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Maternal Cardiorespiratory Arrest
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Nilmini Wijesuriya
Haemorrhage is a major cause of CRA, and may also be a consequence of other causes of CRA. In addition, haemorrhage may be concealed as in some cases of placental abruption, uterine rupture and ruptured ectopic pregnancy. Abdominal examination and ultrasound (for free fluid) are helpful in detecting concealed haemorrhage in these cases. Two large-bore intravenous (IV) cannulae with a minimum gauge of 16 should be inserted as soon as possible. If it is difficult to obtain peripheral access, then central venous access or venous cutdown should be considered. Intravenous access should be gained above the femoral vein, because fluids or drugs administered via the femoral veins may not reach the maternal heart until the fetus is delivered due to compression of the inferior vena cava by the gravid uterus. At the time of gaining IV access, blood should be obtained for group and save (at least six units of packed red cells), a full blood count, blood urea, serum electrolytes, liver function tests and a clotting profile.
Pre-Hospital and Emergency Trauma Care
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Access is preferably central, via the subclavian route, and an 8.5 French Gauge (FG) introducer, more commonly used for passing a pulmonary artery catheter, can be used. Alternative routes are the jugular or femoral veins, or venous cut-down.
Long-Term Management of Vascular Access Ports in Nonhuman Primates Used in Preclinical Efficacy and Tolerability Studies
Published in Journal of Investigative Surgery, 2020
Lucas A. Mutch, Samuel T. Klinker, Jody J. Janecek, Melanie N. Niewinski, Rachael M. Z. Lee, Melanie L. Graham
VAP implantation for central vascular access in nonhuman primates is achieved using jugular venous cutdown (JVC) or femoral venous cutdown (FVC) with a tunneled catheter to a port head placed mid back [25–28] or more recently the refined approach using a single incision peripheral insertion (SIPI) technique to access the inferior vena cava using the saphenous vein [29, 30]. The use of a peripheral access site has the comparative advantage of lower infection rates, similar to what has been observed in the clinic [15, 30]. We have even expanded the use of VAPs for targeted delivery of biologics directly to the portal circulation [31]. The use of a portal VAP for delivery of biologics (e.g. cell or gene therapy products) has the considerable advantage that a surgical event, or repeat events, can be avoided during the period of efficacy and safety evaluations. Likewise, this minimizes the invasiveness of study procedures and minimizes additive effects (e.g. surgery while an animal is diabetic or immunosuppressed) that increase experimental burden on animals.
Current approaches in the treatment of catheter-related deep venous thrombosis in children
Published in Expert Review of Hematology, 2020
Julie Jaffray, Neil Goldenberg
A study evaluating complications of PICCs alone in over 200 children identified the incidence of CVC-related VTE by surveillance imaging was 8.3%, and the majority of subjects were asymptomatic [28]. Study results also noted increased CVC-related VTE risk in catheters that had a malfunction or in subjects with a central line-associated bloodstream infection (CLABSI) [28]. Another study evaluated complications in long-term central venous access devices in pediatric leukemia patients. The patients either had an upper extremity tunneled, cuffed CVC, or totally implanted CVC. Study results revealed CVCs placed in the upper left extremity, percutaneously inserted (over venous cut-down) and lines placed in the subclavian vein over the jugular vein had increased risk of VTE [23], although these findings have not been confirmed in other pediatric studies.
S-ICDs: advantages and opportunities for improvement
Published in Expert Review of Medical Devices, 2022
The first implantable cardiac defibrillator (ICD) was implanted in 1980 [1] and since then, the device has become a cornerstone in primary and secondary prevention of sudden cardiac death. The device has substantially evolved over the last decade with a reduction in generator size, an increase in battery longevity, advanced diagnostic features and therapeutic algorithms. Despite continuous development, acute and chronic complications (perforation, pneumothorax, lead failure, venous occlusion/stenosis, infection, etc.) related to transvenous ICDs (TV-ICDs) remain important drawbacks. In particular, lead failure constitutes a major complication and is associated with oversensing and inappropriate shocks. Rates of lead failure of up to 20% at 10-year follow-up have been reported [2], although these data are historical and do not reflect current experience with better implantation technique (i.e. cephalic venous cutdown and axillary vein puncture) and improved hardware (with 10-year lead survival of 98% [3]). Lead failure is a major reason for device extraction, a procedure, which is associated with high morbidity and mortality. In order to avoid complications related to transvenous leads, efforts have been made to develop an ICD system, which no longer requires transvenous access, and which is more practical and less invasive than surgical epicardial systems (which have since been abandoned). A subcutaneous ICD (S-ICD) system was thus developed by Cameron Health [4] and received CE marking in 2009, before being acquired by Boston Scientific (Marlborough, MA) and receiving FDA approval in 2012. The system has received a Class IIa indication as an alternative to transvenous ICDs to prevent sudden cardiac death according to the 2015 ESC [5] and to the 2017 AHA guidelines [6], as long as pacing for bradycardia, anti-tachycardia pacing (ATP) and cardiac resynchronization therapy (CRT) are not required (and a class I indication in case of inadequate vascular access or high risk of infection [6]). Over the last years, the S-ICD has gained mainstream clinical practice, for example, equaling numbers of single-chamber TV-ICD implantation in some centers according to the Swiss national device registry [7].