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difficult IV access

Marsha Elkhunovich, Joanna Barreras, Valerie Bock Pinero, Nurit Ziv, Aisha Vaiyani, Thomas Mailhot
PURPOSE: Children receiving treatment in the hospital frequently require intravenous (IV) access. Placement of short peripheral catheters can be painful and challenging especially in those children who have difficult access. Many children's hospitals have teams of specialized vascular access nurses experienced in peripheral catheter insertion, and at times use vein visualization devices, including ultrasound (US), to assist in peripheral IV placement. Our objectives were to describe the prevalence and success rate of US-guided peripheral IV placement by vascular access team nurses at a single tertiary children's hospital...
November 15, 2016: Journal of Vascular Access
Megan Johnson, Kenji Inaba, Saskya Byerly, Erika Falsgraf, Lydia Lam, Elizabeth Benjamin, Aaron Strumwasser, Jean-Stephane David, Demetrios Demetriades
Intraosseous (IO) needle placement is an alternative for patients with difficult venous access. The purpose of this retrospective study was to examine indications and outcomes associated with IO use at a Level 1 trauma center (January 2008-May 2015). Data points included demographics, time to insertion, intravenous (IV) access points, indications, infusions, hospital and intensive care unit length of stay, and mortality. Of 68 patients with IO insertion analyzed (63.2% blunt trauma, 29.4% penetrating trauma, and 7...
October 2016: American Surgeon
S M Johnson, G M Garnett, R K Woo
Maintenance of central venous access in patients with chronic medical conditions such as short bowel syndrome demands forethought and ingenuity. We describe an innovative technique for re-utilizing central venous access sites in patients who have chronic central venous access needs. Records of patients undergoing this technique were reviewed between August 2012 and December 2015. The technique involves "cutting-down" to the sterile fibrous tunnel that naturally forms around tunneled catheters. The fibrous sheath is then isolated and controlled much as would be done for a venous "cut-down...
October 14, 2016: Pediatric Surgery International
Marko Jusup, Tânia Sousa, Tiago Domingos, Velimir Labinac, Nina Marn, Zhen Wang, Tin Klanjšček
We review the most comprehensive metabolic theory of life existing to date. A special focus is given to the thermodynamic roots of this theory and to implications that the laws of physics-such as the conservation of mass and energy-have on all life. Both the theoretical foundations and biological applications are covered. Hitherto, the foundations were more accessible to physicists or mathematicians, and the applications to biologists, causing a dichotomy in what always should have been a single body of work...
September 9, 2016: Physics of Life Reviews
Petra Duran-Gehring, Laurie Bryant, Jennifer A Reynolds, Petra Aldridge, Colleen J Kalynych, Faheem W Guirgis
OBJECTIVES: To report our success and complication rates with emergency department (ED) technician-performed ultrasound (US)-guided peripheral intravenous (IV) catheter placement and to compare our results to similar studies in the literature. METHODS: We conducted a retrospective review of a prospective database of patients who underwent US-guided peripheral IV catheter placement attempts for clinical care in the ED. All patients meeting difficult IV access criteria who had a US-guided peripheral IV catheter placement attempted by a trained ED technician were included...
November 2016: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Babita Sangwan, Rahul Rishi, Mukut Seal, Kanav Jain, Pranjali Dutt, Pratim Talukdar
AIMS: The aim of the present study is to compare and assess the fracture resistance of root canal treated teeth with different restorative materials. MATERIALS AND METHODS: The present in vitro study was carried out on seventy-five freshly extracted, noncarious, single-canal human lower-first premolars with similar anatomic characteristics. Teeth were randomly assigned to five groups with 15 teeth being present in each group. Group I is control group (no alteration done), group II is restored with silver amalgam after endodontic therapy, group III is restored with posterior composite after end-odontic therapy, group IV is restored with posterior glass ionomer cement (GIC) after endodontic therapy, and group V is restored with miracle mix after endodontic therapy...
July 1, 2016: Journal of Contemporary Dental Practice
Yan Wang, Qunting Qu, Guangchao Li, Tian Gao, Feng Qian, Jie Shao, Weijie Liu, Qiang Shi, Honghe Zheng
Currently, the specific capacity and cycling performance of various MoS2 /carbon-based anode materials for Na-ion storage are far from satisfactory due to the insufficient structural stability of the electrode, incomplete protection of MoS2 by carbon, difficult access of electrolyte to the electrode interior, as well as inactivity of the adopted carbon matrix. To address these issues, this work presents the rational design and synthesis of 3D interconnected and hollow nanocables composed of multiwalled carbon@MoS2 @carbon...
September 5, 2016: Small
Amit Bahl, Ananda Vishnu Pandurangadu, Jared Tucker, Michael Bagan
OBJECTIVE: This study analyzed outcomes associated with nurse-performed ultrasound (US)-guided intravenous (IV) placement compared to standard of care (SOC) palpation IV technique on poor vascular access patients. METHODS: This was a randomized, prospective single-site study. Phase 1 involved education/training of a cohort of nurses to perform US-guided IVs. This consisted of a didactic module and hands-on requirement of 10 proctored functional IVs on live subjects...
July 1, 2016: American Journal of Emergency Medicine
Sarah Derieg
Care of pediatric surgical patients is not limited to pediatric facilities, and all perioperative RNs should have a basic understanding of the specialized care that children require. This knowledge set includes an understanding of the basic terminology used to describe this patient population as well as the developmental stages of pediatric patients. Preoperatively, the nurse should conduct a thorough assessment and evaluation and address the anxieties and questions of the patient and his or her parent or guardian...
July 2016: AORN Journal
Michela Piredda, Valentina Biagioli, Beatrice Barrella, Ilaria Carpisassi, Roberta Ghinelli, Diana Giannarelli, Maria Grazia De Marinis
BACKGROUND: Early recognition of patients at risk for difficult peripheral intravenous (IV) catheterisation is important in order to adopt strategies able to increase the likelihood of success in IV cannulation, as well as to critically evaluate the use of alternative administration routes or venous devices. AIMS AND OBJECTIVES: This study aimed to identify risk factors for difficult IV cannulation in relation to characteristics of patients, healthcare providers, and devices in adult patients accessing a radiology service...
June 21, 2016: Journal of Clinical Nursing
Lori A Stolz, Anthony R Cappa, Michael R Minckler, Uwe Stolz, Ryan G Wyatt, Carl W Binger, Richard Amini, Srikar Adhikari
INTRODUCTION: It is unclear how many ultrasound-guided peripheral intravenous catheters (USG PIVC) one must place to become proficient at the procedure. The objective of this study was to determine the learning curve associated with PIVC placement and determine how many attempts are required for non-physician learners to reach proficiency. METHODS: This is a prospective observational study. Emergency department (ED) nurses and paramedics with competence in traditional PIVC placement underwent a USG PIVC placement training program...
July 12, 2016: Journal of Vascular Access
Sandeep Singh, Praveen Aggarwal, Rakesh Lodha, Ramesh Agarwal, Arun Kr Gupta, Renu Dhingra, Jayant Sitaram Karve, Srinivas Kiran Jaggu, Balram Bhargava
BACKGROUND & OBJECTIVES: Intraosseous (IO) access is an alternative to difficult intravenous (iv) access during emergency clinical situations. Existing IO solutions are expensive, require power supply and trained manpower; limiting their use in resource constrained settings. To address these limitations, a novel IO device has been developed. The objectives of this study were to evaluate functionality and safety of this device in adult human cadavers. METHODS: The ability of the IO device to penetrate the proximal and/or distal tibia was evaluated in three adult cadavers...
March 2016: Indian Journal of Medical Research
Stacy L Muir, Lance B Sheppard, Anne Maika-Wilson, James M Burgert, Jose Garcia-Blanco, Arthur D Johnson, Jennifer L Coyner
UNLABELLED: Introduction Obtaining intravenous (IV) access in patients in hemorrhagic shock is often difficult and prolonged. Failed IV attempts delay life-saving treatment. Intraosseous (IO) access may often be obtained faster than IV access. Albumin (5%) is an option for prehospital volume expansion because of the absence of interference with coagulation and platelet function. Hypothesis/Problem There are limited data comparing the performance of IO and IV administered 5% albumin. The aims of this study were to compare the effects of tibial IO (TIO) and IV administration of 500 mL of 5% albumin on infusion time and hemodynamic measurements of heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), and stroke volume (SV) in a swine model of hemorrhagic shock...
August 2016: Prehospital and Disaster Medicine
Thomas Hamilton, Madhankumar Sathyamoorthy
UNLABELLED: Patients with Freeman-Sheldon Syndrome (FSS) often need multiple surgical procedures. We present a case of FSS and discuss the anesthetic challenges associated with the case. CASE PRESENTATION: A 10-week-old female with FSS presented for elective Nissen fundoplication and gastrostomy tube insertion. She had a history of difficult intubation at birth. General anesthesia with inhalational anesthetic and spontaneous respirations technique was used. Fiber optic bronchoscope (FOB)-assisted nasal intubation was successful after failed attempts with a Miller blade, GlideScope, and intubation through a laryngeal mask airway (LMA)...
January 2016: Journal of the Mississippi State Medical Association
Gary P Zaloga, Alessandro Pontes-Arruda, Véronique Dardaine-Giraud, Thierry Constans
BACKGROUND: Many patients who cannot tolerate adequate enteral nutrition could benefit from parenteral nutrition support but fail to receive it due to difficult intravenous (IV) access. The objective of this study was to compare the safety and efficacy of subcutaneous (SC) administration of parenteral nutrition with the peripheral IV route. MATERIALS AND METHODS: This was a prospective randomized multicenter study of 121 older hospitalized patients. The primary outcome was the composite end point of major local side effects, defined as local edema, blistering, erythema, phlebitis, cellulitis, unbearable pain, or route failure requiring a switch in route...
February 17, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
F Batisse, A Schmitt, T Vendeuvre, D Herbreteau, C Bonnard
INTRODUCTION: Sclerotherapy offers an alternative to surgery for the treatment of aneurysmal bone cyst (ABC). The main objective of the present study was to assess the radiological efficacy of sclerotherapy in terms of ossification on MRI. Secondary objectives were to assess clinical efficacy on pain evaluation and to analyze recurrence and complications according to type of sclerosing agent and intraoperative imaging technique. MATERIALS AND METHODS: Between 2006 and 2014, 19 patients (7 females, 12 males, aged 3 to 17 years) with ABC treated by sclerotherapy were included...
April 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Helene Gudmann Steuble Brandt, Cecilie Heerdegen Jepsen, Ole Mazur Hendriksen, Astrid Lindekær, Martin Skjønnemand
INTRODUCTION: Peripheral intravenous access (PIA) is a necessity in the treatment and monitoring of the majority of hospitalised patients. Patients with an increased body mass index (BMI) more often than normal-weight patients have a difficult PIA. Identifying veins with ultrasonography has proven helpful when facing a difficult intravenous (IV) access. We hypothesise that, with the help of ultrasonography (US), it is possible to identify at least one vein suitable for IV access in morbidly obese patients (BMI > 40 kg/m(2))...
February 2016: Danish Medical Journal
Kate Cranwell, Meg Polacsek, Terence V McCann
Medical comorbidity in people with long-term mental illness is common and often undetected; however, these consumers frequently experience problems accessing and receiving appropriate treatment in public health-care services. The aim of the present study was to understand the lived experience of mental health consumers with medical comorbidity and their carers transitioning through tertiary medical to primary care services. An interpretative, phenomenological analysis approach was used, and semistructured, video-recorded, qualitative interviews were used with 12 consumers and four primary caregivers...
April 2016: International Journal of Mental Health Nursing
Pratibha P Ghodke, Kiran R Gore, S Harikrishna, Biswajit Samanta, Jithesh Kottur, Deepak T Nair, P I Pradeepkumar
N(2)-Furfuryl-deoxyguanosine (fdG) is carcinogenic DNA adduct that originates from furfuryl alcohol. It is also a stable structural mimic of the damage induced by the nitrofurazone family of antibiotics. For the structural and functional studies of this model N(2)-dG adduct, reliable and rapid access to fdG-modified DNAs are warranted. Toward this end, here we report the synthesis of fdG-modified DNAs using phosphoramidite chemistry involving only three steps. The functional integrity of the modified DNA has been verified by primer extension studies with DNA polymerases I and IV from E...
January 15, 2016: Journal of Organic Chemistry
Richard P Laksonen, Nanci K Gasiewicz
Peripheral intravenous (IV) access provides a means to administer medications, IV fluids, and blood products and allows for the sampling of blood for analysis. The traditional approach to obtaining peripheral IV access relies on vessel visualization in the arm and/or palpation of the blood vessel beneath the skin. However, the general population is aging, obesity is commonplace, and IV drug abuse is widespread, making peripheral IV access difficult. Use of ultrasound-guided peripheral IV access fills a practice gap in safe patient care between traditional peripheral IV access methods of vein visualization and/or palpation and ultrasound-guided central venous access...
December 2015: Nursing Clinics of North America
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