttonhole disminuye el dolor percibido por el paciente comportando una mayor satisfacción. El Buttonhole es una buena alternativa para accesos poco desarrollados o con problemas de punción favoreciendo las opciones de auto-punción y hemodiálisis domiciliaria (AU)

Introduction. The access puncture technique, as well as affecting survival, is a cause for anxiety and discomfort for the patient. There are three puncture techniques: rope-ladder, area and buttonhole. Studies carried out on this last method associate it to a reduction in pain and the complications associated to puncture. Aim To introduce the buttonhole puncture method in our Unit. Methodology Observational descriptive study, carried out at our haemodialysis unit. All the patients on haemodialysis with a healthy and non-prosthetic arteriovenous fistula were included in this study. The sample will be 35 randomized patients with a monitoring period of 6 months. Prior to commencing the study, nursing staff were trained in the technique and a specific puncture protocol was created. All the variables to be analysed are recorded at each haemodialysis session. Descriptive statistics is applied for the Student t variable for the difference between means and x2 and Fisher’s exact test for the proportions, where p<0.05 is considered significant. Kaplan- Meier survival analysis. SPSS 14.0. statistical package. Results The sensation of pain during puncture and bleeding time were reduced significantly in all patients. No complications occurred during the study period. Conclusions The buttonhole puncture technique reduces the pain perceived by the patient, giving greater satisfaction. The buttonhole puncture technique is a good alternative for accesses that are not well developed or have puncture problems, favouring self-puncture and home haemodialysis options (AU)

Prevalência da estenose aterosclerótica do tronco celíaco e da artéria mesentérica superior na arteriopatia oclusiva dos membros inferiores / Prevalence of atherosclerotic stenosis of celiac trunk and superior mesenteric artery in occlusive arteriopathy of lower limbs

A eventual relação entre a aterosclerose das artérias dos membros inferiores com a aterosclerose das artérias intestinais foi pouco estudada. Objetivo: Avaliar pela ecografia vascular (Doppler) presença de lesões com estenose 70 por cento na artéria mesentérica superior e/ou tronco celíaco em doentes com arteriopatia obstrutiva crônica dos membros inferiores. Método: Foram estudados dois grupos, cada um com 60 doentes (40 homens e 20 mulheres). O grupo-caso foi composto por doentes com arteriopatia obstrutiva crônica dos membros inferiores, claudicação intermitente limitante ou dor de repouso e/ou lesões tróficas de extremidade, sem queixas gastrintestinais...

Esophageal Doppler monitoring for hemodynamic assessment.

This article reviews the importance of hemodynamic monitoring in adding to the clinical assessment of critically ill patients. The esophageal Doppler monitor (EDM) provides a less invasive way of obtaining hemodynamic information quickly and safely at the bedside. The concepts of Doppler signal acquisition and important nursing considerations are reviewed. Case studies are provided to understand how data from the EDM can impact patient care decisions at the bedside.

Maternal or fetal heart rate? Avoiding intrapartum misidentification.

Electronic fetal monitoring technology is capable of monitoring and recording maternal heart rate (MHR) patterns that mimic fetal heart rate (FHR) patterns. The ability to distinguish one from the other requires knowledge of FHR and MHR characteristics and monitoring technology. Application of this knowledge may prevent fetal injury and death. This article reviews heart rate monitoring technology and the similarities and differences between MHR and FHR baselines, accelerations, and decelerations. Three case reports are described in which the MHR was mistaken for the FHR prior to the diagnosis of fetal demise. Guidelines to confirm fetal life and prevent misidentification are proposed.