Suction Blood Research Articles

Comparison of the Effect of Intravenous Tranexamic Acid and Sublingual Misoprostol on Reducing Bleeding After Cesarean Section: A Double-Blind Randomized Clinical Trial.

To evaluate the effects of intravenous tranexamic acid (TA) and sublingual misoprostol on reducing bleeding after cesarean section. One hundred and fifty-eight participants with term pregnancies scheduled for cesarean section were randomly divided into two groups. In M group, two sublingual misoprostol pills (400mg) were administrated, immediately after the delivery. In TA group, ten minutes before skin incision, TA ampoule (1g) was injected. In both groups, immediately after the delivery, 20 units of oxytocin in 1L ringer lactate with speed of 1000CC/h was injected. At the end of the operation, the amount of bleeding was measured based on the number of small and large gauzes, the blood in the suction container and the difference of patient's hemoglobin before and 24h after surgery. Hemoglobin level reduction in the TA group was higher than the M group (- 2.45 ± 0.84 vs - 2.14 ± 1.38g/dL) (P < 0.001). Furthermore, number of used gauze and blood suction in the TA group was significantly higher compared to sublingual misoprostol (4.67 ± 1.34 vs 3.25 ± 1.31 and 260.25 ± 79.06 vs 193.94 ± 104.79cc, respectively) (P < 0.001). Mean blood pressure during the entire duration of surgery in the TA group decreased significantly as compared to the M group (P < 0.001). Total bleeding was significantly lower in sublingual misoprostol as compared to the tranexamic acid group. Furthermore, in misoprostol group hemodynamic variables were stabilized greater than tranexamic acid group. IRCT201708308611N6.

In silico study of the dynamic interaction between extracorporeal circulation and native circulation

Abstract An in silico investigation of modelled Extracorporeal Life Support (ECLS) via a femoral arterial cannula revealed the existence of both a defined separation zone between the opposing flows (ECLS, native flow) and different ranges dependent on flow distribution. The interaction between pulsating native circulation and constant ECLS flow is dynamic. A transient simulation model was developed to investigate the dynamic influence on this fluid mechanical interaction. The in silico model is based on a CT-generated 3D model derived from a life-sized silicon aorta. A geometric standard cannula (16Fr) is inserted femoral. Inlet boundary conditions such as the temporal flow profile of a subject from the left ventricle (native circulation) and the flow from the femoral cannula are varied such that during transient simulations the summed flow (total perfusion) is 5.5 l/min. The outlet pressure boundary conditions at the branching arteries are selected such as to model the downstream vascular system. Transient simulations revealed the dynamic effects of different flow fractions (Heart - ECLS) on the flow. Stationary simulations show a separation zone between the two flows, the position of which respectively the ECLSrange, oscillates dependent of the native circulation. Furthermore, it was noted that a raised pulse was impedimental to ECLS. This can be partly compensated by increasing the length of cannula inserted. At the same time the ECLS supply for the brain can improve at the cost of performance post-bifurcation. Increasing the ECLS fraction to above 50% flow led to retrograde flow combined with blood suction from the femoral artery. The EMPAC project model has been further developed to include investigation of the dynamic effects of blood flow. This has made it possible for the first time to analyse in detail and evaluate the temporal effects of both opposing flows streams. A subsequent investigation explains whether aortic elasticity plays a significant role.

The effect of a novel turbulence-controlled suction system in the prevention of hemolysis and platelet dysfunction in autologous surgery blood.

Re-transfusion of autologous blood is an important aspect of intraoperative blood management. Hemolysis and platelet dysfunction due to turbulence in the blood suction system strongly impede later usage of suction blood for re-transfusion. The aim of this study was to analyze the effects of a novel surgical-blood suction system with an automatic control setup for minimization of turbulence in the blood flow. We compared the turbulence-controlled suction system (TCSS) with a conventional suction system and untreated control blood in vitro. Blood cell counts, hemolysis levels according to free hemoglobin (fHb) and platelet function were analyzed to determine the integrity of the suction blood. In the conventional suction system, we found a strong increase of the fHb levels. In contrast, erythrocyte integrity was almost completely preserved when using the TCSS. We obtained similar results regarding platelet function. The expression of platelet glycoproteins, such as GP IIb/IIIa and P-selectin, native or after stimulation with ADP, were markedly impaired by the conventional system, but not by the TCSS. In addition, platelet aggregometry revealed significant platelet dysfunction in conventional suction blood, but less aggregation impairments were present in blood samples from the TCSS. Our findings on an in vitro assessment show major improvements in red blood cell integrity and platelet function of suction blood when using the TCSS compared to a conventional suction system. These results reflect a significant benefit for autologous re-transfusion. We suggest testing the TCSS in surgery for clinical evaluation.

Hard to be killed: Load-bearing capacity of the leech Hirudo nipponia.

With the evolution for several millions of years, leeches have developed a perfect capability to resist mechanical loads, which provides many inspirations to engineer new materials and new devices. To uncover the mechanism of its strong survival ability, several mechanical approaches, such as compression, tension, adhesion, impact and blood suction experiments were tried. Our experimental results show that a leech (Hirudo nipponia) can surprisingly withstand a compressive force of nearly 106 times its body weight. In tension, this animal demonstrates large deformation and its strain can reach a value bigger than 3. To avoid being removed from the host skin, it produces an adhesion force superior to 118 times its body weight, and it can endure an impact force at least 1500 times its weight. Also the leech skin can bear an internal fluid pressure of around 6 times the atmospheric pressure. These data show that the leech cannot be killed easily through normal mechanical loading approaches. All these amazing performances lie in hierarchical structures and ductility of the skin with highly developed and compact annuluses, and this feature is beneficial to leech's survival.

429 The emergency treatment strategy and prognosis of priapism in a Chinese clinic

To explore the emergency treatment principles and prognosis of priapism in a Chinese andrology clinic. The medical records of 24 priapism patients in our emergency department were reviewed retrospectively. The mean age of the patients was 30.6 years (range from 18 to 48 years) with onset time from 4 h to 7 days. Among the 24 patients, twelve patients were caused by injection of vasoactive drugs, 4 patients were accompanied by hematological system diseases, 1 patient had repetitive sex intercourse, 5 patients experienced penile perineal trauma, and the rest 2 patients had no obvious causes. All patients received blood complete cells count, urine analysis, corpus cavernosum blood gas analysis and color Doppler ultrasonography, among which 18 patients were followed with a mean duration of 24 months ranging from 10 to 36 months. According to medical history, corpus cavernosum blood gas analysis and ultrasonography, 16 patients were diagnosed as ischemic priapism, 3 patients were stuttering priapism, and 5 patients were non-ischemic priapism. The venous type priapism patients received initial corpus cavernosum blood suction and α-adrenergic receptor agonist perfusion, whose corpus cavernosum was washed repetitively until its blood color returned to bright red. Ten ischemic priapism patients were recovered after corpus cavernosum blood irragation and α-adrenergic receptor agonist perfusion. The other 5 ineffective ischemic priapism patients received penile corpus cavernosum-glans shunt or penile corpus cavernosum-urethral corpus cavernosum shunt. The rest 1 ischemic priapism patient was treated by bilateral penile corpus cavernosum-great saphenous vein shunt. All 5 non-ischemic priapism patients recovered after 1 to 2 times of highly-selective internal pudendal arteriogram and embolism. Three stuttering priapism patients were received antiandrogen drugs, estrogen and PDE5 inhibitors, whose priapism frequency was ameliorated and controlled. Among the 18 patients under follow-ups, 5 non-ischemic priapism patients maintained erectile function, 10 ischemic priapism patients experienced obvious penile erectile dysfunction, of which 5 patients received penile prosthesis implantation, and 3 stuttering priapism patients maintained partial penile erection.

Is Intraoperative Blood Loss Underestimated in Patients Undergoing Laparoscopic Hepatectomy?

Less intraoperative blood loss is frequently reported as an advantage of laparoscopic hepatectomy (LH) over open hepatectomy (OH). However, the small work space during laparoscopic surgery could lead to insufficient blood suction from the abdominal cavity, with possible underestimation of intraoperative blood loss. This study compared estimated blood loss (E-BL) with intraoperatively counted blood loss (IC-BL) in patients undergoing LH. This study included 110 consecutive patients undergoing partial hepatectomy for solitary liver tumors (59 had OH and 51 had LH). IC-BL and E-BL were determined, and the difference between them was calculated based on the surgical approach. Factors affecting the difference were investigated. IC-BL was quantified from the suction fluid volume and weight of surgical gauzes used for blood and fluid collection. E-BL was calculated with the total blood volume and change in hematocrit. Although there were no significant differences between IC-BL and E-BL in the OH group (292 ± 198 vs. 259 ± 167mL, p = 0.1239), E-BL was significantly greater than IC-BL in the LH group (273 ± 166 vs. 128 ± 177mL, p < 0.0001). Percentage of patients with E-BL > IC-BL in the LH group was significantly greater than in the OH group (86.3 vs. 42.4%, p < 0.0001). The surgical approach (OH/LH) was the only significant independent factor determining E-BL > IC-BL status. E-BL was significantly greater than IC-BL only in patients undergoing LH, and the surgical approach (OH/LH) was the only factor affecting E-BL > IC-BL status. These results suggest that intraoperative blood loss may be underestimated during LH.

New device for intraoperative blood suction avoiding turbulences

IntroductionBleeding during surgery is common. Increased bleeding may disturb procedure, induces haemodynamic instability and results in need for blood transfusion. Allogenic blood transfusions increase mortality and morbidity, especially risk of...

Observation of Mosquito Skin Penetration and Blood Suction using animal skin

Observation of Mosquito Skin Penetration and Blood Suction using animal skin

Shed-blood-separation and cell-saver: an integral Part of MiECC? Shed-blood-separation and its influence on the perioperative inflammatory response during coronary revascularization with minimal invasive extracorporeal circulation systems - a randomized controlled trial.

The postoperative systemic inflammatory response after cardiopulmonary bypass (CPB) is still an undesirable side-effect after cardiac surgery. It is most likely caused by blood contact with foreign surfaces and by the surgical trauma itself. However, the recirculation of activated shed mediastinal blood is another main cause of blood cell activation and cytokine release. Minimal invasive extracorporeal circulation (MiECC) comprises a completely closed circuit, coated surfaces and the separation of suction blood. We hypothesized that MiECC, with separated cell saved blood, would induce less of a systemic inflammatory response than MiECC with no cell-saver. The aim of this study was, therefore, to investigate the impact of cell washing shed blood from the operating field versus direct return to the ECC on the biomarkers for systemic inflammation. In the study, patients with MiECC and cell-saver were compared with the control group, patients with MiECC and direct re-transfusion of the drawn blood shed from the surgical field. High amounts of TNF-α (+ 120% compared to serum blood) were found in the shed blood itself, but a significant reduction was demonstrated with the use of a cell-saver (TNF-α ng/l post-ECC 10 min: 9.5±3.5 vs. 19.7±14.5, p<0.0001). The values for procalcitonin were not significantly increased in the control group (6h: 1.07±3.4 vs. 2.15±9.55, p=0.19) and lower for C-reactive protein (CRP) (24h: 147.1±64.0 vs.134.4±52.4 p=0.28). The use of a cell-saver and the processing of shed blood as an integral part of MiECC significantly reduces the systemic cytokine load. We, therefore, recommend the integration of cell-saving devices in MiECC to reduce the perioperative inflammatory response.

Quantification of Lipid Filtration and the Effects on Cerebral Injury During Cardiopulmonary Bypass

Lipid microemboli (LME) are formed in pericardial suction blood which, when returned to the cardiopulmonary bypass (CPB) circuit, can pass through filter materials and are returned to the arterial cannula. LME have been observed to enter all major organs and have been associated with small capillary arteriolar dilatations in the brains of patients who have died after CPB. However, a causal relationship showing correlation between LME and organ dysfunction has not been demonstrated, or whether removal of LME results in improved organ function. A prospective, single center, randomized controlled trial examined 30 patients (15 per group) undergoing coronary artery bypass grafting using CPB with or without a lipid-depleting filter. The effects of LME filtration on neurocognitive injury were assessed using neuron-specific enolase (NSE). The study group showed a significant reduction in LME after filtration of the pericardial suction blood (p < 0.001), whereas the control group exhibited a significant rise in LME (p < 0.001). There was a significant reduction in peak NSE release (p= 0.013) and significant attenuation throughout the postoperative period (p= 0.002). Correlation and regression analyses showed a significant relationship between the number ofLME post-CPB and peak NSE release (r= 0.42, p=0.02). Several methods of LME filtration have been proposed, but none provided a suitable, efficacious method for use within the clinical setting. The RemoweLL CPB system removes significant numbers of LME from the cardiotomy suction. Furthermore, LME correlate to the release of a known marker of neurologic injury.

Fabrication of Stainless Steel Microneedle with Laser-Cut Sharp Tip and its Penetration and Blood Sampling Performance

The demand for minimally invasive injection needles or needle-shaped tools is growing from those who carry out medical practices such as blood or insulin injections. Applying the mosquito biomimetic, we have used a femtosecond laser to fabricate minimally invasive microneedles out of ultrafine hollow SUS304 pipes, 50μm in outer diameter and 20μm in inner diameter. When such a stainless steel needle tip is angled at 15°, it has the lowest penetration resistance, two and a half times lower than that of the finest hollow needle that is commercially available. A blood suction experiment with a newly developed microneedle has demonstrated that 2.8μellof blood can be drawn out in 20 seconds. Such stainless steel microneedles fabricated by femtosecond lasers have great potential as minimally invasive and mass-producible blood sampling needles to be used for diabetic inspections.

Cell saver processing mitigates the negative effects of wound blood on platelet function.

Wound blood is highly activated and has poor haemostatic properties. Recent data suggest that retransfusion of unwashed wound blood may impair haemostasis. We hypothesized that cell saver processing of wound blood before retransfusion reduces the negative effects. Wound blood was collected from 16 cardiac surgery patients during cardiopulmonary bypass. One portion of the wound blood was processed in a cell saver and one portion left unprocessed. Increasing amounts of unprocessed blood (10% and 20% of the systemic blood volume) or corresponding volumes of processed blood were added ex vivo to whole blood samples from the same patient. Clot formation was assessed by modified thromboelastometry (ROTEM(®) ) and platelet function with impedance aggregometry (Multiplate(®) ). Addition of unprocessed wound blood significantly impaired clot formation and platelet aggregability. Cell saver processing before addition did not influence clot formation but abolished completely the negative effects of wound blood on platelet aggregability tested with all agonists. Median adenosine diphosphate-induced platelet aggregation was 51 (25th and 75th percentiles 42-69) when 20% processed cardiotomy suction blood was added vs. 34 (24-52) U when 20% unprocessed blood was added, P < 0.001. The corresponding figures for arachidonic acid-, thrombin receptor activating peptide- and collagen-induced aggregation was 21 (17-51) vs. 13 (10-25) U, 112 (87-128) vs. 78 (65-103) U and 58 (50-73) vs. 33 (28-44) U, respectively, all P < 0.001). The results suggest that cell saver processing before retransfusion mitigates the negative effects of wound blood on platelet function despite that cell saver processing reduces platelet count.

Novel technique of a multifunctional electrosurgical system for minimally invasive surgery.

Bipolar electrosurgery in the minimally invasive endoscopic surgery theater has been traditionally limited to the use of standard bipolar forceps, which are minimally versatile, have a limited range of motion, and are associated with visualization and handling constraints. The authors designed a novel surgical device system in which commonly used surgical instruments (suction, microscissors, micrograspers, and dissectors) co-function as individually insulated and modular electrodes for bipolar electrosurgery. In this feasibility study, the successful use of these prototypes in endonasal endoscopic transsphenoidal surgery was demonstrated on 2 human cadavers, and in an in vivo arterial coagulation model on 2 live rats. This prototype system provided improved bipolar instrument mobility, minimized the requirement to exchange surgical instruments when performing electrosurgery, and allowed for new maneuvers that optimized surgical workflow, such as the ability to suction blood and smoke while cauterizing. This multifunctional bipolar cautery system may improve surgical efficiency and workflow and facilitate surgical microdissection and electrocautery during minimally invasive, endoscopic, robotic or traditional open surgery.

STUDIES ON THE OCCURRENCE OF COXIELLA BURNETII INFECTION IN TICKS IN SELECTED EASTERN AND CENTRAL REGIONS OF POLAND

Arthropods may play a role in the transmission of Coxiella burnetii as they transmit pathogen both mechanically (as flies), and actively during the host blood suction. The aim of this study was to identify the C. burnetii occurring in ticks harvested from both domestic and livestock animals, as well as from wildlife in randomly selected regions of Poland. The total number 1126 ticks was collected in four regions of Poland: the Masovian, Lublin, Łódź and Podkarpackie Provinces. Among ticks collected from May 2011 to August 2012, the presence of IS1111 gene sequence was detected in 15 (1.33%) cases by real-time PCR test. Among the ticks harvested from domestic and livestock animals in 12 cases (3.1%), and in case of ticks found in open-space rodents in 3 cases (0.4%) we found the presence of marker sequences. The low percentage of C. burnetii infected ticks indicate a limited role of these arthropods in Q fever transmission.

Intraoperative cell salvage during cardiac surgery is associated with reduced postoperative lung injury.

In addition to its blood-sparing effects, intraoperative cell salvage may reduce lung injury following cardiac surgery by removing cytokines, neutrophilic proteases and lipids that are present in cardiotomy suction blood. To test this hypothesis, we performed serial measurements of biomarkers of the integrity of the alveolar-capillary membrane, leucocyte activation and general inflammation. We assessed lung injury clinically by the duration of postoperative mechanical ventilation and the alveolar arterial oxygen gradient. Serial measurements of systemic plasma concentrations of interleukin-6 (IL-6), myeloperoxidase, elastase, surfactant protein D (SP-D), Clara cell 16 kD protein (CC16) and soluble receptor for advanced glycation endproducts (sRAGEs) were performed on blood samples from 195 patients who underwent cardiac surgery with the use of a cell salvage (CS) device (CS, n = 99) or without (CONTROL, n = 96). Postoperative mechanical ventilation time was shorter in the CS group than in the CONTROL group [10 (8-15) vs 12 (9-18) h, respectively, P = 0.047]. The postoperative alveolar arterial oxygen gradient, however, was not different between groups. After surgery, the lung injury biomarkers CC16 and sRAGEs were lower in the CS group than in the CONTROL group. Biomarkers of systemic inflammation (IL-6, myeloperoxidase and elastase) were also lower in the CS group. Finally, mechanical ventilation time correlated with CC16 plasma concentrations. The intraoperative use of a cell salvage device resulted in less lung injury in patients after cardiac surgery as assessed by lower concentrations of lung injury markers and shorter mechanical ventilation times.

Effects comparison of two kinds of methods of subglottic stranded attraction for ICU patients with tracheotomy

Objective To explore effects comparison of two kinds of methods of subglottic stranded attraction for ICU patients with tracheotomy.Methods From May 2011 to January 2014 in our hospital 86 ICU patients with tracheotomy were selected and divided into ex-perimental group and control group with 43 cases in each .The experimental group adopted continuous glottis attraction united intermittent flushing, the control group adopted intermittent attraction and flushing .Vital signs, treatment indicators, VAP, duration of mechanical venti-lation and complications were compared between two groups .Results There were significant differences in VAP occurrence time , duration of mechanical ventilation between two groups .The occurrence rates of cough , Occult blood positive , naked with blood liquid , mucosal dam-age and suction tube jam in the experimental group were less than those in the control group with significant differences （ P 〈0.05 ）.Conclusions Continuous glottis attraction united intermittent flushing for ICU patients with with tracheotomy is a good method , the clinical effects is significant with fewer complications .It is worthy of clinical application . Key words: ICU; ICU; Tracheotomy; Nursing; Attraction

Design modifications and computational fluid dynamic analysis of an outflow cannula for cardiopulmonary bypass.

Cardiopulmonary bypass is a well-established technique during open heart surgeries. However, neurological complications due to insufficient cerebral oxygen supply occur and the severe consequences must not be neglected. Recent computational fluid dynamics (CFD) studies showed that during axillary cannulation the cerebral perfusion is strongly affected by the distance between the cannula tip and the vertebral artery branch. In this study we use two modifications of the cannula design to analyze the flow characteristics by means of CFD and experimental validation with particle image velocimetry (PIV). One approach applies a spin to the blood stream with a helical surface in the cannula cross section. Another approach uses radial bores in a constricted cannula tip to split the outflow jet. The additional helicity improves the perfusion of the cerebral vessels and suppresses the blood suction in the right vertebral artery observed with a standard cannula. The cannula with a helix throughout the entire length changes the blood flow from 2124 to 32 mL/min in comparison with an unmodified design and has the lowest prediction of blood damage. Separating the blood stream does not deliver satisfying results. The PIV measurements validate the simulations and correspond with the velocity distribution as well as vortex locations.

Retransfusion of cardiotomy suction blood impairs haemostasis: Ex vivo and in vivo studies

Objectives. Cardiotomy suction blood in volumes corresponding to 10–20% of the systemic blood volume is retransfused during cardiopulmonary bypass. We hypothesized that retransfusion of unwashed cardiotomy suction blood influences coagulation and platelet function. Design. Systemic blood samples collected during cardiopulmonary bypass were supplemented ex vivo with autologous wound blood (5, 10 and 20%, respectively). Clot formation and platelet function were assessed with thromboelastometry and platelet aggregometry. In an in vivo pilot study 30 patients were randomized into a retransfusion and a no-retransfusion group. Clot formation, platelet aggregability and thrombin generation capacity were compared between the groups. Results. Cardiotomy suction blood had markedly impaired clot stability and reduced levels of fibrinogen and platelets compared with systemic blood. Ex vivo addition of 10% and 20% suction blood to systemic blood impaired platelet aggregability and clot stability. Retransfusion of small amounts of wound blood in vivo (mean volume 280 ml, corresponding to 5% of the blood volume) did not significantly influence haemostasis. Conclusions. The ex vivo results suggest that addition of unwashed cardiotomy suction blood in clinically relevant volumes impairs systemic haemostasis. Retransfusion of smaller volumes in vivo has no or limited impact. Avoiding retransfusion of larger amounts of unwashed cardiotomy suction may improve postoperative haemostasis.

Erratum to: Elevation of urinary liver-type fatty acid-binding protein as predicting factor for occurrence of contrast-induced acute kidney injury and its reduction by hemodiafiltration with blood suction from right atrium

Erratum to: Elevation of urinary liver-type fatty acid-binding protein as predicting factor for occurrence of contrast-induced acute kidney injury and its reduction by hemodiafiltration with blood suction from right atrium

Elevation of urinary liver-type fatty acid-binding protein as predicting factor for occurrence of contrast-induced acute kidney injury and its reduction by hemodiafiltration with blood suction from right atrium

Although contrast-induced acute kidney injury (CI-AKI) has a great impact on patients' prognosis, few data exist regarding predictors of CI-AKI in patients with severe renal dysfunction who have undergone contrast angiography. Therefore, we prospectively studied 25 patients with renal dysfunction, which was defined as the estimated glomerular filtration rate (eGFR) level <45 ml/min/1.73 m(2), undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). We performed hemodiafiltration with blood suction from the right atrium (RA-HDF). The mean level of urinary liver-type fatty acid-binding protein (L-FABP) at baseline was significantly higher in the CI-AKI group than in the non-CI-AKI group (59.8 ± 45.6 vs 13.4 ± 11.9 μg/gCr, P = 0.0003). Multivariate regression analysis demonstrated that baseline urinary L-FABP was an independent significant predictor of CI-AKI (β = 0.741, P = 0.013). Receiver-operating characteristic analysis showed that baseline urinary L-FABP exhibited 100 % sensitivity and 81.8 % specificity for predicting CI-AKI when the cutoff value was defined as 19.0 μg/gCr. Interestingly, the incidence of CI-AKI after CAG or PCI was reduced in the RA-HDF group in a comparison with 41 control patients (12 % vs 27 %) with eGFR level <45 ml/min/1.73 m(2) who underwent PCI before the introduction of RA-HDF. In conclusion, baseline L-FABP levels can be a predictor for occurrence of CI-AKI. We suggest that RA-HDF may prevent the development of CI-AKI in patients with severe renal dysfunction undergoing coronary procedures, although further large-scale prospective study is necessary to confirm our conclusions.