Catheters

Background Patients with previous history of abdominal operations are sometimes excluded from consideration for peritoneal dialysis because of concerns for increased risk of complications during the implantation procedure and inadequate dialysis due to reduced peritoneal surface area. Employing a laparoscopic approach, we compared the outcome of peritoneal dialysis catheters in 2 groups of patients with and without intra-abdominal adhesions. Methods All data in this report were recorded prospectively. Revision-free and overall survival of catheters, the incidence of mechanical and infectious complication, and surgical revision rates were compared between the 2 groups. Results In 217 successful catheter implantations, there was a history of previous abdominal surgery in 42.9% of procedures; only 26.9% of them had intraperitoneal adhesions; 2.8% of patients without history of previous abdominal surgery had intraperitoneal adhesions. There were no significant differences between the 2 ...

Purpose: During abdominal myomectomy for removal of multiple fibroids, the uterine cavity may be breached. Repair of the breach is associated with a risk of development of intrauterine adhesions. We conducted a pilot study to evaluate the effectiveness of temporary placement of a Foley’s catheter balloon inflated with 30 ml normal saline into uterine cavity at the end of surgery to prevent this complication. Methods: Retrospective cohort study. When the uterine cavity was breached during open myomectomy, it was repaired with a No. 2-0 vicryl suture. A Foley catheter balloon was inserted into the uterine cavity at the end of the procedure, and the balloon distended with 30 ml of normal saline. The balloon was removed on the fourth post-operative day. Follow-up hysteroscopy was performed after 6 months. Results: At the time of follow-up hysteroscopy 6 months after the myomectomy, we found no intrauterine adhesions in 16 consecutive women treated with balloon, compared to 3 out of 10 (...

Supplmental oxygen is routinely given via nasal cannula (NC) to patients undergoing moderate sedation for endoscopy. Some patients complain of profuse rhinorrhea and⁄or sneezing after the procedure, which results in additional medical costs and patient dissatisfaction. To determine the causal relationship between the route of oxygen delivery and troublesome nasal symptoms, and to seek possible solutions. Patients (n=836) were randomly assigned to one of the three following groups: the NC group (n=294), the trimmed NC (TNC) group (n=268) and the nasal mask (NM) group (n=274). All received alfentanil 12.5 μg⁄kg and midazolam 0.06 mg⁄kg, and adjunct propofol for sedation. Supplemental oxygen at a flow rate of 4 L⁄min was used in the NC and TNC groups, and 6 L⁄min in the NM group. The incidence of nasal symptoms and hypoxia were assessed. The incidence of rhinitis symptoms was significantly higher in the NC group (7.1%) than in the TNC (0.4%) and NM (0%) groups (P<0.001). The inciden...

A study was conducted to estimate dry matter (DM) degradability in the rumen of lambs offered a basal soybean meal and sorghum grain diet with three levels of white mulberry (WM) leaves (Morus alba). Diets consisted of 90% concentrate and 10% sorghum straw, which was incrementally replaced by WM leaves at 0% (control diet, T1), 2.5% (T2), and 5% (T3) of the total ration. Crude protein (CP) in WM was 21.8% (DM basis). Diets had equal CP (14% DM basis) and metabolizable energy (10.8 MJ/kg DM) content. Three non-castrated Pelibuey male lambs fitted with permanent rumen cannula were utilized in a 3 × 3 Latin square design. Each experimental period consisted of 10 days of adaptation followed by sampling. DM degradability was determined using the nylon bag technique. Bags contained the experimental diets offered in each period and were incubated in rumen in pairs for 4, 8, 12, 24, and 48 h. The potential degradation was higher (P 

• Introduction: Umbilical vein is one of most commonly used vascular routes in neonates. Although a wide experience has been gained since its use was first described in 1947, several mild to serious complications related to the UVC have been reported in the literature. Extravasation of UVC infusate has been cited as one of the rare complications associated with malposition. We aimed to define the incidence and immediate events, preceding and following UVC extravasation. We wanted to identify early predictors, if any, and adverse consequences secondary to UVC extravasation. • Methods: We followed bidirectional retrospective cohort sampling. Cases included all babies admitted in Neonatal unit with UVC related extravasation injury for the period extending from Apr 2011 to Jul 2013. Diagnosis of UVC extravasation was made by analyzing the findings of abdominal ultrasound scan and/or abdominal paracentesis, in addition to clinical features. The clinical details of babies were obtained from unit databases. • Results: We found 19 eligible babies, with 3 babies later excluded, as the diagnosis for UVC extravasation was not convincing enough. All of them had double lumen UVC inserted (data for 3 babies not available). The mean duration of UVC in situ was 91.7 hours, ranging from one day up to more than 10 days. The different type of lesions detected on ultrasound were: increased focal hepatic echogenicity along the course of umbilical vein (9/16), intrahepatic cyst (4/16), perihepatic collection (2/16) and ascites (6/16) varying from small to large volume. In all babies, the UVC tip was found to be below diaphragm at the time of extravasation. 14/16 (87%) received parenteral nutrition (PN), while 2 had only 10% dextrose running through UVC. The dextrose concentration in PN varied between 12.1 to 18.6 %. 4/16 babies had more than 1 attempt at UVC insertion. 11/16 (69%) babies had inotropes and/or sodium bicarbonate administered through UVC. In 13 babies (81%), extravasation injury was symptomatic. The commonest presentation being abdominal distension (83%), followed by non euglycemia (67%). Complications included acute renal failure in 5/16, chronic lung disease in 5/16 and retinopathy of prematurity (≥grade 2) in 4/16. • Implication for practice: Extravasation secondary to UVC is an under recognized entity but can have potentially catastrophic and long lasting effects. Most of them are symptomatic and hence their complications avoidable. The DoH 2001 recommendation, to place the long line tip outside the heart shadow, cannot be extrapolated to UVC. As doing this is more likely to position the UVC in an unsafe, low lying level.

We evaluated two methods for preprocedure predicting the insertion depth of tunneled dialysis catheter (TDC) on chest radiograph (CXR). Patients undergoing TDC insertion via right internal jugular vein were enrolled. By Method 1, the insertion depth was calculated on preprocedure CXR as the distance from the anticipated venous tip (3.5 cm below the cavoatrial junction) to the prearranged skin puncture site (1.5 cm above the right clavicle). By Method 2, the insertion depth was derived by adding the length between the skin puncture site and the upper edge of the clavicle and the length of clavicle-to-tip. The TDC was placed at the estimated insertion depth. The distance of cavoatrial junction-to-arterial tip was then measured from postoperative supine CXR. One hundred and seventy and 121 TDCs were inserted by Method 1 and Method 2, respectively, while 127 and 92 preoperative supine CXR were used for preprocedure measurement. The mean distance of cavoatrial junction-to-arterial tip was 12.055 (8.5684) [mean (SD)], 11.27 (3.3261), 9.524 (5.1590), and 10.538 (2.6956) mm. Methods of determining the insertion depth by preprocedure measurement enable successful TDC tip placement. Method 2 and using preoperative supine CXR enabled more precise and flexible insertion.

A number of recent articles attribute the origin of the use of cervical balloon dilation in the induction of labor to either Barnes in the 1860s or Embrey and Mollison in the 1960s. This review examines the historical record and reveals that, based on current practice attribution should rather be made to two contemporaries of Barnes: the Storer and Mattei. More importantly, Storer’s warning about the rubber used in dilators was ignored, leading to decades of possibly unnecessary deaths following childbirth. To conduct this study key search terms for PubMed, Google Scholar and the website of the University of Ryerson were utilized as “Barnes”, “Woodman”, “balloon dilation”, “balloon catheter”, “foley”, “colpeurynter”, “cervix uteri” and “induction.” Subsequent analysis was done on downloaded articles using BibDesk.

The clinical use of veno-venous extracorporeal membrane oxygenation (VVECMO) in adult patients with respiratory failure is rapidly increasing. However, recirculation of blood oxygenated by ECMO back into the circuit may occur in VVECMO, resulting in insufficient oxygenation. The cannula position and bypass flow rate are two major factors influencing recirculation, but the relationship and ideal configuration of these factors are not fully understood. In the present study, we attempted to clarify these parameters for effective gas exchange. VVECMO was performed in eight adult goats under general anesthesia. The position of the drainage cannula was fixed in the inferior vena cava (IVC), but the return cannula position was varied between the IVC, right atrium (RA), and superior vena cava (SVC). At each position, the recirculation rates calculated, and the adequacy of oxygen delivery by ECMO in supplying systemic oxygen demand was assessed by measuring the arterial oxygen saturation (Sa...

The biomechanical effects of placing a portal through the subscapularis tendon have not been studied. Our hypothesis is that placing a portal through the subscapularis tendon will affect the strain properties of the tendon.Eight shoulders from deceased donors were dissected to expose the subscapularis musculotendinous unit. The subscapularis muscle was isolated, the arm was locked at neutral (0° abduction, 0° flexion/extension, 0° external rotation/internal rotation), and 3 cables were sutured to the subscapularis musculotendinous junction. Each cable was connected to a static weight. Three differential variable reluctance transducers (DVRTs) from Microstrain were sutured into the subscapularis tendon—superior, inferior, and in line with the proposed 5 o’clock portal. The musculotendinous unit was loaded along its line of action with 3, 9, and then 15 kg. Strain at each DVRT was measured in the native subscapularis tendon at each load level. The same strain measurement was taken after placing and removing a 5-mm suture anchor through the 5 o’clock portal and in the tendon after placing and removing an 8-mm cannula.Penetrating the subscapularis tendon with either a 5-mm suture anchor or an 8-mm cannula does not produce any statistically significant change in strain compared with the native tendon.Placing an anchor, or even an 8-mm cannulated portal, does not significantly alter the strain properties of the subscapularis tendon. This lack of effect on the strain characteristics of the subscapularis does not preclude the possibility of clinical effects.