Vein Catheterization Research Articles

Recognizing misplacement of a dialysis catheter in the azygos vein

Uneventful central venous catheterization for hemodialysis patients may not always result in a correct tip position. A case of inadvertent cannulation of the azygos vein is described. Radiographic features for its early recognition are emphasized and mechanisms related with azygos unintended catheterization are discussed.

Central Venous Catheter Placement: Where Is the Tip?

The insertion of central venous catheters is a common bedside procedure performed in intensive care units. Here, we present a case of an 82-year-old man who underwent insertion of a central venous catheter in the internal jugular vein without perceived complications. Postprocedural radiographs showed rostral migration of the catheter, and computed tomography performed coincidentally showed cannulation of the jugular bulb at the level of the jugular foramen. To our knowledge, this is the first report to document migration of a central venous catheter from the internal jugular vein into the dural sinuses, as confirmed by computed tomography. The case highlights the importance of acquiring postprocedural radiographs for all insertions of central venous catheters to confirm catheter placement.

Glutamatergic neurotransmission in the hypothalamus PVN on heart rate variability in exercise trained rats

The paraventricular nucleus of hypothalamus (PVN) is a well known site of integration for autonomic and cardiovascular responses, and the glutamate neurotransmitter plays an important role. The aim of our study was to evaluate the cardiovascular parameters and autonomic modulation by means of spectral analysis after ionotropic glutamate receptor inhibition in the PVN in conscious sedentary (S) or swimming trained (ST) rats. After exercise training protocol, adult male Wistar rats, instrumented with guide cannulae to PVN and artery and vein catheters were submitted to mean arterial pressure (MAP) and heart rate (HR) recording. At baseline, physical training induced a resting bradycardia (S: 379 ± 3, ST: 349 ± 2 bpm, Pb<0.05) and promoted adaptations in HRV characterized by an increase of HF in normalized values and a decrease of LF in absolute and normalized units compared with the sedentary group. Microinjection of kynurenic acid (KYNA) in the PVN of sedentary and trained rats promoted decreases in MAP and HR, but the decrease in HR was smaller in the trained animals (ΔHRS: -48 ± 7, ST: -28 ± 4 bpm, Pb<0.05). Furthermore, the differences in baseline parameters of pulse interval, found between sedentary and trained animals, disappeared after KYNA microinjection in the PVN. Our data suggest that the cardiovascular and autonomic adaptations to the heart induced by exercise training may involve glutamatergic mechanisms in the PVN.

Successful Superior Thyroid Artery Embolisation Using Microporous Beads

During placement of a central catheter in the left internal jugular vein, an arterial puncture led to an expanding haematoma at the level of the thyroid gland due to an ongoing bleeding fed by the left superior thyroid artery, which was successfully treated by embolisation using beads. The micro-porous structure of these microspheres offered optimal attrition, rigidity, elasticity and durability. These beads provided a controlled, targeted embolisation with a better ability to select the desired end point through choice of size.

Effects of acute treatment with dexamethasone on hemodynamic and histopathological changes in rats

We assessed the time-dependent effects of intraperitoneal (i.p.) and intravenous (i.v.) application of dexamethasone (Dexa) on the mean arterial blood pressure (MAP), heart rate (HR) and total blood volume (TBV). We evaluated also the relation between the effects and immunoreactivities of transforming growth factor-beta (TGF-β), epithelial nitric oxide synthase (eNOS), interleukin-1 beta (IL1-β) and vascular endothelial growth factor (VEGF) in rat brain, lung and kidney tissues. Rats were anesthetized and while still breathing spontaneously, a tracheotomy and femoral vein and artery catheterizations were performed. To determine TBV using the hemodilution method, 2 ml albumin-electrolyte solutions were applied by i.v. injection. Group 1 (control group) received a 1 ml bolus injection of physiologic saline, Group 2 received 15 mg/kg and Group 3 received 75 mg/kg Dexa i.p. The hematocrit was measured at 10, 20, 60 and 120 min. For each animal, the values of MAP, HR and TBV were measured within 2 h. For immunohistochemical evaluation, anti-TGF-β, anti-eNOS, anti-IL1-β and anti-VEGF primary antibodies were tested using the avidin-biotin-peroxidase method. TBV was decreased in Group 1 and the increase in MAP was statistically significant. HR values increased slightly. None of the values changed significantly in Group 2. Although TBV was unchanged in Group 3, the decrease in MAP was statistically significant. HR values increased, but the increase was not statistically significant. Mild IL1-β immunoreactivity and moderate TGF-β, eNOS and VEGF immunoreactivities were observed in the brain, lung and kidney samples in Group 1. Increased eNOS immunoreactivity in the kidney samples were observed in Group 2. eNOS immunoreactivity was as strong in the brain and the kidney samples in Group 3. Decreased VEGF immunoreactivity was observed in the lung and kidney tissues in Group 3. Significantly decreased TGF-β immunoreactivity was observed in all tissue samples in Group 3. The decreased MAP values in Group 3 differed from those in Groups 1 and 2. Despite increased eNOS immunoreactivity, especially in brain and kidney, the decrease in VEGF immunoreactivity in Group 3, especially lung and kidney, were consistent with a drop in blood pressure.

Anatomical location of arterial and venous lines significantly affects motor performance in rats

Several motor-function scales have been developed to assess neurological function in animal models of stroke, subarachnoid hemorrhage and closed head injury. We hypothesize that the location of arterial and venous catheters, even in the absence of brain injury, may impact rats' motor performance. Our study examined the effect of catheter location, rate of infection and the time required for catheter placement. We further describe an original technique of tail artery cannulation without exposure of the artery. Sixty-one rats were anesthetized and randomly assigned to one of seven groups, including no catheter, tail artery or artery + vein catheters, or femoral artery or artery + vein catheters. A neurological severity score (NSS) was determined at 1 h, 24 h and 48 h after surgical preparation or catheter placement. NSS at 1 h after placement of unilateral and bilateral femoral catheters was higher than the NSS observed at 1 h after placement of tail arterial and venous catheters (P < 0.01). The NSS also was higher at 24 h in the bilateral femoral catheter groups as compared with the tail catheter groups (P < 0.05). There were no differences in the NSS observed between the groups that had tail catheters and the sham group at 1 h, 24 h or 48 h. Infection rate at the site of catheter placement and the time required for catheter placement was also higher in the femoral catheter groups (P < 0.001). Thus, we propose that the line location may bias a study's results and lead to deceptive interpretations of neurological assessment following rat head injury. Compared to femoral vessels, tail blood vessels are preferable locations for lines placement.

Peritoneal ventilation for oxygenation of asphyxia rabbits

Objective To observe the oxygenation and heartbeat duration effect of peritoneal ventilation with oxygen on a rabbit asphyxia model so as to provide a basis for treatment of severe respiratory damage with peritoneal oxygenation technique. Methods Twenty-four New Zealand rabbits were randomized into control group,air group and oxygen group,eight rabbits per group.Trachea dissection and intubation,carotid artery and vein catheter and placement of peritoneal cavity in and out of air duct were performed.An asphyxia model was built by clamping the tracheal catheter and was administered with peritoneal ventilation (with air in air group and oxygen in oxygen group).Indices including blood gas and mean arterial pressure (MAP) before and at an interval of one minute after asphyxia and heartbeat duration were observed,and their differences between groups were compared. Results The arterial partial pressure of oxygen ( PaO2 ) in the oxygen group was higher than that in the control group within four minutes after asphyxia.The partial pressure of carbon dioxide ( PaCO2 ) [ (77.6 ± 11.2) mm Hg] in the oxygen group was significantly lower than (89.1 ± 10.1 )mm Hg in the control group at four minutes after asphyxia.The heartbeat duration [ (6.48 ± 0.89 ) minutes ] in the oxygen group was longer than (5.03 ± 0.51 ) minutes in the control group.MAP had no obvious changes in the three groups. Conclusion The transperitoneal ventilation with gaseous oxygen can alleviate the decrease of PaO2,increase of PaCO2 and prolong the duration of heartbeat in an asphyxia rabbit model. Key words: Asphyxia; Oxygenators, membrane; Peritoneum; Duration of heartbeat

Bladder sensory signals are positively modulated by urothelial P2X3 and P2X2/3 purinergic receptors in spinal cord injured rats

plete spinal cord transection (spinal cord injured: SCI) at the T8/T9 level or a sham procedure (nonlesion: NL) were performed. Four weeks later, rats were again anesthetized with isofluorane, a suprapubic and a vein catheter were implanted and tracheotomy was performed for artificial ventilation. Laminectomy was executed at the L2 spinal level. The cervical spinal cord was then transected, and rats were pithed. Animals were immobilized on a stereotaxic device, connected to an artificial ventilator and pancuronium (0.2 mg/kg) was i.v. injected.

Can computer tomography help predict feasibility of transseptal puncture after percutaneous closure of an interatrial septal communication?

Transseptal puncture (TSP) is the first step in pulmonary vein isolation and catheter ablation, as well as in left atrial appendage closure in atrial fibrillation. Although TSP has been reported to be successful in patients with device closure of interatrial septal communications, questions pertinent to its feasibility in patients with large devices still remain. We sought to determine whether a "safe zone" for TSP could be visualised by computer tomography (CT), especially if larger device sizes for interatrial septal communication closure (IASC-C) had been used. Retrospective observational study of 20 patients who underwent CT for de novo chest pain occurring after IASC-C or as a diagnostic test for suspected or proven coronary artery disease (CAD). Clinical follow-up was for 20.5 ± 17.6 (6-84) months. CT was done 18 ± 10 (2-28) weeks after IASC-C. Device size and dimensions of both atria in the long and short axes were measured, as was the minimal distance of the device edge to the inferior and inferoposterior atrial floor. The calculated minimal distance from the device edge to the inferior aspect (at 6 o'clock) of the (right or left) atrial floor was 7.2 ± 6.5 (0-27) mm while that to the inferoposterior aspect (at 07:30 o'clock) was 5.3 ± 4.2 (0-15) mm. In both locations, a distance of >6 mm was documented in ten patients (50%) while in nine patients (45%) a space of <6 mm was shown in both locations. There was no correlation between atrial dimensions or device size and minimal device distance to either wall. Conclusion With the exception of cases with the smallest devices (18 and 20 mm), neither device size nor atrial dimensions allow us to predict the feasibility of TSP in patients with a clamshell-type interatrial septal device in place, so that CT may be of help in determining whether a safe puncture space does exist in these patients.

Insertion of Permanent Hemodialysis Catheters through the Great Saphenous Vein

In patients with end stage renal disease when there is inability for the creation of a direct arterio-venous fistula or by using a graft, the insertion of a permanent hemodialysis catheter in a central vein ensures the conduction of hemodialysis. We present a technique of placing a permanent catheter in the inferior vena cava through the great saphenous vein without the use of a guide wire. Over the study period, 12 hemodialyzed patients, with a mean age of 73 years, were referred for placement of a dialysis catheter through the great saphenous veins. The procedure was performed under local anesthesia, ECG monitoring, and fluoroscopic control. The insertion of the tunneled hemodialysis catheters was accomplished with ease, through surgical exposure of the great saphenous vein, without the need for a guidewire. The hemodialysis catheter's function was assessed intraoperatively. No intraoperative or immediate post operative complications were noted while during the study period 3 thromboses and an infection were detected (0,95 per 1000 catheter days). The primary catheter patency rates were 92%, 84%, 54% at 30, 90 and 180 days respectively, varying from 28 to 845 days (mean±SD = 294 ± 243,3). The introduction of dialysis catheters in the inferior vena cava through the great saphenous vein is technically simple with rare complications and with higher patency rates compared to the traditional femoral approach.

INFECTIVE ENDOCARDITIS-RELATED BILATERAL SPONTANEOUS PNEUMOTHORAX IN A HAEMODIALYSIS PATIENT

(MRSA) bacteraemia in another hospi-tal. Two months prior to this admission, he received implanta-tion of a cuffed tunnelled double-lumen catheter in the right jugular vein as the transient vascular access for haemodialy-sis. On the third day of this hospitalization, the haemodialysis catheter was removed under the impression of its related infection. Progressive shortness of breath developed and a chest radiograph showed a left-sided pneumothorax (Fig-ure1A, arrowheads) with progressive consolidation over the right upper lobe, which was absent 3 days before. A com-puted tomographic scan performed after chest tube insertion (Figure 1B) revealed incomplete expansion of the left lung as well as progression of multiple nodular infiltrations and sub-pleural cavities in bilateral lung fields (black arrows). These pulmonary cavities were caused by septic emboli originating from multiple vegetations over the tricuspid valve demon-strated by the transoesophageal echocardiography (Fig-ure 1C, white arrows). Spontaneous pneumothorax has long been recognized as a rare complication of tricuspid endocarditis (1), especially in intravenous drug abusers (2). Bacteraemia associated with tunnelled, cuffed haemodialysis catheters is relatively com-mon (3), and the prognosis of infective endocarditis in hae-modialysis patients is poor (4). The occurrence of persistent bacteraemia in haemodialysis patients using central venous catheter shall prompt the physician to search for possible catheter-related infections, and spontaneous pneumothorax may occur as a catastrophic complication.

Involvement of the paraventricular nucleus (PVN) of hypothalamus in the cardiovascular alterations to head up tilt in conscious rats

We evaluated the involvement of paraventricular nucleus (PVN) in the changes in mean arterial pressure (MAP) and heart rate (HR) during an orthostatic challenge (head up tilt, HUT). Adult male Wistar rats, instrumented with guide cannulas to PVN and artery and vein catheters were submitted to MAP and HR recording in conscious state and induction of HUT. The HUT induced an increase in MAP and HR and the pretreatment with prazosin and atenolol blocked these effects. After inhibition of neurotransmission with cobalt chloride (1mM/100nl) into the PVN the HR parameters did not change, however we observed a decrease in MAP during HUT. Our data suggest the involvement of PVN in the brain circuitry involved in cardiovascular adjustment during orthostatic challenges.

Insertion of Permanent haemodialysis catheters through the great saphenous vein

Aim-BackgroundIn patients with end stage renal disease when there is inability or contraindication for the creation of a direct arterio-venous fistula or the use of a graft, the insertion of a permanent hemodialysis catheter in a central vein ensures the conduction of haemodialysis. We present a technique of placing a permanent haemodialysis catheter in the inferior vena cava through the great saphenous vein. The aim of this study is to show that the above technique is simply, safe and reliable.Patients-MethodsOver the study period, from January 2002 to December 2010, 12 haemodialyzed patients, (8 females and 4 males), with a mean age of 73 years (range 62–91 years), were referred from different renal units for placement of a dialysis catheter through the great saphenous veins. In all patients, the alternative sites of a permanent haemodialysis catheter insertion in the major branches of the superior vena cava had been extensively used. The procedure was performed under local anaesthesia, ECG monitoring, and fluoroscopic control. The insertion of the tunnelled haemodialysis catheters was accomplished with ease, through surgical exposure of the great saphenous vein, without the need for a guidewire.ResultsThe haemodialysis catheter’s function was assessed intraoperatively (blood flow>350 ml/min). No intraoperative or immediate post operative complications were noted. The primary catheter patency duration was recorded, which varied from 28 to 845 days (mean±SD=294±243,3).ConclusionThe introduction of dialysis catheters into the inferior vena cava through the great saphenous vein is technically simple with rare complications and with highly successful results.

Inadvertent bleeding in an infant after inguinal hernioplasty leads to diagnosis of hemophilia B

To the Editor: A seven-month-old male infant who was diagnosed with inguinal hernia at routine medical checkup was admitted to our hospital for surgical repair. Past history and family history were negative for bleeding tendencies, purpura, and hemophilia. Preoperative physical examination and laboratory tests indicated no abnormalities. Coagulation tests were not performed. Hernioplasty was performed with no oozing or complications. The patient was discharged from the operating room at 4 p.m. At 7 a.m. on postoperative day (POD) 1, HR had increased to 132 bpm and BP decreased to 90/40 mmHg. The mother noticed blood contamination of the gauze covering the wound at night, but she did not inform the medical staff. At 9 a.m. on POD1, the attending surgeon noticed the patient to be extremely pale and that the gauze covering the wound was soaked with blood. Blood tests confirmed severe anemia (hemoglobin (Hb) 4.8 g/dl). Emergency hemostasis was performed immediately under general anesthesia. After failure to secure another peripheral venous access, we inserted a central venous catheter in the right internal jugular vein. Preparation of red cell concentrate (RCC) took a long time because blood type screening had not been conducted preoperatively. The coagulation tests showed long APTT (125 s), and thus fresh frozen plasma was transfused. Oozing was observed throughout the surgical field. The blood loss measured intraoperatively was 50 g and laboratory tests at the end of surgery showed Hb 8.9 g/dl, and Ht 26.4% after transfusion of two units of RCC. On POD2, the scrotum began to swell because of oozing which required removal of the stitches to reduce the pressure. On POD6, plasma clotting factor IX was reduced to 8% of the normal value, and he was diagnosed as hemophilia B. Therefore, clotting factor IX was transfused which resulted in complete cessation of oozing on POD11. The patient was discharged on POD26. Routine preoperative management does not include coagulation tests, especially before minor pediatric surgery, for example hernioplasty, for children with no family history of bleeding disorders. Routine use of coagulation tests have been discussed by otorhinolaryngologists who perform elective tonsillectomy and adenoidectomy. Houry et al. [1] and the American Academy of Otolaryngology Head Neck Surgery [2] recommended performing preoperative hemostatic screening tests only for patients with abnormal bleeding history. The reported negative predictive value of normal APTT in the absence of symptoms and M. Sumie (&) T. Yokoo-Matsuoka K. Yamaura Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Maidasi 3-1-1, Higasi-ku, Fukuoka 812-8582, Japan e-mail: sumimako@chorus.ocn.ne.jp

Internal jugular vein thrombosis associated with venous hypoplasia and protein S deficiency revealed by ultrasonography

A 41-year-old woman, who had no thrombotic risk factors and past history except congenital scoliosis, underwent central venous catheterization (CVC) before correction of the scoliosis. When internal jugular vein (IJV) catheterization using the anatomical landmark technique failed, CVC under ultrasound guidance was tried. As a consequence, thrombosis and hypoplasia of the right IJV were incidentally detected by ultrasonography. Central venous catheters were then successfully placed in other veins under ultrasound guidance. Also, after examinations to rule out the possibility of pulmonary embolism and to clarify the causes of the IJV thrombosis, the patient was found to have protein S deficiency. CVC under ultrasound guidance should be recommended to prevent the failure of cannulation and complications such as thromboembolism in patients who could possibly have anomalies of vessels as a result of anatomical deformities caused by severe scoliosis, even if patients do not have thrombotic risk factors such as a history of central catheter insertion or intravenous drug abuse, cancer, advanced age, cerebral infarction, and left ventricular dysfunction. Also, if venous thrombosis is found in patients without predisposing risk factors, one should ascertain the cause of the hypercoagulable state, for example protein S deficiency, and perform appropriate treatment and prevention of venous thromboembolism.

Wie sollen Urologen venöse subkutane Portsysteme implantieren?

Since 1999 urologists at the University of Essen in Germany have performed subcutaneous implantation of venous port systems, controlled by intravasal ECG. Between December 1999 and June 2011 implantation of venous port systems was performed in 241 male (69.5%) and 106 (30.5%) female patients. The port systems were implanted subcutaneously above the pectoralis major muscle under local anesthesia. If it was not possible to isolate the cephalic vein or safe catheter implantation was not feasible, puncture of the subclavian vein was performed. The median follow-up was 491.6 days (2-2568), and 163.254 catheter days (mean 239 days, range 2-2604) were documented. During the follow-up period 191 (55.1%) patients died. The mean surgical implantation and explantation time was 36.5 min (14-85 min) and 25.4 min (10-46 min), respectively; 79.7% were implanted and controlled by ECG. Altogether, 390 devices were used in 379 surgical procedures, 355 implantations (91.1%) and 35 explantations (8.9%). Implanted vessels were the cephalic vein in 303 patients (85.6%) and the subclavian vein in 51 (14.4%) patients. Of 35 explanted devices, the explantation was necessary due to complications in 28 (8.0%) cases: infection n=6 (1.7%, 0.036 per 1,000 catheter days), occlusion n=8 (2.3%, 0.049 per 1,000 catheter days), dislocation n=7 (2.0%, 0.042 per 1,000 catheter days), deep vein thrombosis of the upper extremity n=6 (1.7%, 0.037 per 1,000 catheter days), and clotting n=1(0.3%, 0.006 per 1,000 catheter days). Premature catheter removal (<30 days post-op) was required in six cases (1.9%, 0.036 per 1,000 catheter days) due to complications: three catheter dislocations/malfunctions (0.9%, 0.019 per 1,000 catheter days), one port-related infection, one pocket port infection, and one deep vein thrombosis of the upper extremity (0.3%, 0.006 per 1,000 catheter days). Other problems described in the literature like pneumothorax, vein perforation, or pinch-off syndrome did not occur. Implantation of port systems with ECG control of the catheter tip position is related to a few cases of adverse events and good surgical outcomes. Furthermore, it has also shown great advantages in offering immediate support and early therapy initiation with a fast learning curve for the training urologists. The results of the presented analysis are comparable to those of surgical or radiological departments reported in the literature and provide good evidence that this procedure should be extended to urological centers with a high volume of chemotherapy patients.

Switching control of sympathetic activity from forebrain to hindbrain in chronic dehydration

We investigated the mechanisms responsible for increased blood pressure and sympathetic nerve activity (SNA) caused by 2-3 days dehydration (DH) both in vivo and in situ preparations. In euhydrated (EH) rats, systemic application of the AT(1) receptor antagonist Losartan and subsequent pre-collicular transection (to remove the hypothalamus) significantly reduced thoracic (t)SNA. In contrast, in DH rats, Losartan, followed by pre-collicular and pontine transections, failed to reduce tSNA, whereas transection at the medulla-spinal cord junction massively reduced tSNA. In DH but not EH rats, selective inhibition of the commissural nucleus tractus solitarii (cNTS) significantly reduced tSNA. Comparable data were obtained in both in situ and in vivo (anaesthetized/conscious) rats and suggest that following chronic dehydration, the control of tSNA transfers from supra-brainstem structures (e.g. hypothalamus) to the medulla oblongata, particularly the cNTS. As microarray analysis revealed up-regulation of AP1 transcription factor JunD in the dehydrated cNTS, we tested the hypothesis that AP1 transcription factor activity is responsible for dehydration-induced functional plasticity. When AP1 activity was blocked in the cNTS using a viral vector expressing a dominant negative FosB, cNTS inactivation was ineffective. However, tSNA was decreased after pre-collicular transection, a response similar to that seen in EH rats. Thus, the dehydration-induced switch in control of tSNA from hypothalamus to cNTS seems to be mediated via activation of AP1 transcription factors in the cNTS. If AP1 activity is blocked in the cNTS during dehydration, sympathetic activity control reverts back to forebrain regions. This unique reciprocating neural structure-switching plasticity between brain centres emphasizes the multiple mechanisms available for the adaptive response to dehydration.

Effect of angiotensin II on expression of alveolar epithelial sodium channel in rat

To research the effect of exogenous angiotensin II (AngII) on alveolar fluid clearance (AFC) and alveolar epithelial sodium channel (ENaC) expression in rats. Fifteen healthy Sprague-Dawley (SD) rats were randomly divided into control group, AngII group and AngII type 1 (AT1) receptor blocker ZD7155 pretreatment group, with 5 rats in each group. Exogenous AngII 10 μg× kg(-1)×min(-1)was administered by micro pump via catheter in left jugular vein in AngII group and ZD7155 pretreatment group, whereas control group rats received only normal saline. ZD 7155 10 mg/kg was injected intraperitoneal 30 minutes before administration of exogenous AngII in ZD7155 pretreatment group. The pathological changes in lung were observed after 6 hours. AFC was estimated by Evans-blue labeled 5% albumin. The mRNA and protein expression of ENaC were determined by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting. AFC in AngII group was significantly lower than that of control group [(6.16 ± 3.01)% vs. (16.10 ± 3.46)%, P<0.01], and AFC in ZD7155 pretreatment group was significantly higher than that of AngII group [(10.60 ± 2.05)% vs. (6.16 ± 3.01)%, P<0.05]. α-ENaC mRNA expression was significantly increased in AngII group compared with control group (0.663 ± 0.068 vs. 0.236 ± 0.030, P<0.01), but significantly decreased in ZD7155 pretreatment group when compared with AngII group (0.386 ± 0.061 vs. 0.663 ± 0.068, P<0.01). There was no significant difference in β-ENaC and γ-ENaC mRNA expression among three groups. Compared with control group, α-ENaC protein was significantly increased in AngII group (0.343 ± 0.053 vs. 0.145 ± 0.030, P<0.01), but β-ENaC and γ-ENaC proteins were significantly decreased (β-ENaC: 0.286 ± 0.038 vs. 0.512 ± 0.055, γ-ENaC : 0.144 ± 0.040 vs. 0.460 ± 0.066, both P<0.01). Compared with AngII group, α-ENaC protein was significantly lower(0.228 ± 0.045 vs.0.343 ± 0.053, P<0.01), whereas β-ENaC and γ-ENaC proteins were significantly higher (β-ENaC: 0.358 ± 0.043 vs. 0.286 ± 0.038, γ-ENaC: 0.220 ± 0.033 vs. 0.144 ± 0.040, both P<0.05) in ZD7155 pretreatment group. Exogenous AngII modulates ENaC expression of gene and protein by AT1 receptor pathway, attenuates AFC, and aggravates lung edema.

Application of negative pressure puncture without the cuff in staphylococal scalded skin syndrome

Objective To discuss the effect of negative pressure puncture without the cuff in staphylococal scalded skin syndrome (SSSS). Methods 68 children with SSSS in our department were chosen as research subjects from January 2009 to December 2010, and then were divided into the experimental group and the control group randomly. All children used the distal upper limbs for superficial vein puncture. The control group used vein puncture and catheter fixation by conventional methods, the experimental group used negative pressure puncture without the cuff in order to improve the methods for filling and indwelling intravenous needle fixation. Results In the experimental group, the parent satisfaction degree and the average catheter indwelling time were significantly better than the control group, the adverse reactions were lower than the control group. Success rate of one-time puncture and rate of venous blood return showed no significant difference compared with the control group. Conclusions The method of negative pressure puncture without the cuff is simple, easy to grasp and has a high puncture success rate, is better protection of skin and blood vessels for children with staphylococal scalded skin syndrome. Key words: No cuff; Negative pressure puncture; modified catheter fixation; Staphylococal scalded skin syndrome

Accidental insertion of a percutaneous venovenous cannula into the persistent left superior vena cava of a patient undergoing liver transplantation

Persistent left superior vena cava (PLSVC) is a rare congenital vascular abnormality found in 0.3% of the general population. We report herein a rare complication involving the accidental insertion of a large bore cannula into the PLSVC during liver transplantation (LT). A 63-yr-old man with primary sclerosing cholangitis presented for LT. Given the existence of a tunnelled dialysis catheter in the right internal jugular vein (IJV) and a triple lumen catheter via the left IJV, insertion of an 18 French cannula for venovenous bypass (VVB) was performed via the left IJV using the existing triple lumen cannula as a conduit for a guidewire. Upon initiation of VVB, profound systemic hypotension occurred, and liver transplantation was completed without the further use of VVB. A chest x-ray confirmed a malposition of the VVB cannula with a large left hemothorax. A mini-sternotomy was performed for removal of the VVB cannula, which was found to be inserted in the PLSVC. Retrospectively, the presence of PLSVC was not anticipated due to a normal superior vena cava and a left innominate vein, as revealed by the course of a pre-existing left internal jugular vein triple lumen catheter on a preoperative chest x-ray, and due to a normal-sized coronary sinus on preoperative echocardiography. Malpositioning of a venous cannula in a PLSVC should be anticipated as one of the potential complications of vascular access via the left internal jugular vein.