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.