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Internal Jugular Vein (internal + jugular_vein)
Kinds of Internal Jugular Vein Terms modified by Internal Jugular Vein Selected AbstractsA 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] Patency and Flow of the Internal Jugular Vein After Functional Neck Dissection,THE LARYNGOSCOPE, Issue 1 2000María P. Prim MD Abstract Objectives: To assess the patency and flow of the internal jugular vein after functional neck dissection. Study Design: Prospective study of 54 internal jugular veins in 29 oncologic patients undergoing functional neck dissection between September 1994 and February 1997. Methods: Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of the vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were assessed in all veins before and after dissection. All patients were evaluated before and after the procedure by means of duplex Doppler ultrasonography. Results: In no case was there thrombosis before or after the operation. Although total jugular flow decreases during the early postoperative period, it recovers to normal parameters within 3 months after surgery. Conclusions: According to these results, the patency of the internal jugular vein remains unaltered after functional neck dissection. Ultrasonographically there is no thrombosis after this procedure. [source] Analysis of free flap viability based on recipient vein selectionHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2009David O. Francis MD Abstract Background. Venous anastomotic failure is the primary reason for microvascular free tissue transfer failure. Donor and recipient veins can be oriented in the same longitudinal axis (end-to-end anastomosis), or the donor vein can be anastomosed to the internal jugular vein in an end-to-side configuration. No consensus on the optimal anastomosis configuration exists. We sought to evaluate whether type of venous anastomosis impacts flap survival rate. Methods. Data were collected on all patients undergoing microvascular free flap reconstruction of head and neck defects at the University of Washington between August 1993 and April 2007. Flaps with a single venous anastomosis were analyzed. Flaps were stratified into those with end-to-end and end-to-side anastomoses. Survival rates were compared between groups using bivariate and multivariate techniques. Results. Inclusion criteria were met by 786 free flaps; 87% performed in an end-to-end and 13% in an end-to-side configuration. Flap re-exploration and failure rate were 4.3% and 1.1%, respectively. In multivariate analysis, there was no difference in odds of flap re-exploration (OR .70, 95% CI .23,2.18) or flap failure whether or not an end-to-end or end-to-side anastomosis was performed (OR 2.09, 95% CI .38,11.5). Conclusions. In this large cohort of patients, we found no difference in the odds of flap re-exploration or failure based on venous anastomotic configuration. Reconstructive surgeons should have both anastomotic techniques in their repertoire to optimize the success of every flap. © 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source] Ruptured internal jugular vein: A postoperative complication of modified/selected neck dissectionHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2003Suzanne S. Cleland-Zamudio MD Abstract Background. Postoperative hemorrhage from the internal jugular vein after a modified or selective neck dissection is an infrequent, yet potentially life-threatening, complication. Despite the increasing frequency of modified or selective neck dissections, this complication has not been previously highlighted in the literature. Setting. Tertiary referral academic center. Material and Methods. The records of six patients who experienced this complication were reviewed and analyzed for risk factors that might predict its occurrence. Results. Common risk factors included postoperative pharyngeal fistula formation, significant tobacco history, and poor nutritional status. A more complete circumferential dissection of the vein low in the neck in the presence of hypopharyngeal fistula may place it at a higher risk for rupture. Conclusions. Patients who have a complete circumferential dissection of the internal jugular vein low in the neck and go on to have fistulas develop may be more prone to internal jugular vein rupture. © 2003 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source] Importance of Jugular Valve Incompetence in Contrast Transcranial Doppler Ultrasonography for the Diagnosis of Patent Foramen OvaleJOURNAL OF NEUROIMAGING, Issue 3 2003M. Akif Topçuoglu MD ABSTRACT Transcranial Doppler (TCD) ultrasound with the intravenous injection of agitated saline as contrast (cTCD) is an effective method for detecting right-to-left intracardiac and extracardiac shunt (RLS); however, the sensitivity of cTCD in the diagnosis of RLS remains slightly less than that of transesophageal echocardiography, even in patients with adequate transtemporal ultrasonic bone windows. The authors present a case with cTCD underestimating RLS because of jugular valve incompetence in a 42-year-old man presenting with an episode of transient aphasia. Three weeks after transcatheter closure of a patent foramen ovale associated with an atrial septal aneurysm, he experienced 2 episodes of amaurosis fugax. Following a negative 45-minute embolus detection study with power M-mode TCD, the patient underwent a cTCD study with monitoring of the left middle cerebral artery (MCA), the anterior cerebral artery, and the submandibular extracranial internal carotid artery. A single microbubble (MB) was detected in the left MCA in only 1 of 5 studies; the remaining runs all failed to detect an RLS. Significant MB reflux was noted in the left internal jugular vein because of jugular valve incompetence. The authors conclude that incompetence of the jugular vein valve can result in a false negative cTCD study for RLS detection. [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] MR susceptometry for measuring global brain oxygen extractionMAGNETIC RESONANCE IN MEDICINE, Issue 5 2006María A. Fernández-Seara Abstract Monitoring of oxygen saturation in jugular venous blood gives an estimate of the balance of global oxygen delivery and cerebral oxygen consumption. We present a noninvasive approach to measure oxygen saturation in vivo in the internal jugular vein using MR susceptometry by exploiting the characteristic susceptibility of deoxyhemoglobin, and demonstrate the feasibility of performing such measurements in a group of subjects. We assessed the sensitivity of the method for detecting small changes in oxygen saturation by monitoring the variations observed during breath-holding and hypoventilation experiments. Unlike alternative methods, the susceptometric technique does not require calibration. Magn Reson Med, 2006. © 2006 Wiley-Liss, Inc. [source] The Effect of Rigid Cervical Collars on Internal Jugular Vein DimensionsACADEMIC EMERGENCY MEDICINE, Issue 1 2010Michael B. Stone MD Abstract Objectives:, Prior research has demonstrated that rigid cervical collars cause an increase in intracranial pressure (ICP). The mechanism for this effect is unclear and one proposed mechanism involves obstruction of venous outflow in the neck. Ultrasound (US) allows assessment of internal jugular vein dimensions and may yield information regarding the mechanism for the increase in ICP seen with rigid collar application. Methods:, Forty-two healthy volunteers underwent US examination of the internal jugular vein before and after cervical collar application. Internal jugular vein cross-sectional areas were compared with and without the cervical collar in place. Results:, The cross-sectional area of the internal jugular vein increased significantly (p < 0.0001) after application of the cervical collar. The mean percentage increase in cross-sectional area was 37% (95% confidence interval [CI] = 20% to 53%). Conclusions:, Internal jugular vein cross-sectional area increases after application of a rigid cervical collar. This supports the hypothesis that venous obstruction in the neck may contribute to the increase in ICP seen after rigid collar application. ACADEMIC EMERGENCY MEDICINE 2010; 17:100,102 © 2009 by the Society for Academic Emergency Medicine [source] Cephalad origin of the superior vena cava and the level of the central venous catheter tip on chest radiographsPEDIATRIC ANESTHESIA, Issue 1 2005TOSHIMI ARAI MD Summary Background :,There are suggested radiographic landmarks for the lower margin of the superior vena cava (SVC), but none for the cephalad origin of the SVC in children. Therefore, we determined the cephalad origin of the SVC in relation to the level of thoracic vertebrae in children. Methods :,Sixty-five patients (2,96 months) scheduled for routine diagnostic cardiac catheterization were the subjects of the study. Vena cavogram was obtained. The crossing point between the SVC and the innominate vein was considered as the cephalad origin of the SVC, then this point was related to the level of the thoracic vertebra as a radiographic landmark. Results :,In approximately 90% of the patients studied the proximal origin of the SVC was situated above the level of Th4/5 interspace. Conclusion :,We would like to suggest that the position of the tip of central venous line, when inserted via the right internal jugular vein, should optimally be at the level of Th4/5 interspace on the postoperative chest radiograph. [source] Outcome of pulmonary function in Lemierre's disease-associated acute respiratory distress syndrome,PEDIATRIC PULMONOLOGY, Issue 4 2007Jill M. Cholette MD Abstract Pulmonary function in acute respiratory distress syndrome (ARDS) survivors typically returns to normal with the exception of a persistent reduction in carbon monoxide diffusion capacity (DLco). Septic thrombophlebitis of the internal jugular vein, (Lemierre's syndrome or postanginal sepsis) is a well-described, albeit uncommon cause of ARDS in which metastatic pulmonary thromboemboli precipitate respiratory failure requiring ventilatory support. We describe convalescent pulmonary function in two survivors of Lemierre's disease-associated ARDS, suggesting that the subset of Lemierre's syndrome induced ARDS survivors have an excellent long-term pulmonary prognosis. Pediatr Pulmonol. 2007; 42:389,392. © 2007 Wiley-Liss, Inc. [source] Chondrosarcomas of the Jugular ForamenTHE LARYNGOSCOPE, Issue 10 2008Mario Sanna MD Abstract Objectives/Hypothesis: Chondrosarcomas of the jugular foramen are extremely rare tumors. Our review of the literature revealed eleven previously reported cases. The aim of this study is to describe the presenting symptoms, radiographic findings, operative procedures, and postoperative outcome of five histologically confirmed cases of chondrosarcomas arising from the jugular foramen. A review of the literature is also presented. Study Design: Retrospective study of an quaternary referral otology and skull base private center. Methods: Five cases of surgically treated and pathologically confirmed jugular foramen chondrosarcomas were identified. The follow-up of the series ranged from 23 to 42 months (mean, 32.8 ± 7.7 months). Results: A single stage procedure was adopted in all the cases. Two patients underwent type A infratemporal approaches, one patient underwent a transotic approach extending to the neck with ligature of the internal jugular vein, one patient underwent a petro-occipital transigmoid approach, and one patient underwent a combined petro-occipital transigmoid,transotic approach. Gross total tumor removal was achieved in all patients. The most common complications were lower cranial nerve deficits. To date, no recurrence or residual tumors have been observed at radiological controls. Conclusions: We believe that the primary treatment for chondrosarcomas of the jugular foramen is gross total surgical resection of the tumor. It is our philosophy to reserve postoperative radiotherapy for patients with histologically aggressive tumors, as well as in cases with subtotal resection and recurrent tumors. [source] Patency and Flow of the Internal Jugular Vein After Functional Neck Dissection,THE LARYNGOSCOPE, Issue 1 2000María P. Prim MD Abstract Objectives: To assess the patency and flow of the internal jugular vein after functional neck dissection. Study Design: Prospective study of 54 internal jugular veins in 29 oncologic patients undergoing functional neck dissection between September 1994 and February 1997. Methods: Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of the vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were assessed in all veins before and after dissection. All patients were evaluated before and after the procedure by means of duplex Doppler ultrasonography. Results: In no case was there thrombosis before or after the operation. Although total jugular flow decreases during the early postoperative period, it recovers to normal parameters within 3 months after surgery. Conclusions: According to these results, the patency of the internal jugular vein remains unaltered after functional neck dissection. Ultrasonographically there is no thrombosis after this procedure. [source] ORIGINAL ARTICLE: The ability of anaesthetists to identify the position of the right internal jugular vein correctly using anatomical landmarksANAESTHESIA, Issue 9 2010C. R. Harber Summary We performed a study of 85 consenting anaesthetists to assess their ability to locate the right internal jugular vein using a landmark technique. Initially, a questionnaire was completed ascertaining previous user experience. An ultrasound probe, using the midpoint as an ,imaginary needle', was placed on the neck of a healthy volunteer (with previously confirmed normal anatomy) and the image recorded. Both anaesthetist and volunteer were blinded to the screen until the image was stored. Anaesthetists were grouped into those in training before 2002 (Pre-2002, n = 58), when National Institute for Health and Clinical Excellence guidelines recommending ultrasound guidance were published, and those training after this time point (Post-2002, n = 27). The success rate for identifying the internal jugular vein using the landmark technique was 36/58 (62%) in the Pre-2002 group and 6/27 (22%) in the Post-2002 group (p < 0.001). Three participants in each group would have hit the carotid artery (5% Pre-2002 and 11% Post-2002 respectively; p = 0.2). The advent of routine use of ultrasound has resulted in a cohort of anaesthetists who are unable to use a landmark technique effectively or safely. This has significant training implications. [source] Effects of head rotation on the right internal jugular vein in infants and young childrenANAESTHESIA, Issue 3 2010M. J. Gwak Summary We investigated the effects of head rotation on the cross-sectional area of the right internal jugular vein and its relative position to the carotid artery. Eighty-eight subjects were divided into infants and children groups. The cross-sectional area of the right internal jugular vein and the degree of the carotid artery overlap were measured at 0° (neutral), 40° and 80° of head rotation. The cross-sectional area of the right internal jugular vein was significantly larger at 40° and 80° head rotation compared with the neutral position in both infants and children (p < 0.001). As the head was rotated, the percentage overlap of the carotid artery increased significantly (p < 0.001). We suggest that 40° head rotation appears to be optimal for right internal jugular vein cannulation in paediatric patients. [source] Ultrasonographically guided catheterization of the internal jugular veinANZ JOURNAL OF SURGERY, Issue 9 2009Konstantinos Serafimidis MD No abstract is available for this article. [source] Experience with the Cardiva Boomerang CatalystÔ system in pediatric cardiac catheterization,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2009Sharon Seltzer MD Abstract Objectives: We studied the safety and efficacy of the Cardiva Boomerang CatalystÔ vascular closure system in pediatric patients after cardiac catheterization with access in femoral and internal jugular vessels. Background: Recurrent catheterization and advances in pediatric interventions increase the need for easy hemostasis without a residual foreign body that may prevent re-accessing the vessel. The Boomerang can be deployed in sheaths as small as 4Fr without residual foreign body, with minimal orientation needed, and few complications reported. Methods: In a two-month period, all patients between 18 months and 21 years old catheterized with 4,8Fr sheaths less than 15 cm long were eligible for Boomerang placement. These were compared retrospectively with control patients with manual hemostasis. Anthropomorphic measurements, procedure type, activated clotting time, and sheath size as well as total times of cases, intubation, hemostasis, and extubation were compared between the two groups. Results: Forty-six Boomerangs were deployed in 31 patients and compared with 40 patients with manual hemostasis. Boomerangs were deployed in femoral vessels and the internal jugular vein. Device success with hemostasis was achieved in 39 patients (85%). There were no significant differences in time to hemostasis or extubation between the two groups. No major complications or operator error occurred, including hematoma, transfusion, retroperitoneal bleed, infection, vessel occlusion, or need for surgery. Conclusions: The Boomerang is a safe and easy means of achieving hemostasis in the pediatric population, in femoral vessels as well as internal jugular veins. Its times to hemostasis and extubation were not significantly different from manual hold. © 2009 Wiley-Liss, Inc. [source] Surgically important variations of the jugular veinsCLINICAL ANATOMY, Issue 6 2006B. Satheesha Nayak Abstract Knowledge of variations of veins of head and neck in relation to external jugular, anterior jugular, internal jugular, and facial veins is important to surgeons doing head and neck surgery as well as to radiologists doing catheterization and to clinicians in general. In the current case, multiple variations in the veins of the left side of neck are reported. The anterior division of retromandibular vein was absent. The facial vein continued as anterior jugular vein. The internal jugular vein was duplicated above the level of hyoid bone. There was a large communicating vein between the anterior jugular vein and anterior division of internal jugular vein. Lingual vein drained into the communicating vein. Jugular venous arch was abnormally large, doubled, and highly placed. The veins of the right side were normal. Clin. Anat. 19:544,546, 2006. © 2005 Wiley-Liss, Inc. [source] Insertion and management of percutaneous veno-venous bypass cannula for liver transplantation: a reference for transplant anesthesiologistsCLINICAL TRANSPLANTATION, Issue 5 2010Tetsuro Sakai Sakai T, Gligor S, Diulus J, McAffee R, Marsh JW, Planinsic RM. Insertion and management of percutaneous veno-venous bypass cannula for liver transplantation: a reference for transplant anesthesiologists. Clin Transplant 2009 DOI: 10.1111/j.1399-0012.2009.01145.x © 2009 John Wiley & Sons A/S. Abstract:, Surgical advances using the retrohepatic caval preservation technique in liver transplantation (LT) has significantly decreased the need for veno-venous bypass (VVB). However, VVB still remains a viable adjunct of LT. The venous return cannula has traditionally been inserted using a cut-down technique via the axillary vein, but this technique carries significant risks for lymphorrhea, infection, or nerve damage. Since 2001, our institution has routinely used VVB in adult LT surgery. Percutaneous insertion of an internal jugular venous return cannula is performed by the attending anesthesiologist. The aim of this report is to describe the method of insertion and management of a percutaneous veno-venous return cannula in the internal jugular vein during LT. In-depth detail as well as video clips will provide a reference for LT centers wishing to apply this method in their practice. [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] Patency and Flow of the Internal Jugular Vein After Functional Neck Dissection,THE LARYNGOSCOPE, Issue 1 2000María P. Prim MD Abstract Objectives: To assess the patency and flow of the internal jugular vein after functional neck dissection. Study Design: Prospective study of 54 internal jugular veins in 29 oncologic patients undergoing functional neck dissection between September 1994 and February 1997. Methods: Patency, presence of thrombosis, characteristics of the vein wall, compressibility, area of the vein both in rest and during Valsalva maneuver, expiratory flow speed, Valsalva flow speed, jugular flow in each side, and total jugular flow were assessed in all veins before and after dissection. All patients were evaluated before and after the procedure by means of duplex Doppler ultrasonography. Results: In no case was there thrombosis before or after the operation. Although total jugular flow decreases during the early postoperative period, it recovers to normal parameters within 3 months after surgery. Conclusions: According to these results, the patency of the internal jugular vein remains unaltered after functional neck dissection. Ultrasonographically there is no thrombosis after this procedure. [source] Late Symptomatic Venous Stenosis in Three Hemodialysis Patients Without Previous Central Venous CathetersARTIFICIAL ORGANS, Issue 12 2000Massimo Morosetti Abstract: It is well known that catheters placed in the subclavian or internal jugular veins may develop stenosis in the vein in which the catheter lies. Because the arteriovenous fistula (AVF) relies on good venous outflow, patients with ipsilateral central venous stenosis are subject to the malfunctioning of AVF. Until now, no data were published on patients showing central vein stenosis (CVS) without a previous central venous catheter (CVC) or a pacemaker. In this article, we report on 3 hemodialysis patients manifesting CVS ipslateral to AVF. None of these patients previously had undergone CVC. The stenosis observed had characteristics and symptoms similar to those observed in stenoses consequent to CVC. We concluded that CVS also may occur in subclavian or axillary veins proximal to a working AVF in hemodialysis patients who have never had a CVC and in the absence of compressive phenomena. [source] Use of an Embalming Machine to Create a Central Venous Access Model in Human CadaversACADEMIC EMERGENCY MEDICINE, Issue 2009Lee Wilbur Background:, Human cadavers provide an effective model for procedural training; however, inconsistent blood return during central venous cannulation compromises the overall reliability of this procedure. Objective:, To create and quantitatively assess a human cadaver central venous access model using a continuously-run embalming machine. Curriculum:, Emergency medicine (EM) faculty at Indiana University created this model for a procedure lab designed for EM residents. The right femoral artery was identified by superficial dissection and cannulated distally towards the lower leg. This cannula was connected to a Duotronic embalming machine with a solution composed of 16 oz of 24-index fluid and 3 gallons of tap water at a fixed output of 13 pounds per square inch (psi). Next, the left subclavian vein and artery were identified by dissection and each was cannulated with an 18 gauge angiocath connected to a continuous pressure monitor. Pressures (mmHg) in the subclavian vein and artery were measured continuously while study personnel cannulated the left femoral, right subclavian, right supraclavicular, and right internal jugular veins. This model was assessed for dual sessions lasting two hours each with a two hour break in-between. Results:, During the first session, subclavian pressures were measured at 3 mmHg venous and 22 mmHg arterial, increasing to 11 mmHg venous and 27 mmHg arterial during the second session. Residents were able to withdraw at least 5 milliliters at each central venous site in the embalmed cadaver. Conclusions:, We created a reliable and measurable central venous access model in a fresh-frozen human cadaver using a standard embalming machine. [source] Experience with the Cardiva Boomerang CatalystÔ system in pediatric cardiac catheterization,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2009Sharon Seltzer MD Abstract Objectives: We studied the safety and efficacy of the Cardiva Boomerang CatalystÔ vascular closure system in pediatric patients after cardiac catheterization with access in femoral and internal jugular vessels. Background: Recurrent catheterization and advances in pediatric interventions increase the need for easy hemostasis without a residual foreign body that may prevent re-accessing the vessel. The Boomerang can be deployed in sheaths as small as 4Fr without residual foreign body, with minimal orientation needed, and few complications reported. Methods: In a two-month period, all patients between 18 months and 21 years old catheterized with 4,8Fr sheaths less than 15 cm long were eligible for Boomerang placement. These were compared retrospectively with control patients with manual hemostasis. Anthropomorphic measurements, procedure type, activated clotting time, and sheath size as well as total times of cases, intubation, hemostasis, and extubation were compared between the two groups. Results: Forty-six Boomerangs were deployed in 31 patients and compared with 40 patients with manual hemostasis. Boomerangs were deployed in femoral vessels and the internal jugular vein. Device success with hemostasis was achieved in 39 patients (85%). There were no significant differences in time to hemostasis or extubation between the two groups. No major complications or operator error occurred, including hematoma, transfusion, retroperitoneal bleed, infection, vessel occlusion, or need for surgery. Conclusions: The Boomerang is a safe and easy means of achieving hemostasis in the pediatric population, in femoral vessels as well as internal jugular veins. Its times to hemostasis and extubation were not significantly different from manual hold. © 2009 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||