Cannula-related Complications Research Articles

1350: Nursing intervention on a cardiology ward can reduce peripheral intravenous cannula related complications and infections

1350: Nursing intervention on a cardiology ward can reduce peripheral intravenous cannula related complications and infections

Iris damage by inadvertent cannula injection

Iris damage occurred in 2 patients due to the inadvertent forceful injection of a cannula. Despite luer lock syringes, the J-shaped cannula was injected during cortical removal in one eye and during hydration of the incision at the end of the procedure in the second eye. Iris damage should be added to the growing list of injuries that can result from cannula-related complications.

A Bent Infusion Cannula for Vitreous Surgery

To modify an infusion cannula for vitreous surgery and decrease cannula-related complications. New surgical instrument. A conventional 20-gauge infusion cannula was modified by forming a 135-degree angle at the joint of the flange between the cannula adapter and the needle. The sloped plane of the needle tip was opposite the bent adapter. The cannula was routinely fastened with a 7-0 absorbable suture after insertion into the eye. We used the modified infusion cannula in 50 consecutive phakic eyes (48 patients). Intraoperatively, the cannula remained attached to the globe surface; it did not tilt anteriorly and damage the lens when touched inadvertently. No suprachoroidal or subretinal infusion was observed. Neither the lens nor the retina was damaged. There were no cannula-related retinal detachments or breaks during follow-up. The modified infusion cannula is more effective and safer during pars plana vitrectomy in phakic eyes compared with a conventional cannula.

Prone positioning does not affect cannula function during extracorporeal membrane oxygenation or continuous renal replacement therapy.

Prone positioning in respiratory failure has been shown to be a useful adjunct in the treatment of severe hypoxia. However, the prone position can result in dislodgment or malfunction of tubes and cannulae. Certain patients receiving extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy (CRRT) may also benefit from positional therapy. The impact of cannula-related complications in these patients is potentially disastrous. The safety and efficacy of prone positioning of these patients has not been previously reported. A retrospective chart review evaluated ECMO or CRRT cannula location, and displacement or malfunction during positional change or while prone. The study was set in a General Surgery and Trauma Intensive Care Unit. The subjects were all patients at our institution who simultaneously underwent ECMO or CRRT and prone positioning from July 1996 to July 2001. There were no interventions. Ten patients underwent ECMO and 42 patients underwent CRRT during the study period. Seven patients underwent simultaneous prone positioning and either ECMO (4/10) or CRRT (4/42). A total of 68 turning events (prone to supine or supine to prone) were recorded, with each patient averaging 9.7 (range, 4-16) turning episodes. Turning was performed with sheets and extra nursing personnel; no special mechanical assist devices were used. No patients experienced inadvertent cannula removal during turning. Two patients had poor flow through their cannulae. In one patient, this occurred in the supine position and required repositioning of the cannula. In the second patient, cannulae were changed twice and flow was poor in both the supine and the prone positions. All ECMO and CRRT patients received venous cannulae. Cannula location (seven internal jugular and 11 femoral) did not the affect risk of malfunction. Patients with venous cannulae for ECMO or CRRT can be safely placed in the prone position. Flow rates are maintained in this position. Potential cannula complications of ECMO and CRRT are not a contraindication to prone positioning in severely ill patients.

A Clinical Evaluation of the Use of Radially Expandable Laparoscopic Access Devices in the Pediatric Population

The methods used to obtain laparoscopic and thoracoscopic access are associated with complications ranging from cannula slippage to visceral and major vascular injuries. This study evaluates the use of a radially expandable access device in pediatric minimally invasive surgery with a focus on the incidence of major and minor cannula-related complications. From 1994 to 1999, 2,157 patients at seven institutions underwent minimally invasive procedures using a radially expandable access device (StepTM). Their ages ranged from 1 day to 21 years (mean 7.2 years). The number of devices used per case ranged from one to seven (mean 3.3). Access was obtained using a Veress needle inserted into a radially expandable sleeve, followed by dilatation with a 3-mm, 5-mm, 7-mm, or 12-mm diameter cannula. Factors monitored included abdominal wall bleeding, vascular and visceral injuries, cannula slippage, and loss of pneumoperitoneum. A total of 7,117 cannulas were inserted. There were no major vascular or visceral injuries (0/1,000). Cannula slippage occurred in 19 cases (8.8/1,000), with subsequent loss of pneumoperitoneum occurring in 4 cases (1.9/1,000). There were only 3 cases of abdominal wall bleeding (1.4/1,000). Only one incisional hernia occurred (0.46/1,000), despite the fact that 83% of the fascial defects were left open. In comparison with the literature, the incidence of injury in this series was significantly reduced (p < 0.00001). The StepTM radially expandable access device is safe and effective for laparoscopic and thoracoscopic procedures in children of all ages, including small neonates. This device significantly reduces the risk of entry-related injuries and minimizes the inconveniences of cannula slippage and loss of pneumoperitoneum.

Reduction of cannula-related laparoscopic complications using radial expansion

Reduction of cannula-related laparoscopic complications using radial expansion

Efficacy and safety of a percutaneous right ventricular assist system

Mechanical right ventricular assistance is necessary in the management of profound right ventricular failure resistant to medical therapy. Conventional right ventricular assistance requires a thoracotomy. We developed a technique for assisting the failing right ventricle without thoracotomy. We implanted the percutaneous right ventricular assist system in animals to test its feasibility and safety. A feasibility study was performed in a right ventricular failure model using 12 open chest dogs, and we examined the effects of the system hemodynamically. Next, the system was implanted into 6 goats and driven for 2 to 8 days. Institution of the percutaneous right ventricular assist system revealed overall hemodynamic improvement on right ventricular failure in dogs. In the goat experiment, no animal died from cannula-related complications. No damage to the intracardiac structures and no pulmonary edema were seen. Plasma free hemoglobin concentration did not exceed 10 mg/dL. The percutaneous right ventricular assist system is safe and effective in the management of right ventricular failure.

Tracheostomy in children.

We reviewed the records of 108 patients who had a tracheostomy performed over a 10-year period from July 1979 to April 1989. Median age at tracheostomy was 6 months (1 week-15 years). Indications for surgery were acquired subglottic stenosis (31.4%), bilateral vocal cord paralysis (22.2%), congenital airway malformations (22.2%) and tumours (11.1%). No epiglottis and no emergency situation had to be managed by tracheostomy. Operation was uneventful in all, but 8 patients (7.4%) developed a pneumothorax in the postoperative period. Twenty-one (19.5%) had severe complications during the cannulation period (tube obstruction in 11 patients with cardiorespiratory arrest in 4; dislocation of the tube in 6 patients). Fifteen patients (13.8%) had severe complications after decannulation (2 had a cardiorespiratory arrest); all 15 had to be recannulated. At the end of the study period 85 patients (78.7%) were successfully decannulated with a median period of tracheostomy of 486 days (8 days-6.6 years). The median hospital stay was 159 days (13 days-2.7 years). All patients could be discharged. Eight patients (7.4%) died but no death was related to tracheostomy. In summary the mortality rate is lower than reported in previous reviews and tracheostomy is a safe operation even in small children but cannula-related complications may lead to life-threatening events. The management of tracheostomized small children and infants in a highly staffed and monitored intensive care unit has allowed better handling of complications and has resulted in a reduction in cannula-related deaths.