Silastic Catheter Research Articles

Short-Chain Fatty Acids Induce Colonic Mucosal Injury in Rats with Various Postnatal Ages

Short chain fatty acids (SCFAs) may play a role in the pathogenesis of neonatal necrotizing enterocolitis. To evaluate the injurious effect of SCFAs on the colonic mucosa of rats at various postnatal developmental stages, we studied a total of 170 newborn Sprague-Dawley rats at postnatal ages days 3, 9, and 23. A 1.8-F silastic catheter or umbilical catheter was inserted rectally deep into the proximal colon of the rats. Rats from each of the three postnatal age groups were randomly divided to receive one of the following distinct SCFA solutions: acetic acid, butyric acid, propionic acid, or a mixture of above SCFAs solutions. An additional subgroup of rats from each of the age groups received normal saline as a control. The concentration of each SCFA solution was 300 mM, and the pH of all solutions was adjusted to 4.0. The volume of administered solution was 0.1 mL/10 g of body weight. After 24 h, all rats were killed and the daily weight change was recorded and proximal colon was collected for histologic examination. A histologic injury score was used to quantify the severity of mucosal injury. The severity of mucosal injury induced by luminal SCFAs administration decreased as the rats matured; by postnatal day 23, the injury caused by SCFAs was minimal. Thus, the severity of the colonic mucosal injury induced by luminal SCFAs is maturation dependent; the immature state of the mucosal defense in early postnatal age in newborn rat may explain its greater vulnerability to luminal SCFAs.

A realistic brain tissue phantom for intraparenchymal infusion studies.

The goal of this study was to validate a simple, inexpensive, and robust model system to be used as an in vitro surrogate for in vivo brain tissues in preclinical and exploratory studies of infusion-based intraparenchymal drug and cell delivery. Agarose gels of varying concentrations and porcine brain were tested to determine the infusion characteristics of several different catheters at flow rates of 0.5 and 1 microl per minute by using bromophenol blue (BPB) dye (molecular weight [MW] approximately 690) and gadodiamide (MW approximately 573). Magnetic resonance (MR) imaging and videomicroscopy were used to measure the distribution of these infusates, with a simultaneous measurement of infusion pressures. In addition, the forces of catheter penetration and movement through gel and brain were measured. Agarose gel at a 0.6% concentration closely resembles in vivo brain with respect to several critical physical characteristics. The ratio of distribution volume to infusion volume of agarose was 10 compared with 7.1 for brain. The infusion pressure of the gel demonstrated profiles similar in configuration and magnitude to those of the brain (plateau pressures 10-20 mm Hg). Gadodiamide infusion in agarose closely resembled that in the brain, as documented using T1-weighted MR imaging. Gadodiamide distribution in agarose gel was virtually identical to that of BPB dye, as documented by MR imaging and videomicroscopy. The force profile for insertion of a silastic catheter into agarose gel was similar in magnitude and configuration to the force profile for insertion into the brain. Careful insertion of the cannula using a stereotactic guide is critical to minimize irregularity and backflow of infusate distribution. Agarose gel (0.6%) is a useful surrogate for in vivo brain in exploratory studies of convection-enhanced delivery.

Bacterial Adhesion to Surfactant-modified Silicone Surfaces

Ventricular shunt infections are a major contributor to morbidity in patients being treated for hydrocephalus. The majority of these infections are from Staphylococcus epidermidis. Prevention of bacterial adhesion to the silicone surface of a ventricular catheter could decrease shunt infections. We studied the effectiveness of a surfactant and/or 2% iodine prewash on preventing bacterial adhesion to Silastic catheter material. In a laboratory setting, various concentrations of a surfactant, Poloxamer-188 (P188), and a bactericidal agent, iodine, were compared against a control solution in their ability to prevent bacterial adhesion of S. epidermidis to a silicone surface. Silicone wafers were soaked for 1 hour in the test solution, then inoculated and incubated with S. epidermidis for 24 hours. Bacterial counts were then obtained and compared. The most effective method tested in this study was 20% P188, which allowed only 3.02% bacterial adhesion compared with 22.2% bacterial adhesion in the control (P < 0.001). P188 at a 10% concentration or 20% mixed with iodine had the next most effective inhibition. Of the germicidal solutions, a 5-ppm solution of iodine was the most effective. The most ineffective method tested was 2 ppm iodine, which allowed 13.2% bacterial adhesion. Use of a surfactant and/or a germicidal will provide some protection against bacteria attaching to silicone surfaces before they are surgically implanted. The use of a surfactant soak of 20% P188 or iodine at a concentration of 5 ppm before inoculation with S. epidermidis significantly decreased the bacterial adhesion to silicone wafers. This finding has relevance to clinical practice because it highlights a simple step undertaken before implanting a ventricular catheter that could reduce the adhesion rate of the most common contaminant of these catheters. This step may become an important factor in decreasing infection rates in shunt-dependent patients.

Effects of nitric oxide on morphine self-administration in rat

Previous studies have reported that morphine exerts its effects in part through the release of nitric oxide (NO). In the present study, the effects of acute and chronic administration of the NO precursor, l-arginine and NO synthase (NOS) inhibitor, l-nitro-amino-methyl-ester (l-NAME) on morphine self-administration in rats were investigated. The animals were initially trained to press a lever using food as reinforcer. Rats were surgically prepared with a chronic Silastic catheter implanted in the external jugular vein. Five days after surgery, they were trained to press a lever for drug self-administration. The present data indicate that l-arginine (0.05, 0.1, and 0.15 mg/kg/injection) but not l-NAME (0.05, 0.1, and 0.15 mg/kg/injection) induced self-administration behavior and increased locomotion. The response induced by l-arginine (0.1 mg/kg/injection) was reduced by pretreatment with l-NAME (5, 10, and 15 mg/kg ip). Both the acute (5, 10, and 15 mg/kg ip) and the chronic (200 mg/kg ip; twice daily for 4 days) administration of l-arginine reduced morphine self-administration. However, acute (5, 10, and 20 mg/kg ip) and chronic (50 mg/kg ip; twice daily for 4 days) administration of l-NAME increased morphine self-administration significantly. It can be concluded that NO may have a role in morphine self-administration.

Effects of nitric oxide on morphine self-administration in rat

Previous studies have reported that morphine exerts its effects in part through the release of nitric oxide (NO). In the present study, the effects of acute and chronic administration of the NO precursor, l-arginine and NO synthase (NOS) inhibitor, l-nitro-amino-methyl-ester ( l-NAME) on morphine self-administration in rats were investigated. The animals were initially trained to press a lever using food as reinforcer. Rats were surgically prepared with a chronic Silastic catheter implanted in the external jugular vein. Five days after surgery, they were trained to press a lever for drug self-administration. The present data indicate that l-arginine (0.05, 0.1, and 0.15 mg/kg/injection) but not l-NAME (0.05, 0.1, and 0.15 mg/kg/injection) induced self-administration behavior and increased locomotion. The response induced by l-arginine (0.1 mg/kg/injection) was reduced by pretreatment with l-NAME (5, 10, and 15 mg/kg ip). Both the acute (5, 10, and 15 mg/kg ip) and the chronic (200 mg/kg ip; twice daily for 4 days) administration of l-arginine reduced morphine self-administration. However, acute (5, 10, and 20 mg/kg ip) and chronic (50 mg/kg ip; twice daily for 4 days) administration of l-NAME increased morphine self-administration significantly. It can be concluded that NO may have a role in morphine self-administration.

Surgical management of petrous apex cholesterol granulomas.

To review surgical approaches for drainage of petrous apex cholesterol granulomas, define the criteria for the selection of each approach, and identify factors affecting surgical outcome. Retrospective chart review and follow-up survey questionnaire. Tertiary neurotologic referral center. Thirty-four patients who underwent surgical treatment for symptomatic cholesterol granulomas of the petrous apex, who had a minimum of 3 months of clinical follow-up care and, in some cases, postoperative radiologic follow-up studies. Drainage with or without removal of the cyst lining was achieved through the transcanal infracochlear, transmastoid infralabyrinthine, middle fossa, translabyrinthine, and transotic approaches. Silastic catheters were used to stent drainage sites in some cases. Relief of symptoms, postoperative cranial nerve function, clinical and radiologic recurrence, and need for further surgical intervention were evaluated. Imaging studies were reviewed to determine how anatomic information influenced surgical decisions and outcome. Clinical improvement of symptoms was observed in 28 patients (82%), and recovery of cranial nerve function was observed in 8 of 9 affected individuals. Serviceable hearing was preserved in all but 1 patient. Five patients required revision surgery for recurrent symptoms and lesions. All 5 patients had undergone drainage procedures without the use of stents. The size of the lesion did not influence the surgical outcome. Determination of the appropriate surgical approach to the petrous apex is based on hearing status in the affected ear and on the anatomic relationships between the lesion and the surrounding neurovascular structures. The translabyrinthine approach is useful in nonhearing ears. In hearing individuals, anatomy permitting, the transcanal infracochlear approach with stenting is the preferred approach for drainage of petrous apex cholesterol granulomas.

Salvaging the indwelling central venous line: a technical note

Long-stay indwelling silastic venous catheters are in widespread clinical use. The tunnelled subcutaneous Hickman line [ [1] Morton J.E. Jan-Mohamed R.M.I. Barker H.F. Milligan D.W. Percutaneous insertion of subclavian Hickman catheters. Bone Marrow Transpl. 1991; 7: 39-41 PubMed Google Scholar ] inserted either surgically under general anaesthetic or percutaneously by interventional radiologists in angiography suites are comparable [ 2 Young D. Kettlewell M. Hamilton H. Inserting central venous catheters: case for angiographically guided placement is not proved. Br Med J. 1995; 311: 1090 Crossref PubMed Google Scholar , 3 du Toit J.M.G. Kaftansky R. Wood L. Jacobs P. A risk-to-benefit-analysis for central venous catheters. Transfus Sci. 1996; 17: 379-383 Abstract Full Text PDF PubMed Scopus (2) Google Scholar , 4 Keung Y.K. Watkins K. Chen S.C. Groshen S. Silberman H. Douer D. Comparative study of infectious complications of different types of chronic central venous access devices. Cancer. 1994; 73: 2832-2837 Crossref PubMed Scopus (50) Google Scholar ] and integral to standard practice in many chemotherapy and transplant programmes. Provided attention is given to technical detail excessive bleeding and haematoma formation occur infrequently. However, there are two major reasons for these becoming dysfunctional and lack of experience frequently leads to their unnecessary removal. Conversely failure to appreciate the relationship between this foreign body and the associated clinical signs may delay potentially important corrective action.

Prevention of overt hypoglycemia during exercise: stimulation of endogenous glucose production independent of hepatic catecholamine action and changes in pancreatic hormone concentration.

These studies were conducted to determine the magnitude and mechanism of compensation for impaired glucagon and insulin responses to exercise. For this purpose, dogs underwent surgery >16 days before experiments, at which time flow probes were implanted and silastic catheters were inserted. During experiments, glucagon and insulin were fixed at basal levels during rest and exercise using a pancreatic clamp with glucose clamped (PC/GC; n = 5), a pancreatic clamp with glucose unclamped (PC; n = 7), or a pancreatic clamp with glucose unclamped + intraportal propranolol and phentolamine hepatic alpha- and beta-adrenergic receptor blockade (PC/HAB; n = 6). Glucose production (R(a)) was measured isotopically. Plasma glucose was constant in PC/GC, but fell from basal to exercise in PC and PC/HAB. R(a) was unchanged with exercise in PC/GC, but was slightly increased during exercise in PC and PC/HAB. Despite minimal increases in epinephrine in PC/GC, epinephrine increased approximately sixfold in PC and PC/HAB during exercise. In summary, during moderate exercise, 1) the increase in R(a) is absent in PC/GC; 2) only a moderate fall in arterial glucose occurs in PC, due to a compensatory increase in R(a); and 3) the increase in R(a) is preserved in PC/HAB. In conclusion, stimulation of R(a) by a mechanism independent of pancreatic hormones and hepatic adrenergic stimulation is a primary defense against overt hypoglycemia.

Anastomotic Urethroplasty For Bulbar Urethral Stricture: Analysis Of 168 Patients

We reviewed our experience with anastomotic urethroplasty for anterior urethral stricture. A chart review revealed 168 patients 6 to 82 years old (mean age 38) with at least 6 months of followup (mean 70, range 6 to 291) after anastomotic urethroplasty. Average stricture length was 1.7 cm. Of the 168 patients stricture recurred in 8 (5%) but was managed by direct vision internal urethrotomy or a single dilation in 5, while repeat urethroplasty was required in 3 (2%). In these 3 cases extenuating circumstances included patient dislodgment of the catheter with attempts to replace it that disrupted repair, a history of urethrocutaneous fistula and periurethral abscess, and previous irradiation complicating the stricture in 1 each. Other complications were uncommon, such as transient thigh pain or numbness in 3 patients (2%), small wound dehiscence in 2 (1%), and scrotal hematoma, erectile dysfunction and self-limited pulmonary edema in 1 (less than 1%) each. Anastomotic urethroplasty for anterior stricture has a high success rate of 95%. It is technically straightforward and complications are uncommon. Cure by anastomotic urethroplasty should be strongly favored over long-term management by direct vision internal urethrotomy or dilation.

Usefulness of Introducer Technique Combined with a Commercially Available Anchoring Device for Percutaneous Endoscopic Gastrostomy

Background and Purpose: The pull or push technique for percutaneous endoscopic gastrostomy (PEG) placement has some disadvantages. We have safely performed PEG with the introducer technique using an anchoring device that secures the stomach to the abdominal wall. Patients and Methods: Two patients with neurologic impairment and one with lockjaw underwent PEG with the introducer technique because of feeding difficulties. In the former patients, retroflexion of the neck developed excessively, and periodic changing of the feeding tube was hard to perform. With the patient under general anesthesia, two fixing sutures for gastropexy were placed 2 cm apart using the anchoring device. Between the fixing sutures, a puncture needle with a peel-away sheath was passed into the stomach, and a 13F Silastic catheter was passed through the sheath. The catheter was secured after a balloon was inflated. Feeding was started 24 hours after the catheter insertion. Results: The operative times for the various cases were 42, 6...

Endotoxin decreases 51CrCl3 uptake in early weaned pigs.

Endotoxin, a product of bacterial infections, was used to investigate the effects acute infections on chromium (Cr) uptake in early weaned (14 d of age) pigs. At d 18, pigs were anesthetized, and a 2-mm silastic jugular catheter was inserted and passed subcutaneously to a dorsal position behind the ear. At d 21, pigs were deprived of food for 7 h and injected intraperitoneally with saline or 25 microg endotoxin (lipopolysaccharide from Escherichia coli serotype 0111:B4) per kg body wt suspended in 9 g/L saline. One hour after dosing, an oral dose of 0.7 mCi of 51CrCl3 was given by micropipet. Blood was sampled from the catheter at intervals until necropsy at 8 h after the 51CrCl3 dose. Blood and tissue samples were counted in a gamma counter. 51Cr in blood was significantly lower at 3, 4, 5, 6, and at 8 h after dosing in endotoxin-injected pigs compared to controls. Eight hours after 51CrCl3 dosing, 51Cr retention was significantly lower in the liver, heart, and kidney in endotoxin-treated pigs and tended to be lower in spleen (p<0.06) and in urine (p<0.16) with endotoxin treatment. These data suggest that during acute infection, there might be decreased Cr uptake and retention.

Subclavian vein catheterization

Summary Subclavian catheterization is a practical procedure providingcentral venous access for multiple purposes. Potential complications are related to anatomic considerations and diminish with increasing operator experience. Infectious complications can be reduced by aseptic surgical placement and meticulous care of the catheter itself, preferably by a dedicated intravenous therapy team. 16 Single-lumen silastic catheters are preferable for longterm TPN and subclavian placement should be discouraged for hemodialysis catheters because of the high incidence of subclavian vein stricture.

Sleeve-Related Thrombosis: A New Form of Catheter-Related Thrombosis

In a detailed study of central venous catheter-related sleeve and thrombosis in experimental animals, a new form of thrombosis was detected and termed sleeve-related thrombosis. A silastic catheter was placed in the jugular vein and the anterior vena cava of 22 rabbits and 54 rats. After intervals of 1, 3, 7 days, 2, 3, 4 weeks and 1, 2, 4, 6 months the veins were examined by light microscopy and by transmission electron microscopy. In about 50% of the rats a thrombus was observed at the end of the catheter sleeve. Consecutive cutting allowed the visualization of a transition from a sleeve via part of sleeve and part of thrombus to a pure thrombus. This thrombus was separated from the vein wall and could not be considered a mural thrombus. As the thrombus was only attached to the terminal part of the organized catheter sleeve we propose the name sleeve-related thrombosis.

Ultrasound-Guided Cannulation of the Femoral Vein for Acute Hemodialysis Access with Silicone Catheters

The percutaneous femoral approach for temporary central venous hemodialysis access is a mandatory part of patient management in many clinical settings. It is usually achieved with a blind, exter-nal landmark-guided technique. The aim of this study is to evaluate whether an ultrasound technique can improve on the external landmark method. From 1990 to January 2000, cannulation of the femoral vein was performed on 230 patients (125 male, 105 female, mean age 72 years, range 52-95 years) for temporary vascular access for hemodialysis (172 patients with acute renal failure and 58 patients in end-stage renal disease), using landmark localization with semi-rigid, uncuffed catheters. Between January 2000 and February 2001, ultrasound-guided can-nulation of the femoral vein was utilized in 38 patients (20 male, 13 female, mean age 71 , range 55-93 years) for temporary vascular access for hemodialysis (28 patients with acute renal failure and 10 patients in end-stage- renal failure). Uncuffed, dual-lumen silicone catheters were used. Cannulation of the femoral vein was achieved in 100% of cases using ultrasound, and in 87% using the landmark-guided technique. Using ultrasound, puncture of the femoral artery occurred in 2.6% of patients, and hematoma in 0%. Using the 'blind' technique, puncture of the femoral artery occurred in 11.2% of patients, and hematoma in 3.9%. The average catheter dwell time, in accordance with NKF-DOQI guidelines, was 5 days (range 2 - 14 days) for semi-rigid catheters and 45 days (range 5-120 days) for silastic catheters. The number of complications rose significantly in the patients with semi-rigid catheters. In this group, local exit infection occurred in 105 persons (45% of cases), total catheter thrombosis in 46 (20%), bacteriemia in 28 (12%), and phlebitis of the leg in 6 (2.6%). In the group with silicone catheters local exit infection occurred in 4 patients (10 % of cas-es), total catheter thrombosis in 1 (2.6%), bacteriemia in 2 (5.2%) and phlebitis in 0 (0%). The result of the study suggests that ultrasound-guided cannulation of the femoral vein is superior to traditional techniques relying on anatomic landmark; it reduces the numbers of unsuccessful attempts and the possible acute complications of the procedure. We believe that femoral cannulation with modern flexible silicone catheters can be considered as a reliable temporary access, even for extended periods.

Die Bedeutung der Vena femoralis superficialis bei CVI

Septic phlebitis is characterized clinically by a local syndrome in an arm, the chest or a leg, by an irregular temperature (toothsaw curve), by blood cultures that are simultaneously or successively positive for one or several pathogenic microorganisms, by repeated, multiple infected embolism and by the possibility of endocarditis as a complication. Septic phlebitis occurs either spontaneously (staphylococcosis, syndrome of angina pectoris and infarction), or through secondary infection by secondary microbial colonization of a thrombosis of gynecological or obstetrical origin or, thirdly, as the consequence of venous catheterization (perfusion, pacemaker, explorations). Prevention is based on the selection of the material (silastic piercing catheters), the choice of the site of injection, the observation of strict surgical asepsis and of choice of the fluid injected (no corticoids, nor heparin which inactivates the oligosaccharides). As regards the curative treatment, no use should be made either of heparin or of anti-inflammatory agents (especially no corticoids); first of all, the material that has caused the thrombophlebitis should be withdrawn immediately; secondly, 24 to 36 hours later, a specific antibiotic treatment should be instituted and after two weeks, if still necessary, surgical ligation may be carried out of the inferior vena cava, the subclavian vein or the brachiocephalic venous trunk, depending on the localization of the phlebitis.

Outpatient management of malignant pleural effusions using an indwelling cuffed silastic catheter

Outpatient management of malignant pleural effusions using an indwelling cuffed silastic catheter

Continuous Renal Replacement Therapy in the Initial Management of Neonatal Hyperammonemia Due to Urea Cycle Defects

After completing this article, readers should be able to: 1. Describe the metabolic acidosis that may be seen in urea cycle defects. 2. Delineate the most important factor in determining neurologic outcome in urea cycle defects. 3. Explain the factors that affect the blood ammonia concentration in continuous renal replacement therapy (CRRT). 4. Delineate the most difficult issue in pursuing CRRT in neonates. 5. Describe the morbidities associated with CRRT. MP was born at 39 weeks' estimated gestational age by vaginal delivery to a 35-year-old gravida 3 para 2 woman who had an uncomplicated pregnancy. The 3- and 6-year-old female siblings of the patient were healthy. Apgar scores were 8 at 1 minute and 9 at 5 minutes. The newborn was discharged to home after a 2-day stay in the well baby nursery during which time she appeared to be alert and was breastfeeding appropriately. She presented to the emergency department less than 1 day later after her parents noted increasing lethargy and very poor feeding at home. She was admitted to the neonatal intensive care unit (NICU). Results of a complete blood count with differential count and C-reactive protein evaluation were unremarkable, but the patient progressed to worsening lethargy, respiratory failure, and abdominal distension requiring intubation within hours of admission. The anterior fontanelle was soft on admission physical examination. Further testing revealed a base deficit of 6.1 on arterial blood gas, serum ammonia level of 810 mcmol/L (1,134 mcg/dL), serum lactate level of 5.6 mmol/L (5.6 mEq/L), and serum pyruvate level of 0.06 mmol/L. Results of liver function tests were abnormal, and the infant had a prothrombin time of 35.9 seconds, a partial thromboplastin time of 54.3 seconds, and a fibrinogen concentration of 1.75 g/L (175 mg/dL). Genetic and nephrology consultations were requested immediately. Additional metabolic studies were obtained, including measurement of plasma amino …

Whole gut washout ameliorates the progression of acute experimental pancreatitis

Background: Septic complications are mainly responsible for deterioration of a patient with acute pancreatitis. Intestinal tract is accepted as the main source of pancreatic or peripancreatic infection. Material andmethods: Acute pancreatitis was induced in 40 Sprague-Dawley rats by ligation of the main biliopancreatic duct. Animals were divided into two groups. The first group of animals (n = 20) received high volume polyethylene glycol-3500 (GoLYTELY) for 6 hours through a silastic catheter introduced into the proximal part of the jejunum from a puncture gastrostomy during the initial laparotomy. The second group animals (n = 20) did not receive any treatment. Half of the animals from each group were sacrificed 72 hours later and tissue samples were taken from mesenteric lymph nodes, pancreas, spleen, and liver for bacteriologic cultures. Cecum cultures were also prepared. Blood samples at 72 hours were obtained for the measurement of amylase, lactic dehydrogenase (LDH), lactic acid, alanine aminotransferase (ALT), glucose, calcium, arterial pH, base excess, partial oxygen pressure, bicarbonate, leucocyte count, and hematocrit levels. The pancreas was examined histopathologically. The remaining half of the animals from each group were allowed to survive until death. Results: The levels of amylase, LDH, ALT, lactic acid, pH, pO 2, bicarbonate and base excess for the rats in group I were significantly lower when compared with the rats in group II ( P <0.05). Positive mesenteric lymph node cultures were detected in 30% of group I animals whereas they were positive in 90% of group II animals ( P = 0.0198). Distant organ cultures were positive in 8 animals (liver 5, spleen 2, pancreas 1) in group II, whereas only one positive distant organ culture (liver) was established in group I ( P >0.05). Histopathological scoring observed in the pancreas were less severe for the rats in group I when compared with the rats in group II ( P = 0.012). The rats in group I survived longer than the rats in group II (median survival 6.8 days versus 17.3 days, P <0.001). Conclusions: Whole gut washout with high-volume polyethylene glycol in pancreatitis reduced the blood levels of enzymes and increased the survival. Whole gut washout for acute pancreatitis appears effective to ameliorate the prognostic factors in blood and this modality may be a promising treatment method in acute pancreatitis.

Brachial Plexus Catheter Reservoir for the Treatment of Upper-extremity Cancer Pain: Technical Case Report

Infiltration of the brachial plexus with anesthetics can provide relief of upper-extremity pain from invasive cancer. Because the analgesia is short-lived, however, repeated invasive treatments are necessary. We describe the implantation of a catheter reservoir system, in which anesthetic injections through a subcutaneous port resulted in anesthetic infiltration of the brachial plexus. A 47-year-old Hispanic man with squamous cell carcinoma of the larynx had undergone surgical resection, radiation treatment, and chemotherapy. Two years later, he had locally recurrent disease involving the brachial plexus, neck, and chest wall. The patient's pain was minimally responsive to narcotics, which also caused severe nausea and anorexia. The brachial plexus was localized percutaneously with a needle electrode stimulator. Contrast injection under fluoroscopy confirmed entry into the plexus sheath. With use of the Seldinger technique, two Silastic catheters were placed within the brachial plexus and attached with a "Y" connector to a reservoir. The patient experienced complete relief of upper-extremity pain after a test injection with xylocaine. Thereafter, serial injections of bupivacaine with triamcinolone at 1-week intervals provided complete pain relief. After the treatments were initiated, the patient reported improved sleep and an improvement in his quality of life. A catheter reservoir system for brachial plexus analgesia can provide safe and effective analgesia for upper-extremity pain. This technique negates the need for repeated invasive procedures and avoids the complications of neurolysis.

Multi-purpose silastic dual-lumen central venous catheters for both collection and transplantation of hematopoietic progenitor cells.

Autologous peripheral blood progenitor cell (PBPC) transplantation frequently requires sequential placement and use of two separate central venous catheters: (1) a short-term, large-bore, stiff device inserted for leukapheresis, and after removal of that device, (2) a long-term, multi-lumen, flexible, Silastic catheter for administration of high-dose chemotherapy, re-infusion of hematopoietic cells, and intensive supportive care. We reviewed our recent experience with two dual-lumen, large-bore, Silastic multi-purpose ('hybrid') catheters, each of which can be used as a single device for both leukapheresis and long-term supportive care throughout the transplant process. Quinton-Raaf PermCath and Bard-Hickman hemodialysis/apheresis dual-lumen catheters were used as the sole venous access device in 112 consecutive patients who underwent autologous PBPC collection and transplantation. The catheter exit site was monitored three times a week, and lumen patency was assessed using clinical and radiologic techniques. Catheters were removed prematurely for persistent thrombus, positive blood cultures despite appropriate antibiotics, or mechanical dysfunction. There were no intra-operative or immediate post-operative complications relating to insertion. Thirty-two patients experienced catheter occlusion necessitating urokinase instillation. Persistent occlusive problems were noted in 16 patients, and in 10 patients the catheter had to be removed. Two exit site infections and 17 bacteremias occurred. Catheters had to be removed for persistent infection in two subjects and for mechanical problems in five others. Cost analysis comparing the hybrid catheters alone vs conventional devices revealed a charge of $4230 in patients with hybrid catheters vs. $7530 in those requiring a temporary non-Silastic dialysis catheter in addition to a flexible, long-term Silastic catheter. Hybrid, Silastic, dual-lumen, large-bore central venous catheters are safe, cost-effective and convenient multi-purpose venous access devices that may be used in the setting of autologous PBPC collection and transplantation. The rate of thrombotic, infectious and mechanical complications appears comparable to other central venous access devices.