10-mL Syringe Research Articles

Stability of Epinephrine in a Normal Saline Solution.

Dilution of concentrated epinephrine prior to intravenous use during clinical emergencies can delay urgent interventions. The objective of this study was to determine whether diluted epinephrine remains stable and sterile over time in common hospital settings. Epinephrine samples were prepared by clinically relevant double dilution techniques. Samples were stored in 10-mL syringes and incubated under 1 of 4 simulated hospital environments with a mixture of lighting and temperature settings: 4°C/20°C, with or without fluorescent lighting. Samples were incubated for 0, 15, 30, 60, or 90 days. Capillary zonal electrophoresis was used to quantify the concentration of epinephrine and/or presence of any degradation products. All samples were tested for the presence of bacterial growth using blood agar cultures. Diluted epinephrine samples remained stable for up to 90 days in all 4 simulated clinical storage conditions. No bacterial colony-forming units were detected in any of the environmental samples regardless of incubation duration, light, or temperature conditions. Diluted epinephrine for anticipated clinical emergencies may remain clinically useful for up to 90 days, thus improving patient safety, access to medications, and overhead costs by reducing waste.

Corporal aspiration and sympathomimetic injection for priapism: “Preprocedure preparation” and “procedural considerations”

Priapism is a prolonged and persistent erection that lasts more than 4 hours and is unrelated to sexual stimulation. Although uncommon, it requires expeditious treatment to prevent erectile function compromise. Corporal aspiration is the first-line treatment for patients with ischemic priapism. This article focuses on contemporary corporal aspiration techniques for the management of priapism. After obtaining informed consent and administering local anesthesia, corporal aspiration was initiated by inserting 2 large-bore butterfly needles into the penile shaft. Aspiration is then performed using 10-mL syringes to decompress the corporeal pressure, flush out clots, and restore the pH balance of the penis. Diluted phenylephrine (100–1000 μg/mL) is injected in 1 mL aliquots every 5 to 10 minutes until complete detumescence is achieved. The results show that the overall resolution rate using corporal aspiration followed by phenylephrine injection is 65% to 72%. Ninety percent of men experience detumescence success if aspiration and phenylephrine injection are performed within 12 hours. Conversely, 85% of patients with priapism may require penile shunt surgery if the priapism exceeds 24 hours, and in the majority of these patients, health care providers will consider placing a penile prosthesis if the priapism exceeds 36 hours. Corporal aspiration is the first-line treatment for priapism. When properly performed expeditiously, patients experience a high rate of detumescence. Ischemic priapism is a true urological emergency that requires prompt diagnosis and treatment. The advantages of using corporal aspiration as a first-line treatment include pain relief and the prompt restoration of circulation.

Syringe Port System as a Tubular Retractor Technique for Brain Lesions: Case Series and Review of the Literature

Abstract Objective To describe a tubular retractor technique for brain lesions through a series of cases and to conduct a literature review on intracranial tubular retractors with emphasis on the syringe port system. Materials and Methods We described four cases of lesions with an intraventricular component and different pathological patterns. The surgeries were performed between April, 2021 and July, 2022. The images were acquired through computed tomography (CT) and magnetic resonance imaging (MRI) scans and transferred to the Horos software, version 1.1.7. To make the tubular retractor, a 20-mL syringe and a 14-Fr/Ch, 30-mL/cc Foley probe were used. The syringe was sectioned according to the planned depth based on preoperative imaging. The syringe was the retractor itself, while the probe served as a means of dilating the path to the lesion. Results Gross total resection was achieved in all cases, and the samples collected were satisfactory regarding the results of the anatomopathological study. All patients evolved without any additional deficits and with adequate postoperative image control. Conclusion The syringe as a tubular retractor associated with the Foley probe as a surgical port dilator was useful, and it enabled the radical resection of intracranial tumors related to the lateral ventricle, not limiting the use of auxiliary instruments, neither of microsurgical instruments; therefore, it is an affordable, secure, and inexpensive method.

Postmortem contrast-enhanced computed tomography via direct large-vessel puncture

The aim of this study was to assess the usefulness of postmortem contrast-enhanced CT (PMeCT) performed via direct large-vessel puncture when routine postmortem CT suggests a vascular lesion as the cause of death. PMeCT was performed in 9 cases (4 male, 5 female) with a mean age of 76 years (range 52–92) at the time of death. The mean time elapsed since death was 29.1 h (12.0–72.0). The location of the target vessel for puncture was determined based on the CT table position and a grid placed on the body surface. An 18-G spinal needle was advanced to the puncture site, and the needle tip was confirmed to have reached the intended blood vessel. Using negative pressure with a 20-ml syringe, the needle tip was advanced until reverse bleeding was confirmed. Diluted contrast medium was injected slowly to ensure its dispersion within the blood vessels. Following confirmation of no extravasation, additional doses of diluted contrast agent were injected in 3–4 divided doses, with CT scans obtained at each step to track the distribution of contrast agent over time. PMeCT was successful in all cases, revealing cardiac tamponade in 7 (ascending aortic dissection, n = 6; cardiac rupture, n = 1), thoracic aortic aneurysm rupture, n = 1, and iliac artery aneurysm rupture, n = 1. There were no cases of procedure-related extravasation (pseudo-lesions). When postmortem CT reveals pericardial hematoma or bleeding in the thoracic or abdominal cavity, PMeCT can identify the source of bleeding.

Wound Irrigation Using Normal Saline 0.9% Versus Tap Water: A Review for Street Medicine and Low-resource Providers

Patients experiencing homelessness are a vulnerable cohort who suffer from disproportionate skin disease burden. Acute and chronic wounds represent high morbidity conditions with severe consequences. Adequate management in the form of cleansing and irrigation is necessary for removing cellular debris, bacteria and contaminants. Providers in low-resource street medicine settings may be the first point of contact in the management of wounds encountered by unhoused patients. This review determines the feasibility of improvised irrigation techniques that can be used in street settings to irrigate wounds. A MEDLINE search was conducted and yielded randomized controlled trials, laboratory studies and case-control studies. No significant difference in wound infection and healing rates was found when normal saline 0.9% or tap water was used in wound irrigation. Improvised cleansing devices with suitable irrigation pressure included water bottles punctured with 14-18-gauge needles, 10-mL syringes and 50-syringes. Lower and upper extremity wounds were found to be at higher risk of infection, requiring judicious management and cleaning. Street medicine providers should consider weighing the benefits versus risks of on-site, improvised wound irrigation for acute soft tissue injuries, especially in the setting of limited resources.

Effect of kilovoltage and quality reference mAs on CT-based attenuation correction in 177Lu SPECT/CT imaging: a phantom study

IntroductionCT-based attenuation correction (CT-AC) plays a major role in accurate activity quantification by SPECT/CT imaging. However, the effect of kilovoltage peak (kVp) and quality-reference mAs (QRM) on the attenuation coefficient image (μ-map) and volume CT dose index (CTDIvol) have not yet been systematically evaluated. Therefore, the aim of this study was to fill this gap and investigate the influence of kVp and QRM on CT-AC in 177Lu SPECT/CT imaging.MethodsSeventy low-dose CT acquisitions of an Electron Density Phantom (seventeen inserts of nine tissue-equivalent materials) were acquired using various kVp and QRM combinations on a Siemens Symbia Intevo Bold SPECT/CT system. Using manufacturer reconstruction software, 177Lu μ-maps were generated for each CT image, and three low-dose CT related aspects were examined. First, the μ-map-based attenuation values (μmeasured) were compared with theoretical values (μtheoretical). Second, changes in 177Lu activity expected due to changes in the μ-map were calculated using a modified Chang method. Third, the noise in the μ-map was assessed by measuring the coefficient of variation in a volume of interest in the homogeneous section of the Electron Density Phantom. Lastly, two phantoms were designed to simulate attenuation in four tissue-equivalent materials for two different source geometries (1-mL and 10-mL syringes). 177Lu SPECT/CT imaging was performed using three different reconstruction algorithms (xSPECT Quant, Flash3D, STIR), and the SPECT-based activities were compared against the nominal activities in the sources.ResultsThe largest relative errors between μmeasured and μtheoretical were observed in the lung inhale insert (range: 18%-36%), while it remained below 6% for all other inserts. The resulting changes in 177Lu activity quantification were -3.5% in the lung inhale insert and less than -2.3% in all other inserts. Coefficient of variation and CTDIvol ranged from 0.3% and 3.6 mGy (130 kVp, 35 mAs) to 0.4% and 0.9 mGy (80 kVp, 20 mAs), respectively. The SPECT-based activity quantification using xSPECT Quant reconstructions outperformed all other reconstruction algorithms.ConclusionThis study shows that kVp and QRM values in low-dose CT imaging have a minimum effect on quantitative 177Lu SPECT/CT imaging, while the selection of low values of kVp and QRM reduce the CTDIvol.

Enhancing Patient Safety through Education in a Low-to-Middle-Income Country: Training in the Correct Application of Cricoid Pressure.

Cricoid pressure (CP) is applied to occlude the esophagus during endotracheal intubation in patients at an increased risk of aspiration of gastric contents. Evidence shows marked deficiencies in knowledge and skills for CP application among personnel responsible for this task. This study evaluated the effectiveness of CP training in improving knowledge and skills regarding CP application among anesthesiology technicians and critical care nurses and assessed the retention of skills after 2 months. Five workshops were conducted on effective application of CP. Indications, relevant anatomy, physiology, and correct technique were taught using interactive sessions and videos and hands-on practice on a weighing scale, 50-mL syringe, and trainer model. Pre- and postworkshop tests were conducted for knowledge and skill. An assessment was repeated after 2 months to assess skill retention. Five workshops were conducted for 102 participants. Statistically significant improvements were seen in mean scores for knowledge in postworkshop assessments (12.32 ± 2.12 versus 7.12 ± 2.32; P < .01). Similarly, posttraining mean scores for skill assessment were significantly higher than pretraining scores (6.31 ± 0.96 versus 2.72 ± 2.00; P < .0005), indicating an overall 131% improvement. Seventy-four participants appeared for assessment of the retention of skills. A 20% decrement was observed compared with posttraining scores (5.15 ± 1.71 versus 6.45 ± 0.86; P < .0005). A significant improvement was observed in both knowledge and skills immediately following training. However, this does not ensure long-term retention of clinical skills, as a 20% decrement was observed 2 months after the workshops. Formal training and regular practice are recommended to enable clinicians to perform CP effectively.

A new arthroscopic repair technique for triangular fibrocartilage complex using an intracapsular suture: an outside-in transfer all-inside repair

BackgroundArthroscopic repair is a promising, minimally invasive surgical technique for patients with Palmer type 1B peripheral triangular fibrocartilage complex (TFCC) tears. Although several arthroscopic techniques are effective for repairing Palmer type 1B TFCC tears, some shortcomings remain. So, we report an arthroscopic repair technique for the treatment of Palmer type 1B Atzei class 1 TFCC tears using an intracapsular suture: an outside-in transfer all-inside repair.MethodsA retrospective analysis of 38 Palmer type 1B TFCC injury patients admitted to our hospital were randomly divided into 2 groups. The group A was sutured from the outside to the inside, with a total of 21 cases; the group B was sutured with the new arthroscopic repair technique, with a total of 17 cases. Observe and compare the VAS scores and modified Mayo wrist function scores of all patients before 3, and 6 months after the operation and evaluate the incidence of thread knots in patients with different treatment methods. The methodology was performed an arthroscopic intracapsular suture using an outside-in transfer, all-inside repair technique, which is a modified method of the outside-in and all-inside technique using the needle of a 10-mL sterile syringe, for Palmer type 1B TFCC tears. A No. 2 polydioxanone suture was threaded through the needle and entered the wrist joint. Next, the needle was withdrawn carefully along the suture to the proximal tear ulnar surface of the TFCC and penetrated the TFCC, exiting the articular cavity surface of the ulnar side of the torn TFCC. Finally, arthroscopic knotting was performed.ResultsThis new treatment was as effective as the previously arthroscopic techniques and had the advantages of no additional incision and decreased risk of operation-related complications. The incidence of thread knots in the group A (28.57%) was significantly higher than that in the group B (0%), and the difference was statistically significant (P = 0.024). There was no significant difference in VAS score and modified Mayo wrist function scores between the two groups (P > 0.05).ConclusionsThe outside-in transfer, the all-inside repair technique is suitable for Palmer type 1B Atzei class 1 TFCC tears. We recommend this technique as a useful alternative to the conventional methods of repairing Palmer type 1B TFCC tears.

Balloon-Assisted Portal Vein Embolization Using n-Butyl-2-Cyanoacrylate–Lipiodol–Iopamidol Mixture in Swine: A Comparison of 2 Formulations

PurposeTo compare 2 ratios of n-butyl-2-cyanoacrylate (nBCA)–ethiodized oil (Lipiodol)–iopamidol (NLI) in balloon-assisted portal vein embolization (PVE) in swine. Materials and MethodsIn an in vitro study, NLI prepared at a ratio of 2:3:1 (NLI231) or 1:4:1 (NLI141) was injected into 2.5- or 10-mL syringes filled with swine blood, and the viscosity of NLI was measured to determine an appropriate balloon occlusion time. Two portal vein branches in 8 female swine (n = 16 vein branches) were embolized with NLI231 (n = 8) or NLI141 (n = 8) under balloon occlusion. Portal venography was performed before, immediately after, and 3 days after PVE to evaluate the migration of NLI and the recanalization of embolized portal vein branches. Then, the livers were removed for histopathologic evaluation. ResultsThe times to peak viscosity of NLI231 in the 2.5- and 10-mL syringes were 55.8 seconds (SD ± 7.0) and 85.2 seconds (SD ± 6.3), and those to peak viscosity of NLI141 were 129.2 seconds (SD ± 11.8) and 254.0 seconds (SD ± 21.8), respectively. No migration of NLI231 was observed in all 8 procedures immediately or 3 days after PVE. Migration of NLI141 was observed in 6 of 8 procedures within 3 days after PVE. The migration frequency of the embolic material was lower in the NI231 group than in the NLI141 group (0/8 vs 6/8; P = .051). Histologically, NLI231 occupied the portal veins without any thrombi, whereas NLI141 was accompanied by thrombi in the portal veins. ConclusionsNLI231 may be more suitable than NLI141 for balloon-assisted PVE in swine.

Traceable calibration with 177Lu and comparison of activity meters at hospitals in Norway and Sweden

IntroductionThe activity meter is used to determine the activity of delivered radiopharmaceuticals, administered activity to patients and reference activity when gamma-cameras are calibrated prior to imaged-based dosimetry. The aim is to describe a procedure for cross-calibration of activity meters at different clinical sites, and report on 177Lu activity results when using factory-set calibration factors compared to when calibration is performed with traceability to a primary standard. MethodsThirty activity meters placed at seven hospitals in Norway and Sweden from four manufacturers: Capintec, Commecer, NuviaTech and Veenstra were included. A stock solution with 177Lu was prepared at the local sites and measured in each activity meter with factory settings. The solution was shipped to the reference site at Lund University for measurements in a secondary standard activity meter. Deviations between local and reference activity measurements were determined for three geometries: 25-mL vial, 10-mL syringe and 1-mL syringe. ResultsThe median of the deviations was 6.4 % for the 25 mL vial, 5.9 % for the 10 mL syringe and 6.8 % for the 1 mL syringe. The median of the deviations for the 25 mL vial, was 1.5 % for activity meters from Capintec, 7.0 % for Comecer, 11.0 % for NuviaTech and 2.4 % for Veenstra. The majority of the deviations were positive and the maximum deviation was 14.5 %. ConclusionThe activity of 177Lu measured in an activity meter with factory-set dial settings may yield deviations up to 14.5%, compared to activities measured with traceability to a primary standard. This would imply an undertreatment of patients.

Retrospective first-in-human use of the LithoVue™ Elite ureteroscope to measure intrarenal pressure.

To report on our first-in-human experience using the LithoVue Elite™ ureteroscope (Boston Scientific Corp., Marlborough, MA, USA) to measure intrarenal pressure (IRP) during flexible ureteroscopy. A single-arm retrospective observational analysis was performed in 50 consecutive patients undergoing ureteroscopic lithotripsy using the LithoVue Elite™ system with pressure sensing capability between April 2022 and February 2023 at two centres. A pressure bag set at 150 mmHg or hand irrigation with a 60-mL syringe was used for irrigation and a ureteric access sheath (UAS) was placed at the physician's discretion. Median and maximum IRPs, and relative cumulative time exceeding 20, 40, 60, 80, 100, 120, 140, 160, and 200 mmHg per total procedure time were analysed. The two-sample Mann-Whitney U-test was used, with statistical significance set at P < 0.05. The median (interquartile range [IQR]) patient age and body mass index (BMI) was 62.5 (46.7-68.2) years and 27.6 (23.3-32.1) kg/m2 , respectively. During the median (IQR) total procedure time of 31.9 (17.4-44.9) min, the median and maximum IRPs were 28.5 (20.0-47.5) and 174.0 (133.5-266.0) mmHg, respectively. IRP remained at <60 mmHg during 92% of the procedure times. Patients with Asian ethnicity, and those without pre-stenting or UAS use exhibited longer cumulative/total durations exceeding pre-defined IRP cut-off values. The smaller 10/12-F UAS did not lower pressures as much as the 11/13-F or 12/14-F UAS (P < 0.001). Age, diabetes, hypertension, preoperative α-blockade, stone size, and BMI did not show any statistically significant associations with IRP. The IRP can now be routinely measured during ureteroscopy. Patients had a median IRP of 28.5 mmHg and a maximum of 174 mmHg. Using a smaller UAS (10/12 F), Asian ethnicity, and tight ureters were found to have higher IRPs.

Cosmetic augmentation of lower-lid pretarsal roll with injection of autologous fat for Asians

Autologous fat has the advantages of regeneration, rejuvenation, homology, and support. There are currently no reports indicating that injecting autologous fat enhances the fullness of the lower-lid pretarsal roll. In this retrospective, non-randomized study, the effects of injecting autologous fat to cosmetically enlarge the lower-lid pretarsal roll were evaluated by comparison of preoperative and postoperative photographs and patient satisfaction during the follow-up. First, fat tissues were manually sucked with a 20-ml syringe connected to a 2.5-mm three-hole liposuction cannula. The treated fat tissues were transferred to a 10-ml syringe and centrifuged at 2000rpm for 2min, and then the fibrous tissues were manually removed. Finally, autologous fat was injected using a 1-ml syringe linked to a sharp needle. Forty-seven patients who underwent surgery between 2018 and 2021 were retrospectively evaluated. Only three patients showed obvious asymmetry or uneven outlines after surgery and underwent a second fat injection. During recovery, bruising and minor contouring irregularities obviously improved after 1 or 2 weeks. Eight patients, who had severe bruising, were able to make a full recovery in more than 2 weeks. No patients experienced serious complications. All patients ultimately displayed pretarsal fullness in their lower eyelids and were satisfied with their outcomes. The effects of injecting autologous fat to cosmetically enlarge the lower-lid pretarsal roll are long-lasting, esthetic, and safe.

HPTLC METHOD FOR SIMULTANEOUS ESTIMATION OF LAMIVUDINE, TENOFOVIR DISOPROXIL FUMARATE, AND DORAVIRINE

Objective: The objective of this study was to develop and validate an HPTLC method for the simultaneous estimation of Lamivudine, Tenofovir disoproxil fumarate, and doravirine. The method is aimed to provide reliable and efficient quantification of these drugs. Methods: The chromatographic separation of drugs was performed on aluminum plates coated with silica gel 60 F254. Samples were spotted on the plate as a 6 mm wide band using a linomat applicator and a 100 µl syringe. The mobile phase used was a mixture of ethyl acetate, methanol, and chloroform (07:02:01 % v/v/v). Densitometric scanning at 226 nm was conducted using a Deuterium lamp as the radiation source, and the data were analyzed using win CATS software. The method was validated following the ICH Guideline ICH Q2 (R1). Results: The optimized method lead to the resolution of drugs with the Rf values of doravirine (0.75±0.02), Tenofovir disoproxil fumarate (0.57±0.02), and lamivudine (0.37±0.02). Doravirine exhibited a linear range of 500-1500 ng/band with a favorable linear equation and regression coefficient of 0.999. Tenofovir disoproxil fumarate and lamivudine showed a linear range of 1500-4500 ng/band, and both compounds displayed a linear relationship with a regression coefficient of 0.997. The method's accuracy was assessed through recovery studies, and the LOD and LOQ were determined for each drug. Conclusion: The optimized HPTLC method was validated in this study, following the ICH Q2 (R1) guidelines, it demonstrates its efficacy for the quantitative analysis of Doravirine, Tenofovir disoproxil fumarate, and lamivudine. The method offers reliable quantification of these compounds in a combined dosage form and can be used for routine analysis in pharmaceuticals.

Development and Validation of HPLC And HPTLC for Simultaneous Analysis of E and Z Guggulsterone, A-11–KBA And 11–KBA from Herbal Formulation

RP-HPLC and HPTLC are two easy, sensitive, efficient, and accurate procedures that allow for simultaneous estimates of Z and E guggulsterone, A-11-KBA, and 11-KBA. For the HPLC method, we recommend the use of a symmetry C18 column. Using a solvent gradient based on solvent A (orthophosphoric acid) and solvent B (methanol), the effluent was monitored at 250 nm with a 1.0 mL/min flow rate. The peaks of 11-KBA and A-11-KBA were eluted at 5.8 and 6.3 minutes, while those of Z and E-guggulsterone were at 4.8 and 5.3 minutes. For the HPTLC method of separation, a silica gel layer was applied on an aluminum plate prewashed in methanol using a Camag Linomat V applicator fitted with a 100 μL syringe. The linear expansion was carried out using a solvent mixture of n-hexane, chloroform, ethyl acetate, and methanol (v/v/v: 10:3:3:1, respectively). Camag T.L.C. scanner III (V 1.4.3.6336), operating in reflectance-absorbance mode at 254 nm and controlled by win CATS software, was used to carry out the densitometric scanning. The R.F. resolutions for 11-KBA, A-11-KBA, E-guggulsterone, and Z-guggulsterone in the selected mobile phase were 0.68, 0.61, 0.39, and 0.28, respectively. The linearity, accuracy, and precision of the techniques were all confirmed. The proposed methods were successful in estimating E- and Z-guggulsterone as well as 11-KBA and A-11-KBA.

Effect of irrigation protocols on bone temperature control during guided implant surgery

Objectives: This experimental laboratory study aimed to compare the effect of four external irrigation protocols on bone tissue heating during guided implant drilling. Methods: Forty perforations were made in ten bovine rib specimens using customized surgical templates. Four experimental groups (n=10/group) were tested: Control group = 10-ml syringe with 25°C saline solution, Group 1 = 10-ml syringe with 10°C saline solution, Group 2 = combined external irrigation using a handpiece and a 10-ml syringe with 25°C saline solution, and Group 3 = combined external irrigation using a handpiece and a 10-ml syringe with 10°C saline solution. The temperature was measured at cervical and apical points using K-type thermocouples, a digital thermometer, and a video recorder. Data were analyzed by ANOVA and Pearson’s correlation coefficients (alpha=0.05). Results: The maximum temperature was 42°C (cervical) and 44°C (apical). No difference in temperature changes was found among groups, but the difference between bone specimens was statistically significant. Temperature and time were positively associated for most groups, mainly in the cervical region. Conclusions: All irrigation methods were equally effective in controlling the bone temperature in cervical and apical regions. However, longer drilling times caused a greater increase in temperature.

FINE NEEDLE ASPIRATION CYTOLOGY: A VALUABLE DIAGNOSTIC TOOL FOR NEOPLASTIC CUTANEOUS NODULAR SKIN LESIONS - INSIGHTS FROM A TERTIARY CARE INSTITUTE

This study aimed to evaluate the diagnostic utility of Fine Needle Aspiration Cytology (FNAC) in the evaluation of neoplastic cutaneous nodular skin lesions and to provide insights from a tertiary care institute. A total of 150 patients with cutaneous nodular skin lesions were included in the study, and FNAC was performed using a 23-gauge needle attached to a 10-ml syringe. The study found that FNAC is a valuable diagnostic tool for the evaluation of neoplastic cutaneous nodular skin lesions. It had a sensitivity of 88% and a specificity of 100% for diagnosing malignant lesions. The high sensitivity and specificity of FNAC for diagnosing malignant lesions indicate its usefulness as a diagnostic tool, and it can also help to guide appropriate management and treatment decisions. Therefore, FNAC should be considered as an initial diagnostic tool for evaluating cutaneous nodular skin lesions.

Pulmonary artery resection with autologous pericardial conduit to avoid pneumonectomy in lung neoplasms surgery: How to do it

Pulmonary artery resection with autologous pericardial conduit to avoid pneumonectomy in lung neoplasms surgery: How to do it

The “Syringe Hickey”: An Alternative Skin Marking Method for Lumbar Puncture

BackgroundLumbar puncture is a procedure that is commonly performed in emergency departments. Despite their absence from procedure kits, emergency physicians often use skin markers to delineate landmarks for a lumbar puncture. We prefer to create a temporary indentation in the skin using the suction of a syringe. This “syringe hickey” eliminates the need for a skin marker. DiscussionWe created a photo demonstration comparing the syringe hickey to a skin marker for site marking. The syringe hickey was created using a 10-mL syringe aspirated to 5 mL on the forearm for 1 min. The syringe hickey lasted over 30 min on a range of skin tones across the Fitzpatrick Scale. The skin marker faded but the syringe hickey maintained its definition after application of ultrasound gel and sterilization with either chlorhexidine or betadine. ConclusionsThe syringe hickey is a simple skin marking technique that is resistant to antiseptic agents and ultrasound gel. The syringe hickey may be useful for other procedures that require puncture site marking.

Effects of continuous and slow tracheal tube cuff deflation on cough reflex during extubation in noncardiac surgery patients: a randomised clinical trial

BackgroundThe incidence of cough reflex during extubation is 76%. Cough reflex causes severe hemodynamic fluctuations and airway complications. This prospective trial investigated the potential effects of tracheal tube cuff deflation on cough reflex during extubation.MethodsOne hundred and twenty-six patients scheduled for operations within 3 h under general anaesthesia with orotracheal intubation were randomly assigned to one of three groups: control (C), experimental (E) or syringe (S) groups. Patients in group C underwent tracheal tube cuff deflation using a 10-ml syringe in 1 s, patients in group E underwent tracheal tube cuff deflation continuously and slowly in 5 s using a cuff pressure gauge until the pressure was zero and patients in group S underwent tracheal tube cuff deflation using a 10-ml syringe at a speed of 1 ml s−1. The incidence and severity of cough reflexs during extubation and the incidence of postoperative airway complications within 48 h were assessed.ResultsCompared with group C (60.0%), the incidence of cough reflex in group E was 9.8% (p < 0.001) and in group S was 12.5% (p < 0.001). The severity of cough reflex was graded as 2 (1–2) in group C, 1 (1–1) in group E and 1 (1–1) in group S (p < 0.001 for group comparisons). The incidence of hoarseness in group C was 0.0%, in group E was 19.5% and in group S was 5.0% (p < 0.05 for all groups, p = 0.009 between group C and E).ConclusionsCompared with deflating a trachal tube cuff with a 10-ml syringe in 1 s, the use of a 10-ml syringe at a speed of 1 ml s−1 or a cuff pressure guage within 5 s can both reduce the incidence of cough reflex, but deflating with a cuff pressure guage can increase the incidence of postoperative hoarseness.Trial registrationChinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.

Effects of infusion tubing line lengths and syringe sizes on infusion system compliance: an experimental study using a syringe-type infusion pump at low flow rate.

Ideally, the flow delivery of an infusion system is proportional only to the rate of mechanical actuation of the syringe pump plunger. However, in the real world, overall infusion system compliance may be affected by components such as an extension of tubing lines, or different sizes of syringes. With higher compliance, there may be greater chances of flow irregularity. In this experimental study, we investigated the effects of lengths of infusion lines and syringe sizes on the compliance of syringe pumps with low flow rate (2mlh-1). In the first experiment, infusion system compliance was measured in various settings by occlusion release. As the infusion tubing length and size of the syringe increased, the time to reach each pressure was delayed and the infusion system compliance increased. The contributions to system compliance from syringes were significantly greater compared to those of extended infusion lines. In the occlusion alarm experiment, the occlusion alarm could be delayed by 69.76 ± 3.98min for the 50-ml syringe with a 560cm infusion line set-up. In conclusion, the compliance of a syringe pump system increases as the loaded syringe size, or the length of the infusion tubing increases. The occlusion alarm may be much delayed and not useful in highly compliant systems with respect to the potential occlusion of the infusion system, so more attention is required when using a highly compliant infusion system.