Thrombosis in Children
Hau C. Kwaan, Meyer M. Samama in Clinical Thrombosis, 2019
Increasing need for venous access brought about the introduction of catheters buried under the skin for 1 to 2 in. before introduction and threading into deep vessels and into the right atrium. This has usually been done in the chest wall with threading into the right atrium, or through the vena cava when the larger double-lumen catheters are needed. The rationale behind this innovation was a desire to decrease introduction of surface contaminants into the bloodstream by the superficial tunneling of the catheters. The original Broviac catheter for adults was modified in size by Broviac for babies and children, and more recently the single lumen has been increased to a double lumen for additional lines that are not connecting.48 Hickman varieties have a thicker wall and larger lumen, and are better suited for adults.49
General Management of Blood Cancers
Tariq I Mughal, John M Goldman, Sabena T Mughal in Understanding Leukemias, Lymphomas, and Myelomas, 2017
Sometimes specialists, especially in the United States, select a central venous catheter which is connected to a small implantable port (such as Port-A-Cath; Fig. 7.5). This is a device implanted underneath the skin (subcutaneously) and is particularly suitable for patients receiving less-intensive treatment, and, perhaps, not as many blood products. It can, however, be used with ease even in patients requiring aggressive treatments, such as patients with acute leukemias and aggressive lymphomas. Most implantable ports have a single tube or lumen, but double lumen ports are also available. The main advantage of these devices compared with the external catheters, such as Hickman line, is the ease of maintenance and cosmetic appearance. They are also appealing to parents with young children, who can often pull the external catheters out with great ease, if allowed to. Like the Hickman line, the implantable ports can be installed with ease in the outpatient clinic under minor sedation, by a surgeon. To access the port, a needle is inserted through the skin into the diaphragm and connected to an infusion set through which the desired treatment or blood products can be infused. Unlike the Hickman catheter, a port can be kept in for several years, provided of course that they are maintained well. Once the port is no longer required, it can be removed quickly in the outpatient clinic, by a surgeon.
Yasmin’s story
Viv Martin, Karen Forbes in Developing a Narrative Approach to Healthcare Research, 2018
When I next see Yasmin, we talk more about her attempted suicide. In the intervening two months she has spent yet more time in hospital through severe infection and dehydration. Her Hickman line, the catheter in her chest used for long-term intravenous access, had become severely infected, and had required surgery to remove it. The infection then spread into her blood stream. In addition, she had become seriously dehydrated and close to kidney failure.
Habilitation of very preterm infants at a Post Acute Care Inpatient Rehabilitation (PACIR) center after neonatal intensive care unit (NICU) discharge
Published in Developmental Neurorehabilitation, 2019
Meenakshi Singh, Boriana Parvez, Agnes Banquet, Jordan S Kase
NTISS scores range from 0 to 100, derived from 62 items, with an assigned weight of 1–4 points for each. The total score depends upon the complexity of interventions required for each organ system. As the level of therapeutic intensity and complexity increases, so does the scoring. Certain items are mutually exclusive, and only the most heavily weighted items are used in the computation. As an example, if a baby was treated with high-frequency ventilation then extubated to nasal cannula, the NTISS for this item will be 4, for the highest level of respiratory support. To ensure consistency in the scoring for our study population, certain assumptions were made. For example, the following surgeries were classified as minor: patent arteriosus ductus (PDA) ligation, gastrostomy tube (G-tube) without fundoplication, Broviac catheter placement, Omaya reservoir, Penrose drain placement, or hernia repair. However, G-tube with fundoplication, tracheostomy, bowel resection, and ventriculoperitoneal (VP) shunt placement were considered as major surgeries. Cardiopulmonary resuscitation in the delivery room was defined if the Apgar score was ≤5 at 5 min after birth and/or the requirement of chest compressions and/or epinephrine administration.
Development and validation of a model for predicting the risk of suicide in patients with cancer
Published in Archives of Suicide Research, 2023
Lin Du, Hai-Yan Shi, Yan- Qian, Xiao-Hong Jin, Hai-Rong Yu, Xue-Lei Fu, Hua Wu, Hong-Lin Chen
Several limitations should be considered in our study. Firstly, the samples taken from inpatients, this study may limit generalization to patients from other setting, such as outpatients and tumor hospital. In addition, some information is needed be considered in the future studies, on the common reasons for admission in the hospital, such as chemotherapy, surgery, post-chemo vomiting and hypokalemia, siting of a Hickman line, sepsis, neutropenic sepsis because the thresholds are likely to be very different in different countries, which may also limit the generalization of findings. Secondly, although the use of the item-9 in the PHQ-9 to evaluate SI has been widely recognized, due to the patients’ stigma about the disease and the effects of social desirability bias, which may lead to partial bias. Thirdly, unconscious patients or patients with serious physical diseases who cannot participant in the study independently were excluded, which might lead to some selection bias and underestimated the prevalence of SI in cancer patients in this study. Finally, due to differences in patients' understanding of the questionnaire questions, this may result in partial bias.
Home Total Parenteral Nutrition for Intestinal Failure in Patients with Advanced Small Intestinal Neuroendocrine Neoplasms
Published in Nutrition and Cancer, 2021
Man Liu, Faidon-Marios Laskaratos, Jose Bennell, Jie Chen, Christos Toumpanakis, Dalvinder Mandair, Martyn Caplin
Death was the most common reason for TPN discontinuation, e.g., Patient Nos. 3, 4 and 5. Patient No. 4 developed Hickman line-associated septicemia 3 mo, after TPN initiation and had a trial of enteral nutrition, thus discontinuing TPN. Two months later, having failed to maintain an enteral diet, this patient restarted TPN for 5 mo, and re-developed septicemia, which led to another discontinuation of TPN. During that time, she slowly built up an appropriate enteral calorie intake. Two and half years later, the patient developed severe SBO with low albumin and gross peripheral edema and restarted TPN surviving on TPN for a further 4 mo (Table 2).
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