Introduction: Because establishing venous access in patients can be difficult and time consuming, the use of ultrasound to guide the insertion of peripheral intravenous catheters has become more common. Anecdotal evid...Introduction: Because establishing venous access in patients can be difficult and time consuming, the use of ultrasound to guide the insertion of peripheral intravenous catheters has become more common. Anecdotal evidence indicates ultrasound-guided catheter insertion may result in decreased catheter survival in the vein (dwell-time), but there is little evidence to support this observation. The purpose of this study was to compare dwell-times for peripheral intravenous catheters placed with ultrasound guidance with intravenous catheters placed by means of traditional anatomic insertion in patients in an acute care hospital. Methods: This secondary data analysis examined outcomes of 298 patients who received ultrasound-guided catheter insertion and 299 patients who received traditionally placed intravenous catheters. Multivariable linear regression was used to identify significant predictors of dwell-time for both the traditional and US-guided catheters. Results: The average dwell-times for ultrasound-guided and traditionally placed catheters were significantly different (p 2 = 0.22). Discussion: Dwell-times of catheters placed with ultrasound guidance are shorter than traditionally placed catheters. Ultrasound-guided catheters should be monitored closely for inadvertent removal or infiltration. A plan to place a more permanent type of intravenous access should be considered for patients admitted for patients longer than 24 hours.展开更多
BACKGROUND:Pig islet xenotransplantation has the potential to overcome the shortage of donated human islets for islet cell transplantation in type 1 diabetes.Testing in nonhuman primate models is necessary before clin...BACKGROUND:Pig islet xenotransplantation has the potential to overcome the shortage of donated human islets for islet cell transplantation in type 1 diabetes.Testing in nonhuman primate models is necessary before clinical application in humans.Intraportal islet transplantation in monkeys is usually performed by surgical infusion during laparotomy or laparoscopy.In this paper,we describe a new method of percutaneous transhepatic portal catheterization(PTPC) as an alternative to current methods of islet transplantation in rhesus monkeys.METHODS:We performed ultrasound-guided PTPC in five adult rhesus monkeys weighing 7-8 kg,with portal vein catheterization confirmed by digital subtraction angiography.We monitored for complications in the thoracic and abdominal cavity.To evaluate the safety of ultrasound-guided PTPC,we recorded the changes in portal pressure throughout the microbead transplantation procedure.RESULTS:Ultrasound-guided PTPC and infusion of 16 000 microbeads/kg body weight into the portal vein was successful in all five monkeys.Differences in the hepatobiliary anatomy of rhesus monkeys compared to humans led to a higher initial complication rate.The first monkey died of abdominal hemorrhage 10 hours post-transplantation.The second suffered from a mild pneumothorax but recovered fully after taking only conservative measures.After gaining experience with the first two monkeys,we decreased both the hepatic puncture time and the number of puncture attempts required,with the remaining three monkeys experiencing no complications.Portal pressures initially increased proportional to the number of transplanted microbeads but returned to preinfusion levels at 30 minutes post-transplantation.The changes in portal pressures occurring during the procedure were not significantly different.CONCLUSIONS:Ultrasound-guided PTPC is an effective,convenient,and minimally invasive method suitable for use in non-human primate models of islet cell transplantation provided that care is taken with hepatic puncture.Its advantages must be weighed against the risks of procedure-related complications.展开更多
Background and Objective: Percutaneous central venous cannulation is a common invasive procedure. In comparison with an external landmark technique, the advantages of ultrasound-guided venous access include direct vis...Background and Objective: Percutaneous central venous cannulation is a common invasive procedure. In comparison with an external landmark technique, the advantages of ultrasound-guided venous access include direct visualization of the anatomy and in vivo visualization of venous cannulation. Methods: We evaluated an ultrasound-guided technique for infraclavicular axillary vein cannulation, focusing on its ease of use, success rate and complications rate. One hundred and twenty patients who submitted to central venous catheter placement were punctured using our technique. The patients were positioned so that their ipsilateral upper limb was abducted at 90° to the longitudinal axis, which makes it possible to visualize the infraclavicular vessels due to the elevation of the clavicle, thereby improving accessibility. Results: Cannulation was successful in all patients. The median time from the start of the first puncture (of the skin) until the aspiration of blood was 15 s (range 7 - 135 s). Both infraclavicular axillary veins were cannulated, and the vein was punctured successfully at the first attempt in 95% of the patients, without complications during the procedure. Conclusion: We propose an ultrasound-guided infraclavicular approach of the axillary vein, with a high success rate and no complications in the present cohort.展开更多
文摘Introduction: Because establishing venous access in patients can be difficult and time consuming, the use of ultrasound to guide the insertion of peripheral intravenous catheters has become more common. Anecdotal evidence indicates ultrasound-guided catheter insertion may result in decreased catheter survival in the vein (dwell-time), but there is little evidence to support this observation. The purpose of this study was to compare dwell-times for peripheral intravenous catheters placed with ultrasound guidance with intravenous catheters placed by means of traditional anatomic insertion in patients in an acute care hospital. Methods: This secondary data analysis examined outcomes of 298 patients who received ultrasound-guided catheter insertion and 299 patients who received traditionally placed intravenous catheters. Multivariable linear regression was used to identify significant predictors of dwell-time for both the traditional and US-guided catheters. Results: The average dwell-times for ultrasound-guided and traditionally placed catheters were significantly different (p 2 = 0.22). Discussion: Dwell-times of catheters placed with ultrasound guidance are shorter than traditionally placed catheters. Ultrasound-guided catheters should be monitored closely for inadvertent removal or infiltration. A plan to place a more permanent type of intravenous access should be considered for patients admitted for patients longer than 24 hours.
基金supported by grants from the Natural Science Foundation of Hunan Province(11JJ4078)the National Natural Science Foundation of China(30900359 and 30900377)
文摘BACKGROUND:Pig islet xenotransplantation has the potential to overcome the shortage of donated human islets for islet cell transplantation in type 1 diabetes.Testing in nonhuman primate models is necessary before clinical application in humans.Intraportal islet transplantation in monkeys is usually performed by surgical infusion during laparotomy or laparoscopy.In this paper,we describe a new method of percutaneous transhepatic portal catheterization(PTPC) as an alternative to current methods of islet transplantation in rhesus monkeys.METHODS:We performed ultrasound-guided PTPC in five adult rhesus monkeys weighing 7-8 kg,with portal vein catheterization confirmed by digital subtraction angiography.We monitored for complications in the thoracic and abdominal cavity.To evaluate the safety of ultrasound-guided PTPC,we recorded the changes in portal pressure throughout the microbead transplantation procedure.RESULTS:Ultrasound-guided PTPC and infusion of 16 000 microbeads/kg body weight into the portal vein was successful in all five monkeys.Differences in the hepatobiliary anatomy of rhesus monkeys compared to humans led to a higher initial complication rate.The first monkey died of abdominal hemorrhage 10 hours post-transplantation.The second suffered from a mild pneumothorax but recovered fully after taking only conservative measures.After gaining experience with the first two monkeys,we decreased both the hepatic puncture time and the number of puncture attempts required,with the remaining three monkeys experiencing no complications.Portal pressures initially increased proportional to the number of transplanted microbeads but returned to preinfusion levels at 30 minutes post-transplantation.The changes in portal pressures occurring during the procedure were not significantly different.CONCLUSIONS:Ultrasound-guided PTPC is an effective,convenient,and minimally invasive method suitable for use in non-human primate models of islet cell transplantation provided that care is taken with hepatic puncture.Its advantages must be weighed against the risks of procedure-related complications.
文摘Background and Objective: Percutaneous central venous cannulation is a common invasive procedure. In comparison with an external landmark technique, the advantages of ultrasound-guided venous access include direct visualization of the anatomy and in vivo visualization of venous cannulation. Methods: We evaluated an ultrasound-guided technique for infraclavicular axillary vein cannulation, focusing on its ease of use, success rate and complications rate. One hundred and twenty patients who submitted to central venous catheter placement were punctured using our technique. The patients were positioned so that their ipsilateral upper limb was abducted at 90° to the longitudinal axis, which makes it possible to visualize the infraclavicular vessels due to the elevation of the clavicle, thereby improving accessibility. Results: Cannulation was successful in all patients. The median time from the start of the first puncture (of the skin) until the aspiration of blood was 15 s (range 7 - 135 s). Both infraclavicular axillary veins were cannulated, and the vein was punctured successfully at the first attempt in 95% of the patients, without complications during the procedure. Conclusion: We propose an ultrasound-guided infraclavicular approach of the axillary vein, with a high success rate and no complications in the present cohort.
