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Vascular access
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Marcus D. Jarboe, Ronald B. Hirschl
Totally implantable vascular access devices or “ports” have a catheter connected to a small reservoir, which is implanted subcutaneously (Figure 1.6a). A thick silicone membrane forming the roof of the port can be repeatedly injected percutaneously using a 22-gauge side-fenestrated, non-coring (Huber) needle (Figure 1.6b). The ports are made from stainless steel, titanium, or hard plastic and are available in different shapes and sizes. Those with a preconnected catheter are easier to insert. One variety is designed to be implanted in the arm with central venous access through a peripherally inserted catheter. Because they have no external catheter, port devices have certain advantages over tunneled CVCs. In particular, they are less likely to require removal for infection, they cannot be accidentally removed, and they allow for activities such as swimming. They are therefore preferable for most children who require only intermittent (e.g. weekly) access, including those with hematological diseases and cystic fibrosis. They are less appropriate in children who cannot tolerate regular needle access, or who require continuous access, for example those who will need intensive chemotherapy or parenteral nutrition.
Cytomegalovirus
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
The use of ganciclovir may be limited by adverse effects, most commonly bone marrow suppression. Patients should be monitored for evidence of anemia, leukopenia, or thrombocytopenia and a few patients may require concomitant therapy with growth factors. Other complications reflect the use of central venous access and include a high risk of infection and sepsis, as well as thrombosis or mechanical problems with the catheter. The drug dosage must be adjusted in patients with renal insufficiency.
Miscellaneous procedures
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The ATLS primary survey has five sequential elements: Airway assessment. This includes clearing and maintaining the airway. The cervical spine is immobilised and protected from further injury.Breathing and ventilation. The patient is assessed for signs of airway obstruction, tension or open pneumothorax, haemothorax, flail chest, pulmonary contusion and cardiac tamponade.Circulation and haemorrhage control. Venous access is established, and appropriate therapeutic interventions initiated.Disability and neurological assessment. The patient is assessed for their level of alertness, verbal stimuli response, painful stimuli response or unresponsive.Exposure and environment. The patient is made comfortable and kept warm.
Early stage clinical trials for the treatment of hemophilia A
Published in Expert Opinion on Investigational Drugs, 2022
Gianna M Guzzardo, Robert Sidonio, Jr, Michael U Callaghan, Katherine Regling
Many barriers contribute to the high disease burden in patients with HA. The route and frequency of administration is one of the largest limitations in HA treatment as FVIII has a short half-life (6–8 hours in children and 12–15 hours in adults) and therefore repeated intravenous (IV) infusions are needed every two to three days [3] This prompted the development of extended half-life (EHL) therapies through PEGylation or conjugation increasing their therapeutic duration and allowing for twice weekly infusions, however these modifications typically only increase the half-life to a maximum of 19 hours [10,11]. Regardless, these EHL therapies have improved the overall quality of life for those with HA [11]. Obtaining venous access can be difficult and has been proven to be extremely problematic in younger patients and infants requiring infusions, often leading to frequent clinic or emergency room visits. The balance between medical treatment and other life obligations can be challenging to many affected by HA.
Therapeutic plasma exchange for myasthenia gravis, Guillain-Barre syndrome, and other immune-mediated neurological diseases, over a 40-year experience
Published in Expert Review of Neurotherapeutics, 2022
Mireya Fernández-Fournier, Ana Kerguelen, Francisco Javier Rodríguez de Rivera, Laura Lacruz, Santiago Jimeno, Itsaso Losantos, Dolores Hernández-Maraver, Inmaculada Puertas, Antonio Tallon-Barranco, Aurora Viejo, Ana Frank García, Exuperio Díez-Tejedor
TPE may be perceived by some physicians to be a complex treatment that is difficult to prescribe and long to perform, requiring vascular access by central lines and hospital admission [19]. The technology involved in TPE has however evolved significantly over time. At our center we do systematically hospitalize patients and use central venous access, however nowadays an attempt to solve this inconvenient has developed with peripheral venous access [6]. Some centers have peripheral venous access and out-patient treatment as standard of care, with hospitalization indicated solely on the basis of disease severity [19]. We are currently progressively switching to peripheral vein access guided by Doppler ultrasound to avoid inconvenients and possible complications of central catheters. At our center, as is general practice, TPE is usually performed on alternate days, to allow more pathological molecules including autoantibodies to return from the extravascular space to the circulation and be removed. However TPE can be performed on subsequent days and in fact some authors do recommend this practice in some instances [6,19]. Moreover, as a standard, TPE procedure via centrifugation can be completed in adults in about 90 minutes [6].
Esthetics Effect and the Modified Placement of Robotic-Assisted Single-Site Laparoscopic Gynecologic Surgery by Common Robotic Instruments and LAGIS Single-Site Port
Published in Journal of Investigative Surgery, 2022
Xiaojun Liu, Jinghai Gao, Jing Wang, Jiahao You, Jing Chu, Zhijun Jin
Anesthesiologists with experience in robotic surgery asked patients before surgery to judge the indications and contraindications of general anesthesia. At the same time, the patient’s physical condition and complications were known to judge whether the patient can tolerate anesthesia and robotic surgery.Formulation of anesthesia methods. The anesthesiologist formulated the appropriate anesthesia for this patient based on the results of the inquiry.Signature of informed consent for anesthesia.Preoperative order.Connection of monitors and measurement of basic vital signs.Opening of venous access.Inspection of instruments and equipment and preparation of surgical supplies.Induction and maintenance of anesthesia.Detection of various vital signs and handling of various accidents.