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.
Principles of Surgery
Gozie Offiah, Arnold Hill in RCSI Handbook of Clinical Surgery for Finals, 2019
➢ Central TPN:■ Hickmann line (dedicated tunneled catheter).■ PICC line (Peripherally Inserted central venous catheter).■ Risks of central venous catheterization include: Haematoma / haemorrhage.Line superinfection / infection to surrounding soft tissues.Line obstruction / kinking / malplacement.Damage to surrounding structures from malplacement, including: Pneumothorax.Air embolism.Cardiac dysrhythmias.Carotid artery dissection.
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.
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).
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.
Bacteremia in autoimmune bullous disease patients undergoing double-filtration plasmapheresis
Published in Journal of Dermatological Treatment, 2019
Chika Ohata, Hiroshi Koga, Hiroshi Saruta, Norito Ishii, Takekuni Nakama
Table 1 details the characteristics of enrolled 42 courses of DFPP. Before starting DFPP, the mean age of the patients was 55.5 years; autoantibody titer was increased after a DFPP course as compared to those before it in 3 courses; 17 and 25 courses were performed for untreated and relapsed AIBD cases, respectively; diabetes mellitus was accompanied in 12 courses; corticosteroid pulse therapies before and during a DFPP course were performed in 12 and 7 courses, respectively; and the mean corticosteroid dose immediately before DFPP was 0.55 mg/kg. One of the immunosuppressants such as azathioprine, cyclosporine, mizoribine, or mycophenolate mofetil was used in 23 courses, and azathioprine and cyclosporine were used in one course. Twenty-two cases underwent catheterization on the eroded skin. A central venous catheter (CVC) was used in 22 cases, whereas a peripheral intravenous catheter, which was removed after every DFPP cycle, was used in the remaining 20 cases. The mean time required for a DFPP cycle was 218.8 min, and the mean processed blood volume for a DFPP cycle was 3.13 L. All DFPP cycles were performed 2 or 3 times per week, and the average number of DFPP cycles was 6.6/course.
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