Type Of Cannula Research Articles

Tracheostomy cannulas and voice prosthesis.

Cannulas and voice prostheses are mechanical aids for patients who had to undergo tracheotomy or laryngectomy for different reasons. For better understanding of the function of those artificial devices, first the indications and particularities of the previous surgical intervention are described in the context of this review. Despite the established procedure of percutaneous dilatation tracheotomy e.g. in intensive care units, the application of epithelised tracheostomas has its own position, especially when airway obstruction is persistent (e.g. caused by traumata, inflammations, or tumors) and a longer artificial ventilation or special care of the patient are required. In order to keep the airways open after tracheotomy, tracheostomy cannulas of different materials with different functions are available. For each patient the most appropriate type of cannula must be found. Voice prostheses are meanwhile the device of choice for rapid and efficient voice rehabilitation after laryngectomy. Individual sizes and materials allow adaptation of the voice prostheses to the individual anatomical situation of the patients. The combined application of voice prostheses with HME (Head and Moisture Exchanger) allows a good vocal as well as pulmonary rehabilitation. Precondition for efficient voice prosthesis is the observation of certain surgical principles during laryngectomy. The duration of the prosthesis mainly depends on material properties and biofilms, mostly consisting of funguses and bacteries. The quality of voice with valve prosthesis is clearly superior to esophagus prosthesis or electro-laryngeal voice. Whenever possible, tracheostoma valves for free-hand speech should be applied. Physicians taking care of patients with speech prostheses after laryngectomy should know exactly what to do in case the device fails or gets lost.

Comparison of three cannulas for hysterosalpingography: a prospective, randomized study

OBJECTIVE: To compare three commonly used hysterosalpingogram (HSG) injection devices, the acorn cannula, the balloon catheter, and the cervical cup vacuum cannula, on the patient pain scores during and after HSG, HSG image quality, amount of contrast used, and total fluoroscopic and procedure time. DESIGN: Prospective, randomized study. MATERIALS AND METHODS: HSGs were performed by 4 reproductive endocrinologists (REs). A sample size of 100 was calculated to have 81% power to detect a 20% difference in visual analog scores (VAS), to measure pain perception. Cannula type was assigned by stratified blocked randomization. VAS, amount of contrast used, procedure and fluoroscopic time and HSG image quality scores were analyzed using Kruskall-Wallis, ANOVA and Fishers exact tests. RESULTS: 114 patients were enrolled. 90 patients were included in analysis with 32 patients in the acorn cannula group, 31 in the balloon catheter group, and 27 in the cervical cup vacuum cannula group. Median VAS, fluoroscopic time and amount of contrast used were not statistically significant between the groups. Median procedure time was statistically significant (p=0.0413). Median time for the acorn cannula was 2 minutes, while median time the balloon catheter & vacuum cup groups were 3 minutes. Modeled separately RE (p=0.0155) and cannula type (p=0.0421) were significant predictors of image quality score. Modeled together, RE remained significant (p=0.019) but cannula type was not (p=0.053). ANOVA analysis of the image quality score excluding of total number of images taken showed no difference in RE (p=0.217). CONCLUSION: There was no difference between the groups in pain scores, fluoroscopic time, and contrast used. There is a statistical difference between HSG catheters in procedural time with the acorn cannula requiring the shortest time. Image quality did not vary between technical operators or cannula type, but depended more on the number of images obtained at the time of the HSG.

Sub-Tenon's administration of local anaesthetic for ophthalmological procedure

Anasthetists frequently perfom Sub-Tenon's block for a variety of ophthalmological procedures and is effective in producing sensory block, due to the technique of blunt dissection and the type of cannula used to perform the block, therefore,it cause serious side effects significantly reduce than peribalbar/retrobalbar block. Key words: Ophthalmological procedure; Sub-Tenon's block, Complication ; Prevention and management

Development of a Permanently Controllable Rotating Biopsy Device, Part I: Theoretical Considerations and In-Vitro Results for Five Different Prototypes

To develop different prototypes of permanently controllable rotating biopsy devices with determination of the most efficient prototype in biopsies in bovine myocardium. Five different prototypes of 18-gauge rotating biopsy devices were designed and constructed, four (1 - 4) with various drill-like cutting edges and one (5) cannula type with a lancet-like helically bent cutting edge. Using bovine myocardium as the biopsy tissue, n = 100 specimens per prototype were obtained, and a quantitative analysis including tissue fragmentation, length in mm and weight in mg was carried out. For statistical analysis, the chi-square test for tissue fragmentation and Kruskal-Wallis test for the parameters length and weight were calculated. Prototype 5 showed the highest rate of extraction of one-fragment specimens in n = 66 cases and the lowest rate of failure to obtain tissue in n = 11 cases. The mean length/weight were 4.15 mm/ 3.91 mg for prototype 1, 1.80 mm/ 1.66 mg for prototype 2, 4.61 mm/ 3.28 mg for prototype 3, 5.20 mm/ 3.74 mg for prototype 4, and 9.57 mm/ 6.97 mg for prototype 5. In all three categories, prototype 5 was significantly superior to the prototypes 1 - 4 with p < 0.001. The cannula type with a lancet-like helically bent cutting edge proved to be the most efficient prototype and may now be tested competitively against established automated biopsy devices in vitro.

Treatment of Malperfusion during Surgery for Type A Aortic Dissection

During surgery for acute type A aortic dissection, malperfusion may occur during cardiopulmonary bypass. Retrograde perfusion trough femoral cannulation is considered a predisposing factor. However, this may occur even with antegrade perfusion, because of the presence of multiple flaps or compression of the true lumen by the false lumen. In this particular setting, the aim is to reach a perfusion of the true lumen of the dissected aorta. A technique of epicardial ultrasound-guided direct cannulation of the dissected aorta’s true lumen by a Seldinger technique may help in those cases. We describe the technique with particular interest to the epicardial ultrasound control and the type of arterial cannula to be inserted by the Seldinger technique.

A reply

Thank you for the opportunity to respond. We would like to apologize to Dr Mason and his facility for any confusion which may have taken place concerning the switch from a Contiplex needle to a Tuohy needle in their custom caudal extradural catheter tray (Oxford Set) Ref 4459105 (B Braun Medical Ltd, Thorncliffe Park, Sheffield, UK). Our goal has always been and will continue to be providing our customers with the appropriate tools to deliver the best patient care possible. The above mentioned tray containing a Tuohy needle has in the meantime been discontinued, since we believe, as Drs Mason and Berg do, that this is not the ideal needle for catheter techniques via the caudal route. With regard to styletted vs non-styletted needles for caudal anaesthesia, we agree that data exist in both published studies and expert textbooks which argue both sides of the issue. B. Braun has elected to take the approach of providing only specially designed, styletted caudal needles (Epican®, B. Braun, Melsungen, Germany) to eliminate any potential risk of tissue coring. Non-styletted intravenous catheters, Contiplex needles, and similar options remain available to clinicians who prefer to use intravenous cannula type devices for the caudal approach. However, to minimise potential patient risk, B. Braun has chosen not to include these types of non-styletted options in our portfolio of caudal anaesthesia devices.

The effect of cannula material on the incidence of peripheral venous thrombophlebitis

The incidence of thrombophlebitis following the use of two types of cannulae, a new generation polyurethane cannula Biovalve PUR and a polyurethane hybrid co-polymer Vialon cannula, was compared in a randomised trial. Seventy patients scheduled for elective cardiac surgery were randomly assigned to have either a Biovalve cannula or a Vialon cannula inserted before induction of anaesthesia. Postoperatively, the cannulae were removed either as soon as signs of thrombophlebitis were observed or at the end of seven days, whichever was earlier. There was a significantly lower incidence of thrombophlebitis in the Biovalve PUR group (17%) compared to the Vialon group (60%) at the end of seven days (p < 0.001). None of the cannulae tip cultures resulted in the growth of micro-organisms. There was also a lower incidence of the need for re-siting with the Biovalve than with the Vialon cannulae.

The “Sandblasting” Effect of Aortic Cannula on Arch Atheroma During Cardiopulmonary Bypass

A 69-yr-old woman presented with dyspnea on exertion was found to have moderate-to-severe mitral regurgitation with moderate left ventricular dysfunction (estimated ejection fraction was 30%) and was scheduled for elective mitral valve repair. The patient had undergone uneventful coronary artery bypass graft surgery 7 months earlier. Her medical history was otherwise significant for hypertension and diabetes. Intraoperative transesophageal echocardiography (TEE) confirmed moderate mitral regurgitation and showed diffuse atheromatous disease in the distal aortic arch with a maximal plaque height of 3 mm. Epiaortic scanning was not performed in this case. The mid-ascending aorta was cannulated under direct vision with a 17F Bio-Medicus® (Medtronic Inc, Minneapolis, MN) cannula. This is a straight, wirewound polyurethane cannula with a multiport tip and is usually chosen for femoral arterial cannulation. However, given the patient’s recent previous cardiac surgery and limited visibility of the ascending aorta, the surgeon (D.D.G.) opted for this particular cannula, which offers better flow with less aortic injury than a conventional 22F or 24F cannula. The improved flow characteristics come from the long segment of holes which put the cannula tip near the back wall. The location of aortic cannulation was not changed based on cannula type. After initiation of cardiopulmonary bypass (CPB), a new mobile atheroma was noted in the distal aortic arch, just distal to the tip of the aortic cannula (Fig. 1, see Video 1 available at www.anesthesia-analgesia.org). Although it is possible that this atheroma may have been missed by the pre-CPB routine TEE examination, the possibility of plaque disruption by CPB flow cannot be excluded. Both B-mode and color flow Doppler scans (see Video 2 available online) revealed that the jet stream of flow from the aortic cannula was directed toward the mobile atheroma. The surgical procedure was uneventful. Extracorporeal circulation was maintained at a nonpulsatile flow rate of 2–2.4 L · min−1· m−2. After discontinuation of CPB and removal of the aortic cannula, TEE examination of the aorta demonstrated the mobile atheroma at the same location, unchanged in character. Her postoperative recovery was unremarkable. There were no adverse postoperative neurological sequelae.Figure 1.: Mid-esophageal short axis view of the aorta at the junction of the distal arch and descending thoracic aorta. The cannula tip (A) is very close to the origin of the left subclavian artery that cannot be seen in this view. The subclavian artery would be best seen with the scan angle at 90° and slight rotation of the probe towards the right. The tip of the aortic cannula (A) can be seen directly opposing the atheroma (B). The corresponding Video (Video 1 available online) demonstrates the mobile atheroma.Adverse neurological outcomes have been correlated not only with atheroma in the ascending aorta, but also with those in the arch and descending aorta, and with carotid atherosclerosis (1). Aortic manipulation is usually implicated as being responsible for atheroma detachment and subsequent embolization. However, atheromata may also be detached by the “sandblasting” effect of high velocity aortic cannula flow during CPB that may be directed toward susceptible atheroma (2). Although type of cannula selected (curved versus straight; variable size) may not be associated with a higher incidence of cerebral emboli, location of cannulation (ascending aorta versus distal arch) may affect neurological outcome (3). The cannula selected in our case was 17 in. long and projected to a greater length into the aortic lumen than regularly used aortic cannulae, because it was seen by TEE in the distal arch. Effectively, cannulation in our case may be equivalent to distal aortic cannulation due to ultimate location of the cannula tip. Changes in aortic rotational flow have been documented during CPB and could explain the erosive effect of the high-velocity jet from aortic cannulae (4). In a recent report, Pybus described the potential mechanism for atheroma dislodgement due to rotational flow during CPB (5). Another possibility in the case we report is the development of an acute aortic dissection due to shear forces on an atheromatous aorta. We did not see an intimal tear during our case, making the diagnosis of aortic dissection highly unlikely. However, the plaque disruption that occurred during this surgery may have left the patient vulnerable to the future development of an aortic dissection from poorly controlled hypertension. Intraoperative TEE images during our case demonstrated how a susceptible atheroma may be at risk of detachment due to this sandblasting effect. Thus, surgical neuroprotective strategies aimed solely at identifying ascending aortic atheroma may not be sufficient. Fortunately, the patient did not have a postoperative stroke. Epiaortic scanning may be useful not only with selection of aortic cannulation site, but also adjustment of angulation of the distal tip of the aortic cannula. These echocardiographic images highlight the potential of the juxtaposition of aortic cannula and distal arch atheroma in the etiology of postoperative organ dysfunction.

Systemic venous drainage: can we help Newton?☆

In recent years substantial progress occurred in the techniques of cardiopulmonary bypass, but the factor potentially limiting the flexibility of cardiopulmonary bypass remains the drainage of the systemic venous return. In the daily clinical practice of cardiac surgery, the amount of systemic venous return on cardiopulmonary bypass is directly correlated with the amount of the pump flow. As a consequence, the pump flow is limited by the amount of venous return that the pump is receiving. On cardiopulmonary bypass the amount of venous drainage depends upon the central venous pressure, the height differential between patient and inlet of the venous line into the venous reservoir, and the resistance in the venous cannula(s) and circuit. The factors determining the venous return to be taken into consideration in cardiac surgery are the following: (a) characteristics of the individual patient; (b) type of planned surgical procedure; (c) type of venous cannula(s); (d) type of circuit for cardiopulmonary bypass; (e) strategy of cardiopulmonary bypass; (f) use of accessory mechanical systems to increased the systemic venous return. The careful pre-operative evaluation of all the elements affecting the systemic venous drainage, including the characteristics of the individual patient and the type of required surgical procedure, the choice of the best strategy of cardiopulmonary bypass, and the use of the most advanced materials and tools, can provide a systemic venous drainage substantially better than what it would be allowed by the simple "Law of universal gravitation" by Isaac Newton.

Use of a wire-guided cannula for radial arterial cannulation

We compared the success rates of arterial cannulation with a wire-guided cannula (WGC) and the direct technique with a conventional non-wire-guided cannula (non-WGC). A total of 100 adult patients requiring an arterial line in the operating room were assigned randomly to undergo radial arterial cannulation either with the WGC or with the non-WGC. No significant difference in success rates and insertion times could be demonstrated between the WGC and the non-WGC (78.4% vs 67.3% and 22.6 +/- 13.2 s vs 23.0 +/- 19.3 s, respectively). Among the less experienced operators, insertion time was shorter with the WGC than with the non-WGC (27.7 +/- 11.9 s vs 39.8 +/- 20.4 s; P < 0.05), although the success rate was similar for the two types of cannula. Patient characteristics did not affect either the success rates or the insertion times for the two types of cannula. In conclusion, we have confirmed that the success rates of radial arterial cannulation for patients whose physical status is relatively good were similar with the use of the WGC and the non-WGC.

Influences of Cannula Exit Shape on Blood Flow in Aortic Arch

The liquid flow perfused from the four types of cannula into an aortic arch glass model was visualized by using the PIV method. In the case of end-hole and Dispersion cannulae, the liquid jet from a cannula impinges on the inner wall of an aorta near a first bood vessel branch and flows toward a descending aorta along the outer wall of curvature of the aortic arch. The rms value of the velocity and the magnitude of the strain rate tensor have their large values on the outer wall of curvature. In the case of Soft-Flow cannula, the liquid jet from the cannula impinges on the top of the inner wall of curvature of the aortic arch, and flows toward the third branch. The rms value shows its large values in the whole area of the aortic arch. The magnitude shows its large values on the outer wall of curvature near third branch and the top of the inner wall of curvature. In the case of the SELECT 3D cannula, the liquid flow from a cannula impinges on the top of the inner wall of curvature, and then flows toward the descending aorta along the inner wall of curvature. The rms value and the magnitude have their large values on the descending aorta side of the inner wall of curvature.

Relationship between Sleep-Disordered Breathing and Lifestyle-related Illnesses in Subjects Who Have Undergone Health-screening

Simplified sleep polysomnography was performed in 207 adult men to examine the relationship between the frequency of sleep-disordered breathing (SDB) and lifestyle-related illness. Each subject was checked for SDB using a simplified sleep polysomnograph (Auto-Set Portable; Teijin Limited, Tokyo, Japan). Apnea and hypopnea were detected with a nasal cannula type airflow sensor. Hypoxemia was checked with a percutaneous oxygen saturation (SpO2) monitor. We analyzed the relationships between SDB and body mass index (BMI) and hypertension, hyperlipidemia, liver dysfunction, fatty liver, and abnormal glucose metabolism. Fifty-nine subjects (29%) showed SDB with apnea hypopnea index (AHI) over 15 times/h. The frequency of obesity (BMI > or = 25), hypertension, hypercholesterolemia, fasting blood glucose level, and HbA1c were significantly higher in patients with SDB than in normal individuals (AHI < 5 times/h). The frequencies of hypertension, hyperlipidemia, and abnormal glucose metabolism were compared between the obesity-free normal AHI group and the SDB group, and only that of hypertension was significantly different between the two groups. The present study revealed a high frequency of SDB among Japanese individuals. The results also suggest that as SDB becomes severe, it becomes more closely linked to the onset of lifestyle-related illnesses, such as hypertension, hypercholesterolemia and abnormal glucose metabolism.

Right Atrial Surgery without Caval Snaring

: During tricuspid valve replacement in a patient with previous mitral valve surgery, we made an incidental observation that the right atrium can be opened without caval snaring and without air entering the venous reservoir. We tested this hypothesis on an animal model. : Two patients underwent right atrial surgery using percutaneous cannulation, and no air was entrained without caval snaring. This principle was tested in an animal model using 2 pigs weighing 80 kg each. Percutaneous cannulae were placed under epicardial echo guidance with their tips 4 cm from the right atrium. A "collapsible bag with air drainage system" was introduced into the venous return system to quantify air return from the superior vena cava (SVC) and inferior vena cava (IVC). Two types of percutaneous cannulae with (Cardiovations Quick Draw) and without (Biomedicus) proximal side holes were tested. : In the animal model using Biomedicus cannulae, upon opening the right atrium, air was entrained from the SVC cannula at 60 mL/minute with no air in the IVC. There was no difference in the amount of air between the two cannulae. Pressures measured were 5 cm of water in the IVC and -20 cm water in the SVC. Epicardial ultrasound demonstrated complete collapse of both vena cavae. Partial clamping of the SVC cannula reduced the amount of air to 60 cc/min, and placing a small straight clamp at the SVC atrial junction eliminated the air. No air was noted in IVC cannula. : Inferior vena caval drainage by percutaneous cannula does not entrain air with either type of cannula and without snaring (both in clinical cases and animal model). This might be explained by the presence of a competent Eustachian valve. However, the SVC is not immune to air. Minimal air (approximately 60 mL/minute) could be managed by partial clamping or completely be avoided by placing a small straight clamp without snaring.

Quantitative haemodynamic evaluation of aortic cannulas

We have designed a new type of aortic cannula for extracorporeal circulation which we hypothesize has superior haemodynamic characteristics compared with existing types. The aim of the study was to perform a quantitative evaluation of the haemodynamic performance of commercially available aortic cannulas against our new design. Six existing cannulas and two self-designed, modified DLP cannulas were investigated. Pressure drop, peak velocity and wall thickness were obtained from in vitro experiments. Pressure drop and turbulent stresses were obtained by in vivo experiments. At 5 L/min the pressure drops of the new design were 18-25 mmHg in vitro and 20 mmHg in vivo compared with 25-92 mmHg in vitro and 28-90 mmHg in vivo for the six commercially available cannulas. Turbulent stresses of the new design varied between 25 and 50 N/m2 in vivo compared with 125-500 N/m2. Both in vivo and in vitro results showed a clear haemodynamic superiority of the new cannula-tip design compared with all existing types.

Digestibility of carbohydrates in growing pigs: a comparison between the t-cannula and the steered ileo-caecal valve cannula

We compared the determination of ileal and total tract digestibility of carbohydrates in five experimental diets using a double 5 × 5 Latin square design involving a total of 10 cannulated pigs; half of the pigs were equipped with a simple T-cannula and the other half with steered ileo-caecal valve (SICV)-cannula. The diets consisted of nitrogen-free mixture and soya bean meal, sunflower meal, peas or rape seed cake diluted to about 180 g/kg DM protein with the nitrogen-free mixture. There was no significant difference in the digestibility values using the two types of cannulas with regard to organic matter, sugars (sum of glucose, fructose and sucrose), α-galactosides (sum of raffinose, stachyose and verbascose), starch, cellulose, total non-cellulosic polysaccharides (NCP) and insoluble NCP constituents. The digestibility values for the NCP residues arabinose and galactose, however, were estimated higher but with a lower variability with the SICV-cannula compared with the T-cannula. The type of cannula did no influence the estimation of the total tract digestibility for any of the major dietary constituents, but the total tract digestibility was slightly more variable when the pigs were equipped with the SICV-cannula compared with the T-cannula. There was no difference in the ileal digestibility of sugars, α-galactosides, cellulose and the NCP arabinose and uronic acids residues among the experimental diets, while the ileal digestibility of starch and the remaining NCP sugar residues varied between diets. The total tract digestibility was complete for sugars, α-galactosides and starch, whereas the digestibility of the cell wall constituents varied in accordance with the polymeric composition of the cell walls. It was concluded that ileal digesta samples from SICV-cannula are more homogenous than those from the T-cannula. In cases where the precision of each determination is crucial, the SICV-cannula should be the option.

The physics of suction-assisted lipoplasty

Background Some medical equipment manufacturers and surgeons have asserted that certain types of cannulas and other components of liposuction systems enhance the efficiency of fat aspiration. Objective A laboratory experiment was designed to evaluate the effect of each component of a standard liposuction system on the rate of fat aspiration. A clinical investigation of the effectiveness of a vented (Turbo) cannula versus that of a standard cannula was also undertaken. Methods The equipment used for the experiment included cannulas of varying lengths and diameters, provided with different tip geometries, suction tubes of 2 diameters, graduated canisters, and a vacuum pump. Applesauce was used as a simulated aspirant because its consistency appears similar to that of a mixture of fat and infiltrate. The time required to aspirate 1500 mL of material, with the pump set at maximum vacuum and the temperature and barometric pressure held constant, was measured. Results Aspiration rates for the laboratory experiment with Becker, Keel Cobra Accelerator III, and Mercedes tip geometries were similar. In general, clinical aspiration rates were significantly lower than the laboratory rates. A higher aspiration rate was obtained with the vented Turbo cannula than with the conventional cannula. Conclusions Cannula-tip geometry has a minimal effect on the rate of aspiration; however, use of a tip less than 4 mm in diameter can cause clogging with fibrous tissue and significantly decrease the rate of aspiration. Aspiration is directly proportional to cannula and suction-tubing diameter and inversely proportional to cannula and suction-tubing length. Vented cannulas can enhance aspirate flow and efficiency. Further research is needed to investigate the significance of the fat fragmentation process and the development of fluids to simulate infiltrate/fat solutions in laboratory experiments.

Is there any impact of the shape of aortic end-hole cannula on stroke occurrence? clinical evaluation of straight and bent-tip aortic cannulae.

To compare the impact of straight and bent-tip aortic cannulae on stroke occurrence, location, and severity. Prospective data were collected on 8,129 patients (coronary artery bypass grafting (CABG) and/or valvular surgery). 'Bent-tip' aortic cannulae were used in 15.6% of cases and 'straight' end-hole cannulae in 84.4% of cases. There were a total of 137 strokes: right anterior 52, left anterior 39, bilateral 23, posterior 18, and location not established 5. With the use of bent-tip cannulae, the incidence of strokes was 0.9% versus 1.8% with straight cannulae (chi2, p = 0.026). Bilateral and posterior strokes occurred more often with the use of straight cannulae (chi2, p = 0.015). Straight cannulae also related to the severity of strokes (chi2, p = 0.003). There is an influence of the type of cannula on the occurrence, location, and severity of strokes. Straight cannulae cause significantly more often and more severe bilateral and posterior strokes than bent-tip cannulae.

Syringe type and drug injector risk for HIV infection: a case study in Texas

Studies of accidental needlestick exposure to blood containing human immunodeficiency virus (HIV) have shown that the volume of blood in an exposure is a strong predictor of subsequent infection. Illicit drug injectors, a group at elevated risk for HIV transmission, use syringes manufactured in two styles, one of which (the integral cannula type) retains substantially less blood after intravenous use than the other (the detachable needle type). In this report, we examine some of the factors associated with use of syringes with detachable needles among drug injectors in San Antonio, Texas using data from epidemiological surveys, ethnographic studies, and historical observations. We compare personal history of syringe type use with HIV serostatus in a sample of 501 active drug injectors interviewed and screened for HIV in 1997–1998. Ninety-nine percent of these respondents reported that they currently used only integral cannula syringes, but 13% had used a syringe with a detachable needle within the past 2 years, and 37% had used one in their lifetime. Only 9% had ever used one ⩾20 times in a year. Hispanic (Mexican American) respondents were significantly less likely than other ethnic groups to have ever used a detachable needle syringe. HIV seroprevalence was <1% among heterosexual injectors who had never used a detachable needle syringe compared to 4% among those who had used one ( p<0.05).

THE ASSESSMENT OF THE BILIOPANCRATIC ACCESSORIES INVESTIGATION OF THE ENDOSCOPIC FORUM JAPAN

We carried out the first questionnaire survey about pancreas and biliary endoscopy Japan. The questionnaire was distributed to 19 institutions during the period 4 months and we gathered information from 1193 respondents. The endoscopic approaches to bile duct‐related regions accounted for 81% of all procedures. Therapy accounted for 74% of these. The examination and therapy procedures both achieved a success rate of over 80% The standard type of cannula was the first choice in 52% of endoscopic retrograde pancreatography (ERP) and 45% of endoscopic retrograde cholangiography (ERC). The short taper type (30%) is the second choice in ERP, and the short taper type (26%) and long taper (22%) are the second choice in ERC. EST is currently used in 71% of bile duct stone endoscopies in Japan, where EPBD was thought to be relatively prevalent. Various types (over 30) of sphincterotomes are used and the overall frequencies of guidewire usage are 65%.

Chest Drain Insertion Indications and Techniques

The ability to insert a chest drain safely and painlessly is an important core skill for physicians. This article describes techniques for insertion of larger bore trochar and cannula type chest drains as well as the more recent Seldinger guide-wire type drains. The indications for chest drain insertion will also be reviewed.