Cannula Research Articles

Prodigious Valve: Ultrasound Will Surely Help!!!

Prodigious Valve: Ultrasound Will Surely Help!!!

Paediatric ultrasound-guided vascular access: Experiences and outcomes from an emergency department educational intervention.

This quality assurance project aims to describe the provision of an ultrasound-guided vascular access education package to paediatric emergency department staff. It subsequently aims to measure clinician and departmental responses to this educational intervention to support future effective education provision. Participants were opt-in emergency department staff. Staff were required to be approved to insert intravenous cannulae in the department. A minimum of 50% were non-rotational staff. The educational package consisted of a theory phase (pre-learning video, information document), a practical phase (intensive 90-120 minute individualised session using a mix of live subjects/training equipment), and an embedding phase (education group available for procedural supervision). Data collection was via de-identified, encoded self-reported survey data and logbooks. Twenty-three staff were enrolled for training. Sixteen (69.9%) were non-rotational. Prior to the education intervention, 18 trainees (78.3%) had placed no successful ultrasound-guided peripherally inserted venous cannulae. By 15 weeks following training, six participants (28.6%) had achieved a predetermined competency benchmark; 61.9% had placed at least one successful ultrasound-guided cannula. Difficult intravenous (IV) access predictors were present in 46.3% of patients throughout the data collection period, with infants overrepresented in this group (64.9% with difficult IV access predictors). IV access attempts by staff with prior ultrasound experience increased from 11.0 to 81.8% post-education intervention. A low-resource brief educational intervention around ultrasound-guided vascular access is achievable. Several barriers to education uptake were presented. Targeting the group of trainees with a high degree of motivation led to the highest yield of benchmark competency acquisition.

Assessment of the accuracy of blood drawn from peripheral venous cannula used for infusing intravenous fluids/ drugs versus direct venepuncture to analyse full blood counts in febrile children.

Blood sampling is a common occurrence in current paediatric practice. Dengue and other febrile illnesses are the main disease entities attributable to admissions. These admissions warrant repeated blood sampling especially with regard to full blood counts. Repeated direct pricking for sampling or having an in-situ cannula for bleeding purposes both have their own disadvantages and undesirable effects. Compare the accuracy of parameters of full blood count of a blood sample taken from a cannula in use against a full blood count from a direct prick. Nine parameters of the full blood count were compared in 38 paired blood samples from each subject of a cohort of febrile children aged 1-14 years admitted to Professorial Paediatric Unit of Colombo South Teaching Hospital, Kalubowila, Sri Lanka. Samples were taken when medically indicated only. The mean values of MCV and MCHC from direct venepuncture vs cannula sample were statistically different. Other parameters did not show a statistically significant difference between the samples collected by the two methods. Blood sampling from a cannula in use for intravenous fluids or medications is favourable for majority of parameters of the full blood count and an advantageous alternative for fresh venepuncture bleeding in febrile children.

O-OGC05 Every veneSection Counts – can we improve patient experience in high-risk upper gastointestinal surgery patients?

Abstract Background Patients with upper gastrointestinal (UGI) malignancy undergo major surgical resections resulting in significant postoperative inpatient stays. Central venous access is utilised to aid management of intraoperative physiology, immediate post-operative care and perioperative complications, which are often complex. Central venous catheters (CVC) and peripheral intravenous (IV) cannulae have a relatively short safe duration; consequently these patients undergo numerous unpleasant venous access attempts. Our aim was to optimise quality of care and patient satisfaction in this high-risk patient group, by inserting Peripherally Inserted Central Catheters (PICCs) pre-operatively to facilitate administration of intravenous (IV) medications, fluids and perioperative blood sampling. Methods We reviewed venous access management in this group from October 2019 to May 2020;recording numbers of IV cannuale, CVCs and any associated complications. From September 2020, all patients deemed high-risk, undergoing a major UGI resection were offered a PICC, inserted pre-operatively. We recorded data on use of CVCs and alternative venous access devices, peripheral venous stabs, complications and overall patient experience. Results Over the first 6 month period we sited 30 PICCs - significantly fewer patients required a perioperative CVC (9% vs 64%) in the PICC group and these lines remained in situ for much longer than CVCs (mean 17 days vs 4.7 days). The PICC group required fewer peripheral cannulae (mean 2.73 vs 5.95 per patient). One patient suffered deep vein thrombosis (DVT) but there were no other adverse consequences. Two patients (9%) were treated for fast ventricular response to Atrial Fibrillation successfully on their surgical ward, with IV Amiodarone via their PICC, negating need for critical care admission. Patients in the baseline study required peripheral stabs for blood sampling most days of their inpatient stay (median 12.5 days), whereas the majority of samples were taken from PICCs in the post-intervention group. Satisfaction scores were high in 100% of cases. Conclusions The introduction of PICCs in our high-risk UGI patients has been a huge success, positively influencing the patient journey. There are demonstrable outcome benefits with reduction in CVCs, peripheral cannulations and phlebotomy attempts. In addition, it has facilitated easier and timelier perioperative administration of IV fluids and medication, optimising patients’ experiences and care.

Low Consciousness in a Patient with Venous Air Embolism Introduced via Peripheral Vascular Cannulation.

IntroductionVenous air embolism is rarely seen, can be fatal and is associated mostly with large central venous catheters and mechanical ventilation. Some cases due to peripheral intravenous access have also been reported.Case DescriptionWe present a case of intracranial venous air embolism most likely secondary to peripheral cannulation. On admission, the patient was drowsy with a suddenly deteriorating Glasgow coma scale score. This case emphasizes cautious cannula insertion and close monitoring of the patient in the event of complications.ConclusionIntravenous cannulation is common but care should be taken to avoid catastrophic complications. Consider air embolism as the differential diagnosis if a patient has a low level of consciousness after an intravenous cannula is inserted.LEARNING POINTSA reduced level of consciousness in a patient should be quickly recognised and the differential diagnosis of air embolism considered.Peripheral vascular cannulation should be carefully monitored.High-flow oxygen and efficient monitoring of the patient are required.

A device to detect leakage at the patient end of total intravenous anaesthesia

The use of total intravenous anaesthesia (TIVA) is limited by concerns of disconnections of the tubing, resulting in accidental awareness. We designed a sensor device to detect leakages at the patient end and notify the medical personnel, thereby allowing immediate intervention in preventing awareness. For moisture detection, resistive sensing was selected as the working principle. The prototype was in proximity to the tubing from the TIVA pump and the patient’s intravenous cannula, and able to detect leakages in all potential leakage sites and activate an alarm. Our device consists of a disposable bandage (sensor), attached to a reusable clamp that is directly coupled to a central module (SparkFun MicroView, a small microcontroller with built-in Organic Light-Emitting Diode (OLED) display). The disposable bandage is wrapped around the possible leakage sites. Crucially, the disposable bandage is integrated with two separate moisture sensing threads. When moisture is present, the central module detects a drop in resistance across the moisture sensing threads and activates a flashing LED and buzzer. We have successfully created a functional leak detection device, comprising a moisture sensing bandage and an audio and visual alert system, to address the problem of undetected TIVA leakages at the patient end.

Effectiveness of Valsalva Maneuver on Pain among Patients Undergoing Peripheral Intravenous Cannulation

Background: Peripheral intravenous cannulation is a frequent procedure nurses perform that causes pain and anxiety to patients. The valsalva maneuver performed during venous cannula insertion can effectively reduce the incidence and severity of venipuncture pain in adults. Aim: This study was designed to evaluate the effectiveness of valsalva maneuver in reducing pain among adult patients undergoing peripheral intravenous cannulation. Method: A quasi-experimental research design was adopted in this study, which was conducted at the surgical and medical departments of Mansoura University Hospital. A purposive sample of 60 patients who were randomly classified into two groups: The study group consisted of 30 patients who underwent peripheral intravenous cannulation during valsalva maneuver, and the control group comprised 30 patients who were punctured using the routine method. The patients’ pain scores were evaluated 2 min after cannulation using the numerical rating scale for pain, and the Pain Anxiety Symptoms Scale-20 was used to assess the level of anxiety. Results: In the control group, 40% of the patients had severe pain, whereas, in the study group, 43.3% had mild pain. A statistically significant difference was observed between the control and study groups (p = 0.0023). Moreover, statistically significant differences in pain level and anxiety symptoms were observed between the control and study groups (p < 0.05). Conclusion: The valsalva maneuver is a simple cost-effective method for decreasing pain and level of anxiety during Peripheral intravenous cannulation. Recommendation: we recommend the use of the Valsalva maneuver before performing the Peripheral intravenous cannulation for reducing pain and related stress during venous cannulation in adults.

Bifurcated Arterial Circulation for Hybrid Aortic Reconstruction: A Novel Technique.

Hybrid aortic procedures present many new challenges to the management of cardiopulmonary bypass (CPB). Reoperation or previous thoracic endovascular aortic repair (TEVAR) can further complicate these procedures, increasing the need for flexibility within the CPB system to execute multiple perfusion strategies as cases dictate. This technique describes the use of a bifurcated arterial circulation to provide both cerebral and lower body perfusion during a redo hybrid aortic arch reconstruction. The arterial line was divided into upper and lower body limbs, and connected to an 8-mm Dacron graft to the axillary artery, as well as a percutaneous 16-Fr. OptiSite femoral arterial cannula respectively. A 25-Fr. multi-stage femoral venous cannula was placed percutaneously as well. CPB was initiated utilizing both arterial cannulas with near-infrared spectroscopy and electroencephalogram to monitor the adequacy of cerebral perfusion. Moderate hypothermia of 26°C was induced and a CODA balloon (Cook Medical, Bloomington, IN) was deployed to occlude the proximal limb of a thoracic endovascular repair (TEVAR) graft; the common trunk of the debranched arch vessels was clamped proximally, allowing for simultaneous upper and lower body perfusion. Upon completion of the distal arch, the CODA balloon was removed and total body perfusion was reinitiated via central cannulation utilizing a sidearm on the arch graft.

How I keep my paediatric intravenous cannulas taped in securely

How I keep my paediatric intravenous cannulas taped in securely

Abstract 14444: A Novel Role for the Hypothalamic Paraventricular Nucleus in Resuscitation From Opioid-Induced Respiratory Depression by Fentanyl in the Rat

Introduction: Opioid receptor antagonists, like naloxone, reverses opioid-induced respiratory depression (OIRD). We recently found that systemic oxytocin reverses fentanyl OIRD in rats. Naloxone triggers a surge in oxytocin release from the hypothalamic paraventricular nucleus (PVN) in anesthetized rats. Hypothesis: Given that naloxone induces PVN oxytocin release, we hypothesized that the PVN, an unrecognized brain region for opioid overdose reversal, is capable of respiratory resuscitation following fentanyl OIRD. Methods: Naloxone (5 mg/kg, i.v.) was given to conscious rats with indwelling venous cannulae. Blood samples were extracted at 5 min post-naloxone to measure plasma oxytocin by ELISA. Under anesthesia, phrenic nerve activity was recorded in vagotomized, paralyzed, and artificially ventilated rats to quantify inspiratory drive following fentanyl (60 nmol/kg, i.v.) and assess OIRD reversal potential following unilateral PVN nanoinjection of naloxone (3 nmol/kg, 50 nL) or vehicle (50 nL). In spontaneously breathing mice with channelrhodopsin expressed exclusively in oxytocin neurons, expired CO 2 was used to monitor rhythmic ventilation and to quantify bradypnea during OIRD. Following fentanyl, blue light (473 nm, 12 mW) pulses (10 ms, 20 Hz) or dummy pulses were delivered to the PVN using a 5 s On/1 s Off pattern for 3 min. Results: Systemic naloxone resulted in a surge in plasma oxytocin compared to vehicle in the conscious rat. Naloxone in PVN both reversed and prevented OIRD by systemic fentanyl in the rat. Photostimulation of PVN oxytocin neurons prevented lethal effects of fentanyl OIRD, whereas dummy pulses failed to prevent lethal respiratory arrest in the mouse. Conclusions: Here, we confirm that naloxone stimulates oxytocin neurons of the PVN and results in a surge of plasma oxytocin. PVN opioid receptor antagonism and photoactivation of PVN oxytocin neurons are individually capable of reversing OIRD. Findings also indicate that PVN oxytocin neurons, previously unrecognized in reversal of OIRD, are a novel target for resuscitation agents.

Coolsense® versus EMLA® for peripheral venous cannulation in adult volunteers: A randomised crossover trial.

Peripheral venous cannulation (PVC) is a commonly performed invasive medical procedure. Topical treatments such as the eutectic mixture of local anaesthetics (EMLA®, Aspen Pharmacare Australia Pty Ltd, St Leonards, NSW) attenuate the associated pain, but are limited by requiring up to one hour of application before becoming effective. The Coolsense® (Coolsense Medical Ltd., Tel Aviv, Israel) pain numbing applicator is a new device using a cryoanalgesic means to anaesthetise skin within seconds. Coolsense is being increasingly used for cannulation, but comparative studies are lacking. We recruited 64 healthy adult volunteers to this open-label two sequence, two period randomised crossover trial. Participants had two 20 gauge venous cannulae inserted, one on the dorsum of each hand. Each cannulation attempt was preceded by treatment with Coolsense or an EMLA patch containing 2.5% lidocaine and 2.5% prilocaine. The primary outcome was participant pain using the 0-10 numerical pain rating scale. Secondary outcomes were participant satisfaction scores on a 0-10 scale, treatment preference, and failed cannulation attempts. Participants were randomly assigned to either the Coolsense EMLA (n = 32) or EMLA Coolsense (n = 32) sequence. All participants completed the trial. The pooled mean paired difference of the numerical pain rating scale was -1.84 (95% confidence intervals -1.28 to -2.41; P < 0.001) in favour of EMLA. The pooled mean paired difference for satisfaction score was 2.26 (95% confidence intervals 1.46 to 3.07; P < 0.001) higher with EMLA. Most participants preferred EMLA over Coolsense (P < 0.001). There was no significant difference regarding failed cannulation between the two treatments (P = 0.14). Among healthy individuals undergoing elective PVC, EMLA was associated with reduced pain, increased satisfaction, and was the preferred treatment compared to Coolsense.

The effect of local warming before vascular access on vascular access indicators in adult patients receiving chemotherapy: A systematic review

Background: Intravenous (IV) cannulation is difficult, especially in patients undergoing chemotherapy due to frequent exposure to venous catheterization as well as the destructive effects of chemotherapy drugs on the vessel wall. Therefore, an easy, accessible, and fast method is needed to facilitate venous cannula insertion. Objectives: This study aimed to systematically review studies on the effects of local warming before insertion of peripheral venous cannulas on vascular access in adult patients receiving chemotherapy. Methods: This systematic review was conducted by searching databases including PubMed, Scopus, Cochrane, Embase, CINAHL, and ProQuest. The full search of information sources was conducted from the inception of the databases up to December 7, 2020, using the keywords namely “warming”, “heat”, “chemotherapy”, “cancer”, “vein score”, “catheterization”, “visibility,” and “palpability.” All randomized and nonrandomized trials that were in English language and full text were included. The search was based on the PRISMA guidelines, and finally, six articles were selected for the review. The 8-item JADAD scale was used to evaluate the quality of the included articles. Results: After a complete search, 244 articles were recovered and reviewed. Finally, six articles, including 516 samples, met the criteria for entering the study. Findings indicated that local warming at the IV insertion site increased insertion success rate at the first attempt, increased vein score, increased patient satisfaction and relaxation and reduced the catheterization time, reduced pain intensity, reduced pain perceived by the nurse, and reduced the number of pricks. Conclusion: Findings suggest that using local warming at the IV insertion sites in patients receiving chemotherapy is an effective, easy, and cost-effective method that can be performed using very simple tools and is recommended for all health care providers.

IS THE SWAN-GANZ CATHETER EXCLUSIVELY A TOOL FOR PRESSURE MEASUREMENTS INSIDE THE PULMONARY CIRCULATION? THE MECHANICAL CONTRIBUTION OF THE PULMONARY ARTERY CATHETER TO A CRITICAL DECISION MAKING INTRAOPERATIVELY

Introduction The Pulmonary Artery Catheter (PAC) Swan-Ganz, despite the widespread rumours regarding the possible complications that correlate with its insertion, such as the pulmonary artery rupture, is still - in the experienced hands - an essential tool of hemodynamic monitoring in cardiac surgery. In combination with Transoesophageal Echocardiography (TOE) though, they offer to the Anaesthesiologist an integrated profile of pressure, volume, flow velocity and anatomical information. However, there can still be occasions where the above mentioned hemodynamic and non-hemodynamic data are not enough to guide the surgical decision-making process intraoperatively. In this case report, we present the contribution of the difficulty in advancing the PAC into the Right Atrium (RA), as an indication of Superior Vena Cava (SVC) stenosis, and the need to return to CardioPulmonary Bypass (CPB) to repair it, during a surgery of totally endoscopic Atrial Septal Defect (ASD) closure. Methods A 40yr old female patient is undergoing totally endoscopic cardiac surgery with CPB for the closure of a Superior Sinus Venosus ASD with simultaneous anomalous drainage of the Right Upper Pulmonary Vein (RUPV) into the SVC. The anaesthetic monitoring includes arterial line, PAC and TOE, which confirms the preoperative findings (Figure 1,2,3), while for the needs of the operation the Anaesthesiologist inserts also a CPB cannula in the Right Internal Jugular Vein. Later on, during the phase that the surgeon is advancing the second venous CPB cannula through the femoral vein and the Inferior Vena Cava (IVC) into the RA, the PAC is being withdrawn from its wedge position and is left high inside the SVC, showing the Central Venous Pressure (CVP). Results After the closure of the ASD and the flow diversion of the RUPV into the Left Atrium with a bovine pericardial patch, deairing is taking place, the restoration of the ASD is being confirmed with the TOE and successful CPB weaning occurs. A subsequent TOE scan shows turbulence inside the SVC with the colour Doppler (Figure 4), indicative of stenosis, while the CVP is 15mmHg, and the dilemma that is coming up is if the stenosis is clinically significant or not. However, at the same time it is impossible to readvance the PAC into the RA, an indication of severe SVC stenosis, and the team decides to return to CPB to repair it. After the placement of a second pericardial patch that widens the RA-SVC junction on a beating heart, laminar flow is being depicted inside the SVC (Figure 5), the PAC is being seamlessly floated into the RA (Figure 6) until its wedge position, and the CVP is 8mmHg. The short and the long-term postoperative periods were uncomplicated. Discussion The intraoperative use of the PAC in the current case report, and the difficulty in readvancing it more specifically, proved to be crucial in making an undoubtedly critical decision towards repairing a stenosis that could have been overlooked, if we had simply relied on the CVP, and become even fatal in case of delayed diagnosis. The mechanical contribution of the PAC has been underlined.

Safety and efficacy of peripheral versus centrally administered vasopressor infusion: A single-centre retrospective observational study

BackgroundShock affects one-third of patients admitted to intensive care and is associated with increased mortality. Vasopressor medications are used to maintain blood pressure in shock. Central venous catheters are associated with serious complications and pose logistical difficulties for insertion. Delivery of vasopressors via peripheral intravenous cannula may be a safe alternative. MethodsThis is a retrospective cohort study comparing safety profile and outcomes of vasopressor delivery via peripheral and central routes in critically ill patients over a 12-month period in a mixed medical-surgical intensive care unit. Demographics, clinical characteristics, treatments, and safety outcome data were extracted from medical records. Patients were classified into three groups: vasopressor infusions via peripheral intravenous cannula, combined peripheral intravenous cannula followed by central venous catheter, and central venous catheter only. Groups were compared using the Kruskal–Wallis test for continuous variables and Fisher's exact test for categorical variables. The impact of duration of vasopressor infusion on complication rates was assessed using logistic regression. ResultsWe identified 212 patients who received vasopressor infusion, 39 received via peripheral only (Group 1), 155 via peripheral followed by central (Group 2), and 18 via central only (Group 3). There were some baseline differences between groups. Group 1 had the lowest median Acute Physiology and Chronic Health Evaluation III score (64, interquartile range = 44–77), and Group 3, the highest (86, interquartile range = 57–101). Duration of vasopressor infusion was shortest in Group 1 and longer in Groups 2 and 3. There were no major complications; however, minor complications such as leakage, extravasation, and erythema occurred in 41% of Group 1 and 28% of Group 2 patients. Duration of peripheral vasopressor infusion was not associated with an increased risk of complications. ConclusionsAdministration of vasopressor infusions for short duration in critically ill patients via a peripheral venous cannula may be feasible, with low rates of complications, and offers a safe alternative to central venous access.

Minimally invasive and robotic approaches to mitral valve surgery: Transthoracic aortic crossclamping is optimal

Minimally invasive and robotic approaches to mitral valve surgery: Transthoracic aortic crossclamping is optimal

Sphingomonas paucimobilis septicaemia in a tertiary care hospital in Nigeria: a case report

Sphingomonas paucimobilis is an opportunistic pathogen that occurs naturally in the environment. It has been implicated in both community acquired and healthcare associated infections. Sphingomonas paucimobilis septicaemia is commonly associated with contamination from the environment, the use of hospital and laboratory equipment, indwelling urinary catheters and intravenous cannula. Literature search for Sphingomonas paucimobilis septicaemia revealed several case reports documented globally with only a single case report from Nigeria detected by VITEK 2. We report a case of Sphingomonas paucimobilis septicaemia in 38-year-old unbooked 21 woman, P1+2(1A), admitted into the accident and emergency unit of Lagos University Teaching Hospital, Lagos, Nigeria, with complaints of fever, abdominal pain and distension, generalized body pain and difficulty in breathing, of six days post Caesarean section. Blood culture yielded Sphingomonas paucimobilis. Antibiotics were commenced at admission and exploratory laparotomy done seven days post presentation. However, patient died on day fourteen due to cardiopulmonary arrest.

Safety and utility of modified ultrafiltration in pediatric cardiac surgery.

Modified ultrafiltration (MUF) is employed at the termination of cardiopulmonary bypass (CPB) in pediatric and neonatal patients undergoing congenital heart surgery to reduce the accumulation of total body water thus increasing the concentration of red blood cells and the other formed elements in the circulation. Modified ultrafiltration has been reported to remove circulating pro-inflammatory mediators that result in systemic inflammatory response syndrome (SIRS) postoperatively. Four hundred patients undergoing cardiac surgery requiring cardiopulmonary bypass and weighing less than or equal to 12 kg were retrospectively evaluated for the effectiveness of MUF. After the termination of CPB, blood was withdrawn through the aortic cannula and passed through a hemoconcentrator attached to the blood cardioplegia set and returned to the patient through the venous cannula. The entire CPB circuit volume in addition to the patient's circulating blood volume were concentrated until the hematocrit value displayed on the CDI cuvette within the MUF circuit reached 45% or there was no more volume to safely remove. At the same time a full unit of FFP can be infused as water is being removed, thus maintaining euvolemia. MUF was performed in all 400 patients with no MUF-related complications. Following the conclusion of MUF, anecdotal observations included improved surgical hemostasis, improved hemodynamic parameters, decreased transfusion requirements, and decreased ventilator times. Complete MUF enables the clinician to safely raise the post-CPB hematocrit to at least 40% while potentially removing mediators that could result in SIRS. In addition a full unit of FFP can be administered while maintaining euvolemia.

Comparison of the efficacy of different venous intubation in venous-arterial extracorporeal membrane oxygenation assisted lung transplantation

To compare the curative effects of different venous cannulas and drainage to improve patient's whole body oxygenation during the auxiliary process of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in lung transplantation. From December 2016 to December 2019, 12 patients who were assisted by VA-ECMO in one lung transplantation in People's Hospital of Henan Province were selected as the research objects. According to the number of side holes of venous cannulas, they were divided into two groups: one group with few side holes and other group with multiple side holes. The differences in blood gas indexes among the right radial artery, left radial artery, and right internal jugular vein before and after assistance were compared, and the assistance effect was evaluated. The arterial partial pressure of oxygen (PaO2) of blood gas indexes of the right and left radial arteries in both groups were significantly higher than that before assistance [mmHg (1 mmHg = 0.133 kPa): right and left radial artery in few side holes group: 79.5±4.2 vs. 48.3±3.8 and 88.1±3.5 vs. 48.3±3.8; right and left radial artery in multiple side holes group: 67.7±5.9 vs. 48.7±3.2 and 84.0±3.8 vs. 48.7±3.2, all P < 0.05]. The arterial partial pressure of carbon dioxide (PaCO2) of blood gas index was significantly lower than that before assistance (mmHg: 44.2±2.6 vs. 71.7±4.4 for the right radial artery and 44.7±1.4 vs. 71.7±4.4 for the left radial artery in the group with few side holes; 46.2±2.1 vs. 71.2±3.5 for the right radial artery and 44.1±1.9 vs. 71.2±3.5 for the left radial artery in the group with multiple side holes, all P < 0.05). The partial pressure of oxygen in venous blood (PvO2) of blood gas index of ECMO system in the group with few side holes was significantly lower than that of the multiport side holes group (mmHg: 56.4±3.2 vs. 88.7±1.5, P < 0.01), and the partial pressure of carbon dioxide in venous blood (PvCO2) was significantly higher than that of multiport side holes group (mmHg: 63.6±3.7 vs. 44.2±1.7, P < 0.01). When VA-ECMO is used in lung transplantation, the superior vena cava blood flow can be fully drained by using intravenous cannula with few side holes. It can effectively improve the oxygenation of the upper body of lung transplant patients, avoid the dilemma of hypoxemia in the upper body and hyperxemia in the lower body, provide more effective assistance to patients undergoing single lung transplantation, and is more meaningful for improving the oxygenation status of the whole body in patients undergoing single lung transplantation.

Changing practice to using pre-filled syringes for flushing IV cannulas.

In the UK, the Medicines and Healthcare products Regulatory Agency classifies 'pre-filled syringes' for flushing Intravenous (IV) cannulas and IV access devices as 'borderline' devices and offers some advice on how control measures can help mitigate risks. The Medicines Act (1968) and Medical Device Regulations try to address the legal position of these devices and allow each employer to identify those groups of staff allowed to use them. In turn, this may help address anomalies around the need to prescribe and document their use. This article describes how one large university health board in Wales implemented a change in products and practice and explores the issues around adopting and using CE-marked pre-filled, sterile syringes of 0.9% sodium chloride in place of manually drawing up an IV flush (the CE mark indicates devices that conforms with European legal requirements). Whether the use of individual components or a single pre-filled device can lead to a streamlined and cost-effective way to manage the flushing of IV cannula and vascular access devices was explored. Additional risk factors were identified, and the legal status clarified in line with current guidelines and regulations. As 0.9% sodium chloride in ampoules and vials is classified as a prescription-only medicine, the administration needs control via formal prescription or a patient group direction. Adopting and using these pre-filled syringes as CE-marked medical devices requires careful consideration and sign-off from each employing authority, before implementing them for flushing IV cannulas and IV access devices.

Pre-operative peripheral intravenous cannula insertion failure at the first attempt in adults: Development of the VENSCORE predictive scale and identification of risk factors

Study objectiveOur objective was to develop a clinical scale (the VENSCORE) to predict pre-operative peripheral intravenous cannula (PIVC) insertion failure at the first attempt in adults. DesignThis was a prospective multicenter cohort study that included internal validation with bootstrapping. SettingThe operating rooms of 14 hospitals in southern France from June 2016 to June 2018. PatientsConsecutive adult patients aged 18 years or older were recruited upon arrival to the operating room, regardless of American Society of Anaesthesiology (ASA) physical status. InterventionsPIVC insertion on arrival to the OR. MeasurementsPIVC insertion failure at the first attempt was the outcome of interest. Data collected included the number of PIVC insertion attempts and potential predictors of the risk of failure (including pre-operative patient characteristics and data relative to the procedure). Uni- and multivariable logistic analyses were performed. Based on these results, the VENSCORE scale was developed to predict the risk of failure of the first PIVC insertion. Main resultsIn total, 3394 patients were included, and 27 were excluded because of protocol violations. The PIVC insertion failure rate at the first attempt was 20.3%. Based on multivariable analysis, a history of difficult PIVC insertions, high-risk surgery, poor vein visibility, and moderate to poor vein palpability were identified as risk factors for insertion failure at the first attempt. The area under the curve of the predictive model was 0.82 (95% confidence interval: 0.80–0.84). A VENSCORE value of 0 points was associated with a failure rate of 7%, versus 97% for a score of 6. ConclusionsThe four-item VENSCORE scale could be useful for prospectively identifying adults at risk of first PIVC insertion attempt failure.