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difficult venous 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
Rolf Ljung
Retrospective and prospective studies unambiguously show that prophylactic treatment of severe hemophilia A or B should be started as primary prophylaxis at 1-2 years' of age and ideally before the first joint bleed. The dose and dose frequency should be individually tailored depending on the goal of treatment, venous access and the bleeding phenotype. The circumstances during the first exposures of factor VIII concentrates in hemophilia A may have an impact on the risk of developing inhibitors. Enhanced half-life products, in particular in hemophilia B, will facilitate treatment in patients with difficult venous access but also in achieving a higher trough level...
2016: Thrombosis Journal
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
Arunangshu Chakraborty, Sanjit Agrawal, Taniya Datta, Suparna Mitra, Rakhi Khemka
Chemotherapy in children suffering from cancer usually requires placement of an indwelling central venous catheter (CVC). A child may need to undergo repeated procedures because of infection and occlusion of previous access devices. We present a case of CVC insertion in a child suffering from acute lymphoblastic leukemia where an innovative technique was employed.
October 2016: Journal of Indian Association of Pediatric Surgeons
Siamak Moayedi, Michael Witting, Matthew Pirotte
BACKGROUND: The easy internal jugular (Easy IJ) technique involves placement of a single-lumen catheter in the internal jugular vein using ultrasound guidance. This technique is used in patients who do not have suitable peripheral or external jugular venous access. The efficacy and safety of this procedure are unknown. OBJECTIVE: We aimed to estimate efficacy and safety parameters for the Easy IJ when used in emergency department (ED) settings. METHODS: We conducted a prospective study of the Easy IJ in stable ED patients with severe intravenous access difficulty...
September 19, 2016: Journal of Emergency Medicine
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...
September 14, 2016: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Fabian Speth, Johannes-Peter Haas, Claas H Hinze
BACKGROUND: High-dose intravenous immune globulins (IVIg) are frequently used in refractory juvenile dermatomyositis (JDM) but are often poorly tolerated. High-dose recombinant human hyaluronidase-facilitated subcutaneous immune globulins (fSCIg) allow the administration of much higher doses of immune globulins than conventional subcutaneous immune globulin therapy and may be an alternative to IVIg. The safety and efficacy of fSCIg therapy in JDM is unknown. CASE PRESENTATION: In this retrospective case series, five patients with steroid-refractory severe JDM were treated with high-dose fSCIg due to IVIg adverse effects (severe headaches, nausea, vomiting, difficult venous access)...
2016: Pediatric Rheumatology Online Journal
Angélica de Fátima de Assunção Braga, Franklin Sarmento da Silva Braga, José Hélio Zen Junior, Maria José Nascimento Brandão, Giancarlo Antonio Marcondes, Thales Daniel Alves Barbosa
: Insulinoma is a functional neuroendocrine tumor derived from beta cells of the pancreatic islets of Langerhans, usually solitary, benign, and curable with surgery (enucleation). It rarely occurs during pregnancy and is clinically manifested by hypoglycemia, particularly in the first trimester of pregnancy. During pregnancy, both conservative therapeutic measures (medication) and surgical treatment are challenging regarding the impossibility of studies on drug teratogenicity as well as the maternal-fetal repercussions during surgery, such as hypoglycemia and changes due to stress...
August 11, 2016: Revista Brasileira de Anestesiologia
Chien-Lun Tang, Chih-Hsiang Liao, Wen-Hsien Chen, Shih-Chieh Shen, Chung-Hsin Lee, Hsu-Tung Lee, Yuang-Seng Tsuei
Endovascular embolization is the treatment of choice for carotid-cavernous fistulas (CCFs), but failure to catheterize the cavernous sinus may occur as a result of vessel tortuosity, hypoplasia, or stenosis. In addition to conventional transvenous or transarterial routes, alternative approaches should be considered. The authors present a case in which a straightforward route to the CCF was accessed via transsphenoidal puncture of the cavernous sinus in a neurosurgical hybrid operating suite. This 82-year-old man presented with severe chemosis and proptosis of the right eye...
August 5, 2016: Journal of Neurosurgery
Daniel Z Adams, Andrew Little, Charles Vinsant, Sorabh Khandelwal
BACKGROUND: Venous access in the emergency department (ED) is an often under-appreciated procedural skill given the frequency of its use. The patient's clinical status, ongoing need for laboratory investigation, and intravenous therapeutics guide the size, type, and placement of the catheter. The availability of trained personnel and dedicated teams using ultrasound-guided insertion techniques in technically difficult situations may also impact the selection. Appropriate device selection is warranted on initial patient contact to minimize risk and cost...
September 2016: Journal of Emergency Medicine
Giacomo Forneris, Marco Trogolo, Pasqualina Cecere, Daniele Savio, Dario Roccatello
The Venous Window Needle Guide (VWING™) has recently been proposed for patients with difficult arteriovenous fistula (AVF) access for hemodialysis due to deep vessels or other cannulation-related problems. This totally subcutaneous titanium device is sutured onto the upper wall of the matured fistula and may facilitate cannulation by the button-hole technique. We describe our initial experience with nine implants in six patients with a cumulative follow-up of 83 months, and make some experience-based technical suggestions for implant and surveillance radiological imaging...
June 24, 2016: Journal of Nephrology
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
Julie Le, Areg Grigorian, Samuel Chen, Isabella J Kuo, Roy M Fujitani, Nii-Kabu Kabutey
INTRODUCTION: Peripherally inserted central catheters (PICCs) are a popular alternative to central venous lines. PICCs can provide reliable long-term access for intravenous fluids, antibiotics and total parenteral nutrition. Multiple factors can contribute to difficult PICC removal including adherent fibrin and thrombus formation around the catheter. We discuss a novel endovascular retrieval technique to remove tightly adherent PICCs. CASE PRESENTATION: A 42-year-old male with history of chronic pancreatitis requiring intravenous pain medications, presented with right upper extremity single lumen PICC that could not be removed by standard techniques...
June 1, 2016: Journal of Vascular Access
Kohyar Partovi-Deilami, Jesper K Nielsen, Ann M Moller, Sara-Sophie S Nesheim, Vibeke L Jorgensen
Patients with difficult intravenous access (DIVA) often experience discomfort because of failed attempts to place peripheral venous catheters (PVCs); however, ultrasound guidance may improve this problem with catheter placement. The aim of this study was to evaluate the use of ultrasound when operated by nurse anesthetists for these patients. This prospective observational study with a pre/post design focused on inpatients with DIVA referred for PVC placement, a service provided by nurse anesthetists in most Scandinavian hospitals...
April 2016: AANA Journal
Fernando Montes-Tapia, Antonio Rodríguez-Taméz, Idalia Cura-Esquivel, Itzel Barreto-Arroyo, Adolfo Hernández-Garduño, Isaías Rodríguez-Balderrama, José Quero, Manuel de la O-Cavazos
BACKGROUND: Central venous catheterization is not the first choice of vascular access in neonates. Success depends on the size of the vessel and the skill of the health professional performing the procedure. The internal jugular vein provides a predictable path for central venous cannulation, although it is more difficult to cannulate infants than adults and even more difficult in smaller newborns. METHODS: We conducted a prospective study in 100 newborns, in which a 4 Fr ultrasound-guided central venous catheter was placed in the right internal jugular vein (RIJV)...
October 2016: Journal of Pediatric Surgery
J Defosse, M Schieren, A Böhmer, V von Dossow, T Loop, F Wappler, M U Gerbershagen
BACKGROUND/OBJECTIVE: This study's objective was to evaluate current thoracic anaesthesia practice in Germany and to quantify potential differences depending on the hospital's level of care. MATERIALS AND METHODS: A four-part online survey containing 28 questions was mailed to all anaesthesiology department chairs (n = 777) registered with the German Society of Anaesthesiology and Intensive Care Medicine. RESULTS: The general response rate was 31...
June 2016: Der Anaesthesist
H Esfahani, M Ghorbanpor, A Tanasan
BACKGROUND: Peripheral blood vessels, due to availability are used for many years in cancer patients, however in patients with potentially harmful drugs to skin (vesicant drugs) or difficult accessibility to vessels, the use of implantable port (totally implantable venous access port-TIVAP) devices with central vascular access are important. MATERIALS AND METHODS: In this retrospective study, 85 pediatric cancer patients younger than 16 years, with TIVAP implantation, were followed for their complications and outcome...
2016: Iranian Journal of Pediatric Hematology and Oncology
Chu-Pak Lau, Kathy Lai-Fun Lee
Entirely leadless cardiac pacemakers that are delivered transvenously required the use of large diameter delivery sheath and femoral venous approach. The complexity of external femoral and iliac venous anatomy may limit their implantation. We describe a patient without subclavian venous access and a conventional pacemaker with a failed right ventricular lead, who had difficult iliac venous anatomy that was also compressed by an external endovascular abdominal aortic stent. Successful leadless pacing using a Micra™ (Medtronic Inc) was accomplished with a strong support wire, hydrophilic delivery sheath and guided by venography...
May 25, 2016: Pacing and Clinical Electrophysiology: PACE
Ajay Sundara Raman, Farshad Raissi Shabari, Biswajit Kar, Pranav Loyalka, Ramesh Hariharan
The use of subcutaneous implantable cardioverter-defibrillators is a novel option for preventing arrhythmia-mediated cardiac death in patients who are at risk of endovascular-device infection or in whom venous access is difficult. However, the potential for electromagnetic interference between subcutaneous defibrillators and left ventricular assist devices is largely unknown. We report the case of a 24-year-old man in whom we observed no electromagnetic interference between a subcutaneous implanted cardioverter-defibrillator and a HeartMate II Left Ventricular Assist System, at 3 different pump speeds...
April 2016: Texas Heart Institute Journal
Nancy Moureau, Vineet Chopra
Patients admitted to acute care frequently require intravenous access to effectively deliver medications and prescribed treatment. For patients with difficult intravenous access, those requiring multiple attempts, those who are obese, or have diabetes or other chronic conditions, determining the vascular access device (VAD) with the lowest risk that best meets the needs of the treatment plan can be confusing. Selection of a VAD should be based on specific indications for that device. In the clinical setting, requests for central venous access devices are frequently precipitated simply by failure to establish peripheral access...
April 28, 2016: British Journal of Nursing: BJN
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