Consent for a Cannula
Robert Wheeler in Clinical Law for Clinical Practice, 2020
A 64-year-old woman was lying in the resuscitation room of an emergency department in London while an Surgical House Officer was proposing to insert a cannula into her left arm. This was necessary because she had a suspected fracture of her right humerus. The doctor considered alternative sites of cannulation, including the legs, but due to her general physical condition could not find a suitable vein. The Court of Appeal found that notwithstanding the pressures and anxieties of being a patient in a resuscitation room. She gave no consent to the cannulation of her left arm and accordingly, the doctor who chose to insert it breached his duty of care to her. The Court of Appeal provided no assistance with this, although in fairness, courts only answer the questions posed to them, rather than advising generally upon the clinical dilemma that flows as a consequence of the judgement.
Peripheral Venous Cannulation
James Michael Forsyth, Ahmed Shalan, Andrew Thompson in Venous Access Made Easy, 2019
The approach for all venous access procedures revolves around the 4 Ps: Planning, Preparation, Positioning and Procedure. Once the cannula has entered the vein, there should be a flashback of venous blood visible at the end of the cannula. At this point, the outer tubing can be fully advanced over the inner needle into the vein, whilst simultaneously withdrawing the inner needle so it is completely removed. After this, blood can be withdrawn from the cannula for laboratory analysis. In closing, readers should attach a label to the cannula dressing site with the date of insertion clearly indicated, fill in any required insertion documentation for the patient notes, and dispose of any sharps and clinical waste. Sometimes the cephalic vein at the wrist is mobile from side to side, which can make cannulation difficult. Therefore, readers can use their left index finger and thumb to immobilise the vein as they are aiming to puncture it close to the fingers.
Ultrasound-Guided Peripheral Venous Cannulation
James Michael Forsyth, Ahmed Shalan, Andrew Thompson in Venous Access Made Easy, 2019
This chapter discusses the ultrasound-guided peripheral venous cannulation technique. With appreciation of upper limb venous anatomy, using the ultrasound, readers can try to identify a reasonably sized, superficial and sufficiently straight segment of a vein. The cephalic vein in the mid-forearm is usually the best venous access option because it is not commonly used for cannulation, as it is not easily seen by the naked eye. The other recommended choices include the cephalic vein in the upper arm and the basilic vein in the upper medial arm. Ultrasound-guided venous cannulation is a skill that requires both hand-to-hand and hand-to-eye coordination. This takes time to develop and at the outset may be difficult to achieve instantly. The tip of the needle should be above the vein. Now move the ultrasound probe backwards a very short distance until the tip of the needle vanishes.
Digestibility of carbohydrates in growing pigs: a comparison between the t-cannula and the steered ileo-caecal valve cannula
Published in Archives of Animal Nutrition, 2004
Y. C. Zhang, H Jørgensen, J. A. Fernandez, K. E. Bach Knudsen
We compared the determination of ileal and total tract digestibility of carbohydrates in five experimental diets using a double 5 × 5 Latin square design involving a total of 10 cannulated pigs; half of the pigs were equipped with a simple T-cannula and the other half with steered ileo-caecal valve (SICV)-cannula. The diets consisted of nitrogen-free mixture and soya bean meal, sunflower meal, peas or rape seed cake diluted to about 180 g/kg DM protein with the nitrogen-free mixture. There was no significant difference in the digestibility values using the two types of cannulas with regard to organic matter, sugars (sum of glucose, fructose and sucrose), α-galactosides (sum of raffinose, stachyose and verbascose), starch, cellulose, total non-cellulosic polysaccharides (NCP) and insoluble NCP constituents. The digestibility values for the NCP residues arabinose and galactose, however, were estimated higher but with a lower variability with the SICV-cannula compared with the T-cannula. The type of cannula did no influence the estimation of the total tract digestibility for any of the major dietary constituents, but the total tract digestibility was slightly more variable when the pigs were equipped with the SICV-cannula compared with the T-cannula. There was no difference in the ileal digestibility of sugars, α-galactosides, cellulose and the NCP arabinose and uronic acids residues among the experimental diets, while the ileal digestibility of starch and the remaining NCP sugar residues varied between diets. The total tract digestibility was complete for sugars, α-galactosides and starch, whereas the digestibility of the cell wall constituents varied in accordance with the polymeric composition of the cell walls. It was concluded that ileal digesta samples from SICV-cannula are more homogenous than those from the T-cannula. In cases where the precision of each determination is crucial, the SICV-cannula should be the option.
Iatrogenic laparoscopic spigelian hernia: A possible cause and prevention
Published in Minimally Invasive Therapy, 1995
J. P. Williams, G. T. Deans, W. A. Brough
Summary Following laparoscopic hernia repair, small bowel hemiation occurred through the posterior rectus sheath of a cannula site despite closure of the anterior sheath. The proposed mechanism was coalescence of two adjacent 12 mm defects, resulting from the re-introduction of a displaced cannula. It is recommended that a displaced cannula be re-introduced along the original track using a blunt trocar. This should be done whilst observing the procedure with the video camera. Prevention of cannula site hernia can only be ensured with complete closure of both anterior and posterior rectus sheath.
Evaluation of pain during hysterosalpingography with the use of balloon catheter vs metal cannula
Published in Journal of Obstetrics and Gynaecology, 2015
S. Kiykac Altinbas, B. Dilbaz, T. Zengin, S. Kilic, L. Cakir, O. Sengul, S. Dede
Our aim was to investigate the use of a balloon catheter device in comparison with metal cannula for hysterosalpingography (HSG) in terms of patient comfort. A total of 168 patients were randomised for HSG either with a balloon catheter (n = 83) or metal cannula (n = 85). Scores of pelvic pain during insertion of the devices, injection of the contrast medium and 1 h after the procedure were evaluated using the Wong Baker Faces Pain Rating Scale; complications and reinsertion rates were also noted. The pain scores were significantly lower in the balloon catheter group (p < 0.001). The reinsertion rate of metal cannula was higher (8.2% vs 2.4%) as well as the incidence of nausea being the most common short-term adverse effect (14.1% vs 1.2%) in the metal cannula group (p = 0.002). Performing HSG with a balloon catheter is advantageous for decreasing the pain and side-effects related to the procedure, when compared with the use of a metal cannula.
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