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1.
Medicine (Baltimore) ; 99(12): e19525, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195955

RESUMO

BACKGROUND: To assess the arterial oxygen partial pressure (PaO2) at defined time points during preoxygenation and to compare high-flow heated humidified nasal oxygenation with standard preoxygenation using oxygen insufflation via a facemask for at least 5 minutes, before intubation during induction of general anesthesia. METHODS: This randomized, single-blinded, prospective study will be conducted in patients undergoing head and neck surgery. After standard monitoring, the artery catheter at the radial artery or dorsalis pedis artery will be placed and arterial blood gas analysis (ABGA) for baseline values will be performed simultaneously. Each group will be subjected to 1 of 2 preoxygenation methods (high-flow nasal cannula or simple facemask) for 5 minutes, and ABGA will be performed twice. After confirming intubation, we will start mechanical ventilation and check the vital signs and perform the final ABGA. DISCUSSION: This trial aims to examine the trajectory of PaO2 levels during the whole preoxygenation procedure and after intubation. We hypothesize that preoxygenation with the high-flow nasal cannula will be superior to that with the face mask. STUDY REGISTRATION: This trial was registered with the Clinical Trial Registry (NCT03896906; ClinicalTrials.gov).


Assuntos
Anestesia Geral/tendências , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Cabeça/cirurgia , Oxigenação Hiperbárica/tendências , Pescoço/cirurgia , Gasometria , Cânula/normas , Cânula/estatística & dados numéricos , Humanos , Intubação Intratraqueal/métodos , Máscaras/normas , Máscaras/estatística & dados numéricos , Ventilação não Invasiva/instrumentação , Ventilação não Invasiva/métodos , Oxigênio/sangue , Estudos Prospectivos , Artéria Radial/cirurgia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Dispositivos de Acesso Vascular/normas
2.
Medicine (Baltimore) ; 98(44): e17757, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689833

RESUMO

Nursing staff play a crucial role in maintaining a functional port. Nursing guidelines recommend standard maintenance with 10 ml irrigation without consideration for variations among patients and individual nursing staff. The aim of this study is to identify the efficacy of the current maintenance strategy and analyze the correlation between complications and actual port presentations, based on disassembled intravenous ports after removal from patients. We attempt to organize the information and propose a definite maintenance strategy.After treatment completion, or due to complications, 434 implanted intravenous ports were removed from patients. All ports were deconstructed to observe their actual presentations and were then analyzed in conjunction with medical records. The correlation between complications and actual presentations was analyzed.From March 2012 to December 2017, 434 implanted intravenous ports were removed from oncology patients after completion of treatment or catheter related complications. From the view of maintenance related presentations, injection chamber blood clot was highly correlated with chemotherapy completion (P < .001) and malfunction (P = .005), while tip blood clot (P = .043) was related with chemotherapy completion and catheter fibrin (P = .015) was related to malfunction. From the view of structure related presentations, broken catheter integrity was correlated to chemotherapy completion (P = .007), fracture (P < .001), and malfunction (P = .008). Compression groove was related to chemotherapy completion (P = .03) and broken catheter at protruding stud was related to fracture (P = .04), while diaphragm rupture was correlated to chemotherapy completion (P = .048) and malfunction. (P < .001).Current port maintenance is insufficient for ideal port maintenance, whereby maintenance-related presentations, including tip clot, catheter fibrin, and injection chamber blood clot were identified. We propose a recommended maintenance strategy based on our findings. Structure-related presentations, including broken catheter integrity, broken catheter at protruding stud and diaphragm rupture were seen in patients with longer implantation period. Removal of the implanted port may be considered after 5 years if no disease relapse is noted.


Assuntos
Cateteres de Demora/normas , Protocolos Clínicos , Neoplasias/enfermagem , Dispositivos de Acesso Vascular/normas , Adulto , Idoso , Cateteres de Demora/efeitos adversos , Falha de Equipamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Estudos Retrospectivos , Trombose/etiologia , Dispositivos de Acesso Vascular/efeitos adversos
3.
BMC Vet Res ; 15(1): 240, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296216

RESUMO

BACKGROUND: Vascular access port (VAP) systems are widely used in human medicine to provide long-term venous access. However, in veterinary medicine the use of VAP systems is not common practice and publications on their potential applications have been limited. A VAP system was used as part of an experimental study on liver regeneration and implanted in the canine portal vein to create direct access to the portal venous circulation of the liver. The aim of the present study is to describe the surgical technique, its use, and the complications of a VAP system in three research dogs. RESULTS: The VAP system was successfully used for the intraoperative measurement of portal blood pressure, the administration of cell suspensions, and the collection of portal venous blood samples. Long-term complications consisted of dislocation of the VAP system in one dog (2 months after implantation) and thrombus formation at the catheter tip in two dogs (3 months after implantation). Both complications prevented further use of the VAP but had no adverse clinical implications. CONCLUSIONS: This pilot study suggests that the VAP system is an effective and safe technique to obtain long term access to the portal venous system in dogs. However, complications with port detachment and thrombosis may limit long term use of VAPs in the portal system of dogs.


Assuntos
Veia Porta/cirurgia , Dispositivos de Acesso Vascular/veterinária , Procedimentos Cirúrgicos Vasculares/normas , Medicina Veterinária/métodos , Animais , Cães , Pesquisa , Dispositivos de Acesso Vascular/efeitos adversos , Dispositivos de Acesso Vascular/normas
4.
Ann Anat ; 225: 65-75, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31279868

RESUMO

PURPOSE: To provide a systematic literature review on effectiveness of arteriovenous fistula (AVF) and Shunt (AVS) research animal models. BACKGROUND: Due to advancing human population age, there is increased incidence of patients suffering from vascular and renal diseases leading to dialysis access using AVF and/or AVS. During those interventions native venous or synthetic grafts are arterialized. Despite temporary good patency, complications are a consequence of neointimal hyperplasia (NIH) development that contributes to patients' morbidity and mortality. Basic research attempts to elucidate the pathomechanisms, therefore the small and large animal models are becoming attractive. METHODS: Medline search (within 1966-2018) was performed on AVF/AVS animal models. Studies fulfilled following criteria: (1) reported complete material-methods-results section, (2) included statistically significant number of animals, (3) provided statistically significant results. 55 articles were identified encompassing six animal species used. RESULTS: Large animal models include creation of AVF and AVS in pig, sheep and dog. Porcine animal models use pelvic or femoral vessels, ovine use the common carotid artery (CCA) and jugular vein (JV). Canine animal models use the femoral vessels. Small animal models use rabbit (CCA/JV), rat (JV/CCA, abdominal aorta /Vena cava inferior and femoral artery/femoral vein) and mouse (aortocaval and supraortic AVF models). CONCLUSIONS: Large animal models are best for haemodynamic shear stress studies and in vivo evaluation of new synthetic vascular grafts. Small animal models, especially the genetically manipulated ones, are ideal for analysis of molecular and cellular pathomechanisms. The selection of animal species to be used depends on the addressed research question.


Assuntos
Fístula Arteriovenosa , Derivação Arteriovenosa Cirúrgica , Modelos Animais , Dispositivos de Acesso Vascular/normas , Animais , Cães , Hiperplasia , Camundongos , Neointima/patologia , Coelhos , Ratos , Diálise Renal , Insuficiência Renal Crônica/terapia , Ovinos , Suínos , Doenças Vasculares/terapia
5.
Mil Med ; 184(Suppl 1): 326-328, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901409

RESUMO

With damage control surgery and resuscitation teams, the military is bringing surgical as well as intensive care far forward to areas where mass casualty events are an ever-present threat. One procedure that the team is required to be proficient in is arterial line insertion and transducing. To our knowledge, there are no previously described field arterial line simulation models. We present an arterial line insertion and transducer simulator created using medium resistance Thera-band tubing, saline, Coban, and a SAM splint. Ten deployed members of a damage control surgical team received 30 minutes of instruction on how to properly insert an arterial line and how to set up the transducer equipment. All participants were able to show proficiency in radial artery line insertion and transducer setup despite 8 of the 10 participants having never inserted or setup an arterial line. We describe, to our knowledge, the first arterial line insertion and transducing model utilizing only items found in the deployed environment. This model can be easily made and utilized to train medical personnel of all skill levels to augment the capabilities of medical units in areas where mass casualty events are likely.


Assuntos
Cateterismo/métodos , Simulação de Paciente , Ressuscitação/educação , Dispositivos de Acesso Vascular/normas , Cateterismo/normas , Competência Clínica/normas , Humanos , Medicina Militar/educação
6.
Toxicol Pathol ; 47(3): 264-279, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832552

RESUMO

The design, production, and preclinical testing of neurothrombectomy devices is in a burgeoning phase as the demand escalates for safe and reliable treatment options following neurovascular stroke. Currently, there is a paucity of published data describing the development of iatrogenic vascular lesions occurring secondary to neurothrombectomy procedures. In an effort to test new devices, demonstrate device safety, satisfy regulatory requirements, and develop an understanding of the potential for associated vascular pathology, investigators are establishing appropriate methodology in suitable animal models. Significant challenges exist in identifying a single animal species that can be consistently utilized in all phases of device development. These aforementioned challenges are underscored by the intricacies of neurovascular pathology, thrombovascular interactions, and vascular responses to injury.


Assuntos
Artérias Cerebrais , Segurança de Equipamentos/normas , Acidente Vascular Cerebral/cirurgia , Trombectomia/instrumentação , Dispositivos de Acesso Vascular/normas , Animais , Artérias Cerebrais/lesões , Desenho de Equipamento/métodos , Desenho de Equipamento/normas , Legislação de Dispositivos Médicos , Estados Unidos , United States Food and Drug Administration , Dispositivos de Acesso Vascular/efeitos adversos
7.
Intensive Care Med ; 45(4): 434-446, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30778648

RESUMO

Over the past two decades, ultrasound (US) has become widely accepted to guide safe and accurate insertion of vascular devices in critically ill patients. We emphasize central venous catheter insertion, given its broad application in critically ill patients, but also review the use of US for accessing peripheral veins, arteries, the medullary canal, and vessels for institution of extracorporeal life support. To ensure procedural safety and high cannulation success rates we recommend using a systematic protocolized approach for US-guided vascular access in elective clinical situations. A standardized approach minimizes variability in clinical practice, provides a framework for education and training, facilitates implementation, and enables quality analysis. This review will address the state of US-guided vascular access, including current practice and future directions.


Assuntos
Cateterismo Venoso Central/instrumentação , Ultrassonografia de Intervenção/métodos , Dispositivos de Acesso Vascular/normas , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Estado Terminal/terapia , Humanos , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia de Intervenção/instrumentação , Dispositivos de Acesso Vascular/tendências
8.
Metas enferm ; 22(1): 14-23, feb. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183459

RESUMO

Objetivo: identificar barreras y facilitadores en la adherencia al care bundle para prevenir complicaciones asociadas a dispositivos de acceso vascular; y describirlas en función de las características sociodemográficas y laborales de los profesionales sanitarios implicados. Método: estudio descriptivo transversal. Población: médicos y enfermeras del Hospital Universitario Arnau de Vilanova de Lleida. Instrumento: cuestionario formado por tres bloques: 13 ítems sobre organización del servicio, 16 ítems sobre liderazgo del servicio y ocho sobre recomendaciones del protocolo hospitalario. Análisis bivariante mediante Chi cuadrado y ANOVA. Resultados: participaron 150 profesionales, la mayoría enfermeras (80%). De manera estadísticamente significativa (p< 0,05), las personas de 60 años o más obtuvieron la puntuación más baja en "aplicación el care bundle", y los de 29 años o menos consideraron que estaban menos educados y entrenados en su aplicación; quienes tenían menor experiencia puntuaron por debajo en "conocimiento del protocolo", se consideraron menos entrenados en la aplicación del care bundle, se sentían menos preparados, tenían menos conocimiento de su propio cumplimiento, no aplicaban correctamente el care bundle, ni de forma regular y su opinión sobre la formación fue que no modificaba su práctica clínica. Conclusiones: el cuestionario identifica aspectos mejorables en el protocolo hospitalario sobre dispositivos de acceso vascular, causas de dificultad en la aplicación del bundle y falta de formación continuada hacia el personal, sobre todo el de nueva incorporación


Objective: to identify the barriers and drivers for adherence to the care bundle in order to prevent complications associated with vascular access devices, and to describe them based on the sociodemographical and occupational characteristics of the healthcare professionals involved. Method: a descriptive cross-sectional study. Population: physicians and nurses from the Hospital Universitario Arnau de Vilanova of Lleida. Instrument: A questionnaire formed by three blocks: 13 items on structure of the service, 16 items about leadership of the service, and 8 about recommendations from the hospital protocol. A bivariate analysis through Chi-Square and ANOVA. Results: the study involved 150 professionals, most of them nurses (80%). In a statistically significant way (p< 0.05), ≥60-year-old persons obtained the lowest score in "applying the care bundle", and ≤29-year-old persons considered that they were less educated and trained for its application; those with lower experience had a lower score in "protocol knowledge", they considered they were less trained in the application of the care bundle, they felt less prepared and had lower knowledge of their own compliance, did not apply the care bundle adequately or regularly, and their opinion on training was that it did not modify their clinical practice. Conclusions: the questionnaire identified aspects that can be improved in the hospital protocol regarding vascular access devices, factors that cause difficulty in the application of the bundle, and lack of continuous training for the staff, particularly those recently incorporated


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Infecções Relacionadas a Cateter/epidemiologia , Dispositivos de Acesso Vascular/normas , Pessoal de Saúde/educação , Pacotes de Assistência ao Paciente , Estudos Transversais , Médicos/estatística & dados numéricos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Análise de Variância , Inquéritos e Questionários
9.
BMJ Case Rep ; 12(1)2019 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-30635300

RESUMO

We report a 63-year-old man with well-controlled type 2 diabetes mellitus and hypertension, who presented with new onset nephrotic proteinuria and rapid deterioration in renal function. The atypical clinical presentation prompted us to consider a non-diabetic and non-hypertensive cause and to perform a renal biopsy. A diagnosis of fibrillarglomerulonephritis (FGn) was made based on electronic microscopy. Proteinuria remained in nephrotic range despite treatment with prednisolone, and renal function deteriorated. We suggest that other causes of proteinuria should be considered in patients with diabetes who present with the nephrotic syndrome when there is no other evidence of microvascular disease. We review the spectrum of fibrillar glomerulopathies including FGn, primary and secondary amyloidosis and immunotactoid glomerulonephritis.


Assuntos
Glomerulonefrite/patologia , Síndrome Nefrótica/diagnóstico , Proteinúria/diagnóstico , Amiloidose/diagnóstico , Biópsia/métodos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/etiologia , Síndrome Nefrótica/patologia , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Proteinúria/etiologia , Doenças Raras , Resultado do Tratamento , Dispositivos de Acesso Vascular/normas
10.
Dig Dis Sci ; 64(3): 627-631, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30656564

RESUMO

BACKGROUND: While the available literature recommends placement of two large-bore intravenous (2LBIV) lines in every patient presenting with acute GIB, the adherence and impact of this recommendation have never before been reported. AIMS: We designed a quality improvement project to assess whether the patients presenting to our institution with acute GIB have appropriate intravenous (IV) access or not. METHODS: We conducted a prospective, observational study, of all patients presenting to our emergency department with overt GIB over a 2-month period. Data analysis was performed, and based on the results, an intervention plan was developed and executed. Post-intervention data collection was done over a 3-month period. Our interventions included physician and nursing education, placing posters in the emergency department, and creation of an order set in the electronic medical record system. RESULTS: A total of 46 patients were in the pre-intervention group, and 71 patients were in the post-intervention group. The presence of 2LBIV lines in the pre-intervention group was only 19.5%, which improved to 36.6% in the post-intervention group (p = 0.049). Factors associated with placement of 2LBIV lines were being in the post-intervention group and admission to the intensive care unit. CONCLUSION: The relatively simple and cost-effective intervention of placing 2LBIV lines is not often executed. We suggest that specific mention of 2LBIV placement in guidelines from national gastroenterology societies might improve compliance in this aspect.


Assuntos
Cateterismo Periférico/instrumentação , Cateteres de Demora , Hemorragia Gastrointestinal/terapia , Fidelidade a Diretrizes , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Dispositivos de Acesso Vascular , Idoso , Cateterismo Periférico/normas , Cateteres de Demora/normas , Desenho de Equipamento , Feminino , Hemorragia Gastrointestinal/diagnóstico , Fidelidade a Diretrizes/normas , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Estudos Prospectivos , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Dispositivos de Acesso Vascular/normas
12.
J Clin Apher ; 34(1): 33-38, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30407658

RESUMO

BACKGROUND: An efficient vascular access is mandatory for the proper conduction of therapeutic plasma exchanges (TPE). Peripheral and central venous catheters may be used, with respective advantages and limitations. In this study, vascular access devices (IV catheter, dialysis cannula, central venous catheter) and anatomic vein characteristics were evaluated. METHOD: From January to June 2016, 162 TPE in 29 patients were reviewed. Only TPE using centrifugation method (Spectra Optia apheresis system) were evaluated. Volume exchanged, procedure duration, mean flow rate, number of inlet, and return pressure pauses were recorded. Site, width, and depth of punctured veins were studied. RESULTS: Median exchange volume planned was 3500 mL, and 152 (94%) procedures could be completed. Peripheral venous catheter was inserted in 103 (64%) cases (IV catheter: 61, dialysis cannulae: 42). Ultrasound guidance was used in 12 (11%) cases. Median procedure duration was shorter with central venous catheter (94 minutes), rather than dialysis cannula (133 minutes) or IV catheter (133 minutes). Median numbers of inlet pressure pauses were lower with central venous catheter (0) and dialysis cannulae (6), rather than IV catheter (10). There were no complications with peripheral venous access. There were no anatomic differences between catheterized veins with IV catheter or dialysis cannula. CONCLUSION: The use of peripheral venous access is possible in most of TPE, for emergency and during maintenance therapy. Dialysis cannulae are good compromise between classic IV catheters and central venous catheters, as it allows high flow rates, are easy to insert and associated with few complications.


Assuntos
Troca Plasmática/instrumentação , Dispositivos de Acesso Vascular/normas , Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Cateteres Venosos Centrais , Humanos , Troca Plasmática/métodos , Estudos Retrospectivos
13.
J Clin Apher ; 34(1): 21-25, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30387199

RESUMO

Apheresis treatments, which involve the removal of a component of blood, generally require one access and one return line to continuously draw and return blood into the extracorporeal circuit. At our center, we prefer to use peripheral venous access to avoid central line-related complications, especially infection. Motivated by patient-centered care, the single-needle (SN) option for therapeutic plasma exchange (TPE) offered on the Spectra Optia (Terumo BCT, Lakewood, CO) was evaluated. Five patients underwent procedures using both SN and dual-needle (DN) plasma exchange procedures using the Spectra Optia. TPE procedures ran a median of 51 (range:10-102) minutes longer using the SN-TPE option. Inlet flow rates, plasma removal efficiency, and incidence of citrate reactions were similar between SN- and DN-procedures. Patients reported great satisfaction with SN-TPE.


Assuntos
Agulhas/normas , Troca Plasmática/métodos , Dispositivos de Acesso Vascular/normas , Ácido Cítrico/efeitos adversos , Humanos , Satisfação do Paciente , Troca Plasmática/instrumentação , Troca Plasmática/normas , Fatores de Tempo
14.
World Neurosurg ; 123: e433-e439, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30500582

RESUMO

OBJECTIVE: Fast and secure access to intracranial vessel occlusion is essential for mechanical thrombectomy (MT) in the treatment of acute ischemic stroke. We compared 2 intermediate distal access catheters (DAC: Distal Access Catheter [C1] and SOFIA: Soft torquable catheter Optimized For Intracranial Access [C2]) for procedural speed and safety of MT as well as clinical outcome at discharge and after 90 days. METHODS: This is a retrospective study of all 398 consecutive patients receiving MT with C1 or C2 for the treatment of acute ischemic stroke between September 2010 and June 2016, using a propensity score matched cohort. Baseline characteristics, clinical outcome, and procedural factors such as the number of retrieval attempts or duration of procedure were analyzed. RESULTS: A total of 282 patients (70.9%) underwent MT with C1 and 116 patients (29.1%) with C2. MT with C2 was faster with an average duration of 69.8 ± 51 minutes (mean ± standard deviation) compared with 80.6 ± 54 minutes with C1 (P < 0.05). The average number of necessary stent-retriever maneuvers was significantly lower with C2 (1.8 ± 1.7 vs. 3.2 ± 2.5, P < 0.0001). Successful MT with aspiration only yielded higher modified Thrombolysis in Cerebral Infarction rates (mTIC 2b/3 69.9% vs. 31.5%, P < 0.0001) with C2. Modified Rankin Scale at discharge was significantly lower with C2 (3.5 ± 1.9) versus C1 (3.9 ± 1.7, P < 0.05). No significant differences of modified Rankin Scale 90 were observed. CONCLUSIONS: The use of C2 resulted in reduced procedural times with less stent-retriever maneuvers. Clinical outcome at discharge was better for C2 catheters, whereas no significant difference of outcome was apparent after 90 days.


Assuntos
Infarto Encefálico/terapia , Trombólise Mecânica/métodos , Acidente Vascular Cerebral/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/instrumentação , Cateterismo Periférico/normas , Remoção de Dispositivo , Procedimentos Endovasculares/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Dispositivos de Acesso Vascular/normas , Adulto Jovem
15.
J Infus Nurs ; 41(6): 375-382, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30399074

RESUMO

With most hospitalized patients requiring peripheral intravenous catheters (PIVCs), PIVC-related process improvement may substantially affect the health, safety, and satisfaction of patients and health care workers, in addition to reducing costs. This study examined PIVC practice-related metrics before and after a comprehensive process improvement program, which included a change to closed catheter technology. Data were obtained from observations, clinician interviews, and patient records. Metrics included assessment of risk, especially blood exposure and contamination; measurement of insertion efficiency; and quantification of PIVC failure. A significant improvement in most metrics was achieved after the process improvement program.


Assuntos
Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Melhoria de Qualidade , Dispositivos de Acesso Vascular/normas , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Periférico/métodos , Cateteres de Demora/microbiologia , Humanos , Entrevistas como Assunto , Fatores de Risco , Dispositivos de Acesso Vascular/tendências
16.
BMJ Open ; 8(10): e021040, 2018 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-30344166

RESUMO

OBJECTIVE: Catheter-related bloodstream infections are one of the most important adverse events for patients. Evidence-based practice embraces interventions to prevent and reduce catheter-related bloodstream infections in patients. At present, a growing number of guidelines exist worldwide. The purpose of the study was to assess clinical practice guidelines for peripheral and central venous access device care and prevention of related complications. DESIGN: Systematic review of clinical practice guidelines: We conducted a search of the literature published from 2005 to 2018 using Medline/PubMed, Embase, CINAHL, Ovid, ScienceDirect, Scopus and Web of Science. We also evaluated grey literature sources and websites of organisations that compiled or produced guidelines. Guideline quality was assessed with the Appraisal of Guidelines for Research and Evaluation, Second Edition tool by three independent reviewers. Cohen's kappa coefficient was used to evaluate the concordance between reviewers. RESULTS: We included seven guidelines in the evaluation. The concordance between observers was substantial, K=0.6364 (95% CI 0.0247 to 1.2259). We identified seven international guidelines, which scored poorly on crucial domains such as applicability (medium 39%), stakeholder involvement (medium 65%) and methodological rigour (medium 67%). Guidelines by Spanish Health Ministry and UK National Institute for Health and Care Excellence presented the highest quality. CONCLUSIONS: It is crucial to critically evaluate the validity and reliability of clinical practice guidelines so the best, most context-specific document is selected. Such choice is a necessary prior step to encourage and support health organisations to transfer research results to clinical practice. The gaps identified in our study may explain the suboptimal clinical impact of guidelines. Such low adoption may be mitigated with the use of implementation guides accompanying clinical documents.


Assuntos
Medicina Baseada em Evidências/normas , Guias de Prática Clínica como Assunto , Dispositivos de Acesso Vascular/normas , Humanos , Internacionalidade , Participação dos Interessados
17.
J Trauma Acute Care Surg ; 85(3): 507-511, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30142104

RESUMO

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used in refractory hemorrhagic shock patients. Since the optimal timing of arterial access remains unclear, we evaluated the preocclusion status of patients, and elapsed time from the arrival to the hospital is associated with the survival outcomes in the REBOA patients. METHODS: From August 2011 to December 2016, The Diagnostic and Interventional Radiology in Emergency, Critical care and Trauma-Intra-Aortic Balloon Occlusion (DIRECT-IABO) investigators registered refractory hemorrhagic shock patients undergoing REBOA from 23 hospitals in Japan. Patient characteristics, mechanism of injury, Injury Severity Score (ISS), preocclusion and postocclusion systolic blood pressure, duration of aortic occlusion, clinical time course, and survival outcome were recorded and analyzed. Binary logistic regression analysis was used with mortality and Kaplan-Meier survival analysis was conducted to demonstrate the difference between early and delayed access groups. RESULTS: Among the enrolled 207 cases, the following patients were excluded from the analysis: five since they were younger than 18 years, nine due to failed attempts at REBOA, 51 nontrauma patients, and 33 who received resuscitative thoracotomy plus REBOA. Thus, the remaining 109 cases were analyzed (30-day survivors, n = 60; nonsurvivors, n = 49). The preocclusion systolic blood pressure was higher, and both hospital arrival to initial arterial access and duration of occlusion were shorter in the survivors. Lower ISS (odds ratio, 0.944; 95% confidence interval, 0.907-0.982; p = 0.0039) and shorter arrival to access (odds ratio, 0.989; 95% confidence interval, 0.979-0.999; p = 0.034) were significantly associated with 30-day survival in the logistic regression analysis. The cutoff point of 21.5 minutes was used in the receiver operating characteristic analysis. The early access group showed a significantly shorter time of arrival to definitive hemostasis and also demonstrated a significantly higher survival in the Kaplan-Meier survival analysis (p = 0.014, Log-rank test). CONCLUSION: The arrival to access time and ISS were significantly associated with mortality in the REBOA patients in Japan. The early access group demonstrated better survival. The proactive early access in the resuscitation phase might be related to better patient outcomes. LEVEL OF EVIDENCE: Therapeutic/care management, level V.


Assuntos
Aorta/lesões , Oclusão com Balão/instrumentação , Procedimentos Endovasculares/métodos , Choque Hemorrágico/terapia , Adulto , Idoso , Aorta/patologia , Feminino , Humanos , Escala de Gravidade do Ferimento , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Radiologia Intervencionista/instrumentação , Ressuscitação , Estudos Retrospectivos , Choque Hemorrágico/epidemiologia , Choque Hemorrágico/mortalidade , Toracotomia/métodos , Fatores de Tempo , Dispositivos de Acesso Vascular/normas
18.
J Neurointerv Surg ; 10(Suppl 1): i35-i38, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30037952

RESUMO

BACKGROUND AND PURPOSE: The purpose of this study was to assess the initial post-market experience of the device and how it is compared with the Penumbra Pivotal trial used to support the 510k application. METHODS: A retrospective case review of 157 consecutive patients treated with the Penumbra system at seven international centers was performed. Primary endpoints were revascularization of the target vessel (TIMI score of 2 or 3), good functional outcome as defined by a modified Rankin scale (mRS) score of ≤2 and incidence of procedural serious adverse events. Results were compared with those of the Penumbra pivotal trial. RESULTS: A total of 157 vessels were treated. Mean baseline values at enrollment were: age 65 years, NIHSS score 16. After use of the Penumbra system, 87% of the treated vessels were revascularized to TIMI 2 (54%) or 3 (33%) as compared with 82% reported in the Pivotal trial. Nine procedural serious adverse events were reported in 157 patients (5.7%). All-cause mortality was 20% (32/157), and 41% had a mRS of ≤2 at 90-day follow-up as compared with only 25% in the Pivotal trial. Patients who were successfully revascularized by the Penumbra system had significantly better outcomes than those who were not. CONCLUSION: Initial post-market experience of the Penumbra system revealed that the revascularization rate and safety profile of the device are comparable to those reported in the Pivotal trial. However, the proportion of patients who had good functional outcome was higher than expected.


Assuntos
Isquemia Encefálica/cirurgia , Revascularização Cerebral/métodos , Transtornos Cerebrovasculares/cirurgia , Vigilância de Produtos Comercializados/normas , Acidente Vascular Cerebral/cirurgia , Dispositivos de Acesso Vascular/normas , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Revascularização Cerebral/instrumentação , Revascularização Cerebral/tendências , Transtornos Cerebrovasculares/diagnóstico por imagem , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância de Produtos Comercializados/tendências , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia/instrumentação , Trombectomia/métodos , Trombectomia/tendências , Estados Unidos/epidemiologia , Dispositivos de Acesso Vascular/tendências
19.
Medicine (Baltimore) ; 97(18): e0678, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29718894

RESUMO

Recent studies have shown sheathless guide catheters (GCs) to be safe and effective during complex lesions such as bifurcations, chronic total occlusion (CTO), and/or calcified lesions. We investigated the feasibility and safety of using 7.5-Fr sheathless GC for transradial percutaneous coronary intervention (PCI) to treat left main bifurcation lesions.A total of 82 patients were consecutively enrolled from March 2013 to February 2016. They underwent transradial PCI for left main bifurcation lesions using the 7.5-Fr sheathless GC.The mean syntax score was 28.1 ±â€Š6.1, and the majority (n = 55, 67.1%) was intermediate scores (23∼32). The unprotected LM disease was present in 67 of 82 patients (81.7%), and true bifurcation (Medina 1, 1, 1) was present in 46 of 82 patients (56.1%). The 2-stent technique was used in 62 of 82 patients (75.6%). The 2-stent technique included 31 cases (37.8%) of "Crush," 18 cases (22.0%) of "Cullote," and 13 (15.8%) cases of "T stent and modified T stent" (T stent). Immediate angiographic success rate was 100% (82/82), and procedural success rate was 97.6% (80/82). The vascular complications occurred in 3 patients (3/82, 3.7%).The use of 7.5-Fr sheathless GC is safe and allows PCI for complex bifurcation lesions located in the distal of left main to be performed transradially with a high success rate.


Assuntos
Cateterismo Periférico , Doença da Artéria Coronariana , Vasos Coronários , Complicações Intraoperatórias , Intervenção Coronária Percutânea/métodos , Artéria Radial/cirurgia , Dispositivos de Acesso Vascular , Idoso , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/instrumentação , Cateterismo Periférico/métodos , China/epidemiologia , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Desenho de Equipamento , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dispositivos de Acesso Vascular/efeitos adversos , Dispositivos de Acesso Vascular/normas
20.
J Neurointerv Surg ; 10(8): 784-787, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29487193

RESUMO

PURPOSE: The efficiency of neuroendovascular procedures may partly depend on the time devoted to placement of a radial arterial line (RAL) for intraoperative blood pressure monitoring. An alternative approach is to use a pressure-sensing sheath (PSS) that serves to provide invasive blood pressure monitoring without requiring a separate procedure for placement. We compared the use of a RAL versus PSS and assessed procedure time, anesthetist and patient satisfaction, and cost. METHODS: We performed a single-center, prospective, blockwise, comparative trial of procedure start time using traditional RAL placement versus the EndoPhys PSS for invasive blood pressure monitoring. Endpoints included time from room arrival to groin puncture, patient and anesthetist satisfaction ratings, and costs associated with RAL placement. RESULTS: Twenty patients were enrolled in the PSS+RAL arm and 20 in the PSS-alone arm. Mean time from arrival in the room until groin puncture was 61.9±14.0 min in the RAL group and 51.2±10.8 min in the PSS-alone group (P=0.01; difference=10.7 min). Patients in the PSS-alone group reported less pain than those in the RAL group. Furthermore, anesthetists reported accurate blood pressure in the PSS group. The average cost estimate of RAL placement was US$774.70, with a range of US$743 to US$1171. CONCLUSIONS: Placement of a RAL at the start of the neuroendovascular procedures resulted in increased delays to procedure start time and more patient-reported pain compared with the PSS, which may offer a more efficient means of blood pressure monitoring for neurointerventional procedures. CLINICAL TRIAL REGISTRATION: NCT03239847.


Assuntos
Determinação da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Monitorização Neurofisiológica Intraoperatória/métodos , Procedimentos Neurocirúrgicos/métodos , Artéria Radial/fisiologia , Dispositivos de Acesso Vascular , Idoso , Pressão Arterial/fisiologia , Feminino , Virilha , Humanos , Monitorização Neurofisiológica Intraoperatória/instrumentação , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/instrumentação , Pressão , Estudos Prospectivos , Dispositivos de Acesso Vascular/normas
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