Clues for diagnosing misplaced central venous catheter in the right ascending lumbar vein during right femoral venous access

The right ascending lumbar vein is difficult to detect on anteroposterior abdominalradiographs because it overlaps with the inferior vena cava on anteroposteriorradiographs.Intensive observation by medical providers may be a cue fordiagnosis.However,knowledge of catheter misplacement of the right ascendinglumbar vein is also necessary,because misplacement cannot be suspected withoutthat awareness.

Changes of Stress-Strain Relationship of Rabbit Femoral Vein after Simulated Weightlessness

Objective: To observe the effect of simulated weightlessness on stress-strain relationship and the structural change of rabbit femoral vein. Methods: After seting up the Head-Down Tilt (-20°) (HDT) model to simulate weightlessness, 24 healthy male New-Zealand Rabbits were randomly divided into HDT-21d group, HDT-10d group and control group, with 8 in each. Femoral venous strips and rings were used to make uniaxial tensile test of the longitudinal and circumferential specimens of the vessels. At last we observed the microstructure of femoral vein wall in 3 groups. Results : With the increasing of load stress, both longitudinal and circumferential strains of vein samples from 3 groups increased significantly (P<0. 01). With the decrease of unload stress, strains decrease obviously (P<0. 01). The unloaded longitudinal and the circumferential strain from 3 groups increased much than those of the loaded. Under the same stress (longitudinal 0-2. 0 g, circumferential 0. 5-1. 0 g) , HDT-21d group and HDT-10d group increased obviously in tlie longitudinal or circumferential strain (load and unload) than control, and HDT-21d increased much than that of HDT-10d. The contents and structures of femoral vein walls of HDT-rabbits changed significantly. Some endotheli-um cells of femoral vein became short, columnar or cubic even fell off. Smooth muscle layers became thinner. Conclusion:The compliance of femoral venous increased significantly after weightlessness-simulation and increased much obviously after 21d-HDT than that of 10 d. The structure of femoral vein wall changed obviously. The changes may be one reason for the increase of femoral vein compliance.

A Retrospective Analysis for Different Routes of Administration in Mice-Percutaneous Retro-Orbital, Jugular Catheter, Tail Vein and Femoral Cut Down Injections

Liposomes effectively transport fatty proteins to targeted tissues. Laboratory experiments use multiple methods to administer liposomes, but comparison of these methods is not available. In this retrospective study, we characterized and compared four intravenous administration routes (tail vein, jugular catheter, femoral vein and percutaneous retro-orbital injections) in murine models. ApoE-/- mice were used to compare administration routes. Results indicate that the jugular catheter route delivered the highest amount of liposomes to tissues due to longer period of injections compared to other routes;however, this route failed to remain patent for 8/10 animals. Delivery via tail vein, femoral vein and percutaneous retro-orbital injections resulted in similar accumulation in the organs. When including technical difficulty and expense, percutaneous retro-orbital injections of liposomes are the most convenient and efficacious approach.

Anatomic Dissection of the Femoral Vein at the Bamako Anatomy Laboratory

Objectives: The purpose of this work was to measure the dimensions of the femoral veins, to describe the affluent and the variations of the femoral veins. Methodology: Twenty-four femoral veins of 12 fresh adult cadavers were dissected and photographed. Results: The diameter of the superficial, deep and common femoral veins was respectively 8.75 mm;7.60 mm and 13.95 mm. The common femoral vein was 80.70 mm long. At the level of the superficial vein, the modal disposition was noted in 79.17%;as anatomical variations, it was split in 2 cases, the presence of a collateral canal in 1 case and in 2, and it received a quadricipital muscle vein. At the level of the deep femoral vein, the modal disposition was noted in 16.67%, and the anatomical variations were noted in 83.33% where it received no affluent in the femoral trine. The modal disposition was noted in 91.67% at the level of the mode of birth of the common femoral vein, in 16.67% at the level of its tributaries. The anatomical variations were noted in 8.33% in the mode of birth of the femoral vein, in 83.33% in which the common femoral vein received, in addition to the large saphenous vein, other tributaries, the most frequent of which were the quadricipital veins and the circumflex femoral veins. Conclusion: The diameter of the femoral veins is important. The main tributaries of the common femoral vein are GVS, VQ and circumflex femoral veins. The femoral variations are numerous and important to know to avoid a possible misdiagnosis in case of their thrombosis.

Endovascular stenting combined with external constriction valvuloplasty of superficial femoral vein for the treatment of Cockett syndrome

To evaluate the effect of endovascular stenting combined with external constriction valvuloplasty of superficial femoral vein for the treatment of Cockett syndrome.Methods Forty-two cases of Cockett syndrome with femoral veins reflux were treated with iliac vein stent implantation or venoplasy,and superficial femoral veins were constricted with ePTFE graft patch at the level of the first valves.Results All the iliac veins were patent after stent implantation.A follow-up of 8 to 45 months revealed that limb swelling disappeared in 38 cases with no varicose.Slight limb swelling was left over in 3 cases.Stent thrombosis,developed in one case two months later,subsided by a successful thrombolysis.Conclusion The procedure is mini-invasive,safe and effective for the treatment of Cockett syndrome.6 refs,1 fig.

Removal of a pulmonary artery foreign body during pulse ablation in a patient with atrial fibrillation:A case report

BACKGROUND Foreign bodies in the pulmonary circulation have been documented in the literature and are typically caused by interventional procedures.However,reports of pulmonary artery foreign bodies during femoral vein puncture are rare,and there is no description of this complication from the guidewire surface flows into the pulmonary artery during a pulse ablation in a patient with atrial fibrillation.CASE SUMMARY We described a case in which a linear foreign body suddenly appeared on fluoroscopy image during pulsed ablation of atrial fibrillation.Multiposition angiography showed that the foreign body was currently lodged in the pulmonary artery but was hemodynamically stable.We then chose to use an interventional approach to remove the foreign body from the pulmonary artery.This foreign body was subsequently confirmed to be from the hydrophilic coating of the guidewire surface.This may be related to the difficulties encountered during the puncture of the femoral vein.This is a rare and serious complication of femoral vein puncture.Therefore,we reported this case in order to avoid a similar situation.CONCLUSION Mismatches between interventional devices from different manufacturers used for femoral venipuncture may result in pulmonary artery foreign bodies.

Clinical analysis of central venous catheter-related infections in patients in the emergency ICU

BACKGROUND:Catheter-related infection(CRI)of the central vein is a common cause of nosocomial infection.This study was undertaken to investigate the pathogen culturing and risk factors of CRI in emergency intensive care unit(EICU)in order to provide the beneficial reference.METHODS:From January 2008 to December 2010,a total of 1 363 patients were subjected to catheterization.In these patients,the peak CRI rate of the patients was determined by bacterial cultivation and blood bacterial cultivation.RESULTS:CRI happened in 147 of the 1 363 patients using the central venous catheter.The peak rate of CRI was 10.79%,with an incidence of 3.05 episodes per 1 000 catheter days.Of the147 patients,46.94%had gram-negative bacilli,40.14%had gram-positive cocci,and 12.92%had fungi.Unconditional logistic regression analysis suggests that multiple catheterization,femoral vein catheterization,the application of multicavity catheter,and the duration of catheterization were the independent risk factors for CRI.CONCLUSION:The risk factors for catheter-related infections should be controlled to prevent the occurrence of nosocomial infection.

Venous hemodynamic changes of lower extremity during gynecological laparoscopy

Objective: To study the effect of CO2 pneumoperitoneum and the special 30 degree head-down tilt position on the venous hemodynamics in the lower extremity. Methods: Color doplex ultrasound was adopted to evaluate the diameter and blood flow velocity of the right femoral vein of 18 patients undergoing gynecologic laparoscopy under the same pressure of pneumoperitoneum of 12 mmHg. The diameter of femoral vein and the flow velocity were measured; the blood flow volume was calculated based on the equation of Q = vπr2 . Result: After establishment of pneumoperitoneum, the dilation of the femoral vein and the decrease in the velocity and volume can be observed (P < 0.05). And the 30 degree head-down position could increase the flow velocity and volume of the femoral vein and decrease the diameter of the vessel ( P < 0.05). At 30 minutes of the 30 degree head-down tilt position, the blood flow ameliorated compared with that in prone position after the establishment of pneumoperitoneum. After deflation of pneumoperitoneum, the femoral vein remained dilated( P < 0. 05). Conclusion: During laparoscopy, CO2 pneumoperitoneum may result in the dilation of the vein in lower extremity and retar dance of blood flow. The 30 degree Trendlenburg position can ameliorate the blood flow in the lower extremity. The deflation of the pneumoperitoneum cannot eliminate the effect of CO2 pneumoperitoneum on the lower extremity veins, which may predispose deep venous thrombosis after laparoscopy.

Femoral indicator injection for transpulmonary thermodilution using the EV1000/VolumeView~®: do the same criteria apply as for the PiCCO~®?

Objective： Comparison of global end-diastolic volume index （GEDVI） obtained by femoral and jugular transpulmonary thermodilution （TPTD） indicator injections using the EV1000NolumnView device （Edwards Lifesci- ences, Irvine, USA）. Methods： In an 87-year-old woman with hypovolemic shock and equipped with both jugular and femoral vein access and monitored with the EV1000NolumeView device, we recorded 10 datasets, each comprising duplicate TPTD via femoral access and duplicate TPTD （20 ml cold saline） via jugular access. Results： Mean femoral GEDVI （（674.6±52.3） ml/m2） was significantly higher than jugular GEDVI （（552.3±69.7） ml/m2）, with P=-0.003. Bland-Airman analysis demonstrated a bias of （＋122±61） ml/m2, limits of agreement of -16 and ＋260 ml/m2, and a percentage error of 22%. Use of the correction-formula recently suggested for the PiCCO device significantly reduced bias and percentage error. Similarly, mean values of parameters derived from GEDVI such as pulmonary vascular permeability index （PVPI; 1.244±0.101 vs. 1.522±0.139; P〈0.001） and global ejection fraction （GEF; （24.7±1.6）% vs. （28.1±1.8）%; P〈0.001） were significantly different in the case of femoral compared to jugular indicator injection. Fur- thermore, the mean cardiac index derived from femoral indicator injection （（4.50±0.36） L/（min.m2）） was significantly higher （P=0.02） than that derived from jugular indicator injection （（4.12±0.44） L/（min.m2））, resulting in a bias of （＋0.38±0.37） L/（min.m2） and a percentage error of 19.4%. Conclusions： Femoral access for indicator injection results in markedly altered values provided by the EV1000NolumeView , particularly for GEDVI, PVPI, and GEF.

Application of a three-dimensional microsurgical video system for a rat femoral vessel anastomosis

Background The operating microscopes have been applied to modern surgery for nearly a century.However,generations of microsurgeons have to flex their necks and fix their eyes on the eyepieces of a microscope continually that leads to physical and mental fatigue during a long operation.Stereoscopic three-dimensional （3D） media provides more ergonomic working environment,subsequently,resulting better performance in tasks and more accurate judgment.In this study,an alternative method of magnification was analyzed using a three-dimensional microsurgical video system and compared with the traditional method under microscopy to evaluate the availability and feasibility of a 3D microsurgical video system for microvascular anastomosis.Methods Forty Sprague-Dawley rats were randomly divided into four groups with each of 10.In 20 rats,10 femoral artery anastomoses with a conventional microscope （arterial microscope group） were compared with that of 10 femoral artery anastomoses with a 3D microsurgical video system （arterial 3D group）.For the other 20 rats,10 femoral vein anastomoses using a conventional microscope （venous microscope group） were compared with that of 10 femoral vein anastomoses using a 3D microsurgical video system （venous 3D group）.The arterial and venous microscope groups were considered to be the control groups.The arterial and venous 3D groups were the experimental groups.The examined criteria were as follows：anastomotic time,patency right after the procedure and 10 days later,number of sutures,vessel caliber,and pathological features.Results There were no differences between the operating equipment with respect to vessel caliber,anastomotic time,patency rate,number of sutures,and pathological changes in either the small arteries or veins.The average arterial anastomotic time of the arterial microscope group and arterial 3D group was 34.21 and 33.87 minutes,respectively （P ＞0.05）.The average venous anastomotic time of the venous microscope group and venous 3D group was 29.95 and 31.50 minutes,respectively （P ＞0.05）.Conclusions A small vessel anastomosis can be performed successfully with the help of a 3D display system.Although the vascular anastomotic time did not demonstrate a significant difference between the groups,the 3D microsurgical video system offers another option to improve the working environment for surgeons.Further development of our 3D monitoring system should focus on a higher resolution and better flexibility.

External valvuloplasty technique in deep venous valve insufficiency of the lower limbs

Objective To evaluate the therapeutic effects of external valvuloplasty technique in deep venous valve insufficiency of the lower limbs Methods External valvuloplasty of the femoral vein valve was performed in 30 patients(41 limbs) with deep venous valve insufficiency of the lower limbs The patients ranged in age from 16 to 69 years (±s , 50 8±9 2) External valvuloplasty of the first pair of superficial femoral vein valve was carried out in all limbs External valvuloplasty of the second pair of superficial femoral vein valve was added in 7 limbs and valvuloplasty of the common femoral vein valve in 6 limbs Results Venous claudication, swelling, aching disappeared in 78 0% limbs (32), obvious improvement was seen in 22 0% (9), and varicosis disappeared in all limbs Ulcer healing was observed in 80% (8/10) limbs Deep venous valve sufficiency was shown in 90 2% limbs, and reflux Ⅰ°-Ⅱ° in 4 by color Doppler Conclusion External valvuloplasty is an effective method to treat deep venous valve insufficiency of the lower limbs