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Cannulation
Kinds of Cannulation Terms modified by Cannulation Selected AbstractsPROPHYLACTIC PANCREAS STENTING FOLLOWED BY NEEDLE-KNIFE FISTULOTOMY IN PATIENTS WITH SPHINCTER OF ODDI DYSFUNCTION AND DIFFICULT CANNULATION: NEW METHOD TO PREVENT POST-ERCP PANCREATITISDIGESTIVE ENDOSCOPY, Issue 1 2009László Madácsy Introduction:, The aim of the present study was to reduce post-endoscopic retrograde cholangiopancreatography (ERCP) complications with a combination of early needle-knife access fistulotomy and prophylactic pancreatic stenting in selected high-risk sphincter of Oddi dysfunction (SOD) patients with difficult cannulation. Methods:, Prophylactic pancreatic stent insertion was attempted in 22 consecutive patients with definite SOD and difficult cannulation. After 10 min of failed selective common bile duct cannulation, but repeated (>5×) pancreatic duct contrast filling, a prophylactic small calibre (3,5 Fr) pancreatic stent was inserted, followed by fistulotomy with a standard needle-knife, then a standard complete biliary sphincterotomy followed. The success and complication rates were compared retrospectively with a cohort of 35 patients, in which we persisted with the application of standard methods of cannulation without pre-cutting methods. Results:, Prophylactic pancreatic stenting followed by needle-knife fistulotomy was successfully carried out in all 22 consecutive patients, and selective biliary cannulation and complete endoscopic sphincterotomy were achieved in all but two cases. In this group, not a single case of post-ERCP pancreatitis was observed, in contrast with a control group of three mild, 10 moderate and two severe post-ERCP pancreatitis cases. The frequency of post-ERCP pancreatitis was significantly different: 0% versus 43%, as were the post-procedure (24 h mean) amylase levels: 206 U/L versus 1959 U/L, respectively. Conclusions:, In selected, high-risk, SOD patients, early, prophylactic pancreas stent insertion followed by needle-knife fistulotomy seems a safe and effective procedure with no or only minimal risk of post-ERCP pancreatitis. However, prospective, randomized studies are awaited to lend to support to our approach. [source] TEACHING DEEP CANNULATION OF THE BILE DUCT DURING ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHYDIGESTIVE ENDOSCOPY, Issue 4 2007Kiichi Tamada When performing endoscopic retrograde cholangiopancreatography (ERCP), the smooth introduction of the duodenoscope into the papilla of Vater, an appropriate view of the papilla of Vater, and deep cannulation of the bile duct are essential. The operator must know the difference between the side-viewing endoscope and the forward-viewing endoscope. The rotation of the body and the left arm of the operator, switching with the left wrist, and dialing of the endoscope are essential for appropriately viewing the papilla of Vater. When training operators to do ERCP, a model is useful for helping them understand basic handling. The approach to deep cannulation of the bile duct should be selected based on the type of papilla (slit type, onion type, tongue protrusion type, flat type, and tumor type). Cannulation is more difficult in patients with the tongue protrusion-type of papilla than with a slit type, onion type, or tumor type. According to previous reports, therapeutic ERCP requires the ability to cannulate the common bile duct deeply 80% of the time; 180 to 200 supervised ERCP are necessary to achieve this success rate. [source] RESEARCH INTO PAIN PERCEPTION WITH ARTERIOVENOUS FISTULA (AVF) CANNULATIONJOURNAL OF RENAL CARE, Issue 4 2008Ana E. Figueiredo RN SUMMARY Patients with end-stage renal failure (ESRF) undergoing haemodialysis (HD) are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula (AVF). Repeated AVF punctures lead to a considerable degree of pain, due to the calibre and length of the bevel of fistula needles. Pain is a sensitive, emotional and subjective experience. The objective of this study was to measure pain associated with AVF needling. The analogue visual scale (AVS) divided into 10 equal parts (0 indicating lack of pain, and 10 unbearable pain) was used. Patients7 perceptions were measured in three different HD sessions. Pain was considered mild during AVF needling. The buttonhole technique caused a mean degree of pain of 2.4 (±1.7), compared to 3.1 (±2.3) using the conventional ropeladder technique. Although without reaching a statistically significant difference, diminished pain was associated with the buttonhole technique. [source] TEACHING DEEP CANNULATION OF THE BILE DUCT DURING ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHYDIGESTIVE ENDOSCOPY, Issue 4 2007Kiichi Tamada When performing endoscopic retrograde cholangiopancreatography (ERCP), the smooth introduction of the duodenoscope into the papilla of Vater, an appropriate view of the papilla of Vater, and deep cannulation of the bile duct are essential. The operator must know the difference between the side-viewing endoscope and the forward-viewing endoscope. The rotation of the body and the left arm of the operator, switching with the left wrist, and dialing of the endoscope are essential for appropriately viewing the papilla of Vater. When training operators to do ERCP, a model is useful for helping them understand basic handling. The approach to deep cannulation of the bile duct should be selected based on the type of papilla (slit type, onion type, tongue protrusion type, flat type, and tumor type). Cannulation is more difficult in patients with the tongue protrusion-type of papilla than with a slit type, onion type, or tumor type. According to previous reports, therapeutic ERCP requires the ability to cannulate the common bile duct deeply 80% of the time; 180 to 200 supervised ERCP are necessary to achieve this success rate. [source] A Descriptive Comparison of Ultrasound-guided Central Venous Cannulation of the Internal Jugular Vein to Landmark-based Subclavian Vein CannulationACADEMIC EMERGENCY MEDICINE, Issue 4 2010Daniel Theodoro MD Abstract Objectives:, The safest site for central venous cannulation (CVC) remains debated. Many emergency physicians (EPs) advocate the ultrasound-guided internal jugular (USIJ) approach because of data supporting its efficiency. However, a number of physicians prefer, and are most comfortable with, the subclavian (SC) vein approach. The purpose of this study was to describe adverse event rates among operators using the USIJ approach, and the landmark SC vein approach without US. Methods:, This was a prospective observational trial of patients undergoing CVC of the SC or internal jugular veins in the emergency department (ED). Physicians performing the procedures did not undergo standardized training in either technique. The primary outcome was a composite of adverse events defined as hematoma, arterial cannulation, pneumothorax, and failure to cannulate. Physicians recorded the anatomical site of cannulation, US assistance, indications, and acute complications. Variables of interest were collected from the pharmacy and ED record. Physician experience was based on a self-reported survey. The authors followed outcomes of central line insertion until device removal or patient discharge. Results:, Physicians attempted 236 USIJ and 132 SC cannulations on 333 patients. The overall adverse event rate was 22% with failure to cannulate being the most common. Adverse events occurred in 19% of USIJ attempts, compared to 29% of non,US-guided SC attempts. Among highly experienced operators, CVCs placed at the SC site resulted in more adverse events than those performed using USIJ (relative risk [RR] = 1.89, 95% confidence interval [CI] = 1.05 to 3.39). Conclusions:, While limited by observational design, our results suggest that the USIJ technique may result in fewer adverse events compared to the landmark SC approach. ACADEMIC EMERGENCY MEDICINE 2010; 17:416,422 © 2010 by the Society for Academic Emergency Medicine [source] A Simple Technique of Distal Limb Perfusion During Prolonged Femoro-Femoral CannulationJOURNAL OF CARDIAC SURGERY, Issue 2 2006Navid Madershahian M.D. A serious complication of prolonged femoral cannulation remains the ischemic injury of the distal limb. Subjects: To minimize the incidence of ischemia in the cannulated leg, we have begun to provide antegrade femoral blood flow by placing a vascular introducer percutaneously distal to the arterial cannula into the superficial femoral artery and connecting it to the side port of the arterial line. Conclusion: This technique of distal limb perfusion was found to be safe and effective in preventing lower limb ischemia for patients with prolonged femoral cannulation for extracorporeal circulatory support. [source] The Use of a Femoral Arterial Cannula for Effective Dilation for Percutaneous Femoral Venous CannulationJOURNAL OF CARDIAC SURGERY, Issue 1 2005Hrvoje Gasparovic M.D. The technique presented may be particularly helpful when redo sternotomy is deemed hazardous and cardiopulmonary bypass is judged mandatory prior to redo sternotomy. The patient presented in this paper had two previous cardiac operations with prior surgical exposure of femoral vessels in whom institution of cardiopulmonary bypass prior to sternotomy was of paramount importance due to a 7-cm ascending aortic aneurysm. [source] Use of a Long Preshaped Sheath to Facilitate Cannulation of the Coronary Sinus at Electrophysiologic StudyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2001CHRIS B. PEPPER B.Sc. CS Cannulation Using a Long Sheath. Introduction: Catheterization of the coronary sinus (CS) from the femoral vein can be challenging. We tested whether use of a long preshaped sheath facilitates CS cannulation. Methods and Results: One hundred four patients were randomized into two phases. In phase 1, consecutive patients were allocated to CS catheterization using the long sheath (n = 26) or standard 7-French 15-cm sheath (n = 25). If unsuccessful within 10 minutes, the alternative technique was used. Phase 2 assessed the utility of the long sheath in difficult cases. All patients initially were approached using the standard sheath. If cannulation failed after 10 minutes, patients were randomly allocated to the standard or long sheath approach. In phase 1, the standard approach failed in 4 (16%) of 25 cases. In each case, a long sheath proved successful (mean 3.2 min). The long sheath approach was successful within 10 minutes in all 26 cases. Catheter deployment was significantly quicker with the long sheath, but this was offset by the time required for sheath insertion. In phase 2, the standard approach was successful in 46 (87%) of 53 cases. Of 7 "failures," 3 were randomized to continue the standard approach, which was successful in 1; 4 were randomized to the long sheath approach, and success was achieved in all (mean 4.4 ± 1.5 min). Overall, the CS could not be promptly catheterized in 15% of cases within 10 minutes using the standard sheath, and no failures were seen using the long sheath. No complications arose from the use of either technique. Conclusion: The long sheath was uniformly successful in permitting catheterization of the CS from the femoral approach in both unselected and difficult cases. [source] An outcome study on complications using routine ultrasound assistance for internal jugular vein cannulationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2007M. Lamperti Background:, Ultrasound guidance for central venous cannulation is advised by recent guidelines, but is not being applied in everyday practice. The purpose of this study was to determine the reduction in complications when applying an ultrasound locating device for internal jugular vein catheterization. Methods:, An observational study was conducted from November 2004 to October 2005 in a tertiary neurosurgical hospital on 300 patients undergoing internal jugular vein cannulation using an ultrasound technique. Patients were not randomized and operators were trained using theoretical and practical courses. Prior to the study, the investigators, who were consultant anaesthesiologists, had to perform at least 20 successful supervised cannulations. Results:, Cannulation was successful in all cases. The incidence of arterial puncture was 2.7%, and multiple venous punctures represented the main minor complication (14%). Bivariate analysis of the overall complications revealed no significant correlation with age group, American Society of Anesthesiologists' (ASA) classification, body mass index, or position and diameter of the vein. Conclusions:, Ultrasound cannulation of the internal jugular vein minimized complications. These could be avoided when new ultrasound probes and specific needles are introduced. [source] Ultrasound-guided central venous cannulation in infants and childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2002P. Ĺsheim Background: Percutaneous central venous cannulation in infants and children is a challenging procedure. Traditionally, an external landmark technique has been used to identify puncture site. An ultrasound-guided technique is now available and we wanted to evaluate this method in children and infants, looking specifically at the ease of use, success rate and complications. Methods: Forty-two consecutive infants and children (median 16.5 [0,177] months and 10 [3,45] kg) scheduled for central venous catheter placement were registered. An ultrasound scanner made for guiding puncture of vessels was used. After locating the puncture site, a sterile procedure was performed using an accompanying kit to aid puncture of the vessel. Results: Cannulation was successful in all patients and we had no complications during insertion of the catheters. The right internal jugular vein was preferred in most patients, and in 95% of the patients the vein was punctured at the first attempt. The median time from start of puncture to aspiration of blood was 12 (3,180) seconds. Conclusion: The ultrasound-guided technique for placement of central venous catheters was easy to apply in infants and children. It is our impression that it increased the precision and safety of the procedure in this group of patients. [source] Atrial Versus Ventricular Cannulation for a Rotary Ventricular Assist DeviceARTIFICIAL ORGANS, Issue 9 2010Daniel Timms Abstract The ventricular assist device inflow cannulation site is the primary interface between the device and the patient. Connecting these cannulae to either atria or ventricles induces major changes in flow dynamics; however, there are little data available on precise quantification of these changes. The objective of this investigation was to quantify the difference in ventricular/vascular hemodynamics during a range of left heart failure conditions with either atrial (AC) or ventricular (VC) inflow cannulation in a mock circulation loop with a rotary left VAD. Ventricular ejection fraction (EF), stroke work, and pump flow rates were found to be consistently lower with AC compared with VC over all simulated heart failure conditions. Adequate ventricular ejection remained with AC under low levels of mechanical support; however, the reduced EF in cases of severe heart failure may increase the risk of thromboembolic events. AC is therefore more suitable for class III, bridge to recovery patients, while VC is appropriate for class IV, bridge to transplant/destination patients. [source] Experimental Fluid Dynamics of Transventricular Apical Aortic CannulationARTIFICIAL ORGANS, Issue 3 2010Ikuo Fukuda Abstract To clarify the flow pattern from a transventricular apical aortic cannula, hydrodynamic analysis of transventricular apical aortic cannulation (apical cannulation) was performed using particle-image velocimetry in a glass aortic model. Simulated apical cannulation using a 7-mm Sarns Soft-Flow cannula and the newly developed 7-mm apical aortic cannula was compared with standard aortic cannulation. The flow-velocity, streamline, and distribution of magnitude of the strain rate tensor (function of shear stress) were analyzed. Streamline analysis revealed a steady and organized flow profile in apical cannulation as compared with that in standard aortic cannulation. The magnitude of the strain rate tensor decreased within a few centimeters from the exit of the apical cannula. [source] Emergency Use of Extracorporeal Membrane Oxygenation in Cardiopulmonary FailureARTIFICIAL ORGANS, Issue 9 2009Matthias Arlt Abstract Severe pulmonary and cardiopulmonary failure resistant to critical care treatment leads to hypoxemia and hypoxia-dependent organ failure. New treatment options for cardiopulmonary failure are necessary even for patients in outlying medical facilities. If these patients are in need of specialized center treatment, additional emergency medical service has to be carried out quick and safely. We describe our experiences with a pumpless extracorporeal lung assist (PECLA/iLA) for out-of-center emergency treatment of hypercapnic respiratory failure and the use of a newly developed hand-held extracorporeal membrane oxygenation (ECMO) system in cardiac, pulmonary, and cardiopulmonary failure (EMERGENCY-LIFE Support System, ELS System, MAQUET Cardiopulmonary AG, Hechingen, Germany). Between March 2000 and April 2009, we used the PECLA System (n = 20) and the ELS System (n = 33) in adult patients. Cannulation was employed using percutaneous vessel access. The new hand-held ELS System consists of a centrifugal pump and a membrane oxygenator, both mounted on a special holder system for storing on a standard patient gurney for air or ground ambulance transfer. Bedside cannulation processes were uneventful. The PECLA System resulted in sufficient CO2 removal. In all ECMO patients, oxygen delivery and systemic blood flow could be restored and vasopressor support was markedly down. Hospital survival rate in the PECLA group was 50%, and 61% in the ECMO group. Out-of-center emergency treatment of hypercapnic pulmonary failure with pumpless extracorporeal gas exchange and treatment of cardiac, pulmonary, and cardiopulmonary failure with this new hand-held ECMO device is safe and highlyeffective. Patient outcome in cardiopulmonary organ failure could be improved. [source] The Impact of Aortic/Subclavian Outflow Cannulation for Cardiopulmonary Bypass and Cardiac Support: A Computational Fluid Dynamics StudyARTIFICIAL ORGANS, Issue 9 2009Tim A.S. Kaufmann Abstract Approximately 100 000 cases of oxygen deficiency in the brain occur during cardiopulmonary bypass (CPB) procedures each year. In particular, perfusion of the carotid and vertebral arteries is affected. The position of the outflow cannula influences the blood flow to the cardiovascular system and thus end organ perfusion. Traditionally, the cannula returns blood into the ascending aorta. But some surgeons prefer cannulation to the right subclavian artery. A computational fluid dynamics study was initially undertaken for both approaches. The vessel model was created from real computed tomography/magnetic resonance imaging data of young healthy patients. The simulations were run with usual CPB conditions. The flow distribution for different cannula positions in the aorta was studied, as well as the impact of the cannula tip distance to vertebral artery for the subclavian position. The study presents a fast method of analyzing the flow distribution in the cardiovascular system, and can be adapted for other applications such as ventricular assist device support. It revealed that two effects cause the loss of perfusion seen clinically: a vortex under the brachiocephalic trunk and low pressure regions near the cannula jet. The results suggest that cannulation to the subclavian artery is preferred if the cannula tip is sufficiently far away from the branch of the vertebral artery. For the aortic positions, however, the cannula should be injected from the left body side. [source] Right Axillary Vein Cannulation for Percutaneous Cardiopulmonary SupportARTIFICIAL ORGANS, Issue 2 2007Masato Tochii Abstract:, A 34-year-old male with a past history of permanent inferior vena cava (IVC) filter placement was referred to us for chronic thromboembolic pulmonary hypertension. Percutaneous cardiopulmonary support (PCPS) was required for the lung hemorrhage and reperfusion injury, although the thromboendarterectomy was successfully completed. The arterial cannula was inserted into the femoral artery, and the venous cannula was inserted into the right axillary vein. The patient was weaned from PCPS 1 day after the operation and was discharged 35 days after the operation. Axillary vein cannulation is thought to be a feasible method when PCPS is required for a patient with previous IVC filter placement. [source] Implantation of One Piece Biventricular Assist Device by Left Thoracotomy in an Ovine ModelARTIFICIAL ORGANS, Issue 9 2000Won Gon Kim Abstract: In this report, we describe an operative procedure for our implantable 1 piece biventricular assist device (BiVAD) based on a moving actuator mechanism, using an ovine model. Our implantable BiVAD is a volumetric coupled 1 piece unit including right and left blood sacs and an actuator assembly based on the moving actuator mechanism. The BiVAD was controlled by fixed rate control with 75 bpm for the most part. Both the left and the right full ejection modes with the maximum stroke angle were selected to minimize blood stasis in the blood sacs because of low assist flow condition. Three Corriedale sheep were used for the device implantation by a left thoracotomy incision. Cannulation was successfully performed in all cases. Although exposability of the right atrial appendage varied from animal to animal, the insertion of the cannula was easily performed. The cannulas were connected to the pump-actuator assembly in the preperitoneal pocket. All 3 animals survived the experimental procedure. During implantation of the device, in the 1 month survival animal, pump flow was maintained between 2.0 L/min and 2.5 L/min, mean aortic pressure was 90,110 mm Hg, and mean pulmonary artery pressure was 20,30 mm Hg. The left and right atrial pressure were maintained between 0 and 5 mm Hg. In conclusion, this ovine model for implantation of the 1 piece BiVAD can be an effective alternative for testing in vivo biocompatibility of the device although it needs more consideration for anatomical fittability for future human application. [source] Cannulation of patent arterial duct in patients with pulmonary atresia and ventricular septal defectCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2005Bhava R.J. Kannan DM Abstract During cardiac catheterization in patients with pulmonary atresia and ventricular septal defect, cannulation of the arterial duct was attempted in 23 children via antegrade approach. It was successful in all but two children. Injection of contrast through antegradely placed catheter resulted in improved opacification of pulmonary arteries. This technique facilitated transcatheter dilation of spontaneously closed arterial duct in two children. © 2005 Wiley-Liss, Inc. [source] 4364: Direct intra-arterial (ophthalmic artery) chemotherapy with melphalan for advanced intraocular retinoblastoma: the Italian experienceACTA OPHTHALMOLOGICA, Issue 2010T HADJISTILIANOU Purpose To report the preliminary results of the conservative treatment of advanced retinoblastoma (Stage Va e Vb) obtained with the melphalan protocol (direct intraarterial-ophthalmic artery infusion ). Methods 33 children (35 eyes) with advanced retinoblastoma who were eligible for enucleation were entered in phase two of one center open study-approved protocol of ophthalmic artery infusion of Melphalan to avoid enucleation (Italian Melphalan protocol, approved by the Ethic Commettee , University Hospital of Siena). Two cases have been treated bilaterally. 15 eyes were first diagnosis and 18 were relapses following chemo and/or radiotherapy. In two cases has not been possible to conclude the procedure due to haemodynamic problems. Results The ophthalmic artery was successfully cannulated in 35 eyes (total, 121 procedures). In 2 attempts was impossible to successfully conclude the procedure due to hemodynamic problems. Cannulation of the ophthalmic artery was performed by a femoral artery approach using microcatheters (magic 1.5) while the children were under general anesthesia and anticoagulated. Melphalan was infused into the artery over a 30-minute period (dose of 3-7 mg according to the age and size of the globe). Local and systemic toxicity have been evaluated and documented. Conclusion 33 children (35 eyes) with advanced retinoblastoma (Stage Va and Vb Reese classification) were eligible for the Melphalan Italian Protocol. The 78.7% of treated eyes is in complete remission. Superselective chemotherapy delivered through the ophthalmic artery can avoid enucleation, primary radiation or abuse of systemic chemotherapy. [source] A Prospective Comparison of Ultrasound-guided and Blindly Placed Radial Arterial CathetersACADEMIC EMERGENCY MEDICINE, Issue 12 2006Stephen Shiver MD Abstract Background Arterial cannulation for continuous blood-pressure measurement and frequent arterial-blood sampling commonly are required in critically ill patients. Objectives To compare ultrasound (US)-guided versus traditional palpation placement of arterial lines for time to placement, number of attempts, sites used, and complications. Methods This was a prospective, randomized interventional study at a Level 1 academic urban emergency department with an annual census of 78,000 patients. Patients were randomized to either palpation or US-guided groups. Inclusion criteria were any adult patient who required an arterial line according to the treating attending. Patients who had previous attempts at an arterial line during the visit, or who could not be randomized because of time constraints, were excluded. Enrollment was on a convenience basis, during hours worked by researchers over a six-month period. Patients in either group who had three failed attempts were rescued with the other technique for patient comfort. Statistical analysis included Fisher's exact, Mann-Whitney, and Student's t-tests. Results Sixty patients were enrolled, with 30 patients randomized to each group. Patients randomized to the US group had a shorter time required for arterial line placement (107 vs. 314 seconds; difference, 207 seconds; p = 0.0004), fewer placement attempts (1.2 vs. 2.2; difference, 1; p = 0.001), and fewer sites required for successful line placement (1.1 vs. 1.6; difference, 0.5; p = 0.001), as compared with the palpation group. Conclusions In this study, US guidance for arterial cannulation was successful more frequently and it took less time to establish the arterial line as compared with the palpation method. [source] New method for evaluation of lung lymph flow rate with intact lymphatics in anaesthetized sheepACTA PHYSIOLOGICA, Issue 2 2006T. Naito Abstract Aim:, Lung lymph has commonly been studied using a lymph fistula created by tube cannulation into the efferent duct of the caudal mediastinal node in sheep. In this method, the tail region of the caudal mediastinal node is resected and the diaphragm is cauterized to exclude systemic lymph contamination, and cannulation is performed into one of the multiple efferent ducts originating from the caudal mediastinal node. Moreover, the pumping activity of lymphatics might be diminished by cannulation. Therefore, the purpose of the study was to evaluate the flow rate of lung lymph with maintenance of intact lymphatic networks around the caudal mediastinal node to the thoracic duct in sheep. Methods:, An ultrasound transit-time flow meter was used to measure lung lymph flow. The thoracic duct was clamped just above the diaphragm and the flow probe was attached to the thoracic duct just after the last junction with an efferent duct from the caudal mediastinal node. The lung lymph flow rate was measured at baseline and under conditions of lung-oedema formation. Results:, The baseline lung lymph flow rate in our model was three- to sixfold greater than values obtained with the cannulation method. With oedema-formation, the lung lymph flow rate was the same as that measured using cannulation. Conclusion:, The lung lymph flow was unexpectedly large under the conditions of the study, and our data suggest that the drainage effect of lymphatics is significant as a safety factor against pulmonary oedema formation. [source] PROPHYLACTIC PANCREAS STENTING FOLLOWED BY NEEDLE-KNIFE FISTULOTOMY IN PATIENTS WITH SPHINCTER OF ODDI DYSFUNCTION AND DIFFICULT CANNULATION: NEW METHOD TO PREVENT POST-ERCP PANCREATITISDIGESTIVE ENDOSCOPY, Issue 1 2009László Madácsy Introduction:, The aim of the present study was to reduce post-endoscopic retrograde cholangiopancreatography (ERCP) complications with a combination of early needle-knife access fistulotomy and prophylactic pancreatic stenting in selected high-risk sphincter of Oddi dysfunction (SOD) patients with difficult cannulation. Methods:, Prophylactic pancreatic stent insertion was attempted in 22 consecutive patients with definite SOD and difficult cannulation. After 10 min of failed selective common bile duct cannulation, but repeated (>5×) pancreatic duct contrast filling, a prophylactic small calibre (3,5 Fr) pancreatic stent was inserted, followed by fistulotomy with a standard needle-knife, then a standard complete biliary sphincterotomy followed. The success and complication rates were compared retrospectively with a cohort of 35 patients, in which we persisted with the application of standard methods of cannulation without pre-cutting methods. Results:, Prophylactic pancreatic stenting followed by needle-knife fistulotomy was successfully carried out in all 22 consecutive patients, and selective biliary cannulation and complete endoscopic sphincterotomy were achieved in all but two cases. In this group, not a single case of post-ERCP pancreatitis was observed, in contrast with a control group of three mild, 10 moderate and two severe post-ERCP pancreatitis cases. The frequency of post-ERCP pancreatitis was significantly different: 0% versus 43%, as were the post-procedure (24 h mean) amylase levels: 206 U/L versus 1959 U/L, respectively. Conclusions:, In selected, high-risk, SOD patients, early, prophylactic pancreas stent insertion followed by needle-knife fistulotomy seems a safe and effective procedure with no or only minimal risk of post-ERCP pancreatitis. However, prospective, randomized studies are awaited to lend to support to our approach. [source] TEACHING DEEP CANNULATION OF THE BILE DUCT DURING ENDOSCOPIC RETROGRADE CHOLANGIOGRAPHYDIGESTIVE ENDOSCOPY, Issue 4 2007Kiichi Tamada When performing endoscopic retrograde cholangiopancreatography (ERCP), the smooth introduction of the duodenoscope into the papilla of Vater, an appropriate view of the papilla of Vater, and deep cannulation of the bile duct are essential. The operator must know the difference between the side-viewing endoscope and the forward-viewing endoscope. The rotation of the body and the left arm of the operator, switching with the left wrist, and dialing of the endoscope are essential for appropriately viewing the papilla of Vater. When training operators to do ERCP, a model is useful for helping them understand basic handling. The approach to deep cannulation of the bile duct should be selected based on the type of papilla (slit type, onion type, tongue protrusion type, flat type, and tumor type). Cannulation is more difficult in patients with the tongue protrusion-type of papilla than with a slit type, onion type, or tumor type. According to previous reports, therapeutic ERCP requires the ability to cannulate the common bile duct deeply 80% of the time; 180 to 200 supervised ERCP are necessary to achieve this success rate. [source] Frequent multiple c-ki- ras oncogene activation in pancreatic juice from patients with benign pancreatic cystsDIGESTIVE ENDOSCOPY, Issue 2 2001Akihiko Nakaizumi Background: We detected benign pancreatic cysts in more than half of 12 cases of in situ pancreatic cancer. A few investigators, having detected K- ras mutation in pancreatic juice before the clinical diagnosis of pancreatic cancer, have suggested that this mutation might be an early event in pancreatic oncogenesis. Therefore, in the present study, we evaluated whether benign pancreatic cysts are a precancerous condition as reflected by K- ras mutation in pancreatic juice. Methods: Pancreatic juice was collected through endoscopic cannulation of the pancreatic duct. Analysis of the mutations was performed using the polymerase chain reaction,preferential homoduplex formation assay. Results: The frequencies and types of K- ras point mutations and the rate of multiplicity of K- ras mutations in patients with benign pancreatic cyst were the same as those with pancreatic cancer. Conclusions: Multiple K- ras codon 12 mutations in the pancreatic juice of patients with benign pancreatic cysts are present as frequently as those with pancreatic cancer. These results indicate that patients with benign cysts may be at a high-risk for the development of pancreatic cancer. [source] Emergency Nurses' Utilization of Ultrasound Guidance for Placement of Peripheral Intravenous Lines in Difficult-access PatientsACADEMIC EMERGENCY MEDICINE, Issue 12 2004Larry Brannam MD Objectives: Emergency nurses (ENs) typically place peripheral intravenous (IV) lines, but if repeated attempts fail, emergency physicians have to obtain peripheral or central access. The authors describe the patient population for which ultrasound (US)-guided peripheral IVs are used and evaluate the success rates for such lines by ENs. Methods: This was a prospective observational study of ENs in a Level I trauma center with a census of 75,000, performing US-guided IV line placement on difficult-to-stick patients (repeated blind IV placement failure or established history). ENs were trained on an inanimate model after a 45-minute lecture. Surveys were filled out after each US-guided IV attempt on a patient. ENs could decline to fill out surveys, which recorded the reason for use of US, type of patient, and success. Successful cannulation was confirmed by drawing blood and flushing fluids. Descriptive statistics were used to evaluated data. Results: A total of 321 surveys were collected in a five-month period no ENs declined to participate. There were 280 (87%) successful attempts. Twelve (29%) of the 41 failure patients required central lines, 9 (22%) received external jugular IVs, and 20 (49%) had peripheral IV access placed under US guidance by another nurse or physician. Twenty-eight percent (90) of all patients were obese, 18% (57) had sickle cell anemia, 10% (31) were renal dialysis patients, 12% (40) were IV drug abusers, and 19% (61) had unspecified chronic illness. The remainder had no reason for difficult access given. There were four arterial punctures. Conclusions: ENs had a high success rate and few complications with use of US guidance for vascular access in a variety of difficult-access patients. [source] Witnessing invasive paediatric procedures, including resuscitation, in the emergency department: A parental perspectiveEMERGENCY MEDICINE AUSTRALASIA, Issue 3 2005Jonathon Isoardi Abstract Objective:, To determine whether parents prefer to be present during invasive procedures performed on their children in the ED. Methods:, A prospective study using a written survey was carried out in the ED of a secondary level regional hospital in south-east Queensland. The survey conducted between August 2003 and November 2003 consisted of parental demographics, seven theoretical paediatric procedural scenarios with increasing level of procedural invasiveness (including resuscitation) and reasons for the decisions of parents to either stay with the child or leave the room. Parents of children with Australasian Triage Scale (ATS) triage category 3, 4 and 5 were surveyed. Results:, Of 573 surveys collected, 553 (96.5%) were completed correctly. The number of parents expressing a desire to be present during a procedure performed on their child was 519 (93.9%) for phlebotomy or i.v. cannulation of an extremity, 485 (87.7%) for nasogastric tube insertion, 461 (83.4%) for lumbar puncture, 464 (83.9%) for urinary catheter insertion, 430 (77.8%) for suprapubic bladder aspiration, 519 (93.4%) during procedural sedation and 470 (85%) during a resuscitation where the possibility existed that their child may die. The most common reason for wanting to be present was to provide comfort to their child (542/98%). The most common reason for not wanting to be present was a parental concern of getting in the way (181/33%). Conclusion:, Most parents surveyed would want to be present when invasive procedures are performed on their children in the ED. With increasing invasiveness, parental desire to be present decreased. However, the overwhelming majority of parents would want to be in attendance during procedural sedation or resuscitation. [source] Site-specific expression of CD11b and SIRP, (CD172a) on dendritic cells: implications for their migration patterns in the gut immune systemEUROPEAN JOURNAL OF IMMUNOLOGY, Issue 5 2005Diane Bimczok Abstract Dendritic cells (DC) in the intestinal tract play a major role in directing the mucosal immune system towards tolerance or immunity. We analyzed whether different mucosal DC subsets in pigs have specific functions, localizations, or migration patterns in vivo. Therefore, we collected physiologically migrating DC by pseudo-afferent cannulation of the intestinal duct in eight Göttingen minipigs. Lymph DC were phenotypically and functionally characterized and compared to DC found on histological sections of porcine small intestine and mesenteric lymph nodes (MLN). Four different DC subpopulations were detected. Lamina propria (LP) DC were mainly CD11b+ signal regulatory protein,, (SIRP,)+, DC in Peyer's patches were mainly CD11b,/SIRP,+ in subepithelial domes and CD11b,/SIRP,, in interfollicular regions, whereas MLN DC were largely CD11b+/SIRP,,. Of these four subsets, only the CD11b+/SIRP,+ DC and the CD11b+/SIRP,, DC were present in lymph. This suggests that DC migration to MLN largely originates from the LP. Lymph DC expressed high levels of MHC class,II and costimulatory molecules and had a low capacity for FITC-dextran uptake, indicating a mature phenotype. However, lymph DC did not induce PBMC proliferation in MLR, and migration was not significantly influenced by mucosal antigen application. [source] Role of the Peripheral Intravenous Catheter in False-positive D-dimer TestingACADEMIC EMERGENCY MEDICINE, Issue 2 2001Alan C. Heffner MD Abstract. Objective: To determine whether inserting a peripheral intravenous catheter (IV) can significantly increase the circulating D-dimer concentration. Methods: Twenty healthy young adult volunteers underwent cannulation of an antecubital vein with a 20-gauge Teflon IV. Time 0 venous blood was drawn during IV insertion. The IV was salinelocked and left in place for 90 minutes, at which time a second venipuncture was performed in a contralateral antecubital vein (+90 min). A qualitative D-dimer assay [erythrocyte-agglutination assay, SimpliRED (SRDD)] and a quantitative spectrophotometric assay [enzyme-linked immunosorbent assay (EIA), Dimertest Gold] were performed on all samples. Time 0 means (±SD) were compared with +90 min means by paired t-test, and SRDD pairs were compared with McNemar's test. Results: Time 0 initial venipuncture blood samples yielded a mean D-dimer concentration of 15 ± 24 ng/mL, with 2/20 SRDD tests read as positive (95% CI = 1% to 32%). At +90 min, the D-dimer concentration was 33 ± 21 ng/mL (p = 0.04 vs time 0), with 5/20 SRDD tests read as positive (95% CI = 9% to 49%, p = 0.248). Conclusions: Insertion of an IV increased the circulating D-dimer concentration (determined by EIA), but did not lead to a significant increase in false-positive conversion of the SRDD. An effort should be made to perform D-dimer testing on "first-stick" blood to optimize specificity. However, a strongly positive D-dimer reaction cannot be ascribed to the presence of an IV. [source] The salvage of aneurysmal fistulae utilizing a modified buttonhole cannulation technique and multiple cannulatorsHEMODIALYSIS INTERNATIONAL, Issue 2 2006Rosa M. MARTICORENA Abstract We describe the St Michael's Hospital (SMH) modified buttonhole (BH) cannulation technique as a method that offers a solution for fistulae with aneurysmal dilatation due to repetitive cannulation in a restricted area. This is a prospective cohort study of 14 chronic hemodialysis (HD) patients with problematic fistulae (marked aneurysmal formation and thinning of the overlying skin, bleeding during treatment, and prolonged hemostasis post-HD) because of repetitive, localized cannulation. Each patient was followed for 12 months. The protocol was as follows: creation of tunnel tracks by 1 to 3 experienced cannulators per patient, using sharp needles. After the tunnel tracks were established and cannulation was easily achieved with dull needles, additional cannulators were incorporated with the guidance of a mentor. Bleeding from cannulation sites during dialysis ceased within 2 weeks and skin damage resolved within 6 months in all patients. Hemostasis time postdialysis decreased from 24 to 15 min. Cannulation pain scores decreased significantly. Access flows and dynamic venous pressure measurements remained unchanged. No interventions were required to maintain access patency. In 2 cases, the aneurysms became much less evident. Complications included one episode of septic arthritis and one contact dermatitis. A third patient developed acute bacterial endocarditis 9 months following completion of her follow-up. The SMH modified BH cannulation technique can salvage problematic fistulae, prevent further damage, and induce healing of the skin in the areas of repetitive cannulation. This technique can be successfully achieved by multiple cannulators in a busy full-care HD unit. [source] A Descriptive Comparison of Ultrasound-guided Central Venous Cannulation of the Internal Jugular Vein to Landmark-based Subclavian Vein CannulationACADEMIC EMERGENCY MEDICINE, Issue 4 2010Daniel Theodoro MD Abstract Objectives:, The safest site for central venous cannulation (CVC) remains debated. Many emergency physicians (EPs) advocate the ultrasound-guided internal jugular (USIJ) approach because of data supporting its efficiency. However, a number of physicians prefer, and are most comfortable with, the subclavian (SC) vein approach. The purpose of this study was to describe adverse event rates among operators using the USIJ approach, and the landmark SC vein approach without US. Methods:, This was a prospective observational trial of patients undergoing CVC of the SC or internal jugular veins in the emergency department (ED). Physicians performing the procedures did not undergo standardized training in either technique. The primary outcome was a composite of adverse events defined as hematoma, arterial cannulation, pneumothorax, and failure to cannulate. Physicians recorded the anatomical site of cannulation, US assistance, indications, and acute complications. Variables of interest were collected from the pharmacy and ED record. Physician experience was based on a self-reported survey. The authors followed outcomes of central line insertion until device removal or patient discharge. Results:, Physicians attempted 236 USIJ and 132 SC cannulations on 333 patients. The overall adverse event rate was 22% with failure to cannulate being the most common. Adverse events occurred in 19% of USIJ attempts, compared to 29% of non,US-guided SC attempts. Among highly experienced operators, CVCs placed at the SC site resulted in more adverse events than those performed using USIJ (relative risk [RR] = 1.89, 95% confidence interval [CI] = 1.05 to 3.39). Conclusions:, While limited by observational design, our results suggest that the USIJ technique may result in fewer adverse events compared to the landmark SC approach. ACADEMIC EMERGENCY MEDICINE 2010; 17:416,422 © 2010 by the Society for Academic Emergency Medicine [source] Effect of genipin on the biliary excretion of cholephilic compounds in ratsHEPATOLOGY RESEARCH, Issue 6 2008Masaki Mikami Aim:, Genipin, a metabolite of geniposide, is reported to stimulate the insertion of multidrug resistance protein 2 (Mrp2) in the bile canalicular membrane, and to cause choleresis by increasing the biliary excretion of glutathione, which has been considered to be a substrate of Mrp2. In the present study, the effect of colchicine on the choleretic effect of genipin was investigated. The effect of genipin on the biliary excretion of the substrates of bile salt export pump and Mrp2 was also studied. Methods:, After bile duct cannulation into rats, genipin was administered at the rate of 0.2 ,mol/min/100 g, and the effect of colchicine pretreatment (0.2 mg/100 g) was examined. Metabolites of genipin in the bile were examined by a thin layer chromatography. Taurocholate (TC), sulfobromophthalein (BSP), and pravastatin were infused at the rate of 1.0, 0.2 and 0.3 ,mol/min/100 g, respectively, and the effect of genipin co-administration was examined. Results:, Genipin increased bile flow and the biliary glutathione excretion, and those increases were not inhibited by colchicine. The biliary excretion of genipin glucuronide was less than 10% of the genipin excreted into bile. The biliary excretion of TC, BSP, and pravastatin was unchanged by genipin co-administration. Conclusion:, It was indicated that colchicine-sensitive vesicular transport has no role on the genipin-induced insertion of Mrp2 to the canalicular membrane. Choleresis of genipin is considered to be mainly due to the increased biliary glutathione excretion by genipin, not by the biliary excretion of glucuronide. TC had no effect on the biliary glutathione excretion. [source] | |||||||||||||||||||||||||||||||