PubMed · 12078607
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2002. [Infusions. Equipment].. https://pubmed.ncbi.nlm.nih.gov/12078607/
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PURPOSE: To evaluate the risk of retrograde embolization of flush solution in neonates and infants with routinely used electronic syringe pumps and infusion bag pump flush systems. METHODS: With hospital Ethical Committee approval we studied intubated neonates and infants with a 24-GA radial arterial cannula. Fast flush boluses were delivered from the infusion bag pump flush system by opening the flow regulating device for two seconds at bag pump manometre pressures of 100, 200 and 300 mmHg. In the syringe pump flush system, fast flush bolus volumes of 0.5, 1.0, 1.5 and 2.0 mL were programmed on the electronic syringe pump and released by opening the flow regulating device for two seconds. A 12-MHz ultrasonic probe placed in the jugular fossa was used to detect white bubbles indicating retrograde embolization of flush solution into the ipsilateral subclavian and common carotid artery. RESULTS: Sixteen patients, aged from 1-105 days (median 22 days) were studied. In all patients retrograde embolization into the subclavian artery was detected at syringe pump bolus volumes of 0.5-1.5 mL and at 100-200 mmHg bag pump pressure. In nine of the 16 patients a positive signal was detected in the common carotid artery with 1.5-2.0 mL syringe pump bolus volumes and at 200-300 mmHg bag pump pressure. CONCLUSIONS: In neonates and infants, the standard practice of arterial fast bolus flushing using syringe pump and bag pump flush systems causes retrograde embolization of flush solution into the central arterial and even into the cerebral circulation. The mandatory limitation of fast flush bolus volumes and manometre pressures is urgent in order to reduce retrograde embolization of flush solution and the associated risks in these small patients.
BACKGROUND: Multiloculated ventricular hydrocephalus is a difficult pathology for neurosurgeons to treat. Not only are the shunts for this condition prone to malfunction, but they are also difficult to place. METHODS: The Seldinger technique is used in combination with a rigid scope with a working channel. A soft filiform wire or a thick suture is inserted through the channel. The scope is withdrawn and a ventricular catheter is slid down the wire. The remainder of the shunt is inserted in the usual fashion. RESULTS: We have not encountered any neurologic compromise from this technique. No bleeding was encountered with the described technique. CONCLUSION: The Seldinger technique with appropriate types of guide wires and in combination with an endoscope is a useful technique for difficult to place shunts.
OBJECTIVE: Shunt obstruction represents a permanent threat for patients with shunts, and its prevention and treatment are important parts of neurosurgeons' duties. Although there is little discussion regarding the need to reoperate for treatment of symptomatic shunt failure (SSF), the need to reoperate for treatment of asymptomatic shunt failure (ASF) is debated, as are the guidelines for the follow-up monitoring of patients with shunts. The goal of this study was to assess the effects of systematic follow-up monitoring and shunt revision for ASF; we reviewed our database to compare the results of shunt revision for ASF versus SSF. METHODS: We defined ASF as shunt failure diagnosed for an asymptomatic patient during a systematic consultation. In our institution, children who receive shunts for treatment of hydrocephalus are systematically monitored in an outpatient clinic, with clinical examinations and plain x-rays. Among 1,564 children with shunts, who were monitored for a mean of 10.7 years, 1106 (70.7%) required at least one shunt revision. The indication for the first revision was SSF in 609 cases and ASF in 305 cases; the indication was not specified in 192 cases. We studied the surgical outcomes after the first shunt revision and compared the results for SSF and ASF. RESULTS: After the first revision, shunt infections and subsequent shunt failure were significantly less frequent in the ASF group, compared with the SSF group. The interval between the first shunt revision and subsequent shunt failure was significantly longer in the ASF group. CONCLUSION: Our data support the practice of systematic follow-up monitoring for patients with shunts, for the early diagnosis and systematic treatment of ASF.