Direct blood-pressure measurements: risks,technological evolution and some current problems

The direct measurement of blood pressure has found widespread use in intensive care units, operating rooms, and in emergency departments. Infection, air embolism and thrombosis are some of the risks to patients associated with both the cannulation procedure and with the apparatus used in the blood-pressure measuring process. Although there is constant revision in an attempt to reduce these risks, they cannot be completely eliminated. The need for direct blood-pressure measurements and the physiological effects of air embolism and thrombosis are reviewed. Infection and problems related to the techniques used to insert the catheters are not discussed.     

不同穿刺方法对麻醉系实习生桡动脉穿刺置管成功率的影响

目的通过比较不同穿刺方法对麻醉系临床实习生实施桡动脉穿刺时成功率的影响,探讨其原因并总结最佳的教学方法。方法对需进行有创动脉压监测的病人进行随机分组,分为3组,实习生同样分为3组：其中对照组采用Vasoean^R Braunule^R套管针,A组采用ARROW flash系列带导引钢丝桡动脉专用套管针;B组采用改良Vasoean^R Braunule^R套管针进行桡动脉穿刺置管;并进行成功率比较：结果在起初接触临床时间至2个月内,B组成功率明显较高（P〈0．05）;在之后的实习期间内（2-4个月。4-6个月）,A组成功率明显低于其它两组（P〈0．05）;B组和对照组之间未见明显差异：结论使用改良Vasoean^R Braunule^R套管针桡动脉穿刺方法能提高麻醉系临床实习生实施桡动脉穿刺的成功率,在短期内带动学生学习兴趣的同时增强其自信,是当前理想的临床教学方法。     

Simulated internal jugular vein cannulation using a needle-guiding device

Background

Using a two-dimensional ultrasound-guided approach does not guarantee success during the first attempt at internal jugular vein cannulation. Our randomized, parallel simulation study examined whether a new disposable device could improve the success rate of the first attempt at ultrasound-guided internal jugular vein cannulation of a simulated internal jugular vein.

RESEARCH INTO PAIN PERCEPTION WITH ARTERIOVENOUS FISTULA (AVF) CANNULATION

Patients with end‐stage renal failure (ESRF) undergoing haemodialysis (HD) are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula (AVF). Repeated AVF punctures lead to a considerable degree of pain, due to the calibre and length of the bevel of fistula needles. Pain is a sensitive, emotional and subjective experience. The objective of this study was to measure pain associated with AVF needling. The analogue visual scale (AVS) divided into 10 equal parts (0 indicating lack of pain, and 10 unbearable pain) was used. Patients⁷ perceptions were measured in three different HD sessions. Pain was considered mild during AVF needling. The buttonhole technique caused a mean degree of pain of 2.4 (±1.7), compared to 3.1 (±2.3) using the conventional ropeladder technique. Although without reaching a statistically significant difference, diminished pain was associated with the buttonhole technique.     

Intraosseous cannulation in children

This review outlines the current recommendations for use of intraosseous access in children. It describes the technique of intraosseous cannulation, anatomy, physiology and possible complications. It also briefly describes currently available devices that allow for rapid and effective intraosseous access in infants, children and young adults.     

维持性血液透析患者动静脉血管通路穿刺管理的最佳证据总结

目的 检索、评价并汇总维持性血液透析患者动静脉血管通路穿刺管理的证据,为加强临床医护人员动静脉血管通路穿刺规范管理提供循证依据。方法 系统检索UpToDate临床顾问、美国医疗保健研究与质量局、国际指南协作网、苏格兰校际指南网、英国国家卫生与临床优化研究所、加拿大安大略注册护士协会、医脉通等网站、指南库,以及ACP Journal Club、Cochrane Library、PubMed、Web of Science、CINAHL、中国知网、万方数据库、维普数据库、中国生物医学文献服务系统等数据库中关于维持性血液透析患者动静脉血管通路穿刺管理的证据,文献类型包括临床决策、指南、最佳实践、证据总结、系统评价、专家共识。检索时限为2017年1月—2021年12月。循证团队进行文献筛选、质量评价,并提取、汇总证据。结果 最终纳入8篇文献,其中临床决策2篇、指南4篇、系统评价1篇、专家共识1篇。最佳证据包括首次穿刺时机、穿刺前评估及准备、穿刺方法、穿刺成功判定、穿刺并发症处理、穿刺针拔出后按压、穿刺辅助设备、穿刺人员资质及培训8个方面,共25条证据。结论 血液净化医护人员需结合具体临床情境、证据的促进因素、阻碍因素及患者意愿,有针对性地选择最佳证据,提高动静脉血管通路一次穿刺成功率,减少穿刺相关不良事件,延长血管通路使用寿命。     

Needle-knife assisted ERCP

Background During endoscopic retrograde cholangiopancreatography (ERCP), incising through the wall of the major papilla with an electrocautery needle-knife is a method for achieving access into the bile duct. This procedure, often referred to as a “precut,” may be used when cannulation attempts via the orifice of the papilla are unsuccessful. Potential complications include hemorrhage, duodenal perforation, and acute pancreatitis. Methods The 172 patients who underwent an attempt of a needle-knife assisted ERCP during the years 1997–2003 at our institution were retrospectively evaluated. Results A selective bile duct cannulation was achieved after needle-knife incision in 148 out of 172 patients (86%) at the primary session. In 10 additional patients (6%), a repeated procedure proved successful for cannulation. In the remaining 14 patients (8%), the biliary cannulation failed and was not attempted again. Complications after needle-knife assisted ERCP occurred as follows: three patients (2%) presented with late bleeding after the ERCP and three patients (2%) developed acute pancreatitis. None of the patients required operative treatment for complications. There was no mortality. Conclusion The use of the needle-knife markedly improves the success rate of selective biliary cannulation in ERCP without increasing the rate of complications.     

经皮中心静脉置管术在新生儿科的临床应用

目的介绍新生儿监护室经外周中心静脉置管术(PICC)的临床应用。方法30例早产极低出生体重儿,选用法国VYGON公司生产的Epicutaneo cave catheter中心静脉置管,从上肢肘静脉或颈内静脉穿刺将导管置于其上腔静脉。结果平均置管时间为11 d,败血症发生率不足0.6%。静脉炎发生率3.4%,该技术操作较简单,容易固定和护理。结论经皮中心静脉置管术是一种安全可靠的深静脉置管术,操作较简单,值得临床应用。     

Cannulation of the axillary artery for cardiopulmonary bypass: safeguards and pitfalls

BACKGROUND: The ascending aorta is the customary site for arterial cannulation for cardiopulmonary bypass. Favorable experience at our institution and elsewhere using axillary artery cannulation in treating type A aortic dissections has caused us to broaden our indications for using this site for arterial cannulation for cardiopulmonary bypass. METHODS: Medical records, operative notes, and perfusion records were reviewed in all patients in whom the axillary artery was cannulated directly or by a graft for cardiopulmonary bypass from January 1, 2000 through August 30, 2002. RESULTS: Seventy-five patients underwent axillary artery cannulation during the 32-month interval. Eleven patients had ascending aortic dissections, 20 had extensively diseased ascending aortas, and 44 were individuals undergoing repeat cardiac procedures. The right axillary artery was used in 72 patients and the left in 3. In 16 patients the artery was cannulated directly, and in 59 the arterial cannula was inserted into a prosthetic graft that had been anastomosed to the axillary artery. Axillary artery cannulation was satisfactory in 95% (71 of 75) of the cases in which it was used. CONCLUSIONS: Cannulation of the axillary artery for cardiopulmonary bypass is a dependable approach for procedures including reoperations, aortic dissections, and extensively diseased ascending aortas.