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PubMed2001

Measurement of the mechanical properties of skin with ballistometer and suction cup.

BACKGROUND: There is no consensus on the methodology for describing the mechanical properties of human skin in vivo. Current descriptions are generally method dependent. METHOD: The mechanical properties of palmar skin of the hypothenar as well as dorsal and ventral forearm skin were studied in 17 healthy volunteers. Two methods were used: ballistometry [Dia-stron Torsional Ballistometer (Diastron Ltd., Andover, UK)] and suction cup [The Dermaflex machine (Cortex Technology, Hadsund, Denmark)]. RESULTS: A moderate degree of correlation was found between the methods (rs=0.315-0.540), while internal correlation between different measures obtained with one method was higher (rs=0.375-0.967). The suction cup method parameters (distensibility and elasticity) correlated significantly with the ballistometry parameters (indentation, alpha, area and coefficient of restitution), while the hysteresis did not correlate to ballistometry parameters. The coefficient of variation of both methods (CV=0.02-0.35) was within the range obtained with other non-invasive methods, e.g., TEWL. Regional differences were identified with both methods, while only the suction cup method identified age-related changes. CONCLUSIONS: The results suggest that while both methods may be useful, they describe related but not identical aspects of skin mechanics. The differences in measuring principle suggest that the suction cup method predominantly measures elasticity, while the ballistometer predominantly appears to measure stiffness. Hysteresis may be a unique measure of skin viscosity. Additional studies, however, are needed to specify the clinical significance of the various measures of skin mechanics.

Biomechanical Phenomena↗
PubMed2001

An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units.

Endotracheal suctioning is a frequently performed procedure that has many associated risks and complications. It is imperative that nurses are aware of these risks and are able to practise according to current research recommendations. This study was designed to examine to what extent intensive care nurses' knowledge and practice of endotracheal suctioning is based on research evidence, to investigate the relationships between knowledge and practice, and to evaluate the effectiveness of a research-based teaching programme. This quasi-experimental study was a randomized, controlled, single-blinded comparison of two research-based teaching programmes, with 16 intensive care nurses, using non-participant observation and a self-report questionnaire. Initial baseline data revealed a low level of knowledge for many participants, which was also reflected in practice, as suctioning was performed against many of the research recommendations. Following teaching, significant improvements were seen in both knowledge and practice. Four weeks later these differences were generally sustained, and provide evidence of the effectiveness of the educational intervention. The study raised concern about all aspects of endotracheal suctioning and highlighted the need for changes in nursing practice, with clinical guidelines and focused practice-based education.

Clinical Competence↗
PubMed2003

A meta-analysis of the effects of various interventions in preventing endotracheal suction-induced hypoxemia.

The purpose of this study was to clarify the effects of interventions that were applied to prevent endotracheal suction-induced hypoxia by meta-analysis. To obtain a sample for this meta-analysis, a computerized search was performed through MEDLINE in addition to tracking down additional references cited in bibliographies of past reports. Finally thirty research reports were examined. In terms of the application time of oxygenation, insufflation and preoxygenation were the most prevalently used in the studies. Regarding the methods of oxygenation, the most prevalent technique for oxygenation was hyperoxygenation in combination with hyperinflation. Hyperoxygenation and hyperinflation were most frequently induced by FiO2 of 1 and a 150% tidal volume of three to six breaths, respectively. Suctioning was commonly sustained for <15 seconds using pressures of -80 to -120 mmHg and with size 14 French catheters. Insufflation was less effective than the other methods examined in the present study. From this study, it can be concluded that the interventions that were applied to prevent endotracheal suction-induced hypoxia, regardless of their application times or methods, reduced suction-induced hypoxia significantly.

Adult↗
PubMed1999

Modified technique of suction blistering for epidermal grafting in vitiligo.

BACKGROUND: Suction blister epidermal grafting is a useful modality of treatment of resistant and stable vitiligo; however, it requires expensive and heavy suction apparatus. This study is an attempt to develop a cheap and small apparatus which can be assembled in the physician's own office. PATIENTS AND METHODS: The method was tried in 22 vitiligo/leukoderma patients. The apparatus consisted of a cylindrical funnel connected with a three-way tap, and suction was given by a 50-mL syringe. The pressure inside the suction cup was retained by changing the position of lock of the three-way tap. The pressure was measured by connecting the three-way tap to a vacuum gauge. The apparatus remained adhered to the donor area because of negative pressure. The blister was formed in about 1.5 h. The roof of the blister was grafted onto the dermabraded recipient site. RESULTS: The pigmentation was complete in 20 out of 22 patients. There were no complications. CONCLUSIONS: The technique is inexpensive and easy and obviates the need of cumbersome and heavy equipment.

Adolescent↗
PubMed2001

The role of frozen storage in preserving adipose tissue obtained by suction-assisted lipectomy for repeated fat injection procedures.

BACKGROUND: The injection of autologous free fat obtained by suction-assisted lipectomy for the correction of soft tissue defects is a common procedure in plastic surgery. However, unpredictable partial absorption of the injected fat often necessitates repeated procedures. OBJECTIVE: To examine the role of frozen storage as a means of preserving the fat obtained by suction-assisted lipectomy for repeated procedures. METHODS: Human adipose tissue obtained by suction-assisted lipectomy was stored in a domestic refrigerator at -18 degrees C for 2 weeks. After thawing, the fat was injected into nude mice. In the control group, the fat was injected immediately after the harvesting procedure. Grafts were dissected out and compared 15 weeks postinjection. RESULTS: Injected fat survived in both study and control groups. No significant differences were found between fat graft weight and volume, or in any of the histologic parameters examined. CONCLUSION: Fat obtained by suction-assisted lipectomy may be preserved for future use by freezing.

Adipose Tissue↗
PubMed2003

Outflow control for avoiding atrial suction in a continuous flow total artificial heart.

Continuous flow blood pumps, such as axial flow and centrifugal pumps, have been gaining interest as circulatory devices for total artificial hearts (TAHs) because of their smaller size and simpler structure compared to pulsatile pumps. However, continuous flow pumps are more prone to atrial wall suction than pulsatile pumps are. Sudden increases in flow rate to meet changes in physiological demand, especially in the left pump, often cause atrial wall suction. In this study, a control algorithm to prevent atrial wall suction from occurring in the left atrium by controlling the rotational speed of the right pump, instead of reducing the cardiac output of the left pump, was developed and investigated. The method was tested in a mock circulatory system and in acute animal experiments with adult goats. Two centrifugal pumps were used to totally replace the circulatory function of the natural heart. The cardiac output of each pump was determined independently by a control algorithm running on a computer connected through a serial interface to the pump driving units. Results showed that left atrial wall suction could be prevented using this method, and that the method could be performed simultaneously with physiological control of the artificial heart.

Algorithms↗
PubMed2001

[Vertigo in suction of open mastoid cavities ("radical surgery cavities")].

BACKGROUND: Vertigo during suction-cleaning of open mastoid cavities is caused by cold stimulation of the vestibular organ. In clinical and model-experimental measurements we tried to estimate the physical background and the dimension of this temperature drop. METHODS: Using different techniques like thermo-probes, thermovision, or additional model experiments temperature changes during suction were measured in 5 volunteers with open mastoid cavities. These registrations were carried out with special regard to the moisture of the cavity-walls. RESULTS: Distinct temperature changes during suction were observed. In moist cavities superficial temperature decrease was much higher than in dry ones. Using additional model experiments, temperature conduction towards e.g. the horizontal semicircular canal could be simulated. DISCUSSION AND CONCLUSIONS: Among other mechanisms like replacement of sucked-off air by colder air, or taking away warm air close to the cavity walls, effects of evaporative cold seem to be very significant. This could be demonstrated by moistening cavity walls in patients as well as in model experiments. The conclusion to keep the cavity walls as dry as possible is already a clinical demand. In this paper, the physical background and the dimensions of thermal effects during suction-cleaning could be elucidated.

Body Temperature Regulation↗
PubMed1985

Controlled cardiotomy suction during clinical bubble oxygenator perfusions.

Cardiotomy suction causes platelet damage and hemolysis due to air aspiration along with blood suction (uncontrolled suction = US). However, prevention of air aspiration (controlled suction = CS) reduces platelet damage and hemolysis and improves postoperative hemostasis, as only attainable in membrane oxygenator (MO) perfusions. We therefore studied 3 groups of patients subjected to extracorporeal circulation: bubble oxygenator (BO) with CS (n = 10), BO with US (n = 8) and MO with US (n = 10). If CS was used during BO perfusions we found that only hemolysis was significantly reduced, if compared to BO perfusions with US. Despite the use of CS during BO perfusions, platelets were still significantly better preserved during MO perfusions in which US was used. This was indicated by a higher platelet number, higher ADP-induced platelet aggregation, and lower beta-thromboglobulin plasma concentration, during and immediately after MO perfusions. Blood loss and blood transfusions during the first 18 hours after perfusion were not significantly different between the 3 groups. We conclude that the platelet-preserving capacity of CS is completely lost by the platelet damaging effect of the BO. However, reduction in hemolysis is well maintained.

Adenosine Diphosphate↗
PubMed1988

[Ocular hemodynamics following suction cup oculopression].

In the study reported here the authors investigated the influence on ocular perfusion pressures of suction-cup oculopression, a procedure which permits oculopression without orbital compression. Patients over 50 years of age were examined before cataract extraction. Ulrich's method of ocular oscillodynamography was used to determine ocular perfusion pressures. A Mikuni and Yoneyama suction-cup dynamometer was applied for suction-cup oculopression. Ocular hypotonia following suction-cup oculopression was adequate and comparable to that achieved by other oculopression methods. After oculopression a significant increase in ocular perfusion pressures (retinal, ciliary, and diastolic) was found. However, ocular blood pressure remains constant after oculopression. Moreover, the increase in ocular perfusion pressure could not be explained by oculocardiac reflexes, because there was no change in systemic arterial blood pressure. It must be assumed, therefore, that the increase in ocular perfusion pressures is caused by a lowering of resistance, i.e., a drop in intraocular pressure.

Blood Pressure↗
PubMedDate not supplied

Effect of reusing suction catheters on the occurrence of pneumonia in children.

OBJECTIVE: The purpose of this study was to determine whether disposable suction catheters can be reused in the same patient for a 24-hour period without affecting the incidence of pneumonia. DESIGN: The study design was a randomized controlled trial. SETTING: The study was conducted in the pediatric intensive care unit of a tertiary pediatric center. SAMPLE: Subjects included 486 children with an endotracheal tube in place. OUTCOME MEASURES: The development of pneumonia, diagnosed with radiographic and clinical evidence, was the measure. Cost analysis was also undertaken. METHOD: Subjects in the study group (n = 241) were suctioned using the same catheter for a 24-hour period. Those in the control group (n = 245) had a new catheter for each episode of suctioning. RESULTS: Pneumonia developed in 14 members (5.71%) of the control group and in 12 members (4.98%) of the study group, a difference of 0.7% (95% CI, -3.3% to 4.7%). Cost analysis indicated a saving of Aust $4.14 per patient per day. CONCLUSION: Reusing suction catheters for up to 24 hours is both safe and cost-effective.

Adolescent↗
PubMed2006

Pericardial suction blood separation attenuates inflammatory response and hemolysis after cardiopulmonary bypass.

OBJECTIVES: Retransfusion of pericardial suction blood (PSB) is critically considered under the aspect of the biocompatibility of the cardiopulmonary bypass (CPB). We investigated various indicators of inflammation and blood cell activation associated with CPB and re-transfusion of PSB during cardiac surgery. DESIGN: Thirty-five patients undergoing elective coronary artery bypass grafting were prospectively randomized into two groups. In group A (n = 15, retransfusion group) the pericardial suction blood was continuously retransfused during CPB, in group B (n = 20, no-retransfusion group) the suction blood was separated. Parameters indicating the status of the inflammation and blood cell activation were analyzed before and at the end of CPB, latest after 90 minutes on CPB. RESULTS: Patients' perioperative data did not differ between groups. The inflammatory markers C-reactive protein, PMN-Elastase and Interleukin-6 increased in both groups after CPB (p < 0.04) with significantly lower values in the no-retransfusion group (p < 0.02). Leukocytes and platelet activation markers beta-Thromboglobulin and soluble P-Selectin also experienced a significant elevation during observation time (p < 0.02) without any difference between the groups. Free hemoglobin and LDH tremendously increased during CPB with lower values in the no-retransfusion group. CONCLUSIONS: Cardiotomy suction is a major cause of hemolysis and contributes significantly to the systemic inflammatory response.

Biomarkers↗
PubMed1990

Selective ECG synchronised suction and retroinfusion of coronary veins: first results of studies in acute myocardial ischaemia in dogs.

STUDY OBJECTIVE: The aim of the study was to test an intermittent ECG synchronised suction device which was added to a coronary vein retroinfusion system (selective suction and retroinfusion = SSR) in order to transport oxygenated fluid more efficiently into ischaemic myocardium. DESIGN: The suction period preceding the retrograde pumping period was sufficient to allow the coronary veins to empty upstream of the retroinfusion catheter tip, thus facilitating the refilling of the veins by the retrogradely pumped oxygenated fluid. Subepicardial oxygen partial pressure measurements and determination of post mortem infarct size were used to study the efficacy of SSR treatment in an open chest infarct model. SUBJECTS: 15 beagle dogs were subjected to occlusion of the left anterior descending coronary artery for up to 5 h. MEASUREMENTS AND MAIN RESULTS: Using oxygenated Ringer lactate solution for SSR treatment (given 30 min to 5 h after occlusion of the left anterior descending artery), mean subepicardial PO2 in the ischaemic myocardium of SSR treated dogs increased by 7-12 mm Hg. Mean infarct size was reduced to 5.6(SD 3)% of left ventricle in SSR treated dogs (n = 4) compared to 27(14)% in controls (n = 4). Expressed as percent of volume at risk, mean infarct size was reduced by 84% in SSR treated dogs. CONCLUSIONS: These data suggest that intermittent suction increased the efficacy of coronary venous retroinfusion in acute myocardial ischaemia.

Animals↗
PubMed2006

A double-blind, randomized controlled trial on the use of a 50:50 mixture of nitrous oxide/oxygen in pain relief during suction evacuation for the first trimester pregnancy termination.

BACKGROUND: This prospective study assessed the role of a 50:50 mixture of nitrous oxide (N2O) and oxygen for pain relief during the termination of first trimester pregnancies by suction evacuation under conscious sedation. METHODS: Ninety women undergoing suction evacuation up to 12 weeks of gestation were randomized by a computer-generated randomization list and allocated using sealed envelopes to receive the N2O/O2 mixture or air during the operation. Pain scores during and after suction evacuation, post-operative side effects and satisfaction level were compared. RESULTS: No statistically significant differences in pain scores, post-operative side effects and satisfaction levels were found between the two groups. CONCLUSION: N2O/O2 did not reduce the pain level during suction evacuation for the first trimester pregnancy termination under conscious sedation.

Abortion, Induced↗
PubMed1980

Evaluation of selective bronchial suctioning in the adult.

In the present study, the highest success rate in suctioning of the left main bronchus was achieved when curved-tip catheters of both Portex (40%) (Portex Limited, Hythe, Kent, England) and Rüsch (50%) (Willy Rüsch Gmph & Co. KG, West-Germany) were inserted with the patient's head in the midline position. The second most successful rate in reaching the left main stem bronchus occurred when the head was turned to the right using straight catheters of both Portex (31%) and Rüsch (29%). The third but lesser success rate in suctioning the left main stem bronchus was achieved with the head turned to the right, using curved-tip catheters of both Portex (25%) and Rüsch (23%). the lowest success rate in suctioning the left main stem bronchus was with the head in the midline position using straight catheters of both Portex (19%) and Rüsch (15%). The possible factors which influence success or failure to introducing suction catheters into the bronchi selectively were discussed.

Bronchi↗
PubMed1987

Prevention of suction-induced hypoxemia by simultaneous oxygen insufflation.

The effects of endotracheal suctioning were studied in 38 patients. A significant decline in arterial oxygen tension and saturation was noted in all patients. A new double lumen suction catheter that simultaneously insufflates oxygen while suctioning was tested in these same patients and was found to prevent hypoxemia in all patients. We recommend that the insufflation catheter be added to the protocol of hyperventilation with 100% oxygen to help prevent suction-induced hypoxemia.

Cardiac Surgical Procedures↗
PubMed1987

Prevention of bradycardic responses to endotracheal suctioning by prior administration of nebulized atropine.

Endotracheal suctioning can elicit bradycardia and hypotension. We compared the effectiveness of nebulized atropine with that of parenterally administered atropine in preventing these responses. Six mechanically ventilated patients who reproducibly experienced a 20% or greater fall in resting heart rate exclusively with endotracheal suctioning were given three trials: a) inhaled atropine sulfate (0.05 mg/kg); b) inhaled saline aerosol (0.05 ml/kg); and c) atropine sulfate (1 mg, given im or iv). Mean heart rate fell from 114 +/- 10 to 45 +/- 5 beat/min with suctioning after the saline aerosol (p less than .001). Both nebulized and parenteral atropine sulfate prevented the bradycardic response in all six subjects (p less than .001). After nebulized saline, three patients also experienced a greater than or equal to 10 mm Hg fall in systolic BP. Both nebulized and parenteral atropine prevented the hypotensive response. Tachycardia occurred after parenteral atropine in all six patients, while only one episode of tachycardia was seen after nebulized atropine. Both parenteral and nebulized atropine can prevent bradycardia and hypotension elicited by endotracheal suctioning, but nebulized atropine may have a wider margin of safety at the doses used in this study.

Administration, Inhalation↗
PubMedDate not supplied

The closed tracheal suction system: implications for critical care nursing.

The Closed Tracheal Suction System (CTSS) is a multiple-use suction catheter available for suctioning the ventilator dependent patient. While research has been reported on its impact on oxygen desaturation, ventilator function, and nosocomial pneumonia, the practical issues of the technical design of the catheter and its advantage in decreasing exposure of staff to infected respiratory secretions have not been investigated. This study reports the critical care nurses' perceptions in the use of the SteriCath (Concord/Portex) CTSS focusing on hemodynamic stability, effectiveness of suctioning, patient safety and staff personnel exposure.

Adult↗
PubMed1983

Reassessment of esophageal histology in normal subjects: a comparison of suction and endoscopic techniques.

We have examined esophageal biopsies from 18 asymptomatic volunteers. These normal subjects were also evaluated by esophageal manometry with determination of motor function of the esophagus and lower esophageal sphincter pressure, a modified Bernstein acid infusion test, and a basal pH reflux test. In 12 subjects, biopsies were obtained by suction technique; the remaining six had pinch biopsies performed during upper gastrointestinal endoscopy. Forty-nine (92.5%) of the 53 suction biopsies yielded tissue as deep as muscularis mucosa or at least ample amounts of lamina propria. In contrast, all 28 endoscopic biopsies yielded squamous epithelium only. Moreover, suction biopsies were generally well-oriented (83%), whereas endoscopic biopsies were less commonly well-oriented (35.7%). All volunteer subjects had a negative acid reflux test confirming the absence of latent or asymptomatic reflux. Only one subject (5.6%) had biopsies which met histologic criteria for gastroesophageal reflux. We conclude that: 1) more tissue, more information, and better orientation is achieved with suction than with endoscopic biopsies of the esophagus; 2) the low false-positive rate observed in volunteers in whom gastroesophageal reflux was objectively excluded emphasizes the value of esophageal biopsy as a reliable index in the evaluation of gastroesophageal reflux.

Adult↗