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Central Venous Access in Trauma Bay
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Anjuman Chander, Ashish Aditya, Tanvir Samra, Harshit Singla
In emergency conditions like massive haemorrhage commonly encountered in trauma bay, a wide-bore catheter is required to rapidly replace the lost blood volume with intravenous fluids or blood products. The flow rate through a catheter is determined using the Hagen–Poiseuille equation: Q = πPr4/8ηl. As flow rate is directly proportional to radius and inversely with the length of the catheter, thus for trauma resuscitation, a short catheter with a large diameter should be used along with an introducer sheath. Insertion of two large-bore IV cannulas is a priority, but in circumstances in which peripheral venous access cannot be established, central venous cannulation is considered. The most important point is that CVC insertion in the trauma bay should not delay the primary survey and expedient management in a bleeding patient, and should only be performed by a trained trauma team member.
Introduction
Published in Debbie Peet, Emma Chung, Practical Medical Physics, 2021
Debbie Peet, Emma Chung, Jasdip Mangat, Joanne Cowe
Clinical skills will depend on the role but always include basic life support and infection prevention, which is especially important since the advent of COVID. Other skills may include history taking, use of imaging and physiological measurement techniques, cannulation, injection and some drug administration. These depend on the exact role undertaken. The process for demonstrating competency in clinical tasks varies between institutions, but usually requires the task to be performed a minimum number of times under supervision, as well as being “signed-off” by an approved Assessor.
Circulation
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
An arterial line should not be inserted where there is a risk of compromising distal circulation. Such cases include Buerger’s Disease, Raynaud’s syndrome and end arteries such as the brachial artery. Other contraindications include a present infection at the site of insertion, presence of an AV shunt and burns over the cannulation site.
Risk factors influence the arterial line patency in ICU-bound patients during COVID-19 pandemic: An observational cohort study
Published in Egyptian Journal of Anaesthesia, 2023
Hamed Elgendy, Adel Ganaw, Vipin Kumari, Vijay Settu, Prem Chandra, Hanaa Nafady-Hego, Mohamad Hilani, Hesham Ismail, Mohamed Elkateeb
Eligibility of the study: Patients could be initiated on the protocol if they had fulfilled the above criteria and their first arterial line (index arterial line) inserted during their first day ICU admission was complicated by documented thrombosis or arterial line failure. Arterial line failure included; 1) severe arterial waveform dampening that did not improve with flushing or repositioning; 2) Inability to withdraw blood from the catheter, and/or; 3) Catheter malfunction requiring replacement with documented thrombosis on bedside ultrasound of the vessel [10]. They should have a peripheral artery cannulation with a suitable arterial cannula and a functional arterial line established after insertion. The duration of enrolment and start of Systemic Anticoagulation protocol implementation are as explained before.
Extracorporeal membrane oxygenation for large pulmonary emboli
Published in Baylor University Medical Center Proceedings, 2023
Timothy J. George, Jenelle Sheasby, Rahul Sawhney, J. Michael DiMaio, Aasim Afzal, Dennis Gable, Sameh Sayfo
From 2014 to 2022, 10 patients with submassive or massive PE required periprocedural ECMO support. Nine were placed on femoral venoarterial ECMO, while one was cannulated using a Protek Duo cannula (Liva Nova, London, UK) and supported with an ECMO circuit. The average age was 55.0 ± 14.5 years, and the majority were male, white, and obese (Table 1). Most patients had compromised renal function with a creatinine of 2.1 ± 1.8 mg/dL, most were hypoxic with a partial pressure of oxygen of 48.6 ± 19.8 mm Hg on 100%, and most were acidotic. The majority of patients (70%) had a saddle PE while the remainder had extensive bilateral segmental PE. Two (20%) patients had clot in transit. All patients had evidence of moderate or severe right ventricular dysfunction on transthoracic echocardiogram. The majority of patients (6, 60%) had at least one episode of CPR prior to ECMO cannulation, and 4 (40%) were undergoing CPR when cannulated. The most common cannulation strategy was percutaneous femoral arterial and femoral venous cannulation (9, 90%). In one case, a right atrial to pulmonary artery cannula (Protek Duo) was utilized and connected to an ECMO circuit.
Device profile of the EXALT Model D single-use duodenoscope for endoscopic retrograde cholangiopancreatography: overview of its safety and efficacy
Published in Expert Review of Medical Devices, 2021
Dean Ehrlich, V. Raman Muthusamy
Bang et al. recently published a randomized controlled trial comparing the EXALT to a reusable duodenoscope (Olympus TJF-Q180V) [29]. This trial only included patients with a native papilla. There were 48 patients in the EXALT group and 50 patients in the reusable duodenoscope group. In the EXALT group, ERCP was completed in 46 patients (96%), with 2 patients (4.2%) requiring crossover to a reusable duodenoscope, despite the use of advanced cannulation techniques. Cannulation remained unsuccessful after crossover in both patients. Overall cannulation rates did not significantly differ between the two groups; however, the EXALT group had a significantly lower median number of cannulation attempts (2 vs 5, p = 0.013). The reusable duodenoscope was rated significantly better in passage into the stomach, image quality, image stability, and air-water button functionality. Procedure times, time taken to reach the papilla, and percentage of procedures requiring an advanced cannulation technique were not significantly different between the groups. There were four procedures in the EXALT group that were ASGE grade 4 in difficulty. See Table 1 for a comparison of the available clinical studies using EXALT.