PubMed · 8728216
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H B Lee, M S Park, M K Cha, J H Kim, K I Song, C Moon. 1996. The peritoneal access.. https://pubmed.ncbi.nlm.nih.gov/8728216/
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BACKGROUND: Although most catheter problems in haemodialysis are related to infection or clotting, bleeding associated with the heparin lock is of clinical importance especially during peri-operative conditions. The objective of this in vitro study is to estimate the volume of heparin that may leak into the circulation immediately after performing a catheter lock. METHODS: Different volumes (ml) of a dextrose solution were used to perform a catheter lock on haemodialysis catheters. The tip of the catheter was placed in a test tube containing water for a pre-specified period. The final concentrations of dextrose in the test tube were used to determine the volume of solution that leaked from the catheter. RESULTS: When the total lumen volume was filled, the catheter leak was estimated to be 0.59+/-0.03 and 0.71+/-0.04 ml after 15 and 25 s, respectively. There was a continuous leak of 1.23+/-0.41, 2.20+/-0.34 and 3.38+/-0.23 ml at 5, 15 and 30 min, respectively, after performing a catheter lock on a catheter with a total lumen volume of 4.5 ml. The catheter leak was significantly reduced when only 3.7 ml of solution was used to fill the total lumen volume of 4.5 ml. CONCLUSION: The present study demonstrates a significant early and late leakage from the catheter that occurs after performing a catheter lock. When applied to heparin, the volume of the unwanted catheter leak may result in adverse clinical events, especially following haemodialysis sessions and during peri-operative periods. However, these results are hypothesis-generating, and clinical studies are necessary to evaluate the efficacy of underfilling.
BACKGROUND: Placement of ventricular catheters is a routine procedure in neurosurgery. Ventricle puncture is done using a flexible ventricular catheter stabilised by a solid steel mandrin in order to improve stability during brain penetration. A correct catheter placement is confirmed after removing the solid steel mandrin by observation of cerebrospinal fluid (CSF) flow out of the flexible catheter. Incorrect placement makes further punctures necessary. The newly developed device allows CSF flow observation during the puncture procedure and in addition precise intracranial pressure (ICP) measurement. METHOD: The developed mandrin is hollow with a blunt tip. On one side 4-5 small holes with a diameter of 0.8 mm are drilled corresponding exactly with the holes in the ventricular catheter, allowing CSF to pass into the hollow mandrin as soon as the ventricle is reached. By connecting a small translucent tube at the distal portion of the hollow mandrin ICP can be measured without loss of CSF. The system has been used in 15 patients with subarachnoid haemorrhage (SAH) or intraventricular haemeorrhage (IVH) and subsequent hydrocephalus. FINDINGS: The new system improved the external ventricular drainage implantation procedure. In all 15 patients catheter placement was correct. ICP measurement was easy to perform immediately at ventricle puncture. In 4 patients at puncture no spontaneous CSF flow was observed, therefore by connecting a syringe and gentle aspiration of CSF correct placement was confirmed in this unexpected low pressure hydrocephalus. Otherwise by using the conventional technique further punctures would have been necessary. CONCLUSIONS: Advantages of the new technique are less puncture procedures with a lower risk of damage to neural structures and reduced risk of intracranial haemorrhages. Implantation of the ventricular catheter to far into the brain can be monitored and this complication can be overcome. Using the connected pressure monitoring tube an exact measurement of the opening intracranial pressure can be obtained performed without losing CSF.
OBJECTIVE: Present a revised neurosurgical technique for insertion of the Ommaya reservoir that we have routinely utilized and found to have fewer complications that the standard approach. EXPERIMENTAL DESIGN: Randomized retrospective study of 20 patients who underwent insertion of Ommaya reservoir with the preassembled technique. SETTING: Major university hospital. PATIENTS OR PARTICIPANTS: Twenty patients who underwent Ommaya reservoir placement within the last 5 years were randomly selected for chart and computed tomography review. INTERVENTIONS: A new preassembled technique for Ommaya reservoir placement was utilized in all 20 patients. MEASURES: Retrospective review of the patient records and computed tomography scans of 20 patients undergoing Ommaya placement were performed to assess ventricular catheter placement and any postoperative complications. RESULTS: In all 20 patients, we had consistent ipsilateral right frontal horn placement of ventricular catheter and had no postoperative morbidities, reoperations for ventricular catheter positioning or mortalities. CONCLUSIONS: This technique reduces overall operative time, decreases risk for intraoperative infection, and poor ventricular catheter placement by eliminating the manipulation step of connecting the reservoir to the catheter in vivo.