20-gauge Catheter Research Articles

Increase in PVC-BSI during the second COVID-19 pandemic year: analysis of catheter and patient characteristics.

Increasing nosocomial infections during the COVID-19 pandemic have been reported. However, data describing peripheral venous catheter associated bloodstream infections (PVC-BSI) are limited. To describe the epidemiology and risk factors for PVC-BSI during the COVID-19 pandemic. We conducted retrospective cohort study of prospectively collected PVC-BSI data in a 2100 bed hospital network in Switzerland. Adult patients with a PVC inserted between January 1, 2020 and December 31, 2021 were included. Risk factors for PVC-BSI were identified through descriptive analysis of patient and catheter characteristics, and univariable marginal Cox models. 206,804 PVCs and 37 PVC-BSI were analysed. Most PVC-BSI were attributed to catheters inserted in the Emergency department (76%) or surgical wards (22%). PVC-BSI increased in 2021 compared to 2020 (hazard ratio 2021 vs. 2020 = 2.73; 95% confidence interval 1.19-6.29), with a numerically higher rate ofStaphylococcus aureus (1/10, 10%, vs. 5/27, 19%) and polymicrobial infection (0/10, 0% vs. 4/27, 15%). PVC insertions, patient characteristics, and catheter characteristics remained similar across the study period. PVC-BSI risk was associated with admission to the intensive care unit (ICU), and use of wide gauge catheter ( < = 16G). Increased PVC-BSI during the COVID-19 pandemic was not explained by catheter or patient factors alone, and may result from system-wide changes. PVC-BSI events are primarily attributed to acute care settings, including the emergency department, surgical wards, and the ICU.

Novel drug sampling technique: portal vein catheterization in steers.

To determine the feasibility of catheterizing the portal vein to obtain serial portal vein blood samples in steers. We hypothesized that the portal vein catheterization would be a successful continuous sampling technique with minimal adverse effects in steers. 2 groups of steers were used: a pilot group (n = 2) and experimental group (n = 6). In both groups, steers were sedated with xylazine. The right rib spaces were clipped and aseptically prepped. The portal vein was visualized via ultrasound, and a 14-gauge catheter was placed percutaneously and advanced into the portal vein. A guide wire was passed through the catheter, followed by a tissue dilator and then a vascular balloon catheter. In the pilot group, blood chemistries were performed prior to portal vein catheterization and then again once the catheter was placed (with samples from both the jugular vein and portal catheter). The liver was also examined at necropsy for any gross lesions in both groups. All steers tolerated the portal vein catheters well, with the catheters lasting for the full length of the study period (7 days). The only observed adverse reaction was a superficial abscess at the catheter site (n = 3). On necropsy, 1 liver had gross discoloration, but no other abnormalities were noted. There were no significant changes in biochemistry profiles before or after portal vein catheterization. Portal vein catheterization is a novel and feasible serial sampling technique of the portal vein. This technique can be used in future pharmacokinetic, nutrition, metabolism, or toxicity studies.

The Scrotal Displacement of the Catheter After Femoral Venous Cutdown: A Neonatal Case Report from Iran

Introduction: One of the most preferred cutdown access sites in neonates is the femoral vein; however, the medical staff should be aware of the associated complications. In this study, we present a case where the displacement of the catheter tip after femoral vein cutdown resulted in a scrotal hematoma. Case Presentation: A neonate with a gestational age of 39 weeks and a birth weight of 3740 grams was born in an academic hospital in Tehran, Iran, in 2022. The newborn gradually showed symptoms of respiratory distress and was immediately transferred to the neonatal intensive care unit (NICU). Within the first minutes of NICU admission, the newborn developed acute respiratory distress, and a chest X-ray revealed congenital pneumonia. The patient was promptly intubated, and endotracheal surfactant was administered. Simultaneously, peripheral vascular access was established. On day 3, the vascular access failed, and multiple attempts at percutaneous venipuncture were unsuccessful. A consultation with an expert pediatric surgeon led to the decision to perform a surgical venous cutdown. A 22-gauge catheter was inserted into the external iliac vein through the right femoral access to initiate intravenous fluid and antibiotics. Within the next four hours, the neonate developed right scrotal edema, discoloration, localized erythema, and clear fluid leakage from the right scrotum. Intravenous infusion was urgently clamped. The pediatric surgeon recommended catheter removal, suspecting displacement of the catheter. A sonography examination revealed a hypoechoic 11 × 10 × 4 mm region, indicating a hematoma at the inferior pole of the right testis. The neonate was placed under serial follow-up to monitor vital signs and local manifestations. The patient was managed with conservative treatment and discharged in good condition on the 10th day of NICU admission. Conclusions: The presented case demonstrated scrotal damage following femoral cutdown catheterization. This unexpected complication was effectively managed by the immediate removal of the catheter, close monitoring, conservative therapy, and serial follow-ups, which prevented the progression of local signs. NICU staff should be aware of the potential for testicular injuries in such cases.

Comparison of salpingectomy and tubal detorsion procedures after experimental ischemia-reperfusion injury in a rat fallopian tube model: biochemical and histopathological evaluation

To compare salpingectomy and detorsion procedures and investigate the biochemical and histopathological changes in the fallopian tubes in the experimentally isolated fallopian tube torsion model in rats. Experimental study. Experimental surgery laboratory in a training and research hospital. Twenty-seven Sprague-Dawley rats in the reproductive period. Group 1, control group (n = 6); group 2, bilateral total salpingectomy group after 4 hours of tubal ischemia (n = 7); group 3: 4 hours of bilateral tubal ischemia plus 1 week of reperfusion (n = 7); and group 4, 4-hour period of bilateral tubal ischemia plus 30 days of reperfusion (n = 7). A 22-gauge catheter was administered before and after surgery using methylene blue through the uterine horn of the rat to evaluate tubal patency. Preoperative and postoperative serum antimüllerian hormone (AMH) levels, histopathological examination of the rat tuba uterine and histopathological damage scores, antioxidant compounds (superoxide dismutase [SOD], catalase, and glutathione peroxidase [GSH-Px]), and oxidative stress end product levels (malondialdehyde [MDA] and 8-hydroxy-2'-deoxyguanosine [8-OHdG]). Although a significant difference was observed in the tissue SOD, GSH-Px, MDA, and 8-OHdG values, no significant difference was observed between the groups in serum samples. The tissue SOD and tissue GSH-Px levels in group 2 significantly decreased, and a significant increase was observed in the tissue MDA and 8-OHdG values in group 2. Among the histopathological parameters, epithelial changes, vascular congestion, and the total fallopian tube mean damage score of 4 showed a significant decrease in group 4. When the methylene blue transitions before and after ischemia-reperfusion injury were compared, the values of the methylene blue transition after ischemia-reperfusion injury in groups 2-4 significantly decreased. When the serum AMH levels were analyzed, the postoperative AMH value in group 2 significantly increased. This study reveals that biochemical and histopathological improvement is observed in the fallopian tube tissues gradually when the detorsion procedure is performed for the necrotized tubal tissue instead of salpingectomy. Although there is restoration of epithelial integrity after reperfusion, tubal passage remains absent. This study was approved by the Local Ethics Committee for Animal Experiments of the Health Sciences University, Istanbul Hamidiye Medicine Faculty (approval number 27.05.2022-9269). The study followed the ethics standards recommended by the Declaration of Helsinki.

A standardized educational program to improve peripheral vascular access outcomes in the emergency department: A quasi-experimental pre-post trial.

Difficult intravenous access (DIVA) patients are known to have disproportionately poorer vascular access outcomes. The impact of education and training on vascular access outcomes in this vulnerable population is unclear. We aim to demonstrate the success of a program (Operation (O) STICK) on improving vascular access outcomes in DIVA patients. This was a quasi-experimental pre-post interventional study conducted at a tertiary care emergency department (ED) with 120,000 annual visits and 1100 hospital beds. Adult patients requiring an ultrasound-guided (US) peripheral intravenous catheter (PIVC) in the ED were eligible participants. Traditional (palpation method) insertions were excluded. Using multivariable linear regression and inverse probability weighted (IPW) linear regression, the standard group inclusive of PIVCs inserted by staff without formalized OSTICK training were compared to the interventional group inclusive of PIVCs inserted by staff with training and competency in the OSTICK training model. Data were collected over two time intervals: 4/1/21-9/30/21 (pre; non-OSTICK) and 10/1/22-3/31/23 (post; OSTICK). 2375 DIVA patients included 1035 (43.6%) non-OSTICK and 1340 (56.4%) OSTICK PIVCs. Overall, OSTICK PIVCs had a higher proportion of upper arm or forearm placements (94.6% vs 57.4%; p < 0.001), 20 gauge catheters (97.1% vs 92.3%; p < 0.001), and left-sided placements (54.4% vs 43.5%; p < 0.001). 62.7% of OSTICK PIVCs were placed by ED technicians, compared to 25.5% in the non-OSTICK group (p < 0.001). OSTICK PIVCs were placed on the first attempt 86.2% of the time and by the second attempt 95.4% of the time. In a subanalysis of 1343 hospitalized patients (689 (51.3%) OSTICK vs 654 (48.7%) non-OSTICK), OSTICK PIVCs survived for a median of 92% of the patient's hospital length of stay, compared to non-OSTICK PIVCs at 74% (p < 0.001). Formalized vascular access training in the ED leads to improved adherence to best practices for PIVC insertion, high success of cannulation with minimal attempts, and improved PIVC functionality during hospitalization for DIVA patients. Importantly, these outcomes are sustainable as they were captured 12 months after implementation of the program.

Cost-Effectiveness of Erythrocytapheresis in Children and Young Adults with Beta Thalassemia Major and Sickle Cell Disease

Introduction During the management of hemoglobinopathies, including sickle cell disease (SCD) and thalassemia, red blood cell (RBC) transfusions are crucial in treating symptomatic anemia. Repeated transfusions can lead to iron accumulation in soft tissues, causing inflammation, susceptibility to infections, and damage to vital organs. Currently treatment of iron overload with iron chelation therapy, does not always guarantee optimal and lasting responses. Erythrocytapheresis, an automated method for RBC exchange, has shown promising results in reducing iron overload in patients with SCD and adult patients with β-thalassemia. Studies show limited use in children and young adults, due to optimal flow and venous access problems. At the Antwerp University Hospital, erythrocytapheresis has been adopted as the standard of care in managing patients with both SCD and β-thalassemia major who develop iron overload, with the goals of reducing ferritin levels and preventing permanent complications. This study aimed to evaluate the efficacy and cost-effectiveness ratio associated with the inclusion of erythrocytapheresis in the overall management of these patients. Methods This retrospective study analyzed patients diagnosed with SCD or β-thalassemia major between 2015 and 2022, who were treated for transfusion related iron overload with iron chelation therapy with serum ferritin and hemoglobin (Hb) levels as indicators. The case cohort were treated with erythrocytapheresis alone or in combination with iron chelation therapy, whilst the control cohort was treated with oral iron chelation therapy alone. Long-term venous access was established in all patients utilizing one of two methods: 1) two high pressure intravenous 14-gauge catheters (Port-a-Cath®), one placed in the subclavian vein, and one placed in the inguinal vein 2) or a surgical arteriovenous fistula created in the cubital fossa. Erythrocytapheresis was performed with the Spectra Optia® system (Caridian BCT, Inc) Data to evaluate erythrocytapheresis therapy outcomes were collected at five different time points, until one year post commencing erythrocytapheresis therapy. Results Of the 19 patients, 11 (57,9%) were males with a M:F ratio of 1:0.7. The median age was 13 years (range 1 to 27 years). The cohort consisted of 10 (52,6%) patients with SCD, eight (42,1%) with β-thalassemia major and one (5,3%) with sickle-thalassemia. The cohort treated with erythrocytapheresis showed a significant decrease in serum ferritin ( p&amp;lt;0.001) whilst maintain steady Hb levels ( p&amp;lt;0.001). The cohort treated with oral iron chelation therapy alone, no significant decrease in serum ferritin was found ( p=0.156) but a decrease in Hb levels over time ( p=0.07). Comparing the evolution of median serum ferritin between therapy with erythrocytapheresis and iron chelation therapy showed a statistically significant difference ( p=0.008) ( Fig. 1). Patients with β-thalassemia major receiving erythrocytapheresis showed a greater reduction in serum ferritin compared to patients without ( p=0.036). A difference could not be shown between the erythrocytapheresis and iron chelation single therapies (p=0.100). Optimal continuous flow was achieved with two small Port-a-Cath® systems. A cost benefit analysis showed that the cost of a single erythrocytapheresis is comparable to the lowest dosage of Deferasirox ( Table 1). Erythrocytapheresis could be a financially viable treatment method for children and young adults independent of the resource setting. Conclusion Currently iron chelation therapy is not always sufficient in patients with hemoglobinopathies treated for iron overload. Patients treated with erythrocytapheresis showed more stable and higher hemoglobin levels and a more significant decline in serum ferritin levels compared to iron chelation therapy alone. This study showed that erythrocytapheresis can also be used in children with β-thalassemia major. Further studies are needed to optimize erythrocytapheresis in children and extrapolate these findings to a larger population.

Transfusion Practice: Hemolysis Markers After In Vitro Infusion of Packed Red Blood Cells by the Gravitational Method in Peripheral Catheter.

The objective of this study was to compare hemolysis marker levels after in vitro infusion of red blood cells (RBCs) according to storage time, infusion rate, and peripheral intravenous catheter size. This is an experimental study with randomly administered RBCs in quintuplicate, according to storage time shorter than and longer than 14 days, as well as infusion rate (50 mL/h and 100 mL/h) using catheters with calibers of 14-, 18-, and 20-gauge. Aliquots were collected from RBCs (V1), after equipment and catheter (V2) free-flow filling and after controlled infusion through the catheter (V3). The hemolytic markers analyzed were degree of hemolysis (%), hematocrit (Ht) (%), total hemoglobin (THb) (g/dL), free hemoglobin (FHb) (g/dL), potassium (K) (mmol/L), and lactate dehydrogenase (LDH) (U/L), considering a probability of error ≤5%. Sixty experiments were performed with the analysis of 180 aliquots. When RBCs aged <14 days were used, all catheters tended to increase THb, FHb, and K; while >14 days, RBCs presented increased FHb and degree of hemolysis with catheters of 18-gauge and THb levels at 14-gauge. Among the conditions analyzed, only 20-gauge catheters (the smallest) did not influence changes in hemolysis markers, regardless of RBC storage time.

Radiopharmaceutical administration practices-Are they best practice?

The nuclear medicine community has stated that they are using best practices to gain venous access and administer radiopharmaceuticals, and therefore do not contribute to extravasations. We tested this hypothesis qualitatively and quantitatively by evaluating four different perspectives of current radiopharmaceutical administration practices: (1) clinical observations of nuclear medicine technologists on the job, (2) quality improvement (QI) projects, (3) a high-level survey of current practices in 10 acute care hospitals, (4) intravenous (IV) access site data for 29,343 procedures. These four areas were compared to the gold standard of pharmaceutical administration techniques. From clinical observations of radiopharmaceutical administrations in adult populations, technologists extensively used 24-gauge peripheral intravenous catheters (PIVCs) and butterfly needles. They also performed direct puncture (straight stick). Technologists predominantly chose veins in areas of flexion (hand, wrist, and antecubital fossa), rather than forearm vessels for IV access placement; in many circumstances, antecubital fossa vessels are chosen first, often without prior assessment for other suitable vessels. For selecting the injection vein, technologists sometimes used infrared vein finders but primarily performed blind sticks. Review of QI projects suggested that smaller gauge needles were contributing factors to extravasations. Additionally, the review of surveys from 10 hospitals revealed an absence of formalized protocols, training, knowledge, and skills necessary to ensure the safety/patency of IV devices prior to the administration of radiopharmaceuticals. Finally, findings from a review of IV access data for 29,343 procedures supported the observations described above. We expect that nuclear medicine technologists have the best intentions when providing patient care, but many do not follow venous access best practices; they lack formal protocols, have not received the latest comprehensive training, and do not use the best placement tools and monitoring equipment. Thus, the presumption that most nuclear medicine technologists use best practices may not be accurate. In order to improve radiopharmaceutical administration and patient care, the nuclear medicine community should update technical standards to address the most recent peripheral IV access and administration best practices, provide technologists with vascular visualization tools and the proper training, develop and require annual vascular access competency, and provide active monitoring with center and patient-specific data to create ongoing feedback.

Diagnostic accuracy of the peripheral venous pressure variation induced by an alveolar recruitment maneuver to predict fluid responsiveness during high-risk abdominal surgery

BackgroundIn patients undergoing high-risk surgery, it is recommended to titrate fluid administration using stroke volume or a dynamic variable of fluid responsiveness (FR). However, this strategy usually requires the use of a hemodynamic monitor and/or an arterial catheter. Recently, it has been shown that variations of central venous pressure (ΔCVP) during an alveolar recruitment maneuver (ARM) can predict FR and that there is a correlation between CVP and peripheral venous pressure (PVP). This prospective study tested the hypothesis that variations of PVP (ΔPVP) induced by an ARM could predict FR.MethodsWe studied 60 consecutive patients scheduled for high-risk abdominal surgery, excluding those with preoperative cardiac arrhythmias or right ventricular dysfunction. All patients had a peripheral venous catheter, a central venous catheter and a radial arterial catheter linked to a pulse contour monitoring device. PVP was always measured via an 18-gauge catheter inserted at the antecubital fossa. Then an ARM consisting of a standardized gas insufflation to reach a plateau of 30 cmH2O for 30 s was performed before skin incision. Invasive mean arterial pressure (MAP), pulse pressure, heart rate, CVP, PVP, pulse pressure variation (PPV), and stroke volume index (SVI) were recorded before ARM (T1), at the end of ARM (T2), before volume expansion (T3), and one minute after volume expansion (T4). Receiver-operating curves (ROC) analysis with the corresponding grey zone approach were performed to assess the ability of ∆PVP (index test) to predict FR, defined as an ≥ 10% increase in SVI following the administration of a 4 ml/kg balanced crystalloid solution over 5 min.Results∆PVP during ARM predicted FR with an area under the ROC curve of 0.76 (95%CI, 0.63 to 0.86). The optimal threshold determined by the Youden Index was a ∆PVP value of 5 mmHg (95%CI, 4 to 6) with a sensitivity of 66% (95%CI, 47 to 81) and a specificity of 82% (95%CI, 63 to 94). The AUC’s for predicting FR were not different between ΔPVP, ΔCVP, and PPV.ConclusionDuring high-risk abdominal surgery, ∆PVP induced by an ARM can moderately predict FR. Nevertheless, other hemodynamic variables did not perform better.

Hemolyzed Laboratory Specimens in the Emergency Department: An Underappreciated, but Frequent Problem

IntroductionHemolysis of blood samples from emergency department (ED) patients leads to delays in treatment and disposition. The aim of this study is to determine the frequency of hemolysis and variables predictive of hemolysis. MethodsThis observational cohort study was conducted among three institutions: academic tertiary care center and two suburban community EDs, with an annual census of over 270,000 ED visits. Data were obtained from the electronic health record. Adults requiring laboratory analysis with at least one peripheral intravenous catheter (PIVC) inserted within the ED were eligible. Primary outcome was hemolysis of lab samples and secondary outcomes included variables related to PIVC failure. ResultsBetween January 8, 2021 and May 9, 2022, 141,609 patient encounters met inclusion criteria. The average age was 55.5 and 57.5% of patients were female. Hemolysis occurred in 24,359 (17.2%) samples. In a multivariate analysis, when compared to 20-gauge catheters, smaller 22-gauge catheters had an increased odds of hemolysis (OR 1.78, 95% confidence interval (CI) 1.65-1.91; P < .001), while larger 18-gauge catheters had a lower odds of hemolysis (OR 0.94; 95% CI 0.90-0.98; P = .0046). Additionally, when compared to antecubital placement, hand/wrist placement demonstrated increased odds of hemolysis (OR 2.06; 95% CI 1.97-2.15; P < .001). Finally, hemolysis was associated with a higher rate of PIVC failure (OR 1.06; 95%CI 1.00-1.13; P = 0.043). DiscussionThis large observational analysis demonstrates that lab hemolysis of is a frequent occurrence among ED patients. Given the added risk of hemolysis with certain placement variables, clinicians should consider catheter gauge/placement location to avoid hemolysis that may result in patient care delays and prolonged hospital stays.

Erratum: Noninvasive and Invasive Renal Hypoxia Monitoring in a Porcine Model of Hemorrhagic Shock.

Erratum: Noninvasive and Invasive Renal Hypoxia Monitoring in a Porcine Model of Hemorrhagic Shock.

Optimal injection rate and catheter size for brain perfusion computed tomography using non-ionic contrast medium in clinically normal Beagles

To evaluate the effects of contrast medium injection rates and intravenous injection catheter sizes on the time-density curve (TDC) of brain perfusion computed tomography (PCT) images in clinically normal Beagles and provide a reference range for the perfusion parameters for clinical application of PCT in veterinary medicine. 5 healthy, sexually intact male Beagles. All dogs underwent general anesthesia for PCT. Contrast medium (350 mg I/kg) was injected at 3 different injection rates (2, 3, and 4 mL/second) and with 2 sizes of an intravenous catheter (20-gauge and 24-gauge). The rostral cerebral artery and dorsal sagittal sinus were selected as the regions of interest of the TDC. Initiation time of arterial inflow (ta), venous outflow (tv), peak time of arterial enhancement (Tap), and the peak time of venous enhancement (Tvp), were measured, and the difference between Tap and tv (Tap-tv) and between Tap and ta (Tap-ta) was calculated. Both Tap-tv and Tap-ta were significantly (P < .05) shorter at the rate of 3 mL/second than at 2 mL/second with the 24-gauge catheter. However, there was no significant difference according to catheter sizes. Particularly, a 4 mL/second injection rate using a 24-gauge catheter mostly resulted in contrast medium leakage and catheter rupture. At a rate of 3 mL/second and with a 24-gauge catheter ensures optimal image acquisition and stable contrast medium injection in brain PCT for small dogs. PCT may be useful for diagnosing cerebrovascular events and hemodynamic changes in small dogs.

CONTINUOUS SPINAL ANAESTHESIA: A PROMISING TECHNIQUE FOR PROLONGED LOWER LIMB ORTHOPAEDIC SURGERIES

Background: Continuous Spinal Anaesthesia (CSA) is an advancing technique for prolonged lower limb orthopaedic surgeries. It awards prompt anaesthesia and analgesia, controlled sensorimotor blockade along with better haemodynamic stability using titrated and lower doses of Local Anaesthetic (LA) agents. This mode of regional anaesthesia using intrathecal catheter thus demonstrated to be an efcient and safe technique providing lesser incidence of Local Anaesthetic Systemic Toxicity (LAST) and Post Dural Puncture Headache (PDPH). This study integrates our experience with CSA for prolonged lower limb orthopaedic surgeries. Methodology: Our study comprised six cases posted for lower limb orthopaedic surgery belonging to ASA grades I and II. A 20-gauge catheter was threaded in subarachnoid space. The catheter was inserted 3cm intrathecally through 18-Gauge Touhy's needle in L3-L4 interspace. 1ml of hyperbaric Ropivacaine 0.75% with 10µg Dexmedetomidine as an adjuvant was injected. In our case series, we considered aliquots of isobaric Ropivacaine with a concentration of 0.75% for maintenance of anaesthesia wherefore 0.375% for analgesia. All of our patients were Results: hemodynamically stable intraoperatively as well as in the postoperative period. The average duration of analgesia in the postop period was 14-16 hours on the rst top-up. Excellent patient and surgeon satisfaction was experienced. Our case series concludes that CSA is an Conclusion: effective and better option for Single-Shot and Epidural Anaesthesia in lower limb orthopaedic surgeries under skilled expertise

Intranasal Administration of a Polymeric Biodegradable Film to C57BL/6 Mice.

Nasal drug delivery in rodents is a challenging procedure, especially for brain targeting, as the position of the material in the nasal cavity determines the success of the administration method. The objective of this study was to assess a novel intranasal administration technique for nose-to-brain delivery of biodegradable nasal films. The method was performed in C57BL/6 (n = 10; age, 8 wk) under inhaled sevoflurane. Twenty-four gauge catheters were used for the procedure. Hydroxypropyl methyl-cellulosebased film was formed in the lumen of the catheter and then delivered into the mouse nostril by pushing it out of the lumen using a trimmed and polished needle. Methylene blue was incorporated in the film-forming gel to indicate the delivery area in which the films were deposited. After administration, all mice recovered from anesthesia without incident. None of the mice showed any signs of injury, discomfort, or nose bleeding, thus allowing us to characterize the administration method as noninvasive. Furthermore, postmortem evaluation revealed olfactory-centered placement of the polymeric films, confirming the accuracy and repeatability of the method. In conclusion, this study documented the use of, a novel, noninvasive, intranasal administration technique for nose-to-brain drug delivery in biodegradable films for use in mice.

Efficacy of Sufentanil and Lidocaine on Propofol Injection Pain

Background: Propofol injection pain is one of the shortcomings with this popular medication Objectives: This study explored the effects of lidocaine and sufentanil on propofol injection induced pain during induction of anesthesia and evaluation of the hemodynamic condition of the patients. Methods: In an interventional study on patients planned for elective ophthalmic surgeries, a 20-gauge intravenous catheter was used on the back of the hand. Based on medications administered before propofol injections, the patients were assigned into four groups: Group L: lidocaine 20 mg in 5 cc; Group S: sufentanil 5 μg in 5cc; Group C: sufentanil 5μg and lidocaine 20 mg in 5 cc, Group P: normal saline 5cc. 1/4 of the propofol total calculated dose (2.5mg/kg) was injected after 1 min and after opening of the tourniquet, flow rate was set 20 mg/sec. Subsequently, the pain was evaluated. Ultimately, atracurium 0.5mg/kg, fentanyl (2μg/kg), and the propofol remaining calculated dose were given parenterally. The hemodynamic status was recorded before and after the injection of propofol. Results: Two hundred patients participated in the study. Propofol injection pain was at the least in the C group followed by the L and S groups ranking next (C Conclusions: The use of sufentanil or lidocaine reduced propofol injection pain (compared to normal saline), but it was more effective if the combination of the both medications was used.

Randomized controlled trial to assess reducing the pain of venipuncture in adult patients using an ice pack

Background: Venipuncture is a common procedure in the emergency department, and in some patients, the procedure may cause pain, anxiety, and fear. There are different studies in the literature looking for ways to reduce the pain, either pharmacologically or non-pharmacologically. Most of the studies were done in pediatrics but a few were in adult patients. We conducted this study to determine whether an ice pack application reduces venipuncture pain among emergency department adult patients compared to the conventional way. Methods: We conducted this randomized controlled clinical trial on adult patients in the Security Forces Hospital, Riyadh, Saudi Arabia, from 1 March 2021 to 30 June 2021. Computer randomization was done to randomize subjects to either control or intervention. The 22-gauge needle catheter was inserted in the antecubital fossa in all participants. Results: We included 281 patients aged 18–60 years, who were randomized to the control or intervention group. There were 140 patients in the control group and 141 in the intervention group. The mean average pain score in the control group was 2.19 and 1.66 in the intervention group, with a statistically significant difference (p-value: 0.016). Conclusion: The ice pack application reduces venipuncture pain in adult emergency department patients and was associated with a better first attempt success rate.

Impact of Transfusing Packed Red Blood Cells Through a Rapid Infuser on Potassium Levels.

Hyperkalemia is associated with the rapid transfusion of packed red blood cells in trauma patients. Rapid infusers can infuse blood up to 500 ml/min. This study aimed to determine whether infusing packed red blood cells through a rapid infuser impacts the potassium levels of the infused blood. Two baseline samples were obtained to measure potassium and hemolysis scores in 12 units of expired blood prior to infusion. The blood was then infused via the Belmont Rapid Infuser into collection bags at varying infusion rates (50, 100, 250, and 500 ml/min) utilizing different gauge catheter sizes (18-gauge, 16-gauge, and Cordis catheter). Two postinfusion blood samples were collected and tested for potassium and hemolysis scores and compared with preinfusion values. This process was then repeated with fresh blood. The potassium levels of the samples taken from each unit prior to infusion (average difference 0.245) and after infusion (average difference 0.08) correlated well. There was no difference in potassium levels pre- and postinfusion at any infusion rate after accounting for catheter size and age of blood. The median potassium level of the fresh blood was 5.025 prior to infusion and 4.875 after infusion. The median potassium level of the expired blood was 16.05 prior to infusion and 16.4 postinfusion. There was no significant difference in the hemolysis scores between the preinfusion and postinfusion samples. Hyperkalemia in trauma patients undergoing massive transfusions is not a result of mechanical hemolysis from the high rates of blood infusion.

A novel approach to sclerotomy closure in pars plana vitrectomy: a pilot study

BackgroundMethods of sclerotomy closure following a vitrectomy, including the use of sutures, have been associated with complications such as inflammation, foreign body sensation, and infection. Here, we test an innovative approach to scleral wound closure following pars plana vitrectomy that involves plugging the wound. We investigated several materials with the intent of using products that were either already approved by the FDA for other types of procedures or were biocompatible patient-derived materials.MethodsWe examined whether scleral wounds could be sealed by a clot or internal “plug” rather than a suture or an external adhesive. We tested patient-derived materials (platelet-rich plasma (PRP) and whole blood) as well as polyethylene glycol (PEG) sealant. Whole blood and PRP were prevented from clotting prematurely using sodium citrate, and were clotted for the study with thrombin. Polyethylene glycol (PEG) sealant was prepared according to manufacturer’s recommendations. We used fresh-frozen cadaveric porcine eyes. We tested several methods to form plugs using the above materials, as well as various methods to deliver the plugs into the sclerotomy incisions. We used a novel technique of manual vitrectomy. Successfully generated and implanted clots were tested for efficacy with the Seidel test.ResultsPolyethylene glycol (PEG) sealant fractured during our attempts at molding and inserting the plug. In contrast, both whole blood and PRP yielded successful plugs for insertion. We molded a whole blood clot plug by allowing it to clot inside a 20-gauge angiocath catheter and we successfully delivered it through a 23G trocar. At baseline, no wound leakage was apparent. However, the whole blood clot dislodged during the Seidel test. We successfully molded and delivered a PRP clot plug using a tapered 2-20 μl pipette tip, using MAXGrip Forceps to push it through into the wound. No scleral wound leakage was noted at our baseline physiologic infusion pressure. Furthermore, the PRP clot plug prevented scleral wound leakage up to a pressure of 60 mmHg and was confirmed with the Seidel test.ConclusionOur findings suggest that insertion of a clot plug made from either whole blood or PRP may be an effective strategy for scleral wound closure following pars plana vitrectomy. Further testing in preclinical models is warranted to further refine the materials and methods, since this appears to have the potential to improve the closure of the scleral wounds after pars plana vitrectomy.

Complications of peripheral intravenous catheters and risk factors for infiltration and phlebitis in children

ABSTRACT Aim: This study aimed to identify the types of complications of peripheral intravenous catheters (PIVCs) in hospitalised children and possible risk factors for the development of extravasation, infiltration and phlebitis. Method: The study was conducted in the largest children’s hospital in a region of Turkey, with a bed capacity of 354 and 1400 employees, which provides care only to paediatric patients aged from newborn to 18 years old. In this 5-month prospective study, the complications of PIVCs in hospitalised children and risk factors leading to the development of extravasation, infiltration and phlebitis were recorded. During morning and afternoon daily visits, the researcher examined catheter sites for complications and indications for removal. Results: The study covered 244 patients aged from 1 month to 17 years, 575 PIVCs and 1600 catheter days. The rates of infiltration and phlebitis observed in children with PIVCs were 8.7 % and 15.8% respectively. Logistic regression revealed that using 22- and 24-gauge catheters, hospitalisation in the surgery ward and continuous infusion were significant independent risk factors for the development of infiltration (P&amp;lt;0.001). Direct logistic regression revealed that age in months, hospitalisation in a surgery ward and placement of the catheter in the veins of the antecubital fossa were significant independent risk factors for the development of phlebitis (P&amp;lt;0.001). Conclusion: Catheter size, hospitalisation in the surgery ward and continuous infusion contributed to the development of infiltration. Age, hospitalisation in the surgery ward and catheter placement in the antecubital vein contributed to the development of phlebitis.

Penile Erection Induced by Stimulation of Sacral S1/S2 Spinal Root in Cats

ObjectiveThis study aimed at determining whether stimulation of sacral spinal roots can induce penile erection in cats. Materials and MethodsIn anesthetized cats, a 20-gauge catheter was inserted into the corpus cavernosum to measure the penile pressure. Stimulus pulses (5–80 Hz, 0.2 ms) were applied through bipolar hook electrodes to sacral ventral roots alone or to combined ventral and dorsal roots of a single S1–S3 segment to induce penile pressure increases and penile erection. ResultsStimulation of the S1 or S2 ventral root at 30 to 40 Hz induced observable penile erection with rigidity and the largest increase (169 ± 11 cmH2O) in penile pressure. Continuous stimulation (10 minutes) of afferent and efferent axons by simultaneous stimulation of the S1 or S2 dorsal and ventral roots at 30 Hz also produced a large increase (190 ± 8 cmH2O) in penile pressure that was sustainable during the entire stimulation period. After a complete spinal cord transection at the T9–T10 level, simultaneous stimulation of the S1 or S2 dorsal and ventral roots induced large (186 ± 9 cmH2O) and sustainable increases in penile pressure. ConclusionThis study indicates the possibility to develop a novel neuromodulation device to restore penile erection after spinal cord injury using a minimally invasive surgical approach to insert a lead electrode through the sacral foramen to stimulate a sacral spinal root.