TRAINING AND SUPERVISION OF TEMPORARY TRANSVENOUS PACEMAKER INSERTION

SUMMARY To assess the current training and practice of central venous cannulation and temporary transvenous pacemaker insertion, a telephone survey of senior house officers (n=60) and registrars (n=20) was carried out in 80 acute hospitals in England and Wales. A median of one central line and two pacings were performed under supervision before the respondents were left unsupervised. The procedures were almost invariably taught at the bedside and usually by a fellow SHO or registrar. Virtually all the doctors surveyed were familiar with subclavian puncture, but experience with other routes was limited; 39/80 doctors questioned were unhappy about the training they had received, and 47 felt that formal training, such as tutorials or videos, would have helped. Training in central vein cannulation and temporary pacing needs to be more structured. This could be done by the use of videos or mannequins, and should include the use of routes other than the subclavian.     

PLASMA VISCOSITY AND THE DIAGNOSIS OF GIANT CELL ARTERITIS

The level of plasma viscosity associated with the diagnosis of giant cell arteritis, and its use as a replacement for the erythrocyte sedimentation rate (ESR) is examined, by reviewing the records of 59 patients undergoing temporal artery biopsy. All patients with positive temporal artery biopsy had plasma viscosity above the upper limit of normal (1.72 mPa.s), range 1.88 to 2.28. There was a large group of patients with a possible diagnosis, supported by a raised plasma viscosity, who in the absence of a positive biopsy were not felt to have clinical disease requiring steroid treatment. The role of plasma viscosity appears to be similar to that of the ESR in the diagnosis of giant cell arteritis.     

CLINICOPATHOLOGICAL PROFILE OF ABDOMINAL TUBERCULOSIS

SUMMARY The clinical and histopathological profile is presented of 145 patients with abdominal tuberculosis studied prospectively over a period of 5 years. The study highlights the role of various investigations and therapeutic response in this condition.     

Complications of central venous access devices in children with and without cancer

Objective: Complications of indwelling central venous access devices (CVAD) were assessed in 63 children with cancer and 35 without cancer.
Methodology: Central venous access devices placed surgically in 1991 were reviewed for complications.
Results: In cancer patients, the median CVAD duration was 211 days (range 9–924), compared to 37 days (range 3–339) in the non-cancer patients. Although significantly more CVAD, 41 of 72 (57%), were infected in the cancer patients compared to 14 of 40 (35%) CVAD in the non-cancer patients (OR = 2.46, 95% Cl 1.03–5.93), the rate of line infection in cancer patients was lower: 2.8 per 1000 catheter days compared with 7.6 per 1000 in non-cancer patients ( P = 0.0014). Infection was significantly more common in intensive chemotherapy cancer patients ( P = 0.0002).
Conclusions: Treating infected CVAD with antibiotics or hydrochloric acid (HCl), clearing occluded lines with streptokinase/HCl and repairing fractured lines, when successful, resulted in a considerable gain in the number of days of use for the CVAD.     

Platelet crossmatches of single-donor platelet concentrates using a latex agglutination assay

A latex agglutination assay was evaluated for the purpose of identifying compatible platelet donors for alloimmunized recipients. Assay reagents were prepared by adsorbing detergent-solubilized, donor- specific platelets to polystyrene latex beads. Semiquantitative results for up to 30 donors can be completed in less than 1 hour. These reagents retained their immunoreactivity for at least 3.5 months. A retrospective study has established the assay's upper limit of compatibility. The prospective study evaluated transfusions to a group of multiply transfused patients. Part I evaluated 143 crossmatched, single-donor platelet transfusions given to 50 patients. In 96 percent of the cases, a positive crossmatch was associated with an unsuccessful transfusion outcome; in 84 percent of the transfusions, a negative crossmatch predicted a satisfactory platelet increment. The overall predictability, sensitivity, and specificity were 87, 62, and 99 percent, respectively. Part II evaluated 105 transfusions given to the 43 patients (of 50) in whom no incidence of fever, sepsis, or bleeding could be documented. A positive crossmatch was 96-percent efficient in predicting an unsuccessful transfusion, whereas a negative crossmatch was associated with an adequate platelet increment following 89 percent of the transfusions. The overall predictability was 91 percent, the sensitivity was 72 percent, and the specificity was 99 percent. Within- run and between-run variations were 6.3 and 6.2 percent, respectively. These results demonstrate that detergent-solubilized platelet antigens, immobilized on latex particles, can be used in a cost-effective crossmatching procedure.