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PubMed1993

[Pericardial puncture under echocardiographic control].

The authors summarize their hitherto assembled experience with pericardiocentesis under echocardiographic control. From May 1986 to December 1991 they made these punctures 55 times in 49 patients. In the majority therapeutic puncture was involved, only seven times puncture was used for diagnostic purposes. Echocardiography can evaluate not only the presence of an exudate and assess its haemodynamic impact but it is the optimal method for finding an optimal site for puncture and it is very suitable for checking the course of the operation. In smaller operations and in biopsies of pathological pericardial tissue it is advisable to use special instruments which make the procedure safe. The authors recorded a total of three failures, in one instance the exudate was removed with the assistance of a surgeon, in one instance the situation was coped with by repeated puncture and in one instance by a conservative procedure. None of the patients developed complications. A list of the latter is discussed. The method is nowadays part of therapeutic procedures of the cardiologist.

Adult↗

PubMed1993

[Aneurysma spurium after iatrogenic arterial puncture--incidence, risk factors and surgical therapy].

Due to the markedly increased number of arterial punctures performed during diagnostic angiography and angioplasty procedures for cardiac and peripheral vessel disease, the complication of false aneurysms after arterial puncture has gained increasing significance. The incidence of false aneurysms after puncture reported in the literature ranges from 0.05-2%. However, careful sonographic follow-up may reveal an incidence twice as high. The goal of this retrospective investigation of 28 patients with false aneurysms was to elucidate risk factors leading to failure of spontaneous closure of the arterial site, as well as to examine the symptoms and clinical course of such patients. Pseudoaneurysms became manifest, depending on the method of puncture, on average 16.4 days after the procedure. The highest risk was seen in adipose patients (18 pts., 64.3%). In these patients the number of tangential and multiple vessel punctures was also highest. Further risk factors were local vessel sclerosis, hypertension, diabetes mellitus, poor general condition, and disturbances of blood coagulation. The typical clinical findings were seen in only 13 patients. In 3 patients blood loss was the predominant symptom. Twelve further pseudoaneurysms (42.8%) were found incidentally at follow-up. The diagnosis was made in all patients sonographically. In 1 patient it was initially identified as an incidental finding at angiography. In 25 cases simple vessel reconstruction was possible (stitch or patch). In 3 cases (10.7%) a more extensive procedure involving vessel replacement was necessary. Severe postoperative complications included local infection (in 2 patients, 1 of whom also had a recurrent false aneurysm) and arterial bleeding necessitating surgical intervention (1 patient).(ABSTRACT TRUNCATED AT 250 WORDS)

Aneurysm, False↗

PubMed1996

[Iatrogenic spinal epidermoid tumors. A late complication of spinal puncture].

INTRODUCTION. Epidermoid tumors in the spinal canal are rare. Whether congenitally or iatrogenically caused, they form as the result of epidermal cells implanted within the spinal channel. Such implantation can occur during a variety of procedures and events such as bullet wounds, surgery, myelography or punctures for diagnosis, anesthesia or treatment. Although this complication is not discussed in books or journals on anesthesiology, we have found it mentioned in over 100 published cases reporting iatrogenically caused spinal epidermoid tumors. ETIOPATHOGENESIS. Iatrogenic epidermoid tumors of the spine derive from the implantation of epidermal tissue transported inside the spinal canal during lumbar punctures without guidance or with inadequate guidance. There is ample evidence that such tumors are iatrogenic. All cases occur in patients with a history of lumbar puncture. They are rarely associated with congenital anomalies. They are extramedullary. They tend to develop near sites of earlier lumbar puncture, usually near the conus medullaris and the cauda equina. Iatrogenic epidermoid tumors of the spine have been reproduced experimentally in two studies in which autologous skin fragments were implanted in the spinal canal. CLINICAL SIGNS. These tumors are well tolerated by patients for extended periods of time, ranging from 2 to 10 years. At the cauda equinus, tumors can grow slowly for long periods without signs of nerve compression. Symptoms are directly related to tumor size and site. All patients with tumors at the cauda equinus report severe pain radiating toward the roots of compressed nerves. Nuclear magnetic resonance makes it possible to detect the tumor without administration of intrathecal contrast. At present gadolinium-DTPA improves the image so that these tumors can be distinguished from other types. The prognosis for epidermoid tumors of the spine is good, as they are histologically benign. Treatment is always surgical. CONCLUSION. Although the causal relation between epidermoid spinal tumors and lumbar puncture is well documented, anesthesiologists are not sufficiently aware of this possible complication. Between 1977 and 1995, 28 new cases were published. We believe that a deeper understanding of such rare complications will show us how to prevent them while providing appropriate use of epidural and subarachnoid anesthesia.

Epidermal Cyst↗

PubMed1996

[Percutaneous puncture treatment of kidney cysts under echographic control].

Experience had with percutaneous puncture treatment under echographic control in 122 patients presenting kidney cysts is shared. The indications and contraindications for treatment, puncture technique applied and drugs used for cyst epithelium sclerosis are discussed, followed by a description of an original method of cyst cavity draining. In all patients with cyst drainage duely performed the outcome of treatment is successful. Good therapeutic results upon using sclerosing substances are attained in 88.7 per cent, while in cysts not subjected to medication-in 64.3 per cent, or else the total of positive outcomes amounts to 81.8 per cent. After puncture, it is advised to insert a drain into the cystic cavity, and invariably administer sclerosing substances. The readily performed technique of puncture, lack of serious complications, short hospitalization and prompt recovery of the ability for work are unquestionable advantages of the method proposed. In case of cyst recurrence it is possible to perform secondary puncture.

Adolescent↗

PubMed1991

Macrophage antigen presentation and interleukin 1 production after cecal ligation and puncture in C3H/HeN and C3H/HeJ mice.

Following cecal ligation and puncture with a 25-gauge needle, endotoxin-sensitive C3H/HeN mice have a 45% mortality compared with no mortality in endotoxin-resistant C2H/HeJ mice. Macrophage production of interleukin 1 and antigen presentation were studied in these two strains of mice following cecal ligation and puncture at 2, 4, 8, 16, and 24 hours and at 2, 4, 6, and 8 days. Splenic macrophages were cultured with a T-helper cell clone (D10.G4.1), and antigen presentation and interleukin 1 production were measured by D10.G4.1 proliferation. Macrophage antigen presentation by C2H/HeJ mice was markedly increased compared with that in C3H/HeN mice at all times after cecal ligation and puncture, most strikingly at 2 days (185m740 cpm for C3H/HeJ mice vs 30,300 for C2H/HeN mice). Macrophage interleukin 1 production was significantly increased in C3H/HeJ mice vs C3H/HeN mice at all times after cecal ligation and puncture (except at 2 days) and was maximal at 8 days (25,000 cpm for C3H/HeJ mice vs 5190 for C3H/HeN mice). These data suggest that the differences in mortality after cecal ligation and puncture between these two strains of mice may relate to a supranormal response of macrophages of C3H/HeJ mice or to an inadequate response of macrophages of C3H/HeN mice.

Animals↗

PubMed2002

Posture and fluids for preventing post-dural puncture headache.

BACKGROUND: Potentially disabling postural headache occurs after dural puncture in 1-70% of patients. It has been suggested that such headaches may be less common if patients routinely have a period of bed rest or receive supplementary fluids after the procedure. OBJECTIVES: To assess the effects on post dural puncture headache of a period of bed rest versus early mobilisation, of different positions during a period of bed rest, and of administering supplementary fluids after the procedure. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (Cochrane Library, Issue 4, 2000), MEDLINE (January 1994-December 1998), and EMBASE (January 1980-December 1998). We also searched the reference lists of articles identified electronically, and contacted trial authors for information about other potentially relevant studies. Date of the most recent search: December 2000. SELECTION CRITERIA: We sought randomised, unconfounded trials, among all types of patients, that compared the effects on post-dural puncture headache of: bed rest versus early mobilisation; head-down tilt versus horizontal or prone versus supine positions during bed rest; or the administration of supplementary fluids versus control. DATA COLLECTION AND ANALYSIS: One reviewer extracted data from the reports of all trials considered eligible for inclusion. The authors of included studies were invited to check the information extracted and provide any details that were unavailable in the published reports. Intention-to-treat analyses were performed. MAIN RESULTS: Eleven trials among 1723 patients compared either bed rest with immediate mobilisation or a longer versus a shorter period of bed rest. There was a non-significant relative increase in the odds of the primary outcome of postural headache among patients allocated more rather than less bed rest (196/639 [31%] bed rest versus 169/615 [27%] early mobilisation; odds ratio [OR] 1.21; 95% confidence interval [CI] 0.94 to 1.55). Analyses confined to the methodologically most rigorous trials gave similar results. Only two trials among 126 patients compared different positions during bed rest. No statistically significant differences were found, but small numbers made the comparisons imprecise. One trial among 100 patients assessed fluid supplementation. Again, the numbers of patients and outcome events were small, and indicated the possibility of both reduced and increased postural headache with additional fluids. REVIEWER'S CONCLUSIONS: There is no good evidence from randomised trials to suggest that routine bed rest after dural puncture is beneficial. The role of fluid supplementation in the prevention of post-dural puncture headache remains uncertain.

Bed Rest↗

PubMed1977

Percutaneous puncture guided by ultrasonic multitransducer scanning.

A technique for percutaneous puncture guided by real-time scanning is described. By means of a special puncture adaptor fastened to one end of a multitransducer, a needle can be guided in the plane of scanning in an adjustable angle to the transducer front. By this technique, the puncture target as well as the needle can be monitored on the real-time image during the entire puncture procedure. The technique has been used for amniocentesis, fine needle biopsy of a renal mass, renal cyst puncture, and pericardiocentesis.

Biopsy, Needle↗

PubMedDate not supplied

The safety of fetoscopy: (I). Effect of umbilical vessel puncture on the fetal heart rate and cord histology.

The fetal heart rate (FHR) was continuously monitored during 42 umbilical vessel punctures performed at the placental insertion of the cord in 24 diagnostic fetoscopies in which pure fetal blood was obtained. In only one patient did a deceleration first appear during puncture and aspiration of fetal blood. In two patients decelerations preceded fetoscopy and in two others they began during the fetoscopy but before puncture of an umbilical vessel. In 19 patients, the FHR did not change at all during the procedure. Fetal haemorrhage after sampling was either absent or minimal. Six pregnancies were terminated because a positive diagnosis had been made and 18 healthy babies were born. Umbilical cords were examined after 7 terminations of pregnancy and after 6 deliveries. In the former group the puncture could just be seen with the naked eye and the needle track was demonstrated histologically in 6. No traces of the puncture or other abnormalities were found in the cords after delivery. Fetal blood sampling from umbilical cord vessels, particularly at the placental insertion of the cord, is the technique of choice since pure fetal blood can be obtained without increasing the risk of fetoscopy.

Blood Specimen Collection↗

PubMed2001

[Needle holder for reducing radiation burden of examiners in CT-assisted puncture. Technical contribution].

PURPOSE: To evaluate the use of a needle guide for CT guided puncture for the reduction of radiation dose of the interventional radiologist. MATERIAL AND METHODS: A total of 20 CT-guided punctures was performed. An approach from anterior was used in 12 cases and an approach from lateral was used in 8 cases. We evaluated the practicability, the precision and possible artifacts caused by the needle guide. RESULTS: All 20 punctures could be performed with the needle guide without any complications. We observed no artifacts on the images due to the needle guide. The ability to guide the puncturing needle was not affected by the needle guide. The use and the efficacy of the needle guide were best for the approach from anterior as well as a lateral approach. However, for angulated appraches from caudal to cranial there was no benifit regarding the distance of the hands of the interventional radiologist from the radiation beam of the CT unit. CONCLUSIONS: The use of the needle guide is reducing the radiation dose of the interventional radiologist during CT-guided punctures.

Biopsy, Needle↗

PubMed1998

[Duplex ultrasound risk stratification of percutaneous puncture of the brachial artery for diagnostic and interventional coronary angiography].

Diagnostic and interventional heart catheterization in peripheral vascular disease often requires due to iliacal disease additional methods of arterial approach besides the Judkin's technique. The percutaneous catheterization of the brachial artery finds widespread use. A major complication linked with this method is an increased rate of thrombotic occlusions at the puncture site. Thus, we investigated in a prospective set-up the ability of duplex ultrasound to identify predictive risk factors for vascular complications. Over a period of 20 months, 8000 patients referred to heart catheterization were studied. Routine catheterization via the femoral route was contraindicated in 34 out of 8000 mostly due to severe peripheral vascular disease with multiple vascular risk factors (diabetes, hypertension, and smoking). 53 patients who had a comparable low risk-profile served as the control group. The brachial artery was examined by ultrasound duplex for vessel anatomy and diameter at the puncture site before coronary angiography. Both groups (patient and control group) showed in 15% a variable anatomy with a premature division of the brachial artery in 6% proximal of the elbow and in 9% already distal to the axillary artery. Because of reduced diameters of these variable vessels no procedure was carried out at these arms. In all cases the opposite arm was successfully used instead, because the variants were always located only at one arm. The diameter of the brachial artery measured in average 5.0 +/- 0.8 mm and 4.8 +/- 0.7 mm in patients and controls, respectively. Women had a significantly smaller vessel diameter than men, measuring a difference of 0.4 and 0.6 mm, respectively (p < 0.05). For coronary angiography 6F and 7F arterial sheats were used equally, and in 32% of all cases a coronary intervention was performed. 31 (91%) procedures were carried out without complications; there was a false aneurysm in 1 patient (3%) and an occlusion of the brachial artery at the puncture site in 2 patients (6%). The occluded vessels of two diabetic women had a reduced diameter at the level of 10% of the standard distribution and an unfavorable ratio of sheat-to-vessel-diameter which lead initially to an obstruction of nearly 50% of the vessel lumen during catheterization. Screening of the brachial artery by ultrasound duplex before a percutaneous catheterization for coronary angiography and intervention showed reproducibly the variable anatomy and differences in vessel diameter, which can be risk factors for thrombotic occlusion. Important details for the location of the puncture site and the possible size of the arterial sheat can be obtained, so that coronary interventions with 7F catheter systems are still practicable. This technique is a simple and efficient method to estimate the relative risk of arterial occlusion prior to percutaneous puncture of the brachial artery, especially in a group of patients with severe atherosclerosis and elevated vascular risk-factors.

Adult↗

PubMed1999

[Postdural puncture headache: diagnosis, prevention and therapy].

Lumbar puncture (LP) is a routine technique performed for a variety of procedures, e.g. diagnosis, administration of drugs, myelography and spinal anaesthesia. Postdural puncture headache is a common complication (30-40% in diagnostic LP). Prevention can be accomplished by using small-gauge needles (< or = 25 G) or pencil-point needles (22 G). Therapy should be carried out in a stepwise approach. The first step is bedrest, use of analgetics, i.v. fluids and an adequate guidance of the patient. The second step comprises special drug therapy. Several methods of pharmacologic management have been presented in the literature, but most of these are case reports. There is a lack of large double-blind placebo-controlled studies. Theophylline, caffeine, ACTH and sumatriptan are potentially promising agents for the treatment of postdural puncture headache. The efficacy of theophylline has been proven in a double-blind and placebo-controlled study. There are a few studies and case reports reporting that caffeine p.o. and i.v. is effective in the treatment of postdural puncture headache, but recurrence of headache after caffeine therapy is frequent. ACTH acts on a complex hormonal system. The treatment with sumatriptan has been reported in only a few case reports. The third step, and one of the most effective treatments of postdural puncture headache, is the epidural blood patch. The success rate ranges between 80 and 97%.

English Abstract↗

PubMed2006

A model for foramen ovale puncture training: Technical note.

BACKGROUND: Trigeminal neuralgia is a common cause of facial pain, characterized by shock-like pain affecting one or more branches of the trigeminal nerve. When conservative treatment fails and microdecompression is not indicated, percutaneous procedures are helpful. This percutaneous approach is done by a puncture up to the Gasserian ganglion, through the foramen ovale. Although simple and safe, this puncture demands some expertise from neurosurgeons. For that, a partnership between neurosurgeons and bio-engineers has developed a model for foramen ovale puncture, allowing practice for residents and young neurosurgeons. METHOD: A model for foramen ovale puncture has been created by interposition of synthetic materials over a skull, simulating the human face. FINDINGS: This model has shown great similarity with that found in conventional surgeries, even upon repeated testing by experienced functional neurosurgeons and young residents. CONCLUSION: This model for foramen ovale puncture training has demonstrated valuable help for initial practicing of this common neurosurgical procedure, particularly in centers where there are not many cadavers available for training.

Catheter Ablation↗

PubMed1993

Accidental skin punctures during ophthalmic surgery.

PURPOSE: Accidental skin puncture carries the risk of both hepatitis B and human immunodeficiency virus transmission. There have been studies of the incidence of these skin punctures in general surgery, but no study has focused on ophthalmic surgery. METHOD: All incident reports of skin punctures in the Bascom Palmer Eye Institute operating rooms from January 1990 through November 1991 were reviewed retrospectively. The incidence of skin puncture also was studied propsectively from December 1991 through May 1992. During the prospective phase, the healthcare worker was asked to complete an anonymous form regarding the instrument involved, whether it was clean or contaminated, the persons involved, and whether the room lights were on or off. RESULTS: There were 37 such occurrences in 14,878 operations (0.25%) during the retrospective study and 12 in 4246 operations (0.28%) in the prospective period. In only one case was the instrument contaminated by contact with a patient known to have positive serology for the human immunodeficiency virus. There were no documented seroconversions of healthcare personnel for either hepatitis B or human immunodeficiency virus. In 63% of these occurrences, the penetrating instrument was known to be definitely contaminated with the patient's blood. Only one person was handling the instrument 84% of the time. CONCLUSION: The low but present danger to ophthalmic personnel during surgical procedures justifies precautions to decrease the occurrence of skin punctures.

Accidents, Occupational↗

PubMed1998

Role of antral puncture in the treatment of sinusitis in the intensive care unit.

OBJECTIVE: The objective of this study was to determine whether maxillary sinus puncture caused an alteration in antibiotic treatment and thus affected the outcome of sinusitis in the intensive care unit. STUDY DESIGN: A retrospective review was done of cases of maxillary sinus puncture between 1991 and 1994. RESULTS: Forty-two patients were identified. All patients had findings suggestive of sinusitis on plain sinus films or CT scans of the sinuses. Twenty-five punctures (60%) recovered pus, of which 80% grew organisms. Fourteen patients (33%) had a negative lavage, and 12% of these samples grew organisms (p = 0.001). Sixty-eight percent of the cultures identified a single organism compared with 32% with multiple organisms. Gram-negative organisms were found most commonly, followed by anaerobes. In 57% of the cases antibiotic therapy was changed. In 77% of the cases the change was directed by the culture result and in 35% the therapy was changed despite a negative culture result (p = 0.002). Resolution of symptoms occurred in 83% of patients who had antibiotics changed whereas with no change in antibiotics only 42% had resolution (p = 0.001). CONCLUSION: A sinus puncture seems to be helpful in patients with fever and positive findings on sinus films. If pus is obtained by maxillary puncture, a positive culture may be found in 80% of the cases. Changes in antibiotic regimen on the basis of culture findings seem to give a better outcome.

Adult↗

PubMed1998

Hemostasis of punctured blood vessels using high-intensity focused ultrasound.

The hemorrhagic complications of vascular injury can be significant. We report on the use of high-intensity focused ultrasound (HIFU) to stop the hemorrhage of punctured blood vessels in pigs. Two HIFU transducers with frequencies of 3.5 and 2.0 MHz, each equipped with a water-filled conical housing, were used. Major blood vessels (femoral artery and vein, axillary artery, carotid artery and jugular vein), 2-10 mm in diameter, of anesthetized pigs were exposed surgically and punctured with 14- and 18-gauge needles to produce moderate to profuse bleeding. Complete hemostasis was achieved in less than 3 min of HIFU treatment in most blood vessels, and all vessels were patent after the treatment. Both HIFU frequencies were effective in producing hemostasis. Gross examination of the HIFU-treated vessels showed a consistent hardening of the soft tissue surrounding the blood vessels, providing a seal for the puncture hole. Microscopic examination of the vessels showed a remarkably localized HIFU treatment, resulting in coagulation of the adventitia, and an extensive fibrin network around the vessels and in the puncture hole. The vessel walls exhibited focal swelling, without evidence of irreversible injury. HIFU may provide a useful method for achieving hemostasis of punctured and traumatized blood vessels in a variety of clinical settings.

Animals↗

PubMedDate not supplied

Adrenocorticotropic hormone infusion as a novel treatment for postdural puncture headache.

BACKGROUND AND OBJECTIVES: In two patients, one scheduled for epidural anesthesia and the other for placement of a spinal catheter for operative procedures, severe postdural puncture headache developed and was refractory to conservative therapy. METHODS: The first patient had several unintentional dural punctures, and the second underwent a planned dural puncture with an 18-gauge needle for insertion of a 20-gauge catheter. When neither patient responded to conservative therapy following development of postdural puncture headache, an infusion of adrenocorticotropic hormone (ACTH) was given prior to consideration of epidural blood patching. RESULTS: Both patients obtained complete and permanent relief from their headaches. CONCLUSION: A single treatment with ACTH may offer an alternative therapy in the treatment of postdural puncture headache.

Adrenocorticotropic Hormone↗

PubMed1991

Puncture procedures utilizing transvaginal ultrasonic guidance.

The introduction of transvaginal sonography has enabled the use of this scanning method for guided puncture procedures. A total of 102 puncture procedures are described: 63 fetal reductions, eight punctures of ectopic pregnancies, 19 drainages of pelvic contents, seven punctures of ovarian cysts, four diagnostic culdocenteses and one injection of a cervical pregnancy. Every procedure is discussed in detail. There was only one procedure-related complication. The advantages of the ultrasound-guided vaginal puncture procedure are its performance under real-time imaging, a low complication rate, a better pregnancy outcome when considering the reduction of multifetal gestations, and, most importantly, the fact that abdominal surgery can be avoided in several cases.

Journal Article↗

PubMed2001

Arterial puncture phlebotomy in whole-blood donors.

BACKGROUND: An arterial puncture during whole-blood phlebotomy is a rare event. A series of arterial punctures was evaluated to determine the clinical findings and the incidence of complications. STUDY DESIGN AND METHODS: Arterial punctures reported by staff between January 1, 1999, and February 28, 2001, were evaluated. Follow-up interviews were done with the phlebotomy nurses to determine what the clinical findings were and what the incidence of complications was. RESULTS: Twelve cases of arterial punctures were identified from 410,000 blood donations (0.0029%; 1/34,000). Eleven cases had a fast blood-flow rate of <4 minutes; 9 units (75%) were bright red; and in 4 cases (33%), the needle was pulsating. One case was diagnosed because the donor developed a brachial artery pseudoaneurysm 3 days after donation. Four hematomas occurred, for an occurence rate of 33 percent (0.35% in the general donor population). There was also an association with newly trained staff. CONCLUSION: Fast blood-flow rate is the most common clinical feature after an arterial puncture. Bright red blood is usually, but not always, present, and a pulsating needle is sometimes present. Hematoma is a relatively common complication, and brachial artery pseudoaneurysms are rare, although one case was seen in this study.

Adult↗