Arteriovenous Puncture Research Articles

Anaesthesia administered as S(+)-ketamine for cardiac intervention in children with common congenital heart disease.

Safety and efficacy were assessed of different S(+)-ketamine doses combined with propofol administered as anesthesia to common pediatric congenital heart disease (CHD) patients undergoing cardiac interventional surgery to provide reference data as guidance for use in clinical settings. Sixty CHD children admitted to Beijing Anzhen Hospital, Capital Medical University from December 2020 to December 2021 who underwent elective cardiac intervention were assigned to 3 groups (H, L, M, 20 patients/group) using a random number table-based method. Patients received 1% propofol (2 mg/kg) and intravenous injections of S(+)-ketamine (Group L, 0.4 mg/kg; Group M, 0.5 mg/kg; Group H, 0.6 mg/kg) followed by intravenous pumping of 1% propofol (4-6 mg/kg/h). Heart rate (HR), mean arterial pressure, and pulse oxygen saturation were recorded preoperatively (T0), at the time of anesthesia maintenance (T1), at the time of arteriovenous puncture (T2), and when they awakened (T3). Additionally, propofol dose and incidence rates of intraoperative body movement, postoperative agitation, and postoperative nausea/vomiting were recorded. For the 3 groups, Group H awakening time was significantly longer than that of Group L (P = .039). Notably, intergroup intraoperative propofol times differed significantly (P = .009). Meanwhile, T0 to T3 intragroup HR values differences were significant (P = .017; P = .001; P = .005, respectively). Group L HR was significantly elevated at T2 relative to T0 (P = .003), Group M HR was significantly elevated at T1 and T2 relative to T0 (P = .019; P = .003, respectively), and Group H HR values were significantly elevated at T1 and T2 relative to T0 (P = .012; P = .005, respectively). At all 4 time points no statistically significant intergroup differences in mean arterial pressure values were observed (P = .587). T1 to T3 pulse oxygen saturation values for all 3 groups were significantly greater than corresponding T0 values. Although intergroup intraoperative body movement incidence differed significantly (P = .044), intergroup differences in awakening time agitation and postoperative nausea/vomiting incidence rates were insignificant (P = .732, P = .887, respectively). Use of 0.6 mg/kg S(+)-ketamine with propofol was most effective as anesthesia for common pediatric CHD patients undergoing cardiac interventional surgery.

Dynamic Needle Tip Positioning versus Palpation and Ultrasound for Arteriovenous Puncture: A Meta-analysis

At present, dynamic needle-tip positioning (DNTP) technology is applied in arteriovenous puncture, challenging the use of ultrasound technology alone and palpation. Our goals were to extract data from experimental DNTP, ultrasound and palpation studies, using Review Manager, Version 5.3, for data analysis, and to evaluate whether DNTP has certain advantages in puncture. PubMed, EMBASE, the Cochrane Library, CNKI and WanFang Data Knowledge Service Platform were searched for randomized and non-randomized studies that compared DNTP with conventional ultrasound-guided techniques, no DNTP or palpation. The risk ratio with 95% confidence interval was calculated using the model corresponding to the I² value. Studies were identified to compare clinical indexes. With respect to clinical indexes, DNTP is better in terms of first-attempt success, overall success and complications. However, in infants, first-attempt success, overall success and number of additional punctures did not indicate good efficacy for DNTP compared with palpation. Artery puncture was also not performed well under ultrasound. On the basis of the current evidence, the advantages of DNTP over palpation and ultrasound are reflected in the successful first attempt rate of all groups and in all subgroups except infants. Therefore, for emergencies in elderly patients, DNTP can be used as a general method. Given that some of the studies were of low quality, more trials of high quality should be conducted to further verify the findings.

To explore the preventive and therapeutic effects of Xuebijing injection on acute lung injury induced by cardiopulmonary bypass in rats by regulating the expression of microRNA-17-5p and its mechanism

To investigate the preventive effect of Xuebijing injection on acute lung injury induced by cardiopulmonary bypass (CPB) and the underlying mechanism. (1) In vivo experiment: 30 Sprague-Dawley (SD) rats were randomly divided into sham group, CPB group, Xuebijing pretreatment group (XBJ+CPB group) with 10 rats in each group. CPB model was reproduced in rats; and CPB was not performed in sham group, but only through arteriovenous puncture. In the XBJ+CPB group, 4 mL/kg Xuebijing injection was injected intraperitoneally 2 hours before CPB, sham group and CPB group were injected with equal volume of normal saline at the same time. The blood from femoral artery was analyzed 4 hours after operation, and the oxygenation index (PaO2/FiO2) was calculated. Then the rats were sacrificed to collect bronchoalveolar lavage fluid (BALF), and the lung permeability index (PPI) was calculated. The lung tissues were harvested, and the wet/dry weight ratio (W/D) of lung tissue was measured. The index of quantitative evaluation of alveolar injury (IQA) was measured. The levels of interleukins (IL-1, IL-6) and tumor necrosis factor-α (TNF-α) in lung tissue and BALF were measured by enzyme-linked immunosorbent assay (ELISA). The content of malondialdehyde (MDA) and the activities of myeloperoxidase (MPO) and superoxide dismutase (SOD) in lung tissue were detected by biochemical method. The microRNA-17-5p (miR-17-5p) expression in lung tissue was determined by quantitative reverse transcription-polymerase chain reaction (RT-qPCR). (2) In vitro experiments: type II alveolar epithelial cells (AEC II) were cultured in vitro, and they were randomly divided into control group (the cells were treated by preoperative serum of CPB in patients with ventricular septal defect), CPB group (the cells were treated by serum after CPB in patients), and XBJ+CPB group (Xuebijing injection 10 g/L+serum after CPB in patients). After 12 hours of culture in each group, the expression of miR-17-5p was detected by RT-qPCR. AEC II cells were transfected with miR-17-5p mimic, inhibitor or corresponding control oligonucleotide (negative control), respectively, to observe the effect of miR-17-5p on Xuebijing regulating CPB-induced apoptosis rate and caspase-3 activity. (1) In vivo experiment: compared with the sham group, the PPI, lung W/D ratio, IQA, and IL-1, IL-6, TNF-α in lung tissue and BALF, as well as MDA content and MPO activity in lung tissue were significantly increased, PaO2/FiO2 and SOD activity in lung tissue were significantly decreased. The parameters of the XBJ+CPB group were significantly improved, suggesting that Xuebijing pretreatment could improve CPB-induced ALI in rats. The expression of miR-17-5p in lung tissue of the CPB group was significantly down-regulated as compared with sham group (2-ΔΔCt: 0.48±0.13 vs. 1.00±0.11, P < 0.05); while the expression of miR-17-5p in the XBJ group was significantly up-regulated as compared with the CPB group (2-ΔΔCt: 1.37±0.09 vs. 0.48±0.13, P < 0.05), indicating that the improvement of Xuebijing injection on lung injury after CPB might be related to miR-17-5p. (2) In vitro experiment: the changes in miR-17-5p expression in each group of AEC II cells confirmed in vivo results. After transfection of miR-17-5p mimic, the apoptotic rate and caspase-3 activity of each group were significantly lower than those transfected with negative control, and the decrease was more significant in the XBJ+CPB group [apoptotic rate: (7.37±0.95)% vs. (12.60±1.90)%, caspase-3 (A value): 0.82±0.09 vs. 1.37±0.08, both P < 0.05]. After transfection of miR-17-5p inhibitor, the apoptotic rate and caspase-3 activity of each group were significantly more than those transfected with negative control [in the XBJ+CPB group: apoptotic rate was (16.30±1.86)% vs. (12.60±1.90)%, caspase-3 (A value) was 1.78±0.13 vs. 1.37±0.08, both P < 0.05]. This indicated that the apoptosis of AEC II cells cultured in serum after CPB was significantly reduced by miR-17-5p, and further reduced by the pretreatment with Xuebijing. Xuebiing injection can reduce the inflammatory reaction and oxidative stress of lung tissue in rats with ALI induced by CPB, and improve oxygenation. The mechanism may be related to up-regulation of miR-17-5p expression in AEC II cells and inhibition of apoptosis of AEC II cells.

Study of hand hygiene requirements in the operation skill of physician qualification examination

Objective To explore the difference of hand hygiene requirement between guide-line of skill practice for national examinations of doctors’ qualification（clinical practitioners） and stan-dard for hand hygiene for healthcare workers in health care settings for some sterile techniques. Methods Eight sterile techniques in guideline of skill practice for national examinations of doctors’ qualification（clinical practitioners） such as changing a dress and taking out stitches, aspiration, ure-thral catheterization, arteriovenous puncture, thoracentesis, abdominal puncture, lumbar puncture and bone marrow puncture were chosen and the results were compared with standard for hand hygiene for healthcare workers in health care settings. Results Three of eight sterile technics mentioned hand-washing, six of eight mentioned wearing sterile gloves, and zero of eight mentioned antiseptic han-drubbing; however, only one of six （16.67%） before wearing sterile gloves mentioned handwashing. Conclusion The requests of hand hygiene between guideline of skill practice for national examina-tions of doctors’ qualification （clinical practitioners） and standard for hand hygiene for healthcare workers in healthcare settings are not concordant , which from the root leads to the inconsistence of doctors’ learning at different stages of education and training . It is suggested that the examination organization departments should refer to the relevant provisions of the state in the preparation of guidelines, and regulate medical practice behavior with consistent standards. Key words: Qualification examinations for doctors; Skill practice; Guideline; Standard for hand hygiene