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2.
Biomed Res Int ; 2022: 6128557, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35502334

RESUMO

Objective: In this study, we aimed to evaluate the effect of administering lidocaine as a local anesthetic at the puncture site prior cannulation on reduction of pain during intravenous cannulation (IVC). Methods: A total of 77 patients were divided into two groups as the patients who received a local anesthetic prior IVC procedure (n = 40) and the control group (n = 37). Patients' demographic data, including age, gender, height, weight and body mass index, IV gauge, IV site, heart rate (HR), and oxygen saturation (SpO2) were recorded and analyzed. Patients in both groups scored the pain they felt during IVC through the visual analog scale (VAS) and the verbal descriptor scale (VDS). Results: No statistically significant difference was found between the two groups in terms of the demographic features. There was no significant difference between the two groups in terms of the cannula gauges and site of IVC. The mean post-IVC HR value was statistically significantly higher compared to pre-IVC in the control group (p = 0.032), while no difference was found between the mean pre- and postprocedure HR in the lidocaine group. The mean VAS score was significantly lower in the lidocaine group compared to the control group (p < 0.001). There was a significant difference between the groups in terms of the current VDSs. The rate of the patients reporting mild pain was statistically significantly higher in the lidocaine group compared to the control subjects (p < 0.001). Conclusion: According to the results of this study, lidocaine HCL-impregnated padded dressing prior IV cannulation significantly reduced pain sensation during IVC.


Assuntos
Anestésicos Locais , Lidocaína , Adulto , Anestésicos Locais/uso terapêutico , Bandagens , Cateterismo/efeitos adversos , Humanos , Lidocaína/uso terapêutico , Dor/tratamento farmacológico
4.
BMC Pediatr ; 22(1): 237, 2022 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-35488225

RESUMO

BACKGROUND: Venous cannulation is among the most stressful and painful experiences of children hospitalization. Children with thalassemia need regular blood transfusion which needs venous access each time. The quality of care and quality of life of children will be improved if appropriate methods are used to reduce pain. This study aimed to compare vapocoolant spray and music in the reduction of pain of Venous cannulation in children with thalassemia. METHODS: The study was a randomized controlled clinical trial with a cross-over design. Thirty-six children with thalassemia from Thalassemia Patients of Pasteur Hospital in Bam from October to December 2020 and were recruited and randomly allocated to two arms. The pain of venous cannulation (no treatment) was measured in the first blood transfusion session as control. In the second and third sessions, two arms received music and vapocoolant spray before the venous cannulation with a cross-over design. The intensity of pain was measured by a Visual Analogue Scale (VAS). The change in pain scores was tested by ANOVA and Tukey post-hoc test between three measurements. RESULTS: During and after the cannulation, the pain was significantly lower in the vapocoolant measurement than in control and music (p < 0.05). There was a significant effect of vapocoolant spray during the procedure F (2, 90) = 25.604, p = 0.001. Also, there was a significant effect of vapocoolant spray after the procedure F (2, 90) = 10.087, p = 0.004). Music did not reduce the pain during cannulation (p = 0.413) and after that (p = 0.807) significantly when compared with control. CONCLUSIONS: Vapocoolant was an effective method of pain reduction in the reduction of venous cannulation pain. Music was not effective in the reduction of venous cannulation pain when we compared it with controls. The pain of venous cannulation is rated as high and it can have negative effects on the children. There is a need to do more research on the methods of pain reduction of venous cannulation. TRIAL REGISTRATION: The trial is registered: IRCT20111019007844N13, 13/03/2020. Available at: https://en.irct.ir/trial/42904 .


Assuntos
Música , Cateterismo , Criança , Humanos , Dor/etiologia , Dor/prevenção & controle , Medição da Dor/métodos , Qualidade de Vida
5.
BMC Anesthesiol ; 22(1): 88, 2022 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-35361115

RESUMO

BACKGROUND: A peripheral venous catheter (PVC) is the most widely used device for obtaining vascular access, allowing the administration of fluids and medication. Up to 25% of adult patients, and 50% of pediatric patients experience a first-attempt cannulation failure. In addition to patient and clinician characteristics, device features might affect the handling and success rates. The objective of the study was to compare the first-attempt cannulation success rate between PVCs with wings and a port access (Vasofix® Safety, B. Braun, abbreviated hereon in as VS) with those without (Introcan® Safety, B. Braun, abbreviated hereon in as IS) in an anesthesiological cohort. METHODS: An open label, multi-center, randomized trial was performed. First-attempt cannulation success rates were examined, along with relevant patient, clinician, and device characteristics with univariate and multivariate analyses. Information on handling and adherence to use instructions was gathered, and available catheters were assessed for damage. RESULTS: Two thousand three hundred four patients were included in the intention to treat analysis. First-attempt success rate was significantly higher with winged and ported catheters (VS) than with the non-winged, non-ported design (IS) (87.5% with VS vs. 78.2% with IS; PChi < .001). Operators rated the handling of VS as superior (rating of "good" or "very good: 86.1% VS vs. 20.8% IS, PChi < .001). Reinsertion of the needle into the catheter after partial withdrawal-prior or during the catheterization attempt-was associated with an increased risk of cannulation failure (7.909, CI 5.989-10.443, P < .001 and 23.023, CI 10.372-51.105, P < .001, respectively) and a twofold risk of catheter damage (OR 1.999, CI 1.347-2.967, P = .001). CONCLUSIONS: First-attempt cannulation success of peripheral, ported, winged catheters was higher compared to non-ported, non-winged devices. The handling of the winged and ported design was better rated by the clinicians. Needle reinsertions are related to an increase in rates of catheter damage and cannulation failure. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT02213965 , Date: 12/08/2014.


Assuntos
Cateterismo , Pacientes , Adulto , Cateteres , Criança , Humanos , Injeções
6.
Eur Rev Med Pharmacol Sci ; 26(6): 1914-1922, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35363340

RESUMO

OBJECTIVE: Short-axis out-of-plane (SA-OOP) and long-axis in-plane (LA-IP) are the two major approaches used in ultrasound (US)-guided radial arterial catheterization. Nevertheless, their efficacy and safety remain controversial. Therefore, this meta-analysis aimed at comparing the two approaches for radial arterial catheterization. MATERIALS AND METHODS: The PubMed, Embase, and Cochrane Library databases were searched for relevant articles published from database inception until December 2020. We selected randomized controlled trials comparing the short- and long-axis methods for US-guided radial artery catheterization. The results were analyzed using RevMan software to determine the adequacy and conclusiveness of the available evidence. RESULTS: Six studies (725 patients) ultimately met the inclusion criteria. No significant difference was observed between the SA-OOP and LA-IP approaches for US-guided radial artery catheterization (relative risk [RR], 0.99; 95% confidence interval [CI], 0.96-1.03; p =0.61; I2=0%). The first-attempt success rate was similar between the two groups (relative risk [RR], 1.02; 95% CI, 0.79-1.32; p =0.90; I2=87%). The incidence of hematoma formation was similar between the two groups (RR, 1.91; 95% CI, 0.66-5.56; p =0.24; I2=77%). CONCLUSIONS: The SA-OOP approach does not increase the total or first-attempt success rate of radial artery catheterization using the LA-IP approach. More highly powered well-designed trials are needed to evaluate additional outcomes.


Assuntos
Artéria Radial , Ultrassonografia de Intervenção , Cateterismo , Humanos , Artéria Radial/diagnóstico por imagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Ultrassonografia , Ultrassonografia de Intervenção/métodos
8.
Arq Gastroenterol ; 59(1): 29-34, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35442332

RESUMO

BACKGROUND: This paper aims to determine factors associated with difficult biliary cannulation (DBC) that are identifiable before procedures. METHODS: This is a nested case-control study within a historical cohort in adult patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) from 2015-2019 in the Hospital Universitario San Ignacio, Colombia. This study assessed the associations among variables that could be identified before or at the beginning of procedures and the probability of DBC. These associations were evaluated through a bivariate and multivariate analysis. The study used criteria for DBC defined by the European Society of Gastrointestinal Endoscopy. RESULTS: A total of 498 ERCP performed in 376 patients were analyzed. Of all procedures, 144 (29%) fulfilled criteria for DBC. The multivariate analysis showed an association between DBC and the acute care hospital setting (OR:2.92; CI95% 1.70-5.01; P<0.001), redundant papilla (OR:7.26; CI95% 3.38-15.61; P<0.001), or peridiverticular papilla (OR:2.45; CI95% 1.38-4.36; P=0.002). No association was found between DBC and endoscopist's experience, bilirubin levels, or dilation of the biliary tract. CONCLUSION: The DBC is a frequent event. Alterations in the papilla and ERCP performed in the acute care hospital setting are the principal factors associated with DBC. This information might be useful to predict DBC and establish healthcare and administrative strategies to reduce its implications.


Assuntos
Sistema Biliar , Cateterismo , Adulto , Estudos de Casos e Controles , Cateterismo/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Dilatação , Humanos , Estudos Retrospectivos
9.
BMJ Open ; 12(4): e056649, 2022 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-35410930

RESUMO

INTRODUCTION: Chronic urinary retention is a common lower urinary tract disorder, mostly neurogenic or idiopathic in origin. The preferred treatment is clean intermittent urinary self-catheterisation (CISC) four to six times a day. In most European countries, virtually all patients use single use catheters, which is in contrast to several countries where the use of reusable catheters is more common. The available literature on the use of reusable catheters is conflicting and until now, no randomised controlled trial with sufficient power has been performed to investigate if reusable catheters for CISC is as safe as single use catheters. METHODS AND ANALYSIS: We described this protocol for a prospective, randomised controlled non-inferiority trial to investigate if the use of reusable catheters is as safe as single use catheters for CISC patients, measured by symptomatic urinary tract infections (sUTIs). Secondary objectives are adverse events due to a sUTI, urethral damage, stone formation, quality of life and patient satisfaction. A cost-effectiveness analysis will also be performed. 456 Participants will be randomised into two groups stratified for age, gender, menopausal status and (non-)neurogenic underlying disorder. The intervention group will replace the reusable catheter set every 2 weeks for a new set and replace the cleaning solution every 24 hours. The control group continues to use its own catheters. The primary outcome (amount of sUTIs from baseline to 1 year) will be tested for non-inferiority. Categorical outcome measures will be analysed using χ2 tests and quantitative outcome variables by t-tests or Mann-Whitney U tests. Two-sided p values will be calculated. ETHICS AND DISSEMINATION: This protocol was reviewed and approved by the Medical Ethics Committee of the Erasmus MC (MEC 2019-0134) and will be performed according to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist for non-inferiority trials. The results of this randomised controlled non-inferiority trial will be published in a peer-reviewed journal and will be publicly available. TRIAL REGISTRATION NUMBER: NL8296.


Assuntos
Cateterismo , Retenção Urinária , Cateterismo/efeitos adversos , Cateterismo/métodos , Humanos , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Retenção Urinária/terapia , Infecções Urinárias/etiologia
10.
Exp Clin Transplant ; 20(Suppl 1): 153-155, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35384828

RESUMO

Kidney transplantation continues to be the treatment of choice in patients with end-stage chronic kidney disease. Unfortunately, most patients in the adult population have coexisting diseases. Anemia, platelet dysfunction, and changes to the cardiovascular system are not the exception in the evolution of the disease. This group of patients has an increased risk of intraoperative and postoperative complications associated with the general conditions of their body and other complications related to the surgical procedure. For this reason, adequate control of fluids and electrolytes under adequate monitoring and hemodynamic support are essential; these can optimize the patient's vital signs and improve the conditions of the implant to guarantee proper functioning. In this series, 18 kidney transplant recipients with peripheral insertion central venous catheter were reviewed. There was an acceptable rate of success with proper placement. No complications inherent to the installation technique were found. In all patients, the installation was successful.


Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Falência Renal Crônica , Transplante de Rim , Adulto , Cateterismo , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Humanos , Falência Renal Crônica/etiologia , Transplante de Rim/efeitos adversos , Transplante de Rim/métodos , Resultado do Tratamento
11.
World J Pediatr Congenit Heart Surg ; 13(3): 379-382, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35446221

RESUMO

Background: Surgical neck cannulation for pediatric extracorporeal cardiopulmonary resuscitation (ECPR) requires multiple interruptions of manual chest compressions to facilitate the procedure. Effective uninterrupted CPR is essential to prevent neurological injury. We hypothesized that an automated chest compression device can be used to provide effective and uninterrupted chest compressions during pediatric neck ECPR cannulation. The feasibility of surgically cannulating the right carotid artery and right internal jugular vein in an infant during ongoing automated chest compressions was tested in a simulation study. Methods: A working prototype of a pediatric chest compression device was designed to provide automated chest compressions on an infant CPR manikin at the rate of 120 compressions/minute. A feedback device attached to the manikin was used to monitor the effectiveness of CPR. A synthetic artery, vein along with carotid sheath and skin was utilized to simulate surgical neck exploration. ECPR simulation was conducted using the compression device to provide chest compressions. Results: Four ECPR simulations were conducted during which vessel sparing (n = 2) and non-vessel sparing (n = 2) cannulation of the right internal carotid artery and right internal jugular vein were performed during ongoing mechanical chest compressions. All four cannulations were successfully performed without the need to interrupt chest compressions. Conclusions: In a simulated environment, pediatric ECPR neck cannulation with uninterrupted chest compressions may be accomplished using an automated chest compression device. The strategy of compression device-assisted ECPR cannulation requires further study and could potentially reduce the neurological complications of ECPR.


Assuntos
Reanimação Cardiopulmonar , Reanimação Cardiopulmonar/métodos , Cateterismo , Dor no Peito , Criança , Simulação por Computador , Humanos , Lactente , Manequins , Pressão
12.
Clin Sports Med ; 41(2): 317-328, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35300843

RESUMO

Continuous peripheral nerve block catheters are simple in concept: percutaneously inserting a catheter adjacent to a peripheral nerve. This procedure is followed by local anesthetic infusion via the catheter that can be titrated to effect for extended anesthesia or analgesia in the perioperative period. The reported benefits of peripheral nerve catheters used in the surgical population include improved pain scores, decreased narcotic use, decreased nausea/vomiting, decreased pruritus, decreased sedation, improved sleep, and improved patient satisfaction.


Assuntos
Bloqueio Nervoso , Anestésicos Locais , Cateterismo/métodos , Cateteres , Humanos , Bloqueio Nervoso/métodos , Nervos Periféricos
13.
Georgian Med News ; (323): 180-183, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35271493

RESUMO

The introduction of intraosseous injection methodology is very important in critically ill patients, with whom peripheral venous catheterization is impossible and there is not enough time to access a central vein due to a life-threatening condition of the patient. To carry out the relevant methodology in Georgia, for the first time in 2016 and then in 2017, the USA Mayo Clinic Emergency Care Physicians held trainings in Intraosseous Catheterization, which included both theoretical (indications, contraindications, complications, etc.) and practical trainings (techniques for using a special tool on manikin bone).A team of emergency physicians from two Pediatric Clinics of Georgia was later selected to undergo the above-mentioned training (theoretical and practical). Both teams were tested before and after the training. The results were compared. For two years, a certain number of physicians performed appropriate manipulation in patients. The aim of our further study was to determine whether physicians possessed theoretical and practical skills two years after training. Doctors were divided into two groups: those who performed this manipulation during this period and those who did not. The results of the testing ahve shown the need for periodic intraosseous catheterization training so that physicians who have not practiced this manipulation would not lose the relevant skills and perform this manipulation safely when needed.


Assuntos
Serviço Hospitalar de Emergência , Infusões Intraósseas , Cateterismo , Criança , República da Geórgia , Humanos , Infusões Intraósseas/métodos , Corpo Clínico
14.
BMJ Case Rep ; 15(2)2022 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-35228231

RESUMO

Patients with advanced intra-abdominal malignancy frequently experience nausea and vomiting, however these symptoms can be difficult to manage. A woman in her seventies with high grade primary peritoneal adenocarcinoma developed intermittent small bowel obstruction following extensive surgery. Poor relief was provided by pharmacological approaches and nasogastric tube insertion. Further surgical management was deemed unsuitable due to the significant possibility of complications and likely impairment of the patient's quality of life. A conservative approach was used by using a novel therapeutic intervention: an endoscope was used to visualise an enterocutaneous fistula tract proximal to the obstruction and a gastrostomy catheter was fluoroscopically inserted. This maintained fistula tract patency, permitting drainage of bowel contents and therefore resolving the patient's symptoms. We therefore describe a novel therapeutic approach where endoscopic insertion of a gastrostomy catheter maintained patency of an enterocutaneous fistula, enabling lasting relief of bowel obstruction in a manner acceptable to the patient.


Assuntos
Fístula Intestinal , Obstrução Intestinal , Cateterismo/efeitos adversos , Feminino , Gastrostomia/efeitos adversos , Humanos , Fístula Intestinal/complicações , Fístula Intestinal/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Qualidade de Vida
17.
Spinal Cord Ser Cases ; 8(1): 34, 2022 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-35332117

RESUMO

STUDY DESIGN: Case series. OBJECTIVES: To assess the safety and efficacy of prostatic artery embolization (PAE) to reduce prostate volume (PV) and facilitate intermittent catheterization (IC) in individuals with concurrent benign prostatic hyperplasia (BPH) and spinal cord injury (SCI). SETTING: Italian tertiary referral center for people with SCI. METHODS: We retrospectively collected all data of individuals undergoing PAE from 2015 to 2020 because of BPH-related problems during IC. PAE was performed under local anesthesia with superselective catheterization of the prostatic arteries. Technical success was defined as bilateral embolization. We determined pre- and post-procedural PV by magnetic resonance imaging. RESULTS: We considered 10 cases with tetraplegia (n = 5) and paraplegia (n = 5). Nine (90%) procedures were technically successful, while we performed monolateral PAE in one case. The median pre-procedural PV was 61 mL. After 6 months, all patients experienced significant PV reduction (median: 19.6%), and 7/7 patients with indwelling urinary catheter started successfully IC. Neither intra- nor post-procedural complications occurred within a median follow-up of 33 months. CONCLUSIONS: PAE proved to be a safe and effective treatment for BPH to facilitate IC in people with SCI. Considering the minimal morbidity of PAE, further multi-center studies are mandatory to draw definitive conclusions and warrant its widespread adoption in this population.


Assuntos
Embolização Terapêutica , Hiperplasia Prostática , Traumatismos da Medula Espinal , Artérias , Cateterismo , Embolização Terapêutica/métodos , Humanos , Masculino , Próstata/irrigação sanguínea , Hiperplasia Prostática/complicações , Hiperplasia Prostática/terapia , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/terapia
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