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Vascular access difficult

Noriyoshi Yashiki, Tsuyoshi Yachi, Keiichi Kimura
A 40-year-old female was injured in a car accident while driving. Computed tomography confirmed a dissection localized to the distal aortic arch and hematoma around the area. Severe liver damage with surrounding extravasation was also confirmed. Furthermore, multiple rib fractures and lumbar spine fracture were apparent. Thoracic endovascular aortic repair( TEVAR) was performed after transcatheter arterial embolization to treat the liver injury. As both the iliac and femoral arteries were narrow, the internal iliac artery was transected peripherally and used as an access route...
February 2019: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Renate Sørgjerd, Geir Arne Sunde, Jon-Kenneth Heltne
BACKGROUND: Intravenous access in critically ill and injured patients can be difficult or impossible in the field. Intraosseous access is a well-established alternative to achieve access to a noncollapsible vascular network. We wanted to compare the use of a sternal and tibial/humeral intraosseous device in a physician-staffed helicopter emergency medical service. METHODS: The helicopter emergency medical service in Bergen, Norway, is equipped with two different intraosseous devices, the EZ-IO and FAST-Responder...
February 13, 2019: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Travis M Dumont, Robert W Bina
Background: Thrombectomy has become established as a successful treatment strategy for ischemic stroke, and consequently, more patients are undergoing this procedure. Due to comorbid conditions, chronic disease states, and advanced age, many patients have anatomy which complicates revascularization, specifically difficult aortic arch anatomy, or tortuous common and internal artery anatomy, or both. Methods: In the present study, these unfavorable anatomic parameters were analyzed for 53 patients undergoing acute thrombectomy for ischemic stroke...
November 2018: Journal of Vascular and Interventional Neurology
Melinda R Steis, Lynn Unruh, Varadraj Prabhu Gurupur, Emilia Shettian, Meredeth Rowe, Adam Golden
Study findings support targeted interventions that facilitate early recognition and appropriate action. ABSTRACT: Background: When older adults with cognitive impairment develop new physical or behavioral symptoms, their family caregivers face a difficult decision: whether and when to seek professional medical care. Most family caregivers lack formal training in assessment and may have difficulty making such decisions. The Veterans Health Administration's home-based primary care (HBPC) program, which is widely available, offers community-dwelling frail veterans and their family caregivers guidance, with the goal of reducing hospitalization and institutionalization in long-term care facilities...
February 7, 2019: American Journal of Nursing
Tomohiro Yamamoto, Miriam Flenner, Ehrenfried Schindler
To the Editor, Nasotracheal intubation is a widely used technique in anaesthesia management for procedures including oropharyngeal, dental, and maxillofacial surgeries[1-3]. It provides an uninhibited access to the mouth and plays an important role when dealing with difficult airways[4-6]. It is also used in patients with cervical spine instability owing to injury[7] or in patients with a cervical spine fixation owing to a disease or previous operation[8]. Moreover, it is selected for patients who require prolonged intubation for intensive care[9]...
February 6, 2019: Anaesthesiology Intensive Therapy
Vivak Hansrani, Kamel Muhammad, Natasha Charlswood, Haytham Al-Khaffaf
BACKGROUND: Dialysis-associated steal syndrome remains a difficult clinical scenario for vascular access surgeons. The ideal treatment would improve blood flow to the hand without compromising the fistula; however, most treatment options rarely allow for both. The study describes an innovative technique used in clinical practice over a 17-year period for the treatment of dialysis-associated steal syndrome. The procedure and long-term results are discussed. METHODS: 27 patients with dialysis-associated steal syndrome were recruited over 17 years at two large UK University Teaching Hospitals and treated with the extension technique...
February 4, 2019: Journal of Vascular Access
Taisuke Yokota, Joho Tokumine, Alan Kawarai Lefor, Ayako Hasegawa, Tomoko Yorozu, Takayuki Asao
RATIONALE: Obtaining venous access in a patient with extensive postburn scar contractures is a challenge. PATIENT CONCERNS: A 39-year-old woman suffered a burn 2 years previously with a total body surface area burn of 93%, and a burn index of 85. Reconstructive surgery was previously performed 39 times. Split-thickness skin grafting to the neck was planned. She had no accessible peripheral veins. DIAGNOSIS: Difficult venous access due to excessive burn scar contractures...
January 2019: Medicine (Baltimore)
Polona Jaki Mekjavić, Vilma Jūratė Balčiūnienė, Lala Ćeklić, Jan Ernest, Zuzana Jamrichova, Zoltán Zsolt Nagy, Iva Petkova, Sławomir Teper, Ivana Gardašević Topčić, Miroslav Veith
BACKGROUND: Despite the significant impact of retinal diseases such as wet age-related macular degeneration (wAMD) and diabetic macular edema (DME), there is a limited understanding of how these conditions are managed in Central and Eastern Europe (CEE). OBJECTIVES: To provide a comprehensive overview of the clinical and economic burden of wAMD and DME in CEE and the status quo associated with their management. METHODS: A narrative literature review was undertaken to identify existing data on wAMD and DME, including epidemiology, economic burden, clinical guidelines, and available and reimbursed treatments...
January 8, 2019: Value in Health Regional Issues
Andrew Barton
BACKGROUND: Peripheral intravenous cannulation is one of the most common invasive procedures for hospitalised patients. Patients with difficult venous access require special measures to facilitate cannulation. Veinplicity applies mild electrical stimulation to forearm veins to aid vessel dilation. To assess this new technique, we compared its effect on the veins to that of standard heat treatment. METHODS: In all, 20 volunteers were randomised to receive either application of heat packs to the forearm and later stimulation with Veinplicity or the same two treatments in reverse order...
January 4, 2019: Journal of Vascular Access
Olive Lennon, Catherine Blake, Jo Booth, Alex Pollock, Maggie Lawrence
BACKGROUND: Stroke secondary prevention guidelines recommend medication prescription and adherence, active education and behavioural counselling regarding lifestyle risk factors. To impact on recurrent vascular events, positive behaviour/s must be adopted and sustained as a lifestyle choice, requiring theoretically informed behaviour change and self-management interventions. A growing number of systematic reviews have addressed complex interventions in stroke secondary prevention. Differing terminology, inclusion criteria and overlap of studies between reviews makes the mechanism/s that affect positive change difficult to identify or replicate clinically...
December 13, 2018: Systematic Reviews
Julia E Noel, Hamed Sajjadi
Endoscopic technology is widely used in rhinology and anterior skull base surgery, but it has been less quickly incorporated into otologic practice. The design of the instrumentation forces surgeons to work one-handed and limits depth perception. Nevertheless, endoscopy also offers wide fields of view and access to spaces that are typically difficult to visualize. Its advantages have broadened the type and extent of operations that can be performed via the ear canal. We describe a method of endoscopic resection of glomus tympanicum tumors in 5 adults who had undergone endoscopic or endoscopy- assisted resection...
December 2018: Ear, Nose, & Throat Journal
Daniel B Chastain, Anthony Davis
Osteomyelitis remains difficult to treat, typically requiring a prolonged course of intravenous (IV) antibiotics. The optimal route and duration of antibiotics remains ill-defined due to limited prospective clinical trials. Oritavancin is a long acting, semisynthetic, lipoglycopeptide antibiotic with rapid, concentration-dependent bactericidal activity against many Gram-positive organisms. Favorable pharmacokinetics makes oritavancin an appealing alternative for currently available antibiotics requiring daily infusions to decrease the risk of vascular access complications associated with outpatient antimicrobial therapy...
December 8, 2018: International Journal of Antimicrobial Agents
Muhammad O Chohan, Serena Marchiò, Leslie A Morrison, Richard L Sidman, Webster K Cavenee, Elisabetta Dejana, Howard Yonas, Renata Pasqualini, Wadih Arap
Importance: Cerebral cavernous malformations (CCMs) are vascular lesions of the brain that may lead to hemorrhage, seizures, and neurologic deficits. Most are linked to loss-of-function mutations in 1 of 3 genes, namely CCM1 (originally called KRIT1), CCM2 (MGC4607), or CCM3 (PDCD10), that can either occur as sporadic events or are inherited in an autosomal dominant pattern with incomplete penetrance. Familial forms originate from germline mutations, often have multiple intracranial lesions that grow in size and number over time, and cause an earlier and more severe presentation...
November 26, 2018: JAMA Neurology
Joseph R Pare, Samara E Pollock, James H Liu, Megan M Leo, Kerrie P Nelson
OBJECTIVES: Ultrasound guided peripheral intravenous catheters (USPIV) are frequently utilized in the Emergency Department (ED) and lead to reduced central venous catheter (CVC) placements. USPIVs, however, are reported to have high failure rates. Our primary objective was to determine the proportion of patients that required CVC after USPIV. Our secondary objective was to determine if classic risk factors for difficult vascular access were predictive of future CVC placement. METHODS: We performed a retrospective review for patients treated at a large academic hospital...
February 2019: American Journal of Emergency Medicine
Marcio S Rassi, Johnni O Zamponi, Duarte N C Cândido, Jean G de Oliveira, Gustavo A R Passos, Luis A B Borba
Introduction  The management of petroclival meningiomas is among the most intimidating in neurosurgery, due to its difficult accessibility and close relationship with vital structures; therefore, an appropriate exposure is mandatory. We present a surgical video demonstrating a presigmoid transtentorial approach, associated with the opening of the retrosigmoid dura to a petroclival meningioma, performed by the senior surgeon (L.A.B.B.), along with its indications and pitfalls. Approach Decision  The patient's clinical history is summed to the tumor's radiological features as its extension, vascularization, and venous drainage, when selecting the appropriate approach...
December 2018: Journal of Neurological Surgery. Part B, Skull Base
Raymond L Merritt, Michael E Hachadorian, Kristof Michaels, Eric Zevallos, Kubwimana M Mhayamaguru, Zuheily Closser, Charlotte Derr
Context: Previous studies have shown that safe venous cannulation is difficult when the internal jugular vein (IJV) overlies the carotid artery (CA) as the probability of inadvertent arterial penetration is greatly increased. Aims: The goal of this study was to examine the anatomical relationships of the IJV and CA as a function of the degree of head rotation in order to minimize the risk for CA puncture. Settings and Design: Our study was a prospective study using a sample of 496 Emergency Department patients...
July 2018: Journal of Emergencies, Trauma, and Shock
Eunjin Bae, Hajeong Lee, Dong Ki Kim, Kook-Hwan Oh, Yon Su Kim, Curie Ahn, Jin Suk Han, Sang-Il Min, Seung-Kee Min, Hyo-Cheol Kim, Kwon Wook Joo
BACKGROUND: The number of elderly patients with end-stage renal disease is increasing rapidly. The higher prevalence of comorbidities and shorter life expectancy in these patients make it difficult to decide on the type of vascular access (VA). We explored the optimal choice for VA in elderly hemodialysis patients. METHODS: We included elderly patients (> 65 years) visiting our VA clinic and divided them into three groups as follows: radiocephalic arteriovenous fistula (AVF), brachiocephalic AVF, and prosthetic arteriovenous graft (AVG)...
November 6, 2018: BMC Nephrology
Carlo Lomonte, Carlo Basile, Sandip Mitra, Christian Combe, Adrian Covic, Andrew Davenport, Dimitrios Kirmizis, Daniel Schneditz, Frank van der Sande
Life-sustaining haemodialysis requires a durable vascular access (VA) to the circulatory system. The ideal permanent VA must provide longevity for use with minimal complication rate and supply sufficient blood flow to deliver the prescribed dialysis dosage. Arteriovenous fistulas (AVFs) have been endorsed by many professional societies as the VA of choice. However, the high prevalence of comorbidities, particularly diabetes mellitus, peripheral vascular disease and arterial hypertension in elderly people, usually make VA creation more difficult in the elderly...
October 17, 2018: Nephrology, Dialysis, Transplantation
Eyal Barzel, John W Larkin, Allen Marcus, Marta M Reviriego-Mendoza, Len A Usvyat, Murat Sor, Franklin W Maddux
INTRODUCTION: Hemodialysis patients with an arteriovenous fistula can use buttonhole techniques for cannulation. Although buttonholes generally work well, patients may report difficult and painful cannulation, and buttonholes may fail over time. We aimed to assess the effectiveness of tract dilation in treatment of failing buttonholes. METHODS: We retrospectively analyzed data from patients treated with buttonhole tract dilation at an outpatient vascular access center between January 2013 and August 2015...
October 14, 2018: Journal of Vascular Access
Sushant Govindan, Ashley Snyder, Scott A Flanders, Vineet Chopra
OBJECTIVES: To quantify variation in use and complications from peripherally inserted central catheters placed in the ICU versus peripherally inserted central catheters placed on the general ward. DESIGN: Retrospective cohort study. SETTING: Fifty-two hospital Michigan quality collaborative. PATIENTS: Twenty-seven-thousand two-hundred eighty-nine patients with peripherally inserted central catheters placed during hospitalization...
December 2018: Critical Care Medicine
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