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1.
Nefrologia (Engl Ed) ; 42(1): 1-7, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36153888

RESUMO

Chronic kidney disease (CKD) is an emerging global burden with an increasing number of patient's requiring renal replacement therapy (RRT), with hemodialysis being the most prevalent dialysis modality. A functioning vascular access remains the main constrain for an adequate treatment. Clinical and, in some patients, ultrasound evaluation are fundamental for better access planning. Access planning is dependent not only on patient clinical characteristics and preference but also in vascular patrimony. As such, ultrasound evaluation aids in characterizing patient arterial and venous upper arm anatomy and provides information for which access would better suit each patient. Doctors dealing with CKD patients should be familiar with the role of ultrasound and Doppler use in access planning.


Assuntos
Derivação Arteriovenosa Cirúrgica , Insuficiência Renal Crônica , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Humanos , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Terapia de Substituição Renal , Veias
2.
Rev. flum. odontol ; 3(59): 1-7, set.-dez. 2022. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1380373

RESUMO

A Fibrina Rica em Plaquetas (PRF) é caracterizada por sua abrangente aplicabilidade na Odontologia. Neste sentido, a venopunção é uma etapa fundamental para sua obtenção. Tal procedimento consiste na identificação das veias superficiais, localizadas na região da fossa antecubital dos membros superiores, para que através da utilização do sistema a vácuo de coleta seja obtido o sangue venoso do paciente. O objetivo deste trabalho é realizar um guia prático abordando cada etapa que compreende a coleta sanguínea para produção do PRF permitindo sua reprodutibilidade de forma segura e eficiente.


Platelet Rich Fibrin (PRF) is characterized by its wide applicability in Dentistry. In this sense, venipuncture is a fundamental step towards obtaining it. Such procedure consists of the identification of superficial veins, located in the region of the antecubital fossa of the upper limbs, so that through the use of the vacuum collection system, the patient's venous blood is obtained. The objective of this work is to carry out a practical guide covering each step that comprises the blood collection for the production of the PRF allowing its reproducibility in a safe and efficient way.


Assuntos
Veias , Coleta de Amostras Sanguíneas , Odontologia , Fibrina Rica em Plaquetas
3.
Sci Rep ; 12(1): 15277, 2022 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-36088359

RESUMO

Refilling of the vascular space through absorption of interstitial fluid by micro vessels is a crucial mechanism for maintaining hemodynamic stability during hemodialysis (HD) and allowing excess fluid to be removed from body tissues. The rate of vascular refilling depends on the imbalance between the Starling forces acting across the capillary walls as well as on their hydraulic conductivity and total surface area. Various approaches have been proposed to assess the vascular refilling process during HD, including the so-called refilling coefficient (Kr) that describes the rate of vascular refilling per changes in plasma oncotic pressure, assuming that other Starling forces and the flow of lymph remain constant during HD. Several studies have shown that Kr decreases exponentially during HD, which was attributed to a dialysis-induced decrease in the whole-body capillary hydraulic conductivity (LpS). Here, we employ a lumped-parameter mathematical model of the cardiovascular system and water and solute transport between the main body fluid compartments to assess the impact of all Starling forces and the flow of lymph on vascular refilling during HD in order to explain the reasons behind the observed intradialytic decrease in Kr. We simulated several HD sessions in a virtual patient with different blood priming procedures, ultrafiltration rates, session durations, and constant or variable levels of LpS. We show that the intradialytic decrease in Kr is not associated with a possible reduction of LpS but results from the inherent assumption that plasma oncotic pressure is the only variable Starling force during HD, whereas in fact other Starling forces, in particular the oncotic pressure of the interstitial fluid, have an important impact on the transcapillary fluid exchange during HD. We conclude that Kr is not a good marker of LpS and should not be used to guide fluid removal during HD or to assess the fluid status of dialysis patients.


Assuntos
Capilares , Diálise Renal , Simulação por Computador , Humanos , Ultrafiltração , Veias
4.
J Infus Nurs ; 45(5): 252-257, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36112872

RESUMO

No information exists on the minimum number of times that fist clenching should be performed to increase vein visibility and palpability. In this study, the researchers aimed to determine the average number and duration of fist clenching to increase vein visibility and palpability before peripheral intravenous catheter insertion. This observational study included 207 healthy individuals. Participants meeting the inclusion criteria were asked to perform fist clenching. The number and duration of fist clenches performed to increase dorsal metacarpal vein and cephalic vein grade were determined. The participants carried out fist clenching 7.57 ± 4.26 times for the first increase and 22.16 ± 7.93 times for the second increase in dorsal metacarpal vein grade. Fist clenching was carried out 10.05 ± 7.30 times for the first increase and 21.30 ± 7.86 times for the second increase in cephalic vein visibility. A statistically significant, weak, but positive relationship was observed between the duration of fist clenching and the change in dorsal metacarpal vein grade and anxiety level ( r = 0.194, P < .005). However, the relationship was negative between room temperature and the duration of fist clenching in dorsal metacarpal vein grade ( r = -0.207, P = .003). This inexpensive and simple technique should be performed in specified numbers before catheter insertion.


Assuntos
Cateterismo Periférico , Veias , Mãos , Humanos
5.
J Morphol ; 283(10): 1318-1336, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36059180

RESUMO

Diploic veins (DV) run within the cranial diploe, where they leave channels that can be studied in osteological samples. This study investigates overall DV variability in human adults and the effects of sex, age, cranial dimensions, and dysmorphogenesis associated with craniosynostosis (CS). The morphology of macroscopic diploic channels was analyzed in a set of the qualitative and quantitative variables in computed tomography-images of crania of anatomically normal and craniosynostotic adult individuals. Macroscopic diploic channels occur most frequently in the frontal and parietal bones, often with a bilaterally symmetrical pattern. DV-features (especially DV-pattern) are characterized by high individual diversity. On average, there are 5.4 ± 3.5 large macroscopic channels (with diameters >1 mm) per individual, with a mean diameter of 1.7 ± 0.4 mm. Age and sex have minor effects on DV, and cranial proportions significantly influence DV only in CS skulls. CS is associated with changes in the DV numbers, distributions, and diameters. Craniosynostotic skulls, especially brachycephalic skulls, generally present smaller DV diameters, and dolichocephalic skulls display increased number of frontal DV. CS, associated with altered cranial dimensions, suture imbalance, increased intracranial pressure, and with changes of the endocranial craniovascular system, significantly also affects the macroscopic morphology of DV in adults, in terms of both structural (topological redistribution) and functional factors. The research on craniovascular morphology and CS may be of interest in biological anthropology, paleopathology, medicine (e.g., surgical planning), but also in zoology and paleontology.


Assuntos
Craniossinostoses , Crânio , Animais , Suturas Cranianas , Craniossinostoses/diagnóstico por imagem , Craniossinostoses/patologia , Humanos , Crânio/anatomia & histologia , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Veias
6.
Respir Care ; 67(9): 1190-1204, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36002161

RESUMO

In the absence of an indwelling arterial catheter, capillary blood gas sampling may be used to evaluate the acid/base and ventilation status of neonatal and pediatric patients with cardiorespiratory conditions. These guidelines were developed from a comprehensive review of the literature to provide guidance for the collection, handling, and interpretation of blood obtained from an arterialized capillary sample. Capillary and venous blood gas measurements are a useful alternative to arterial blood gas measurements for neonatal and pediatric patients who do not require close monitoring of [Formula: see text] In the presence of alterations in body temperature, blood pressure, or peripheral perfusion, agreement between a capillary blood gas with an arterial sample is recommended to determine whether changes in these physiologic conditions reduce reliability. Perfusion to the sample site should be assessed and preference given to blood sampling from a well perfused site, and blood should be analyzed within 15 min of sampling to minimize the propensity for pre-analytical errors. Clinicians should consider re-collecting a blood sample, obtained from an artery, vein, or capillary, when the blood gas or analyte result interpretation does not align with the patient's clinical presentation. A pneumatic tube system can be reliably used to transport blood gas samples collected in a syringe and capillary tube to a clinical laboratory for analysis. To reduce the cumulative pain effect and risk of complications, the capillary puncture procedure should be minimized when possible. Non-pharmacologic interventions should be used to reduce pain associated with capillary blood gas sampling. Automatic lancets are preferred to puncture the skin for capillary blood gas collection.


Assuntos
Coleta de Amostras Sanguíneas , Veias , Gasometria/métodos , Coleta de Amostras Sanguíneas/métodos , Capilares , Criança , Humanos , Recém-Nascido , Dor , Reprodutibilidade dos Testes
7.
Ulus Travma Acil Cerrahi Derg ; 28(9): 1312-1316, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36043933

RESUMO

BACKGROUND: Ultrasound-guided vein cannulation is an essential skill in emergency medicine. Prohibitive costs of commercial ultrasound phantoms limit the ability to adequately train residents. We assess the clinical utility of homemade phantoms for medical education. METHODS: Eighteen emergency medicine residents each performed 10 ultrasound-guided IV attempts on patients, half of the attempts before and half after a training course using two homemade ultrasound phantoms with 14 total Penrose drains. We conducted a prospective feasibility study using pre- and post-training surveys comparing confidence and success rates of IV cannulation attempts on patients. RESULTS: Residents demonstrated an improvement in successful ultrasound-guided peripheral vein cannulations from an average of 47.8% during the first five attempts to 71.1% in the last five attempts. No benefit was noted from the first to the fifth attempts, nor from the six to the tenth attempts, suggesting minimal benefit from experience early on. Residents reported increased confidence in performing ultrasound-guided venous cannulation on patients, identifying the correct probe, adjusting gain and depth, visualizing veins in short and long axis, differentiating arteries from veins, and vein cannulation on a phantom model. CONCLUSION: Homemade ultrasound phantoms are cost effective, increase confidence, and improve emergency medicine residents' ability to perform ultrasound-guided vein cannulation.


Assuntos
Cateterismo Venoso Central , Medicina de Emergência , Cateterismo , Medicina de Emergência/educação , Humanos , Veias Jugulares , Estudos Prospectivos , Ultrassonografia de Intervenção , Veias/diagnóstico por imagem
8.
Sensors (Basel) ; 22(16)2022 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-36015799

RESUMO

In today's information age, how to accurately identify a person's identity and protect information security has become a hot topic of people from all walks of life. At present, a more convenient and secure solution to identity identification is undoubtedly biometric identification, but a single biometric identification cannot support increasingly complex and diversified authentication scenarios. Using multimodal biometric technology can improve the accuracy and safety of identification. This paper proposes a biometric method based on finger vein and face bimodal feature layer fusion, which uses a convolutional neural network (CNN), and the fusion occurs in the feature layer. The self-attention mechanism is used to obtain the weights of the two biometrics, and combined with the RESNET residual structure, the self-attention weight feature is cascaded with the bimodal fusion feature channel Concat. To prove the high efficiency of bimodal feature layer fusion, AlexNet and VGG-19 network models were selected in the experimental part for extracting finger vein and face image features as inputs to the feature fusion module. The extensive experiments show that the recognition accuracy of both models exceeds 98.4%, demonstrating the high efficiency of the bimodal feature fusion.


Assuntos
Identificação Biométrica , Algoritmos , Identificação Biométrica/métodos , Biometria , Humanos , Redes Neurais de Computação , Veias
9.
Plast Reconstr Surg ; 150(4): 915-918, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35939645

RESUMO

SUMMARY: The profunda artery perforator flap has numerous advantages. For coverage of extremity wounds, however, traditional subfascial harvest results in a thick flap, which routinely requires secondary thinning. The author describes his approach and experience with thin and superthin profunda artery perforator flaps for extremity reconstruction. With preoperative perforator localization via computed tomography angiogram, color Doppler, and handheld Doppler, the author used a single dominant perforator for extremity reconstruction in 10 consecutive patients. The mean age of patients who had a thin or superthin profunda artery perforator flap for extremity reconstruction was 41.2 ± 21.3 years. Flaps were used to cover wounds in the upper ( n = 3) and lower ( n = 7) extremities. Mean flap thickness was 0.7 ± 0.2 cm. Mean flap artery diameter was 16 ± 3 mm; mean flap vein diameter was 21 ± 6 mm. Mean pedicle length was 6.8 ± 1.2 cm. The difference between the actual measured intraoperative proximal-distal distance and the preoperative computed tomography angiogram measurement for each patient was calculated, with a mean difference of 1.2 ± 0.6 cm. Advantages of the profunda artery perforator flap include a concealed donor site, large perforator caliber, long pedicle length, and a straightforward perforator dissection. Intraoperative measurement of the proximal-distal distance of the dominant perforator fell within 2 cm of the preoperative computed tomography angiogram measurement in all cases. The thin and superthin profunda artery perforator flaps provide new reconstructive options, particularly suited for use in the extremities. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Artérias/cirurgia , Dissecação , Extremidades , Humanos , Pessoa de Meia-Idade , Retalho Perfurante/irrigação sanguínea , Procedimentos Cirúrgicos Reconstrutivos/métodos , Veias , Adulto Jovem
10.
Acta Biomater ; 151: 414-425, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35995404

RESUMO

Vein grafts, the most commonly used conduits in multi-vessel coronary artery bypass grafting surgery, have high intermediate- and long-term failure rates. The abrupt and marked increase in hemodynamic loads on the vein graft is a known contributor to failure. Recent computational modeling suggests that veins can more successfully adapt to an increase in mechanical load if the rate of loading is gradual. Applying an external wrap or support at the time of surgery is one way to reduce the transmural load, and this approach has improved performance relative to an unsupported vein graft in several animal studies. Yet, a clinical trial in humans has shown benefits and drawbacks, and mechanisms by which an external wrap affects vein graft adaptation remain unknown. This study aims to elucidate such mechanisms using a multimodal experimental and computational data collection pipeline. We quantify morphometry using magnetic resonance imaging, mechanics using biaxial testing, hemodynamics using computational fluid dynamics, structure using histology, and transcriptional changes using bulk RNA-sequencing in an ovine carotid-jugular interposition vein graft model, without and with an external biodegradable wrap that allows loads to increase gradually. We show that a biodegradable external wrap promotes luminal uniformity, physiological wall shear stress, and a consistent vein graft phenotype, namely, it prevents over-distension, over-thickening, intimal hyperplasia, and inflammation, and it preserves mechanotransduction. These mechanobiological insights into vein graft adaptation in the presence of an external support can inform computational growth and remodeling models of external support and facilitate design and manufacturing of next-generation external wrapping devices. STATEMENT OF SIGNIFICANCE: External mechanical support is emerging as a promising technology to prevent vein graft failure following coronary bypass graft surgery. While variants of this technology are currently under investigation in clinical trials, the fundamental mechanisms of adaptation remain poorly understood. We employ an ovine carotid-jugular interposition vein graft model, with and without an external biodegradable wrap to provide mechanical support, and probe vein graft adaptation using a multimodal experimental and computational data collection pipeline. We quantify morphometry using magnetic resonance imaging, mechanics using biaxial testing, fluid flow using computational fluid dynamics, vascular composition and structure using histology, and transcriptional changes using bulk RNA sequencing. We show that the wrap mitigates vein graft failure by promoting multiple adaptive mechanisms (across biological scales).


Assuntos
Mecanotransdução Celular , Túnica Íntima , Animais , Artérias Carótidas/patologia , Artérias Carótidas/cirurgia , Humanos , Hiperplasia/patologia , RNA , Ovinos , Túnica Íntima/patologia , Veias/patologia
11.
Zh Vopr Neirokhir Im N N Burdenko ; 86(4): 104-108, 2022.
Artigo em Russo | MEDLINE | ID: mdl-35942844

RESUMO

BACKGROUND: Intracranial hemorrhage is the most common complication of cerebral arteriovenous malformations (AVM). In recent years, most studies devoted to the features of AVM functioning consider venous drainage as important factor influencing the rupture of malformation. OBJECTIVE: To review the literature data on the relationship between the features of venous drainage of cerebral arteriovenous malformations and intracranial hemorrhage. MATERIAL AND METHODS: We found 43 studies discussing the features of AVM venous drainage for the period from 1982 to 2020. Most of reports were published between 2005 and 2020. RESULTS: Deep venous drainage and a single drainage vein were the most significant factors influencing the risk of hemorrhage. Venous ectasia, reflux, stenosis, number, length and tortuosity of drainage veins were less important for the risk of AVM rupture. CONCLUSION: Analysis of the features of AVM venous drainage can make it possible to predict the natural course of disease and risk of intracranial hemorrhage. These aspects are essential for neurosurgical treatment.


Assuntos
Hemorragia Cerebral , Malformações Arteriovenosas Intracranianas , Drenagem/efeitos adversos , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/cirurgia , Hemorragias Intracranianas/etiologia , Estudos Retrospectivos , Veias
12.
Biosensors (Basel) ; 12(8)2022 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-36005008

RESUMO

The study of brain venous drainage has gained attention due to its hypothesized link with various neurological conditions. Intracranial and neck venous flow rate may be estimated using cardiac-gated cine phase-contrast (PC)-MRI. Although previous studies showed that breathing influences the neck's venous flow, this aspect could not be studied using the conventional segmented PC-MRI since it reconstructs a single cardiac cycle. The advent of real-time PC-MRI has overcome these limitations. Using this technique, we measured the internal jugular veins and superior sagittal sinus flow rates in a group of 16 healthy subjects (12 females, median age of 23 years). Comparing forced-breathing and free-breathing, the average flow rate decreased and the respiratory modulation increased. The flow rate decrement may be due to a vasoreactive response to deep breathing. The respiratory modulation increment is due to the thoracic pump's greater effect during forced breathing compared to free breathing. These results showed that the breathing mode influences the average blood flow and its pulsations. Since effective drainage is fundamental for brain health, rehabilitative studies might use the current setup to investigate if respiratory exercises positively affect clinical variables and venous drainage.


Assuntos
Coração , Imageamento por Ressonância Magnética , Adulto , Encéfalo , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Respiração , Veias , Adulto Jovem
14.
Medicina (Kaunas) ; 58(8)2022 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-36013532

RESUMO

Background and Objectives: Retrograde free venous flaps represent a separate entity among free venous flaps: their physiology is still unclear, but they provide an immediate visible refill after reconnection, with a similar behaviour to conventional flaps. Therefore, the dimensions and the indications of these flaps can be extended beyond what was previously believed, and they can be easily customized, including with respect to tendons and nerves. Nevertheless, they are still debated and regarded as unsafe. Materials and Methods: From 2012 to 2019, we performed 31 retrograde free venous flaps on 31 patients to reconstruct hands, digits, and in one case the heel. All the flaps were arterialized in a retrograde manner; the donor site was the forearm in 28 cases, the foot in 2 cases, and the calf in 1 case. We recorded the size, vein architecture, donor site, donor artery, donor morbidity, function for composite and non-composite flaps, immediate complications, late complications, survival rate, and the number of revisions. We recorded the hand function when appropriate. A total of 10 flaps were also intraoperatively studied with indocyanine green to monitor their hemodynamical behaviour. Results: All the patients were followed for an average of 8 months (6-15). The flap dimensions ranged from 6 cm2 to 136 cm2. All the flaps, except two that had complete necrosis, survived. Two flaps had partial necrosis. There was no correlation between necrosis and the size of the flap, with one case of necrosis and one of partial necrosis in the small flaps (<10 cm2). None of the cases with partial necrosis needed a new flap. Two flaps developed a late arterio-venous shunt that was ligated. Conclusions: The retrograde free venous flaps proved to be a useful tool for complex reconstructions of the hand and extremities. They can provide a large island of pliable skin and composite tissue with tendons and nerves, but surgeons must be aware of some caveats.


Assuntos
Traumatismos da Mão , Lesões dos Tecidos Moles , Antebraço/cirurgia , Traumatismos da Mão/cirurgia , Humanos , Necrose , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Veias/cirurgia
15.
PLoS One ; 17(8): e0272566, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35939451

RESUMO

BACKGROUND: Although compression therapy is well established for patients with deep venous thrombosis (DVT) and chronic venous disease (CVD), considerable variation exists in its organization in clinical practice which may impact patient outcomes. The current study aims to deepen our understanding of the main drivers of the complex care organization for compression therapy and to identify targets for improvement. METHODS: This realist evaluation includes a mixed-method design consisting of semi-structured interviews with patients and health care professionals involved in compression therapy (n = 30), stakeholder meetings (n = 2) and surveys (n = 114). Data were collected to create the content of context-mechanism-outcome-configurations (CMOcs) important in compression therapy. Based on these CMOcs, targets for improvement to optimize the organization of compression care were identified. RESULTS: We identified overarching context factors and mechanisms targeting four optimal outcomes for the organization of compression therapy: selecting initial compression therapy types that support patient's self-reliance (1), evidence based selection of elastic compression stocking type and class (2), patient-based selection of assistive devices (3), individualizing treatment duration for DVT patients (4a) and providing follow-up for CVD patients (4b). We found that increasing health care professionals' knowledge of compression therapy, the availability of unambiguous protocols and guidelines, increasing patient involvement (and if applicable their informal care giver) in the decision making process, the accessible availability of resources, and increasing interdisciplinary consultation enhanced desirable outcomes. These targets triggered mechanisms such as increased health care professionals' willingness, confidence and motivation to provide patient-based care and increased patients' self-confidence and self-efficacy. CONCLUSIONS: This study provides a detailed insight into what needs to be in place to optimize compression care and identified five main targets for improvement.


Assuntos
Síndrome Pós-Trombótica , Doenças Vasculares , Doença Crônica , Humanos , Síndrome Pós-Trombótica/etiologia , Meias de Compressão/efeitos adversos , Inquéritos e Questionários , Doenças Vasculares/etiologia , Veias
16.
Cell Mol Life Sci ; 79(9): 491, 2022 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-35987946

RESUMO

Endothelial cells in veins differ in morphology, function and gene expression from those in arteries and lymphatics. Understanding how venous and arterial identities are induced during development is required to understand how arterio-venous malformations occur, and to improve the outcome of vein grafts in surgery by promoting arterialization of veins. To identify factors that promote venous endothelial cell fate in vivo, we isolated veins from quail embryos, at different developmental stages, that were grafted into the coelom of chick embryos. Endothelial cells migrated out from the grafted vein and their colonization of host veins and/or arteries was quantified. We show that venous fate is promoted by sympathetic vessel innervation at embryonic day 11. Removal of sympathetic innervation decreased vein colonization, while norepinephrine enhanced venous colonization. BMP treatment or inhibition of ERK enhanced venous fate, revealing environmental neurotransmitter and BMP signaling and intrinsic ERK inhibition as actors in venous fate acquisition. We also identify the BMP antagonist Noggin as a potent mediator of venous arterialization.


Assuntos
Células Endoteliais , Veias , Animais , Artérias , Diferenciação Celular/fisiologia , Embrião de Galinha , Transdução de Sinais , Veias/metabolismo
19.
J Infus Nurs ; 45(4): 220-224, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35820127

RESUMO

In the past 30 years, midline catheter use has grown rapidly. For several reasons, many providers and facilities are attempting to reduce the number of central venous catheters and subsequent central line-associated bloodstream infections (CLABSIs) by using midline catheters. Vessel preservation requires attention to all vascular access device (VAD)-associated complications and not only central line bloodstream infection. There is still much confusion about the appropriate tip location and the characteristics of fluids and medications that can safely be infused through a midline catheter residing in a peripheral vein. The Infusion Therapy Standards of Practice (the Standards) focuses on assessment of characteristics of infusion therapies that must be considered for VAD selection as an evidence-based list of fluids and medications for infusion through peripheral veins has yet to be established. This review of midline catheter studies evaluates the evidence regarding the substitution of a midline catheter for a central venous catheter. Many issues need to be addressed, such as studies that include an outcome list that mixes defined clinical complications (eg, thrombosis) with signs and symptoms of complications (eg, leaking). Another issue is basing a major change of clinical practice on retrospective chart reviews. Although a midline catheter may be appropriate for some patients, additional studies of a higher level of evidence are needed before this major practice change should occur.


Assuntos
Cateterismo Periférico , Cateteres Venosos Centrais , Trombose , Cateteres Venosos Centrais/efeitos adversos , Humanos , Estudos Retrospectivos , Veias
20.
J Plast Reconstr Aesthet Surg ; 75(8): 2831-2870, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35821010

RESUMO

Immediate lymphatic reconstruction (ILR) is targeted at preventing breast cancer related lymphedema (BCRL) by anastomosing disrupted arm lymphatic channels to axillary vein tributaries. Inadequate vein length and venous back-bleeding are two technical reasons that lead to ILR procedures being aborted intraoperatively. Recently, our team began routinely harvesting a lower extremity vein graft (LEVG) for all ILR procedures to reduce our abort rate. We describe the surgical approach of an LEVG and evaluate the effects on aborted case rates and intraoperative time. A retrospective review of our institutional lymphatic database was conducted. Two hundred and forty-seven breast cancer patients were taken to the operating room for attempted ILR in the past 5 years. Prior to the use of an LEVG (n = 205), our abort rate was 14%. Since routinely performing an LEVG with ILR (n = 42), we have not aborted a single case. Despite an LEVG requiring one additional anastomosis to connect the vein graft to the native axillary vein tributary, this technique has not changed the intraoperative time for ILR procedures. In this technical contribution, we describe our early experience performing immediate lymphatic reconstruction utilizing a lower extremity vein graft. Implementation of this technique appears to have promising effects on aborted case rates without affecting intraoperative time, and greatly facilitates the lymphovenous anastomosis.


Assuntos
Linfedema Relacionado a Câncer de Mama , Vasos Linfáticos , Linfedema , Anastomose Cirúrgica , Humanos , Extremidade Inferior/cirurgia , Vasos Linfáticos/cirurgia , Linfedema/etiologia , Linfedema/prevenção & controle , Linfedema/cirurgia , Veias/cirurgia
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