首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 31 毫秒
1.
PURPOSE: To determine in-line pressures generated in small-bore central venous catheters during power injection of computed tomographic (CT) contrast media. MATERIALS AND METHODS: Five 3.0-7.0-F central venous catheters for pediatric patients were tested at full and half lengths in vitro. In-line pressures were measured during power injection of three contrast media. Rates of injection were increased in steps from 0.1 to 5.0 mL/sec or until a peak pressure of 100 psi (700 kPa) was achieved. The maximum tolerated flow rate was determined with reference to the manufacturer's suggested operating pressure limit for each catheter. RESULTS: At full length, the maximum tolerated flow rates were as follows: 2-3 mL/sec for the large lumen and 1-1.4 mL/sec for the small lumen of the 7.0-F double-lumen catheter; 0.2-0.4 and 0.8-1.2 mL/sec for the 3.0- and 4.0-F peripherally inserted central catheters, respectively; 0.7-1.2 mL/sec for the 6.6-F catheter; and only 0.2 mL/sec for the 4.2-F catheter, which ruptured during testing at higher flow rates. CONCLUSION: Flow rates were documented at which certain small-bore central venous catheters should tolerate power injection of CT contrast media with peak pressures remaining below the manufacturer's recommended operating pressure limits. These data may serve as a guide for clinical use.  相似文献   

2.
BACKGROUND: Peripherally inserted central venous catheters (PICCs) are commonly used intravenous access devices in children. Although PICCs are intended to be placed in central veins, many fail to reach this location. These noncentral PICCs are used for administration of medications and isotonic solutions. OBJECTIVES: To examine the efficacy of noncentral PICCs for completion of therapy, the complications associated with their use, and the effectiveness of noncentral PICCs as compared with PICCs placed in a central vein. DESIGN: A prospective cohort study of children in whom PICCs were inserted, from January 1, 1994, to January 1, 1996. SETTING: A university-affiliated teaching institution. MAIN OUTCOME MEASUREMENT: Completion of intravenous therapy. RESULTS: A total of 587 PICCs were studied. Thirty-nine percent of PICCs were placed in noncentral veins. Centrally placed PICCs had significantly longer catheter duration compared with those placed noncentrally (16.6 vs 11.4 days, respectively). However, central and noncentral PICCs had similar therapy completion rates (73% and 69%, respectively). Catheter failure because of occlusion and accidental dislodgment were similar for central and noncentral PICCs. Likewise, complications caused by exit-site infection, phlebitis, and catheter-associated sepsis were also similar for catheters in the 2 locations. Catheter survival curves were similar for central and noncentral PICCs. CONCLUSIONS: Our study demonstrates that PICCs placed in noncentral veins provide reliable and safe intravenous access for administration of many medications and isotonic solutions for about 2 weeks' duration. The placement of PICCs in central veins may be restricted to those children who need central vascular access because of the type of intended therapy.  相似文献   

3.
PURPOSE: To determine what interaction and effect different cholesterol gallstone solvents have on catheters used for gallstone chemolysis. MATERIALS AND METHODS: Five types of catheters used for biliary procedures were chosen: polyethylene, Percuflex, silicon, Silitek, and polyurethane. The solvents chosen were methyl tert-butyl ether, ethyl propionate, isopropyl acetate, and N-propyl acetate. After incubation of the catheters in the solvents for 72 hours, they were air dried. Weight and area changes were determined for each catheter. Additionally, carbon-13 nuclear magnetic resonance (NMR) spectroscopy was performed for analysis of composition changes. RESULTS: Three catheters--silicone, Silitek, and polyurethane--showed changes in their physical characteristics that would make them less desirable for stone chemolysis. The silicone catheter showed changes in elastic texture as well as marked weight reduction. The Silitek and polyurethane catheters had similar, but less dramatic changes. C-13 NMR analysis of collected solvents showed that commonly used plasticizers were leached out of some catheters. CONCLUSION: These results suggest that all catheters are not suitable for use with all solvents. The choice of catheter should be made based on the solvent in use. The polyethylene catheter performed best under the conditions and endpoints used in this study.  相似文献   

4.
Peripherally inserted central catheters in an acute-care hospital   总被引:1,自引:0,他引:1  
BACKGROUND: Peripherally inserted central catheterization is a relatively new approach for intravenous therapy in acute-care hospitals. Few studies are available on peripherally inserted central catheters (PICCs) used in adult patients in an acute-care setting. We examine the natural history and outcome of PICC use in our hospital. METHODS: A retrospective review was undertaken of all hospitalized patients who had PICCs inserted in an acute-care, metropolitan teaching hospital for any reason from July 1991 through July 1992. Patients who had PICCs inserted, used, and then removed in the same hospitalization were evaluated. RESULTS: A total of 135 PICCs were inserted in 114 patients. Six PICCs (4.4%) were inserted in intensive care unit settings and 129 (95.6%) in general medical or surgical service. The mean duration catheters were in place before removal was 14.1 days. Sixty-three catheters (46.7%) were removed following completion of therapy. The rate of PICC-related infection was 2.2% (three catheters). The occlusion rate was higher for 20-gauge catheters (18.4%) than for 18-gauge catheters (8.2%) (P = .08). When the rate of complications was compared as a function of catheter use (total parenteral nutrition vs any other use), there was no statistically significant difference (P = .12). Overall complications related to catheter insertion and removal were uncommon. CONCLUSIONS: Based on our study, we conclude that the PICC provides a reasonable and safe alternative to other centrally placed venous devices. In addition, the convenience of maintaining a PICC compared with peripheral intravenous access makes this an attractive method for in-hospital use.  相似文献   

5.
PURPOSE: To assess the effect of the injection rate of contrast medium on pancreatic and hepatic enhancement at abdominal helical computed tomography (CT). MATERIALS AND METHODS: Sixty-four contrast medium-enhanced abdominal helical CT scans (64 adult patients) were obtained with 150 mL of contrast medium. The injection rate was 2.5 mL/sec for the first 32 scans and 5.0 mL/sec for the remaining 32. Scans were obtained at 5-sec intervals, with an intermediate 8-sec breathing interval. Hepatic and pancreatic enhancement levels were measured and averaged, and time-attenuation curves were plotted for both groups. Differences in weight, age, time to peak pancreatic and hepatic enhancement, and peak enhancement were assessed with the Student t test. RESULTS: Both peak enhancement and time to peak enhancement were significantly different between the two injection rates (P < or = .002), with faster, more intense hepatic and pancreatic enhancement at the higher rate. At 2.5 mL/sec, the pancreas reached a peak attenuation level of 65 HU at 69 sec, and the liver reached a peak of 58 HU at 87 sec. At 5.0 mL/sec, the pancreas reached a peak attenuation of 84 HU at 43 sec, and the liver reached a peak of 75 HU at 63 sec.  相似文献   

6.
6 male albino Sprague-Dawley rats performed on a free operant avoidance schedule with a response-shock interval of 20 sec and a shock-shock interval of 2 sec. Avoidance response rates increased, and shock frequency decreased when the Ss were exposed to elevated pressures of both air and a nitrogen-oxygen mixture in a hyperbaric chamber. Increases in response rates were related to raised partial pressures of nitrogen at 89.0 psi and 111.3 psi. Conditional probabilities of interresponse times indicate that increases in response rates were not due to disruption of temporal discrimination. Increased avoidance rates under pressure suggest direct excitatory effects of high pressures of nitrogen. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)  相似文献   

7.
RATIONALE AND OBJECTIVES: To improve the safety and success of selective and superselective arterial catheterization in the rabbit. METHODS: A 2-F catheter introducer system was devised that consisted of the sheath of an 18-gauge, 5.1-cm sheath needle and a hemostatic valve attached to the hub of the sheath. The system was tested in 14 adult male New Zealand white rabbits with regard to ease of insertion and facilitation of superselective arterial catheterization. RESULTS: The introducer system was easily placed in all rabbits, and no bleeding was seen around the sheath at the puncture site. Preshaped 2-F polyethylene catheters were readily inserted through the assembly and sheath. The valve prevented bleeding from around the catheter, and the side-arm flush tube served as a route for heparinization. The system greatly facilitated the manipulation of 2-F angiographic catheters. CONCLUSION: Use of the introducer system with a 2-F polyethylene angiographic catheter improved the success of selective and superselective arterial catheterization in the rabbit.  相似文献   

8.
OBJECTIVE: The authors report the use of multiple implanted intraspinal port and catheter systems per test animal to study the in vivo functional characteristics and reliability of a new implantable spinal drug delivery port system. METHODS: Four ewes were each implanted with two epidural and one subarachnoid silicone elastomer catheters at the lumbar level. Each catheter was connected in series to one of three Therex filtered spinal delivery ports implanted subcutaneously in a similar grid pattern in each ewe to facilitate percutaneous identification. Saline (2 ml) was injected 3 times weekly in each port. The ease of injection and behavioral responses were recorded for 207-213 days of implantation until sacrifice/necropsy. RESULTS: All ports functioned reliably during the study. However, injection through two of the four subarachnoid catheters resulted in behavioral withdrawal responses intermittently. This behavioral pattern was much less common after epidural port injections. All four subarachnoid and four of eight epidural port and catheter systems were tested with local anesthetic just before sacrifice. Motor block was observed in three of four subarachnoid and three of four epidural port and catheter systems tested. Integrity of the other four epidural ports was tested by injection of methylene blue at sacrifice. This dye did not distribute in the epidural space in one of the latter four epidural ports (not local anesthetic tested) because of a concentric fibrotic reaction about the catheter. Similar fibrotic reactions surrounded the catheters that failed a functional test with local anesthetic. CONCLUSIONS: The implantable intraspinal port system tested functions reliably under repetitive percutaneous access. However, filtering such ports, though desirable to prevent entry of debris into the spinal canal, did not eliminate pericatheter chronic subarachnoid and epidural reaction. The number of test animals required to test 12 ports chronically was reduced by two-thirds without undue trauma to the individual test subject. Chronic percutaneous injection of an implanted subarachnoid system is feasible but may be associated with behavioral effects similar to that seen with chronic epidural systems. Fibrosis around chronic silicone catheters limited functional utility in one-fourth of the implanted test systems. Further study of the potential reactivity of chronic epidural and subarachnoid catheters is indicated.  相似文献   

9.
10.
OBJECTIVE: We studied factors that affect satisfaction of patients who have undergone placement of peripherally inserted central venous catheters (PICCs) by interventional radiologists and patients' willingness to undergo placement of future PICCs. SUBJECTS AND METHODS: This longitudinal prospective consecutive cohort study included 85 patients referred for PICC placement. A record was made of catheter type, time taken for placement, patient age, and possible complications. Follow-up was obtained by telephone interview to determine the effect of site of placement in the arm, residence time of catheter, additional complications, and interference with activities of daily living on patient willingness to undergo future PICC placement at the same site. Logistic regression analysis was used to determine factors statistically predictive of patient willingness to undergo placement of future PICCs. RESULTS: Patients having PICCs placed above the elbow were more often satisfied (55 of 61 respondents) with catheter location than patients having placements at the elbow (three of 17 respondents). Patient willingness to undergo future PICC placement was strongly related to catheter location (p < .0001) and interference with activities of daily living (p < .0001). Catheter type, residence time, time taken for the placement, age, and complications were not associated with patient willingness to undergo future PICC placement. CONCLUSION: PICC placement above the elbow is more acceptable to patients than placement at the elbow. PICC placement above the elbow and patients' perception of less interference by the PICC with activities of daily living are positively related to patient willingness to undergo future PICC placement.  相似文献   

11.
We studied the cause of cracking of a clinically used polyurethane (PU) catheter during the constant infusion of etoposide (VP-16) injection (Lastet), administered without dilution to patients as a part of combination high-dose chemotherapy. After VP-16 injection was infused into the PU catheter at a constant infusion rate (30 ml/h) for 24 h, a decrease in the elasticity (36% of untreated) and on increase in the length of the catheter (3.7%) were observed. These changes were significantly higher than those treated with the control saline. The similar changes of the PU catheter were observed after treatment with a basal solution containing polyethylene glycol 400 (PEG 400), polysorbate 80 and ethanol, which is the vehicle of the VP-16 injection, and with ethanol alone. Moreover, obvious degeneration of the internal wall (occurrence of spots like melting) and cutting face (micro-cracking) of the catheter was observed with an electron microscope after treatment with the vehicle. On the other hand, the elasticity or extension of the PU catheter were not changed after treatment with saline or PEG 400. From these findings, it was suggested that the degeneration and subsequent cracking of the PU catheter during the infusion of VP-16 injection was caused by ethanol contained in its injection solution. No cracking or morphological changes of polyvinyl chloride (PVC) and silicone catheters were found after treatment with the vehicle solution. However, since it has been reported in previous reports that di(2-ethylhexyl)phthalate was leached from PVC bags, the high dose chemotherapy with the dilution-free VP-16 injection should be achieved safely and effectively using a silicon catheter, rather than the PU catheter.  相似文献   

12.
OBJECTIVES: Our goal was to provide the range of cost savings associated with various catheter reuse strategies. BACKGROUND: Percutaneous transluminal coronary angioplasty catheters are commonly reused in several countries outside the United States. However, the cost-effectiveness of such reuse strategies has not been evaluated. METHODS: Three theoretical models of catheter reuse were constructed using the actual costs for treating patients with coronary angioplasty at the Cleveland Clinic. Costs were calculated based on the number of balloon catheters, the amount of contrast agent used and the rates for urgent revascularization that were observed in a prospective Canadian study on catheter reuse. RESULTS: The median cost to treat a lesion by means of coronary angioplasty using new catheters was $8,800 per patient. In reuse models, the potential to reduce cost depended on the number of balloon catheters used and the rates of urgent revascularization. The "best care" scenario offered a potential savings of $480 (5.5% of total in-hospital cost), whereas the "worst case" scenario resulted in an increased cost of $1,075 (12.2% of total in-hospital cost) compared with the single-use strategy. Cost of the "likely case" scenario was similar to that of the single-use strategy. Sensitivity analyses identified the different rates of revascularization and cost of balloon catheters required to offset potential savings in each strategy. CONCLUSIONS: Although reusing coronary angioplasty catheters may reduce total in-hospital costs, even a modest increase in complications requiring urgent revascularization may offset any potential savings. However, if an increase in complications and procedure time can be avoided, the reuse strategy has significant economic potential and, ultimately, may be extended to other percutaneous coronary interventional equipment.  相似文献   

13.
PURPOSE: To determine the frequency and clinical effects of extravasation related to rapid bolus infusion of ionic and nonionic contrast media. MATERIALS AND METHODS: Records of 5,106 computed tomographic studies in adult patients who underwent mechanical bolus injection of contrast medium through a plastic cannula in an upper extremity were retrospectively reviewed. RESULTS: Mean infusion rate was 2.8 mL/sec (range, 1-5 mL/sec). Extravasation occurred in 48 (0.9%) patients, including in four of 928 patients who received the median injection rate (2.5 mL/sec). Injection rate was not correlated with frequency or amount of extravasation. Average age and use of ionic versus nonionic contrast medium were identical in patients with and in those without extravasation. There was no sex difference. Thirty-one patients had extravasation of ionic contrast medium; nine of these had extravasation of at least 50 mL. Seventeen patients had extravasation of nonionic contrast medium; seven of these had extravasation of at least 50 mL. Hyaluronidase infiltration was often used as treatment for larger extravasations (in 10 patients each with extravasation of ionic or nonionic medium). No patient required surgical intervention, and none had severe or permanent long-term effects. CONCLUSION: The frequency of extravasation of contrast medium after mechanical bolus injection is higher than that reported for hand-injection or drip-infusion techniques, but there is no correlation between injection rate and extravasation frequency.  相似文献   

14.
BACKGROUND AND OBJECTIVE: To report the results of silicone oil removal from aphakic eyes using a self-sealing clear corneal incision under topical anesthesia. PATIENTS AND METHODS: Twenty-two eyes of 22 patients who had pars plana vitrectomy combined with silicone oil injection underwent silicone oil removal under topical anesthesia using a self-sealing clear corneal incision. Mean time between silicone oil injection and removal was 3.1+/-1.42 months. Fourteen eyes were filled with 1300 cs of silicone oil and 8 eyes were filled with 5700 cs of silicone oil. The removal was performed with passive washout in the eyes filled with 1300 cs of silicone oil and with active aspiration in the eyes filled with 5700 cs of silicone oil. RESULTS: All of the 22 silicone oil removal procedures performed under topical anesthesia had clear corneal incisions that did not require suturing at the end of surgery. Three cases that had 1300 cs of silicone oil required aspiration because of residual silicone oil bubbles. CONCLUSION: Silicone oil can be removed from the aphakic eye using a self-sealing corneal tunnel incision under topical anesthesia.  相似文献   

15.
OBJECTIVE: The aim of the study was to evaluate the optimization of injection rates with an automatic power injector versus manual injection for contrast-enhanced breath-hold three-dimensional (3D) MR angiography of the abdominal aorta and its branches. SUBJECTS AND METHODS: In a prospective study, 50 patients underwent breath-hold 3D MR angiography (5/2 [TR/TE]; flip angle, 30 degrees) of the abdominal vessels on a 1.5-T system. Each patient received 0.15 mmol/kg of gadopentetate dimeglumine. All patients were randomly assigned to one of five equally sized groups. The contrast bolus was injected manually in group 1, always by the same investigator, who tried to perform a steady injection rate of 2 ml/sec. An automatic injector was used in groups 2-5 with injection flow rates of 0.5 ml/sec, 2 ml/sec, 4 ml/sec, and 6 ml/sec. The start of the MR sequence was tailored individually to the applied volume of contrast material after determination of circulation times by a test bolus. We measured the signal-to-noise and contrast-to-noise ratios as well as the relative vascular enhancement. The visualization of different abdominal vessel segments was independently ranked on a scale of 1-5 (1 = not visible; 5 = excellent visualization) by three reviewers who were unaware of the applied contrast material injection rate. RESULTS: The signal-to-noise and contrast-to-noise ratios of groups 3 and 4 (2 ml/sec and 4 ml/sec, respectively) were significantly (p < .05) higher than the ratios of groups 1, 2, and 5. The average relative vascular enhancement of groups 3 and 4 was significantly higher (p < .05) than the enhancement of all other groups. The contrast bolus applied with a faster injection rate (group 5) did not cover large parts of the K-space, resulting in increased blurring of the vessel contours. The subjective evaluation of large and small diameter vessels showed significantly better results in groups 3 and 4 than in groups 1, 2, and 5. CONCLUSION: The use of an automatic MR power injector proved superior to manual injection of contrast material. The optimal injection rate was 2 ml/sec for 3D breath-hold MR angiography of the abdominal vessels.  相似文献   

16.
RATIONALE AND OBJECTIVES: Small electrolyte additions to a nonionic contrast medium reduce the risk of ventricular fibrillation (VF) during wedged catheter injection of a contrast medium. The current study was designed to further investigate contrast-medium-induced VF by studying the effect of pretreatment with different antiarrhythmic drugs. METHODS: During a simulated wedged catheter situation, iohexol was injected into the anterior descending branch of the left coronary artery in five open-chest, anesthetized dogs pretreated with lidocaine, propranolol, amiodarone, almokalant, or verapamil. RESULTS: Wedging the catheter for 60 sec did not induce VF. However, all 15 wedged catheter injections with iohexol induced VF within 28 sec (19 +/- 1 [mean +/- standard error of the mean]) despite pretreatment with antiarrhythmic drugs. Prior to VF, conduction was slowed and monophasic action potential duration lengthened in the contrast-medium-perfused myocardium, although no significant changes occurred in the control area. CONCLUSION: The combination of catheter wedging and long-lasting contrast medium injection has a high risk of causing VF. Although adding a small amount of electrolytes to nonionic contrast media can reduce the risk of VF, antiarrhythmic drug therapy may not have a protective effect.  相似文献   

17.
Infection of cerebrospinal fluid (CSF) shunts is one of the major complications associated with their use and is usually managed by shunt removal, temporary insertion of an external drainage and implantation of a new shunt system. We have evaluated the efficacy of a rifampin-loaded silicone ventricular catheter to prevent bacterial colonization and infection in vitro and in an animal model. On the basis of an incorporation process a rifampin-loaded catheter was developed which is capable of releasing rifampin in bacteriocidal concentrations for 60 days and more. In a stationary bacterial adherence assay using S. epidermidis as test strain, the colonization resistance of the device was demonstrated. To assess the capability of the catheter to prevent CSF shunt infections, a rabbit model was developed which allowed the establishment of a reliable and reproducible CSF infection by implantation of silicone catheters into the ventricle and inoculating S. epidermidis (minimal dose 10(6) cfu) or S. aureus (minimal dose 10(3) cfu). Rifampin-loaded catheters (12 animals inoculated with S. epidermidis, 8 animals inoculated with S. aureus) were compared with non-loaded (14 animals inoculated with S. epidermidis, 19 animals inoculated with S. aureus) control catheters, and infection was documented by clinical, microbiological and histological methods. In contrast to the control group, none of the animals with rifampin-loaded catheters showed clinical signs of infection. Furthermore, in none of the materials obtained after sacrifice of the animals (catheter, brain tissue, CSF, blood) could the infecting bacteria be cultured, whereas in materials from animals with the unloaded catheter the infecting strains could always be cultured from the catheter and from surrounding brain tissue. The histological examination of catheter-adjacent tissue supported these findings. We conclude that a rifampin-loaded silicone ventricular catheter is capable of completely preventing bacterial colonization and infection by staphylococci as the main causative organisms in CSF shunt infections and should be further evaluated in clinical trials.  相似文献   

18.
PURPOSE: Nephrostomy catheters are prone to kinking or damage because the thin, flexible silicone tube is too vulnerable against mechanical stress even when the proximal end is carefully fixed. We developed a simple method to reinforce the outside part of a thin catheter protruding from the skin. MATERIALS AND METHODS: We treated 7 children with nephrostomy catheters or ureteral stents with a diameter of 8F or smaller. After insertion a large plastic tube was wrapped around the small catheter, and fixed to the skin and to the peripheral collection system with adhesive tape. RESULTS: Handling of the catheters improved and there was less need for re-fixation. CONCLUSIONS: Thin nephrostomy catheters can be effectively protected by wrapping them into a larger, outer tube after insertion.  相似文献   

19.
The advent of intravenous therapies administered in the home setting has created a demand for the peripherally inserted central catheter (PICC). A variety of PICCs is now on the market, offering choices of insertion methods as well as size and length. This article represents a retrospective look at 858 PICCs inserted over a 3-year period, using three insertion methods: 1) the Seldinger technique, 2) the peel-away sheath, and 3) the break-away needle. A brief history of PICCs along with problems encountered, an account of PICCs in immune-suppressed patients, and principles of catheter management are presented.  相似文献   

20.
The objectives of this research were to evaluate and compare the interactions of several polyurethane-based central venous catheter materials with blood. Specifically, measurements of fibrinogen adsorption, platelet adhesion, kallikrein generation, and fibrinopeptide A (FPA) release were performed. The catheter materials examined in this study included: platinum-cured, 50 shore A durometer, barium sulfate-filled, silicone (SI); Tecoflex EG85A-B20 polyurethane (PU); PU catheters whose outer surface had been impregnated with ion beam-deposited silver atoms (AgI and AgII); PU catheters coated with a hydrophilic, polyacrylic acid polymer (UC); PU catheters coated with an air-cured PTFE emulsion (CS); and PU catheters coated with an aminofunctional dimethylsiloxane copolymer (JG). The time course of fibrinogen adsorption from plasma to the SI, JG, PU, and CS materials was similar, with CS exhibiting the least amount of adsorbed fibrinogen after 1 h (65 +/- 4.7 ng cm-2) and PU the greatest (144 +/- 16.5 ng cm-2). After 90 min of contact, AgI and AgII exhibited the greatest number of adherent platelets, levels that were approximately two to three times higher than those on the other catheter materials. With the exception of UC and PU, which caused kallikrein generation levels approximately half that of the positive (glass) control, little kallikrein formation was observed for any of the materials relative to the negative control. Finally, FPA generation was greatest using the SI, CS, and PU materials, with the latter causing the production of almost four times the amount of FPA as the negative control. This preliminary assessment of the hemocompatibility of the various catheters suggests that the surface treatments did not adversely affect their interactions with blood components; further investigations of these materials are therefore warranted in order to completely characterize their behavior prior to use in clinical situations.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号