General Approach To Upper Gastrointestinal Bleeding
John P. Papp in Endoscopie Control of Gastrointestinal Hemorrhage, 2019
When the initial appearance of the patient suggests hypovolemia, one member of the team should be establishing intravenous access by one or more routes depending on the apparent severity of the blood loss. A larger bore, #18- or #19-gauge needle or a venous catheter should be used. It is preferable to place the intravenous line in the right arm, since the patient usually is placed on his left side for the endoscopic examination. Placement of a central venous catheter is indicated in patients with severe bleeding to monitor central pressure and for fluid and blood replacement. Baseline blood studies should be obtained from a specimen taken with the initial venipuncture and ideally include a complete blood count, platelet estimate, blood urea nitrogen, glucose, prothrombin time, partial thromboplastin time, electrolytes, and chemistry profile (SMA12). The first portion of the blood sample obtained should be sent immediately to the blood bank for typing and cross-match for four units of whole blood. Packed red blood cells may be indicated in certain situations such as congestive heart failure.
Duodenal atresia and stenosis
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
Postoperative care consists primarily of supportive measures to provide nutrition while awaiting the return of intestinal function. Immediate enteral feeding can be started if a transanastomotic tube is placed at the time of the initial operation. Transanastomotic feeding may reduce parenteral nutrition use and improve the time to oral feeding. The disadvantages of transanastomotic feeding include tube dislodgment and intestinal injury. Parenteral nutrition may be used to provide nutritional support postoperatively. To minimize the risks of parenteral nutrition (especially hepatotoxicity), total calories, protein, and fat intake should be kept at the lowest levels possible to allow growth. Peripherally inserted central venous catheters are used commonly.
Functional Assessment
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
Even the appropriate management of acute infection by antibiotic therapy, hospitalization, or surgery has the potential to further complicate a patient's course of illness and recovery. Medication interactions are common and are especially troublesome in those individuals receiving medical therapy for multiple chronic illnesses. Addition of antibiotics to a patient's regimen has the potential to increase adverse drug events, side effects, and drug-drug interactions; these concerns are further augmented by renal insufficiency or liver dysfunction. For example, hospitalization of elderly patients with digoxin toxicity is associated with concomitant administration of the antibiotic clarithromycin, presumably due to inhibition of P-glycoprotein, which normally promotes clearance of digoxin (4). Hospitalization presents the possibility of iatrogenic complications, whose rates increase with the age of the patient. Peripheral and central venous catheters carry an inherent risk of infection. The common act of inserting a Foley catheter can lead to undesirable events such as development of simple and complicated UTI, delirium, and complications of enforced immobility, a result of the catheter acting as a tether that restrains the patient's movement.
Comparison of intermittent versus continuous infusion of 3% hypertonic saline on intracranial pressure in traumatic brain injury using ultrasound assessment of optic nerve sheath
Published in Egyptian Journal of Anaesthesia, 2022
Amr Samir Wahdan, Ahmed Abdallah Al-Madawi, Khaled Abdelrahman El-Shafey, Safinaz Hassan Othman
On admission to N-ICU, the baseline characteristic data of patients were collected from the medical records of the local trauma database (e.g., age, sex, weight, body mass index [BMI], comorbidity, Injury Severity Score, AIS, and injury diagnosis). Hemodynamics (mean heart rate [HR], MAP, temperature, and oxygen saturation [SpO2]) were then evaluated, and routine laboratory tests (complete blood count, Na, potassium [K], serum urea, serum creatinine, alanine transaminase, aspartate transaminase, international normalized ratio, prothrombin concentration, lactate, bilirubin, plasma osmolarity, and blood gases) were performed. A central venous catheter was inserted. Additionally, at this time, the GCS scores, Simplified Acute Physiology Score (SAPS II), and Acute Physiology and Chronic Health Evaluation (APACHE II) scores were measured.
Recent developments in in vitro and in vivo models for improved translation of preclinical pharmacokinetics and pharmacodynamics data
Published in Drug Metabolism Reviews, 2021
Jaydeep Yadav, Mehdi El Hassani, Jasleen Sodhi, Volker M. Lauschke, Jessica H. Hartman, Laura E. Russell
Tada et al. recently assessed the PK of 5-fluorouracil after hepatectomy in a colorectal liver metastasis rat model to evaluate the correlation between liver dihydropyridine dehydrogenase, which is the main enzyme catabolizing 5-fluorouracil (5-FU), and 5-FU toxicity (Tada et al. 2020). The model consists of male Wistar rats undergoing a hepatectomy by which the median and left lateral hepatic lobes were removed, as described previously (Martins et al. 2008; Komori et al. 2014). Following this procedure, a central venous catheter insertion was performed. Then, the neck was surgically dissected, and a polyurethane catheter was inserted in the right external jugular vein and advanced into the superior vena cava. A PinPort™ was set to the edge of the catheter to allow access to the vein. The administration of 5-fluorouracil was performed four days after the hepatectomy. It was concluded that 5-FU dose should be reduced for patients undergoing major hepatectomy, because of the possibility of increased 5-FU toxicity due to the reduction of dihydropyrimidine dehydrogenase (Tada et al. 2020).
Acute and chronic non-pulmonary complications in adults with cystic fibrosis
Published in Expert Review of Respiratory Medicine, 2019
Lucile Regard, Clémence Martin, Guillaume Chassagnon, Pierre-Régis Burgel
Over time, peripheral venous access can become challenging in adults with CF who have received repeated courses of IV antibiotics. Central venous catheters (CVCs), including peripherally inserted central catheters (PICC) and totally implantable central venous catheters (TICVC), are frequently used in this population. Both PICCs and TICVCs can lead to local or systemic complications although complication rates remain low in the CF adult population: 13.1–21.0% for PICC lines and 0.337 to 0.905 per 1000 catheter days for TICVC have been reported [58–63]. The most frequent complications for PICC lines include occlusion (18–21%) and pain (18%) [59,64]. Symptomatic deep vein thrombosis has been reported in 2–8% of PICC carriers [59,65] and infectious complication rates are very low (0–0.8%) [59,61]. A recent multicenter study identified several risk factors for PICC line complications, including larger catheter diameter, multiple lumens, poor nutritional status, Burkholderia cepacia spp., infection and having ≥5 PICCs inserted during the study period [61]. TICVCs can lead to complications such as thrombosis (Figure 1(c)), embolism, superior vena cava (SVC) syndrome (Figure 1(d)), occlusion, stenosis, sepsis, and pneumothorax [62].
Related Knowledge Centers
- Axillary Vein
- Femoral Vein
- Groin
- Internal Jugular Vein
- Subclavian Vein
- Vein
- Thorax
- Neck
- Catheter
- Venous Access