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Nineteen peripheral arteries were examined by Doppler US 1 month to 2 years after their catheterization. Two of them were completely obstructed and 4 showed signs of arterial stenosis. No functional repercussion was observed. This minor risk seems low as compared to the advantages of the technique.
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In critical ill patients, determination of blood gases is a crucial part of patient evaluation and management. In intensive care situations many blood-gas determinations are required in a single day. The introduction of an arterial catheter into a small peripheral artery is an invaluable technique that allows continuous blood-sampling. During the past three years we had catheterized either the radial, ulnar or the pedal artery in 450 instances. The arterial catheter was left in place from 1 to 15 days. There were no serious complication. Haemorrhage due to accidental opening of the catheter occurred in three occasions. No case of ischaemia was encountered after a single artery catheterization. Temporary ischaemia of the upper limb appeared in three patients after simultaneous catheterization of both ulnar and radial arteries. The infection rate was nil. Arterial catheterization and maintenance of indwelling catheter for repeated blood-samples is a simple and safe procedure with minimal complications, invaluable in the management of critical ill patients.
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The use of pulsatile gonadotropin-releasing hormone is an effective means of inducing ovulation, but requires prolonged intravenous (IV) or subcutaneous administration. We hypothesized that the use of self-contained infusion pumps using fluids maintained in a closed system would permit safe peripheral IV administration of gonadotropin-releasing hormone, and possibly other hormones, over prolonged intervals. Thirty-eight female patients undergoing pulsatile IV gonadotropin-releasing hormone therapy were followed for 1958 catheter days (230 catheters). Catheters were removed for signs of local inflammation, at the completion of a treatment episode or, initially, at routine intervals of 7-10 days. There were no episodes of fever (temperature over 37.5C) and three episodes of local inflammation. The incidence of significant catheter-tip cultures was 11%, and none were associated with local inflammation. There were four positive blood cultures (2%), none associated with local or systemic signs of infection. We conclude that the use of a closed system of prolonged peripheral IV cannulation is relatively safe when combined with fastidious care of the catheter site and careful outpatient monitoring for long-term administration of pulsatile gonadotropin-releasing hormone.
There are a number of therapeutic options for fluid administration in patients who lack usual venous access. Ways to establish this access include limb elevation and wrapping, the application of nitroglycerin ointment to dilate veins, and blood pressure cuff inflation. Ultrasonography can also be used to delineate vascular structures. Cutdown procedures are the oldest, most direct method to reach uncommon venous sites, such as the inferior epigastric, intercostal, iliac, and lateral thoracic veins. Today, cutdown procedures are regarded as the method of last resort, and they should be performed in operating suites or similar settings. Possible complications include inadvertent arterial puncture and hemorrhage.
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AIM: This paper reports a review of the scientific evidence for elective replacement of peripheral intravenous catheters in adults in the absence of any clinical complications, with the aim being to reduce the incidence and severity of thrombophlebitis. BACKGROUND: The incidence of thrombophlebitis associated with peripheral intravenous catheters has been reported to range from 5.3% to 77.5%. Many factors that increase the risk for thrombophlebitis have been reported, of which time in situ is one. In Sweden, the recommended guideline is elective replacement of peripheral intravenous catheters every 12-24 hours. METHOD: A systematic literature review was carried out in 2005 using the Cochrane Library, OvidMedline and CINAHL databases and hand searching of reference lists and with keywords catheterization, peripheral, thrombophlebitis and parenteral nutrition. The review included randomized controlled trials of elective replacement of peripheral intravenous catheters in adults. Three reviewers assessed the data found according to predetermined criteria. FINDING: Three randomized control trials met the inclusion criteria and were retrieved for critical appraisal. The samples in two of the trials included patients requiring total parenteral nutrition. Patients in the third trial were receiving crystalloid and drugs. Time intervals for elective replacement varied. Study quality and relevance were rated as 'medium' in two of the trials and as 'low' in the third trial. CONCLUSION: Limited scientific evidence suggests that elective replacement of peripheral intravenous catheters reduces the incidence and severity of thrombophlebitis.
Endothelial cell injury and platelet activation are considered primary events in the pathogenesis of coronary artery disease (CAD) and are marked by plasma concentrations of von Willebrand factor (vWF) and soluble thrombomodulin, and by soluble P-selectin, respectively. Because both endothelial cells and platelets interact with contrast media, we aimed to detect immediate and 24-h changes in these markers following coronary angiography in patients with and without CAD. Sixteen patients with angiographically proven CAD and 14 patients without significant coronary stenosis were investigated. Blood samples were obtained from an antecubital vein before and 24 h after cardiac catheterization, and from the coronary sinus before and immediately after angiography. Concentrations of the markers were determined using enzyme-linked immunosorbent assays. In the coronary sinus samples, the only significant finding was an increase in levels of soluble P-selectin in the patients with CAD (P < 0.038). In the post-catheterization peripheral blood samples, concentrations of soluble P-selectin (P = 0.004), vWF (P = 0.0007) and soluble thrombomodulin (P = 0.0013) were all increased in patients with CAD. In contrast, patients without CAD demonstrated increased levels of vWF only (P = 0.0015) in peripheral blood samples obtained 24 h after angiography. We conclude that both immediate and 24-h changes take place in endothelial cells and platelet markers in response to cardiac catheterization, and that these changes are different in patients with angiographically proven CAD and in patients free of disease. These differences may reflect alterations in endothelial cell or platelet reactivity in patients with CAD.
To determine glandular steroid release of adrenals and ovaries in female hyperandrogenism, a standardized method for percutaneous transfemoral venous blood sampling was developed. In eight volunteers and 67 patients, catheterization was performed during the early follicular phase (days 3-7; between 8 and 10 a.m.) to reduce interference from cyclic and circadian variations of secretion. Serial samplings reduced the episodic effluent changes. Anatomical variations and collateral flow as well as stress effects and the dosage of contrast media were studied. During catheterization, peripheral cortisol levels did not differ significantly from control groups. Collaterals had no effect on hormone levels. Contrast media increased cortisol effluent levels only when they were sampled following venography. Four-vessel venous sampling was found to be indicated if peripheral testosterone was more than 1.5 ng/ml and/or dehydroepiandrosterone sulfate more than 6,700 ng/ml. If an ovarian (adrenal)/peripheral gradient of testosterone exceeded 2.7 ng/ml, surgical intervention for tumor removal at the site of hormone excess was felt to be necessary.