Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 366
Filtrar
1.
Medicine (Baltimore) ; 98(45): e17940, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702683

RESUMO

Venous air embolism (VAE) can be observed in the right heart system on contrast-enhanced computed tomography (CT), following injection of contrast media with a power injector system. Although most VAEs are mostly asymptomatic, they may result in paradoxical air embolism (PAE).To evaluate whether the incidence of VAE on coronary CT angiography is associated with the process of preparation of the intravenous access route.We retrospectively evaluated 692 coronary CT examinations at 3 institutions. Trained CT nurses placed an intravenous cannula in the forearm. Tubes connected to the cannula were prepared in the following ways: A, using an interposed three-way cock and a 20-mL syringe filled with normal saline to collect air contamination in the tube; B, through direct connection to the power injector system without the interposed 3-way cock; and C, using an interposed three-way cock and a 100-mL normal saline drip infusion bottle system to keep the tube patent. The incidence and location of VAE and preparation of intravenous injection were assessed.The overall incidence of VAE was 55.3% (383/692), most frequently observed in the right atrium (81.5%, 312/383). Its incidence varied significantly across the 3 techniques (A: 21.6% (35/162), B: 63.2% (237/375) and C: 71.6% (111/155); P < .001). No patient demonstrated any symptom associated with VAE.Using a 3-way cock with syringe demonstrated the lowest incidence of VAE on coronary CT angiography. It is thus recommended to reduce potential complication risks related to intravenous contrast media injection.


Assuntos
Angiografia por Tomografia Computadorizada/efeitos adversos , Embolia Aérea/etiologia , Embolia Paradoxal/etiologia , Átrios do Coração/diagnóstico por imagem , Idoso , Meios de Contraste/administração & dosagem , Embolia Aérea/complicações , Embolia Aérea/epidemiologia , Embolia Paradoxal/epidemiologia , Humanos , Injeções Intravenosas/efeitos adversos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Curr Opin Anaesthesiol ; 32(3): 377-383, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30893121

RESUMO

PURPOSE OF REVIEW: This review summarizes the current evidence available to guide anaesthetists along the decision-making process between inhalational and intravenous anaesthesia when caring for paediatric patients. RECENT FINDINGS: A recent large randomized controlled trial in children with risk factors demonstrated a significant benefit of intravenous induction over inhalational induction with regards to respiratory adverse events. This difference is particularly pronounced in those with respiratory symptoms. SUMMARY: For children scheduled for elective surgery, intravenous induction has significant advantages with regards to reduced respiratory adverse events and for less postoperative behavioural disturbances, it may be associated with more anxiety at the time of induction. The anaesthetist in charge of the patient needs to weigh up the balance between the clinical risk of respiratory adverse events, the 'veins on offer', the level of anxiety and previous experiences of the child and his/her parents.


Assuntos
Anestesia por Inalação/métodos , Anestesia Intravenosa/métodos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Dor/prevenção & controle , Sistema Respiratório/efeitos dos fármacos , Anestesia por Inalação/efeitos adversos , Anestesia Intravenosa/efeitos adversos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Ansiedade/etiologia , Ansiedade/prevenção & controle , Ansiedade/psicologia , Criança , Comportamento Infantil/efeitos dos fármacos , Comportamento Infantil/fisiologia , Tomada de Decisão Clínica , Humanos , Injeções Intravenosas/efeitos adversos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/psicologia , Agulhas , Dor/etiologia , Satisfação do Paciente , Seleção de Pacientes , Período Pós-Operatório , Sistema Respiratório/fisiopatologia
4.
J Patient Saf ; 14(1): 60-65, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28902007

RESUMO

OBJECTIVES: Current literature estimates the error rate associated with the preparation and administration of all intravenous (IV) medications to be 9.4% to 97.7% worldwide. This study aims to compare the number of observed medication preparation and administration errors between the only commercially available ready-to-administer product (Simplist) and IV push traditional practice, including a cartridge-based syringe system (Carpuject) and vials and syringes. METHODS: A prospective, multisite, observational study was conducted in 3 health systems in various states within the United States between December 2015 and March 2016 to observe IV push medication preparation and administration. Researchers observed a ready-to-administer product and IV push traditional practice using a validated observational method and a modified data collection sheet. All observations were reconciled to the original medication order to determine if any errors occurred. RESULTS: Researchers collected 329 observations (ready to administer = 102; traditional practice = 227) and observed 260 errors (ready to administer = 25; traditional practice = 235). The overall observed error rate for ready-to-administer products was 2.5%, and the observed error rate for IV push traditional practice was 10.4%. CONCLUSIONS: The ready-to-administer group demonstrated a statistically significant lower observed error rate, suggesting that use of this product is associated with fewer observed preparation and administration errors in the clinical setting. Future studies should be completed to determine the potential for patient harm associated with these errors and improve clinical practice because it relates to the safe administration of IV push medications.


Assuntos
Infusões Intravenosas , Injeções Intravenosas , Erros de Medicação/estatística & dados numéricos , Humanos , Infusões Intravenosas/instrumentação , Infusões Intravenosas/métodos , Infusões Intravenosas/estatística & dados numéricos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/métodos , Injeções Intravenosas/estatística & dados numéricos , Preparações Farmacêuticas , Estudos Prospectivos
5.
Hu Li Za Zhi ; 64(5): 69-80, 2017 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-28948593

RESUMO

BACKGROUND: Peripheral intravenous access is a common and invasive procedure that is performed in pediatric clinical settings. Children often have difficult intravenous-access problems that may not only increase staff stress but also affect the timeliness of immediate treatments. PURPOSE: To determine the efficacy of near-infrared devices in facilitating peripheral intravenous access in children, using a systematic review and meta-analysis. METHODS: Six databases, namely the Index to Taiwan Periodical Literature System, Airiti Library, CINAHL, Cochrane Library, PubMed/MEDLINE, and ProQuest were searched for related articles that were published between the earliest year available and February 2017. The search was limited to studies on populations of children that used either a randomized controlled trial or controlled clinical trial approach and used the key words "near-infrared devices" AND "peripheral intravenous access." The 12 articles that met these criteria were included in the analysis. The Cochrane Collaboration bias assessment tool was used to assess the methodological quality. In addition, RevMan 5.3.5 software was used to conduct the meta-analysis. RESULTS: The near-infrared devices did not significantly improve the first-attempt success rate, number of attempts, or the procedural time of peripheral intravenous access in children. However, the subgroup analysis of difficult intravenous-access factors revealed a significant improvement in the first-attempt success rate of children with difficult intravenous access scores (OR = 1.83, p = .03). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Near-infrared devices may improve the first-attempt success rate in children with difficult intravenous access by allowing healthcare professionals to visualize the peripheral veins. Therefore, we suggest that the difficult intravenous-access score be used as a screening tool to suggest when to apply near-infrared devices to children with difficult peripheral intravenous access in order to maximize efficacy of treatment.


Assuntos
Infusões Intravenosas/instrumentação , Injeções Intravenosas/instrumentação , Criança , Humanos
6.
Eur J Radiol ; 87: 8-12, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28065379

RESUMO

PURPOSE: To compare the 24-gauge side-holes catheter and conventional 22-gauge end-hole catheter in terms of safety, injection pressure, and contrast enhancement on multi-detector computed tomography (MDCT). MATERIALS & METHODS: In a randomized single-center study, 180 patients were randomized to either the 24-gauge side-holes catheter or the 22-gauge end-hole catheter groups. The primary endpoint was safety during intravenous administration of contrast material for MDCT, using a non-inferiority analysis (lower limit 95% CI greater than -10% non-inferiority margin for the group difference). The secondary endpoints were injection pressure and contrast enhancement. RESULTS: A total of 174 patients were analyzed for safety during intravenous contrast material administration for MDCT. The overall extravasation rate was 1.1% (2/174 patients); 1 (1.2%) minor episode occurred in the 24-gauge side-holes catheter group and 1 (1.1%) in the 22-gauge end-hole catheter group (difference: 0.1%, 95% CI: -3.17% to 3.28%, non-inferiority P=1). The mean maximum pressure was higher with the 24-gauge side-holes catheter than with the 22-gauge end-hole catheter (8.16±0.95kg/cm2 vs. 4.79±0.63kg/cm2, P<0.001). The mean contrast enhancement of the abdominal aorta, celiac artery, superior mesenteric artery, and pancreatic parenchyma in the two groups were not significantly different. CONCLUSION: In conclusion, our study showed that the 24-gauge side-holes catheter is safe and suitable for delivering iodine with a concentration of 300mg/mL at a flow-rate of 3mL/s, and it may contribute to the care of some patients, such as patients who have fragile and small veins. (Trial registration: UMIN000023727).


Assuntos
Cateterismo Periférico/instrumentação , Meios de Contraste/administração & dosagem , Tomografia Computadorizada Multidetectores/métodos , Intensificação de Imagem Radiográfica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/métodos , Feminino , Humanos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/métodos , Iohexol/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Intensificação de Imagem Radiográfica/instrumentação , Adulto Jovem
7.
AJR Am J Roentgenol ; 208(3): 632-636, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28075612

RESUMO

OBJECTIVE: The purpose of this study was to assess the difference between mechanical versus hand administration of IV contrast agents on the diagnostic quality of pediatric pulmonary CT angiography (CTA). MATERIALS AND METHODS: A retrospective review of the medical records was performed to detect pediatric patients (≤ 18 years) with pulmonary CTA performed between September 2012 and March 2015. Patients were placed into two cohorts on the basis of the method of contrast administration (mechanical vs hand). Additional information obtained included IV size or gauge, IV site, amount and type of contrast agent administered, and rate of administration (mL/s). The quality of the CT images was independently evaluated by two pediatric radiologists using a qualitative 4-point visual assessment scale and quantitatively with attenuation (HU). An ANOVA controlling for age compared the contrast enhancement in the central pulmonary arteries between the cohorts. RESULTS: One hundred forty-eight consecutive pediatric patients (71 boys and 77 girls; mean age, 11.1 years; age range, 8 days-17.9 years) were identified between September 2012 and March 2015. Mechanical administration of contrast material was performed in 117 patients (79.1%; mean age [± SD], 13.7 ± 3.7 years), and hand administration of contrast material was performed in 31 patients (20.9%; mean age, 1.6 ± 1.8 years). After adjusting for age, the degree of enhancement within the pulmonary arteries was not statistically different between the two IV contrast administration methods at the main pulmonary artery (mechanical vs hand administration: mean attenuation, 310 ± 128 vs 338 ± 142 HU, respectively, p = 0.505), right pulmonary artery (305 ± 124 vs 329 ± 146 HU, p = 0.556), and left pulmonary artery (303 ± 125 vs 340 ± 151 HU, p = 0.349). CONCLUSION: It is possible to perform diagnostic-quality pulmonary CTA for the assessment of the central pulmonary arteries with hand administration of IV contrast material in pediatric patients with small-gauge IV catheters.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste/administração & dosagem , Injeções Intravenosas/instrumentação , Injeções Intravenosas/métodos , Artéria Pulmonar/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
8.
Am J Health Syst Pharm ; 74(1): e47-e54, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-28007721

RESUMO

PURPOSE: Results of a study to examine the physical compatibility of ceftolozane-tazobactam with common i.v. medications during simulated Y-site administration are presented. METHODS: Ceftolozane-tazobactam was reconstituted according to manufacturer recommendations and diluted with 0.9% sodium chloride or 5% dextrose to solutions containing 15 mg (10 mg of ceftolozane and 5 mg of tazobactam)/mL. All other i.v. drugs were prepared according to manufacturer recommendations and diluted with 0.9% sodium chloride or 5% dextrose to standard concentrations used clinically. Y-site administration was simulated by mixing ceftolozane-tazobactam solution with each tested drug solution at a 1:1 ratio. Solutions were inspected for visual, turbidity, and pH changes immediately and 15, 60, and 120 minutes after mixing. Incompatibility was defined as precipitation, color change, a positive Tyndall test, a change in turbidity of ≥0.5 nephelometric turbidity unit, or a change in pH of ≥1 unit during the 120-minute observation period. RESULTS: Of the 95 i.v. drugs tested, ceftolozane-tazobactam was compatible with 86 drugs in both diluents; notably, it was compatible with metronidazole in both solutions. No substantial pH changes were observed in any tested combination. Ceftolozane-tazobactam was incompatible with albumin, amphotericin B, caspofungin, cyclosporine, nicardipine, and phenytoin sodium due to turbidity changes and with propofol due to formation of an oily layer. CONCLUSION: Ceftolozane-tazobactam 15 mg (10 mg of ceftolozane and 5 mg of tazobactam)/mL was physically compatible with 86 of 95 study drugs tested in both 0.9% sodium chloride injection and 5% dextrose injection during simulated Y-site administration.


Assuntos
Antibacterianos/química , Cefalosporinas/química , Ácido Penicilânico/análogos & derivados , Infecções Urinárias/tratamento farmacológico , Antibacterianos/administração & dosagem , Cefalosporinas/administração & dosagem , Química Farmacêutica , Incompatibilidade de Medicamentos , Excipientes/química , Glucose/química , Humanos , Infusões Intravenosas/efeitos adversos , Infusões Intravenosas/instrumentação , Infusões Intravenosas/métodos , Injeções Intravenosas/efeitos adversos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/métodos , Nefelometria e Turbidimetria , Ácido Penicilânico/administração & dosagem , Ácido Penicilânico/química , Cloreto de Sódio/química , Solubilidade , Tazobactam
9.
Am J Health Syst Pharm ; 74(1): e55-e63, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-28007722

RESUMO

PURPOSE: The physical compatibility of isavuconazonium sulfate with 95 i.v. drugs during simulated Y-site administration was studied. METHODS: Isavuconazonium sulfate for injection and all other drugs were reconstituted according to the manufacturer's recommendation and further diluted with 0.9% sodium chloride injection or 5% dextrose injection to a final concentration (1.5 mg/mL for isavuconazonium sulfate and standard concentrations used clinically for other drugs). A Y site was simulated in glass culture tubes by mixing 5 mL of the tested drug and isavuconazonium sulfate solutions in each diluent. Incompatibility was defined as changes in visual characteristics or increases in turbidity by greater than 0.5 nephelometric turbidity units over the 120-minute experiment. RESULTS: Of the 95 drugs tested, isavuconazonium sulfate was physically compatible with 66 drugs in 0.9% sodium chloride injection and 60 drugs in 5% dextrose injection. Incompatibility was observed with albumin, amphotericin B deoxycholate, amphotericin B lipid complex, amphotericin B liposome, ampicillin-sulbactam, cefazolin, cefepime, ceftaroline fosamil, ceftazidime, ceftriaxone, cefuroxime, colistimethate sodium, cyclosporine, ertapenem, esomeprazole, filgrastim, fosphenytoin, furosemide, heparin, meropenem, methylprednisolone, micafungin, phenytoin, potassium phosphate, propofol, sodium bicarbonate, sodium phosphate, and tedizolid. Azithromycin, bumetanide, penicillin G potassium, and piperacillin-tazobactam were incompatible with isavuconazonium sulfate in 5% dextrose injection only. CONCLUSION: Of the 95 drugs tested, isavuconazonium sulfate 1.5 mg/mL was physically compatible with 66 drugs in 0.9% sodium chloride injection and 60 drugs in 5% dextrose injection. Incompatibility was observed with 18 antimicrobials, including most cephalosporins tested, and 14 other i.v. drugs in at least 1 of the 2 tested diluents.


Assuntos
Antifúngicos/química , Infecções Fúngicas Invasivas/tratamento farmacológico , Nitrilos/química , Piridinas/química , Triazóis/química , Antifúngicos/administração & dosagem , Química Farmacêutica , Incompatibilidade de Medicamentos , Estabilidade de Medicamentos , Emulsões/administração & dosagem , Emulsões/química , Glucose/química , Humanos , Infusões Intravenosas/efeitos adversos , Infusões Intravenosas/instrumentação , Infusões Intravenosas/métodos , Injeções Intravenosas/efeitos adversos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/métodos , Nefelometria e Turbidimetria , Nitrilos/administração & dosagem , Piridinas/administração & dosagem , Cloreto de Sódio/química , Solubilidade , Fatores de Tempo , Triazóis/administração & dosagem
10.
Nat Mater ; 16(1): 147-152, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27698353

RESUMO

Bleeding is largely unavoidable following syringe needle puncture of biological tissues and, while inconvenient, this typically causes little or no harm in healthy individuals. However, there are certain circumstances where syringe injections can have more significant side effects, such as uncontrolled bleeding in those with haemophilia, coagulopathy, or the transmission of infectious diseases through contaminated blood. Herein, we present a haemostatic hypodermic needle able to prevent bleeding following tissue puncture. The surface of the needle is coated with partially crosslinked catechol-functionalized chitosan that undergoes a solid-to-gel phase transition in situ to seal punctured tissues. Testing the capabilities of these haemostatic needles, we report complete prevention of blood loss following intravenous and intramuscular injections in animal models, and 100% survival in haemophiliac mice following syringe puncture of the jugular vein. Such self-sealing haemostatic needles and adhesive coatings may therefore help to prevent complications associated with bleeding in more clinical settings.


Assuntos
Hemofilia A/complicações , Hemorragia/etiologia , Hemorragia/prevenção & controle , Hemostasia Cirúrgica/instrumentação , Agulhas/efeitos adversos , Punções/efeitos adversos , Punções/instrumentação , Animais , Materiais Revestidos Biocompatíveis/química , Desenho de Equipamento , Análise de Falha de Equipamento , Injeções Intravenosas/efeitos adversos , Injeções Intravenosas/instrumentação , Masculino , Camundongos , Camundongos Endogâmicos BALB C
11.
BMC Health Serv Res ; 16: 458, 2016 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-27581947

RESUMO

BACKGROUND: The acquisition of needle-stick injuries (NSI) in a healthcare setting poses an occupational hazard of transmitting blood-borne pathogens from patients to healthcare workers (HCWs). The objective of this study was to systematically review the evidence about the efficacy and safety of using safety-engineered intravenous devices and safety-engineered phlebotomy devices by HCWs. METHODS: We included randomized and non-randomized studies comparing safety-engineered devices to conventional/standard devices that lack safety features for delivering intravenous injections and/or for blood-withdrawal procedures (phlebotomy). The outcomes of interest included NSI rates, and blood-borne infections rates among HCWs and patients. We conducted an extensive literature search strategy using the OVID interface in October 2013. We followed the standard methods for study selection and data abstraction. When possible, we conducted meta-analyses using a random-effects model. We used the GRADE methodology to assess the quality of evidence by outcome. RESULTS: We identified twenty-two eligible studies: Twelve assessed safety-engineered devices for intravenous procedures, five for phlebotomy procedures, and five for both. Twenty-one of those studies were observational while one was a randomized trial. All studies assessed the reduction in NSIs among HCWs. For safety-engineered intravenous devices, the pooled relative risk for NSI per HCW was 0.28 [0.13, 0.59] (moderate quality evidence). The pooled relative risk for NSI per device used or procedure performed was 0.34 [0.08,1.49] (low quality evidence). For safety-engineered phlebotomy devices, the pooled relative risk for NSI per HCW was 0.57 [0.38, 0.84] (moderate quality evidence). The pooled relative risk for NSI per device used or procedure performed was 0.53 [0.43,0.65] (moderate quality evidence). We identified no studies assessing the outcome of blood-borne infections among healthcare workers or patients. CONCLUSION: There is moderate-quality evidence that the use of safety-engineered devices in intravenous injections and infusions, and phlebotomy (blood-drawing) procedures reduces NSI rates of HCWs.


Assuntos
Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Flebotomia/instrumentação , Patógenos Transmitidos pelo Sangue , Desenho de Equipamento , Pessoal de Saúde , Humanos , Injeções Intramusculares/instrumentação , Injeções Intravenosas/instrumentação , Injeções Subcutâneas/instrumentação , Equipamentos de Proteção , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança
12.
Crit Care ; 20: 102, 2016 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-27075364

RESUMO

BACKGROUND: Indications for intra-osseous (IO) infusion are increasing in adults requiring administration of fluids and medications during initial resuscitation. However, this route is rarely used nowadays due to a lack of knowledge and training. We reviewed the current evidence for its use in adults requiring resuscitative procedures, the contraindications of the technique, and modalities for catheter implementation and skill acquisition. METHODS: A PubMed search for all articles published up to December 2015 was performed by using the terms "Intra-osseous" AND "Adult". Additional articles were included by using the "related citations" feature of PubMed or checking references of selected articles. Editorials, comments and case reports were excluded. Abstracts of all the articles that the search yielded were independently screened for eligibility by two authors and included in the analysis after mutual consensus. In total, 84 full-text articles were reviewed and 49 of these were useful for answering the following question "when, how, and for which population should an IO infusion be used in adults" were selected to prepare independent drafts. Once this step had been completed, all authors met, reviewed the drafts together, resolved disagreements by consensus with all the authors, and decided on the final version. RESULTS: IO infusion should be implemented in all critical situations when peripheral venous access is not easily obtainable. Contraindications are few and complications are uncommon, most of the time bound to prolonged use. The IO infusion allows for blood sampling and administration of virtually all types of fluids and medications including vasopressors, with a bioavailability close to the intravenous route. Unfortunately, IO infusion remains underused in adults even though learning the technique is rapid and easy. CONCLUSIONS: Indications for IO infusion use in adults requiring urgent parenteral access and having difficult intravenous access are increasing. Physicians working in emergency departments or intensive care units should learn the procedures for catheter insertion and maintenance, the contraindications of the technique, and the possibilities this access offers.


Assuntos
Serviços Médicos de Emergência/métodos , Infusões Intraósseas/normas , Ressuscitação/instrumentação , Ressuscitação/métodos , Adulto , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos , Infusões Intraósseas/métodos , Infusões Intraósseas/estatística & dados numéricos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/métodos , Ressuscitação/estatística & dados numéricos
13.
J Clin Ultrasound ; 44(3): 136-42, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26302446

RESUMO

PURPOSE: To evaluate the feasibility of using continuous infusion, in comparison with bolus injection, of a sulfur hexafluoride-microbubble contrast agent to prolong the duration of hepatic parenchymal enhancement in humans during sonographic examination. METHODS: This pilot study was approved by our institution's ethics committee. Ten patients (5 men and 5 women; mean age ± SD, 65 ± 10 years) each received two injections: a bolus injection (2 ml/s) and then continuous infusion (0.5 ml/min) of the contrast agent by using an automatic injector. Acquired cine clips were transferred to a personal computer, and the video intensity was quantified by dedicated software. RESULTS: From the time of the first microbubble visualization in the scanning plane, maximal enhancement was reached in 6.3 ± 0.94 seconds after bolus injection and in 13.9 ± 1.44 seconds during continuous infusion (p = 0.002, Wilcoxon's test for paired data). Compared with bolus injection, continuous infusion prolonged the duration of contrast enhancement (4.3 minutes ± 42 seconds versus 7.3 minutes ± 40 seconds; p = 0.002), although no statistically significant difference in maximal enhancement was observed (45 ± 18% for bolus injection and 39 ± 6% for continuous infusion; p = 0.62). CONCLUSIONS: Continuous infusion of sulfur hexafluoride-filled microbubbles via an automatic power injector prolongs hepatic contrast enhancement without significantly modifying the maximal enhancement over that at baseline. These data, coming from a pilot study, can be used to design a larger study with adequate statistical power.


Assuntos
Meios de Contraste/administração & dosagem , Aumento da Imagem/métodos , Fígado/diagnóstico por imagem , Fosfolipídeos/administração & dosagem , Hexafluoreto de Enxofre/administração & dosagem , Ultrassonografia , Idoso , Estudos de Viabilidade , Feminino , Humanos , Injeções Intravenosas/instrumentação , Injeções Intravenosas/métodos , Masculino , Microbolhas , Projetos Piloto
14.
Acta Radiol ; 57(5): 557-64, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26185266

RESUMO

BACKGROUND: It can be challenging to achieve adequate vessel opacification during percutaneous coronary interventions when using thin catheters, hand injection, and iso-osmolar contrast media (CM) such as iodixanol (Visipaque™). PURPOSE: To explore these limitations and the possibility to overcome them with iosimenol, a novel CM. MATERIAL AND METHODS: Three X-ray contrast media with different concentrations were used in this study. A series of in vitro experiments established the relationship between injection pressure and flow rate in angiography catheters under various conditions. The experiments were conducted with power and hand injections and included a double-blind evaluation of user perception. RESULTS: By using hand injection, it was generally not possible to reach a maximum injection pressure exceeding 50 psi. The time within which volunteers were able to complete the injections, the area under the pressure-time curve (AUC), and assessment of ease of injection all were in favor of iosimenol compared with iodixanol, especially when using the 4F thin catheter. Within the pressure ranges tested, the power injections demonstrated that the amount of iodine delivered at a fixed pressure was strongly related to viscosity but unrelated to iodine concentration. CONCLUSION: There are substantial limitations to the amount of iodine that can be delivered through thin catheters by hand injection when iso-osmolar CM with high viscosity is used. The only viable solution, besides increasing the injection pressure, is to use a CM with lower viscosity, since the cost of increasing the concentration, in terms of increased viscosity and consequent reduction in flow, is too high. Iosimenol, an iso-osmolar CM with lower viscosity than iodixanol might therefore be a better alternative when thinner catheters are preferred, especially when the radial artery is used as the access site.


Assuntos
Benzamidas/administração & dosagem , Meios de Contraste/administração & dosagem , Iohexol/administração & dosagem , Propanolaminas/administração & dosagem , Ácidos Tri-Iodobenzoicos/administração & dosagem , Cateteres , Técnicas In Vitro , Injeções Intravenosas/instrumentação , Concentração Osmolar , Intervenção Coronária Percutânea , Pressão , Reologia , Seringas , Viscosidade
16.
Pain Med ; 16(11): 2084-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26442619

RESUMO

OBJECTIVE: To quantify the incidence of inadvertent vascular penetration during lumbosacral transforaminal epidural injections using blunt-tip, pencil-point, and catheter-extension needles. STUDY DESIGN/SETTING: This is a prospective, observational, consecutive cohort study. SUBJECTS: Two hundred consecutive patients undergoing lumbosacral transforaminal epidural injections at an academic outpatient spine center. METHODS: Four hundred seventy-five fluoroscopically guided lumbosacral transforaminal epidural injections were performed on consecutively consenting patients by one interventional spine physician, using three different needle types. The presence or absence of vascular uptake was determined during contrast injection under live fluoroscopy. RESULTS: Vascular uptake of contrast was observed in 58 of the total 475 injections, for an overall incidence of 12.2%. By needle type, the incidence of inadvertent vascular uptake was 16.6% (26/157) in the pencil-point group, 15.6% (24/154) in the blunt-tip group, and 4.9% (8/164) in the catheter-extension group. The difference in rates is statistically significant between the catheter-extension needle group and both the pencil-point group (P = 0.0009) and blunt-tip group (P = 0.0024). A secondary analysis was performed to quantify the incidence of functional pitfalls between needle groups, with a significantly lower incidence in the pencil-point group compared to both the catheter-extension (P = 0.0148) and blunt-tip needle (P = 0.0288) groups. CONCLUSIONS: Blunt-tip and pencil-point needles have comparable risk of inadvertent vascular injection during lumbosacral transforaminal injections. Catheter-extension needles demonstrated a reduce incidence of vascular uptake, but also result in a significantly higher rate of functional pitfalls that limits their usefulness in routine practice.


Assuntos
Injeções Epidurais/instrumentação , Injeções Intravenosas/instrumentação , Região Lombossacral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Meios de Contraste , Feminino , Fluoroscopia , Humanos , Injeções Intravenosas/métodos , Masculino , Pessoa de Meia-Idade , Agulhas , Estudos Prospectivos , Adulto Jovem
18.
J Neuroradiol ; 41(1): 87-91, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24405685

RESUMO

Arteriovenous malformations (AVMs) may be cured by injecting liquid embolic agents such as Onyx. Reflux, however, can sometimes be difficult to control and may jeopardize a complete embolization. The pressure cooker technique (PCT) was designed to create an anti-reflux plug by trapping the detachable part of an Onyx-compatible microcatheter with coils and glue in order to obtain wedge-flow conditions, thereby enabling a better understanding of macrofistulous AVMs and a more comprehensive, forceful and controlled Onyx embolization. The PCT might enlarge the range of AVMs amenable to endovascular cure. Three illustrative cases are presented.


Assuntos
Dimetil Sulfóxido/administração & dosagem , Embolização Terapêutica/instrumentação , Embolização Terapêutica/métodos , Embucrilato/administração & dosagem , Hemostáticos/administração & dosagem , Malformações Arteriovenosas Intracranianas/terapia , Polivinil/administração & dosagem , Dispositivos de Acesso Vascular , Adulto , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Injeções Intravenosas/instrumentação , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pressão , Radiografia , Adesivos Teciduais/administração & dosagem , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA