Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Punctures”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 469 records · Page 26Linked to original sources
PubMed1998

Intrathecal catheter insertion during labour reduces the risk of post-dural puncture headache.

PURPOSE: To describe the anaesthetic management and report the incidence of PDPH in three parturients who had experienced accidental dural puncture during labour and the subsequent deliberate intrathecal insertion of an epidural catheter. CLINICAL FEATURES: Inadvertent dural puncture with a 16-gauge Tuohy needle occurred during the first stage of labour at 3-4 cm cervical dilatation in all three women. The 20-gauge epidural catheter was immediately inserted into the subarachnoid space after accidental dural penetration. Intermittent intrathecal injections of lidocaine or bupivacaine with fentanyl were administered to provide analgesia during labour and delivery. Two of the women had spontaneous vaginal deliveries, whereas Caesarean section was performed in one case due to acute fetal distress during the second stage of labour. The intrathecal catheter was left in-situ for 13-19 hr after delivery and the women were questioned daily for symptoms of PDPH. None of the three women developed PDPH after dural puncture and intrathecal catheterisation with the epidural catheter. CONCLUSION: Immediate intrathecal insertion of the epidural catheter after accidental dural puncture during labour proved to be an effective prophylactic technique to prevent PDPH in these three parturients.

Adult↗
PubMedDate not supplied

Use of a collagen-based device for closure of low brachial artery punctures.

PURPOSE: To report our experience with the Angioseal vascular closure device for hemostasis of distal brachial artery puncture. METHODS: Between September 2003 and August 2005, 64 Angioseal vascular closure devices were inserted in 64 patients (40 men, 24 women; mean age 65 years) immediately after diagnostic or therapeutic arterial angiographies performed through a 5 Fr to 7 Fr sheath via the distal brachial artery. Ultrasound examination of the brachial artery preceded the angiography in all cases and only arteries wider than 4 mm were closed by the Angioseal. In cases of a sonographically evident thin subcutaneous space of the cubital fossa, tissue tumescence, using 1% Lidocaine, was performed prior to the arterial closure. RESULTS: The deployment success rate was 100%. No major complications were encountered; only 2 patients developed puncture site hematoma, and these were followed conservatively. CONCLUSIONS: Closure of low brachial artery punctures with the Angioseal is simple and safe. No additional manual compression is required. We recommend its use after brachial artery access interventions, through appropriately wide arteries, to improve early patient ambulation and potentially reduce possible puncture site complications.

Adult↗
PubMed1999

Cholecystokinin peptides in cerebrospinal fluid: a study in healthy male subjects lumbar-punctured without preceding strict bed-rest.

In a recent study we analysed the concentrations of two forms of cholecystokinin (CCK), CCK-8S (sulphated) and CCK-4 in cerebrospinal fluid (CSF) obtained from 14 healthy male volunteers lumbar-punctured after a minimum of eight hours of strict bed-rest. We have now lumbar-punctured another group of 14 healthy males, using the same procedure except for the requirement of strict bed-rest prior to puncture. In contrast to our previous study, the concentration of CCK-4 (but not CCK-8S) was significantly higher in the second CSF fraction (7-12 ml) than in the first one (0-6 ml). On using the concentration ratio between the second and first fraction, CCK-8S (but not CCK-4) correlated positively with the atmospheric pressure, which is in contrast to our previous study in which a significant negative correlation was found. When the lumbar CSF concentrations were expressed as the concentration per minute of tapping-time (an estimate of the mass flow), atmospheric pressure, age and the neuraxis distance in the lying position made significant contributions to the variance in CCK-8S. A significant positive correlation with atmospheric pressure was found for CCK-4. In conclusion, the results indicate that the question of strict bed-rest or not prior to lumbar puncture may have to be considered when interpreting data on lumbar CSF concentrations of CCK. A controlled study is warranted.

Adult↗
PubMed2003

Optimal patient position for lumbar puncture, measured by ultrasonography.

The purpose of this study was to identify the patient position for lumbar puncture associated with the widest interspinous distance utilizing ultrasound. Sixteen healthy adult volunteers were placed in three positions commonly used for lumbar puncture (lateral recumbent with knees to chest, sitting and bent forward over an adjustable bedside stand, and sitting with feet supported and chest to knees) and the distance between lumbar spinous processes was measured by ultrasound. Measurements were compared between the three positions. Differences were analyzed using Tukey's honestly significant difference test. The results showed that the interspinous distance was significantly greater in the "sitting, feet supported" position than in the other two positions ( P<0.001). The "sitting, feet supported" position may offer advantages for selected patients undergoing lumbar puncture. Ultrasonography may be a useful adjunct when performing lumbar puncture in the emergency department.

Adult↗
PubMedDate not supplied

Acid monoamine metabolites in the CSF of healthy controls punctured without preceding strict bedrest: a retrospective study.

Data were obtained from 46 healthy volunteers, 16 males and 30 females, lumbar punctured at the L4-5 level without strict bedrest prior to puncture. 18 ml of CSF was collected at the puncture, which was performed with a 0.9 mm diameter needle. Contradictory to previous reports, body height did not influence CSF 5-hydroxyindoleacetic acid (5-HIAA) or homovanillic acid (HVA). Age influenced HVA (but not 5-HIAA) in a curvilinear manner in male volunteers and the HVA/5-HIAA ratio in females. In contrast to previously reported correlations between 5-HIAA and HVA, a weak correlation was found, but only in females. In males, body weight related to 5-HIAA and atmospheric pressure to HVA, both in a positive direction. Our findings are largely contradictory to previous reports, a fact that might, hypothetically, be due to the absence of strict bedrest before puncture. The use of a comparatively wide needle (0.9 mm in diameter) and the amount of 18 ml CSF drawn might, taken together, make at least some contribution to an explanation.

Adolescent↗
PubMed1977

Renal cyst puncture and abscess formation.

Percutaneous needle puncture and aspiration of suspected cystic renal masses may provide accurate diagnosis in selected cases. However, renal cyst puncture is not a totally innocuous procedure and certain complications may be encountered. Report is made of 2 cases of renal cyst puncture followed by abscess formation, necessitating surgical intervention. An improved technique involving surgical preparation of the operative area and utilization of double-needle method of cyst puncture is advocated.

Abscess↗
PubMed1994

Collagen application versus manual compression: a prospective randomized trial for arterial puncture site closure after coronary angioplasty.

OBJECTIVES: This study evaluated the safety and efficacy of a newly developed puncture-sealing device consisting of subcutaneous bovine collagen application designed to facilitate local hemostasis after coronary angioplasty. BACKGROUND: The most common local hemostatic procedure after coronary angioplasty consists of heparin discontinuation and delayed sheath removal followed by mechanical compression at the puncture site. METHODS: Between December 1991 and February 1993, 124 patients undergoing coronary angioplasty with either a 6F guiding catheter followed by a heparin infusion for > 12 h or a 7F or 8F guiding catheter with optional heparin infusion were prospectively randomized to either delayed sheath removal followed by manual compression (n = 62) or sheath removal immediately after angioplasty combined with bovine collagen application for puncture site closure (n = 62). Half of the collagen plugs were delivered using measured and half using estimated skin-artery distance. Clinical and duplex sonographic evaluations of the puncture site were performed 24 h later. RESULTS: No significant difference in the incidence of local hematomas was observed. Major complications were false aneurysm, venous thrombosis and arterial occlusion. The incidence of false aneurysm was the same in both groups (4 [7%] of 62). Venous thrombosis (2%) and arterial occlusion (2%) were each recorded in one patient, both in the collagen application group. CONCLUSIONS: Sheath removal and collagen application with this new vascular hemostasis device used directly after coronary angioplasty are not superior to delayed sheath removal after heparin discontinuation followed by mechanical compression. Arterial collagen sealing with this device in its current form is associated with a small but worrisome risk of arterial occlusion.

Aged↗
PubMed2006

[How to operate kidney puncture in percutaneous nephrolithotomy?].

Obtaining a precise percutaneous calyceal puncture gave way to the development of percutaneous nephrolithotomy, one of the first micro-invasive techniques described in urology. Both radiologist and urologist can perform puncture, sometimes in a collaborative effort. However, being followed by a true surgical procedure, it should be done in the O.R; perfect knowledge of the procedure is mandatory for every urologist. Standard guidance uses a fluoroscopic C-arm device, only able to guide the needle precisely towards the apex of the chosen calyx. Moving the C-arm with cephalad tilting will provide 3-D imaging. Ultrasound guidance is an alternative, but might be difficult with non dilated upper tract. CT guidance and retrograde puncture are rarely used. The access is to be adapted according to the patient (adult or child), type of stone (single or multiple access), or kidney position (eutopic or ectopic). Direct ad stable puncture entering the apex of the chosen calyx is a pre-requisite for easy and efficient subsequent nephrolithotomy.

Humans↗
PubMed2005

Bedside ultrasound for difficult lumbar puncture.

Lumbar puncture is a common procedure performed in the emergency department for evaluation of several life-threatening conditions, including meningitis and subarachnoid hemorrhage. We describe the use of bedside ultrasound to assist in performance of the lumbar puncture in situations where the standard "blind" technique of needle insertion using palpable spinal landmarks is likely to be difficult or to fail. Use of ultrasound to guide lumbar puncture needle placement was originally reported 30 years ago in the Russian literature. More recently, ultrasound has been used for guiding needle placement for epidural and spinal anesthesia by anesthesiologists and for diagnostic lumbar puncture on infants by radiologists.

Adult↗
PubMed2006

Efficacy of a direct puncture approach for anterior circulation aneurysms using a newly developed guiding catheter - especially for geriatric patients.

BACKGROUND: Endovascular surgery is being increasingly used as an alternative to craniotomy clipping surgery, especially for aged patients and complicated cases. However, tortuous atherosclerotic arteries sometimes interfere with advancement of catheters so that direct puncture may be necessary. Short guiding catheters for use with this approach have been newly developed, as discussed in this article. METHODS: One hundred twenty three anterior circulation aneurysms in 121 patients were consecutively treated by endovascular coil embolization, of which 42 (34%) were older than 70 years. RESULTS: With 21 aneurysms, coil embolization via the transfemoral approach failed, but all could be successfully treated with the direct puncture approach with minor complications such as 1 transient ischemic attack and 1 nonsymptomatic minor leakage. In the aged patients, the direct puncture approach with short guiding catheter resulted in complete obliteration of aneurysms in 20 (71%) of 28 with follow-up angiography. CONCLUSION: Direct puncture using newly developed short guiding catheters is an alternative to femoral approaches for patients with anterior circulation aneurysm with tortuous arteries and obvious atherosclerotic change at bifurcations of the common carotid artery.

Adult↗
PubMed1980

Ultrasound followup of renal cyst puncture.

The place of ultrasound and cyst puncture in the evaluation of renal masses is reviewed. Complications of cyst puncture, although rare, do occur. A review of 16 cases of renal cyst puncture revealed only 2 minor complications: in 1 case a pericystic hemorrhage occurred and in 1 case an intracystic hemorrhage was detected. Both complications were asymptomatic and detected by ultrasound. Ultrasound has proved to be an excellent means of followup for renal cyst puncture.

Diagnosis, Differential↗
PubMed1980

Lumbar puncture in children with convulsions associated with fever.

452 previously healthy children aged over six months and under six years were admitted to the Sheffield Children's Hospital between January, 1972, and December, 1976, after their first convulsion associated with fever. 304 of the children had a lumbar puncture. 25 punctures were necessary according to defined clinical criteria--including those in 15 children who were subsequently shown to have meningitis. All 148 children who did not have a lumbar puncture made a prompt and uneventful recovery. Children with convulsions associated with fever should be referred to hospital. A lumbar puncture should be performed when meningitis is suspected, after examination by a senior and experienced member of the staff. It should not be carried out as a routine procedure.

Child, Preschool↗
PubMed1998

[Post-lumbar puncture headache in children. Treatment with epidural autologous blood (blood patch)].

UNLABELLED: Post-lumbar puncture headaches (PLPH) are uncommon in children, but when they occur treatment is challenging. PLPH in adults have been successfully treated by the use of the epidural blood patch. This treatment has been very rarely reported in children. CASE REPORT: A 13-year-old boy, weighing 64 kg, had a lumbar puncture as part of a work-up for a 4-day history of right hemithorax pain. This pain was associated with hypoesthesia; there were no cutaneous vesicles. Neurological examination revealed decreased strength in the left upper extremity. A magnetic resonance imaging of the cervicodorsolumbar spine was normal. Three hours after lumbar puncture, the patient complained of bifrontal headaches. The headaches worsened in the upright position and they prevented the boy from ambulating. Treatment with acetaminophen was unsatisfactory. On day 9, the initial symptoms that had motivated the lumbar puncture had disappeared, but PLPH persisted. Therefore, an epidural blood patch was performed (EBP). A 18-gauge 1 Perican needle was introduced into the peridural space at the L3-L4 interspace using the loss of resistance technique. Fifteen milliliters of blood were drawn in a sterile fashion and without anticoagulant from the patient's forearm and injected slowly through the epidural needle. The patient experienced immediate, complete, and definite relief of his PLPH. Follow-up did not show any complication. CONCLUSION: EBP can be useful in the treatment of PLPH lasting more than 5 days in children.

Adolescent↗
PubMed1991

Use of angiographic needles with or without stylets: pathologic assessment of vessel walls after puncture.

There is controversy as to whether angiographic needles without stylets produce more arterial damage than those with stylets. Iliac arteries from 15 fresh human cadavers were punctured 56 times with either an 18-gauge angiographic needle with a stylet or one without a stylet (28 punctures with each needle type). These puncture sites were serially sectioned and examined microscopically. Each needle tract was evaluated for margin irregularity, shape of puncture, and approximation of edges. No statistically significant differences in arterial wall changes were found. The authors' data suggest that the choice of beveled needle use in angiography can probably be made on a basis other than concern for differences in vessel wall damage secondary to the presence or absence of a stylet.

Angiography↗
PubMedDate not supplied

Use of a collagen hemostatic closure device to achieve hemostasis after arterial puncture: a cost-effectiveness analysis.

PURPOSE: To evaluate whether a collagen hemostatic closure device is a safe, cost-effective alternative to manual compression for achieving hemostasis at arterial puncture sites. MATERIALS AND METHODS: A cost-effectiveness analysis, based on a meta-analysis of published data, was performed from the perspective of the health-care system. The gain in effectiveness was expressed as the decrease in rate of puncture-site complications that required treatment. Costs associated with achieving hemostasis and treating complications were included. RESULTS: Use of a collagen closure device decreased the number of puncture-site complications from 31:1,000 to 16:1,000. The average cost of using the device was $177 per patient compared with $42 per patient for manual compression. The incremental cost of averting one complication exceeded $9,000. CONCLUSION: Use of a collagen closure device to achieve hemostasis after an arterial puncture may reduce the complication rate, but the additional cost per complication averted is very high.

Aneurysm, False↗
PubMedDate not supplied

Patient-controlled epidural analgesia with fentanyl-bupivacaine: influence of prior dural puncture.

BACKGROUND AND OBJECTIVES: Combined spinal epidural anesthesia (CSEA) involves the epidural administration of local anesthetic and opioid solutions adjacent to the prior dural puncture, potentially increasing their diffusion into the subarachnoid space. This study was designed to evaluate the influence of dural puncture on the adequacy and extent of analgesia, and drugs requirements of patient-controlled epidural analgesia (PCEA) in the postoperative period. METHODS: In this prospective double-blind study, 40 patients undergoing major abdominal surgery under general anesthesia followed with PCEA were randomly assigned to either group I (preoperative insertion of an epidural catheter) or group II (preoperative dural puncture with a 25-g Quincke needle + insertion of an epidural catheter). Postoperatively, a PCEA pump delivered an infusion of 0.1% bupivacaine + fentanyl (3 microg/mL) at 5 mL/h. Participants were allowed to self-administer 5-mL boluses of the same solution with a 15-minute lock-out interval. Hourly epidural solution requirements were recorded for 40 hours. Sensory and motor block, and pain scores were also analyzed. RESULTS: There was no difference between groups with regard to epidural solution requirements, pain scores, spread of sensory blockade, or intensity of motor block. CONCLUSION: Dural puncture with a 25-gauge Quincke needle, performed as part of CSEA, does not influence the drug requirements when a combination of 0.1% bupivacaine and fentanyl (3 microg/mL) is used for PCEA after major abdominal surgery.

Abdomen↗
PubMed1999

Effect of experience with spinal anaesthesia on the development of post-dural puncture complications.

BACKGROUND: This clinical study was conducted in order to investigate the effect of operator experience with spinal anaesthesia (SA) on development of postural post-dural puncture headache (PPDPH) and postoperative backache. METHODS: The study was a cohort study of the first 100 SA performed by each of 5 trainees in anaesthesiology at the very beginning of their training period. SA was conducted with assistance and guidance according to usual departmental practice. In each SA, data regarding level of puncture, needle size, number of punctures, use of introducer and infiltration anaesthesia were recorded. In addition, usual problems and complications connected with dural puncture were registered. A visual analogue scale was used to record how difficult the procedure was experienced by the trainees. Postoperatively, the patients were contacted by the same trainee, usually by telephone. A semi-structured interview was conducted where occurrence and duration of headache, backache and other complaints were recorded. Headache was classified as PPDPH or non-PPDPH, and intensity of the headache was registered using a numerical rating scale (NRS) from 0 to 10. RESULTS: Five hundred SA in 495 patients with a mean age of 61.3 years were included in the study. Of these, 394 patients were completely followed-up postoperatively; the main reason for the drop-out was patient-related factors such as advanced age and dementia. Headache occurred in 56 patients postoperatively. PPDPH was diagnosed in 33 and non-PPDPH occurred in 23 patients. Postoperative backache was experienced by 27 patients. No significant effect experience with SA could be found regarding the occurrence of postoperative complications; 16 compared to 17 patients with PPDPH were found in the first and the last half of patients. A marked inter-individual difference in the occurrence of PPDPH was found in the patients treated by the 5 trainees. CONCLUSIONS: We could not demonstrate an effect of experience and training on development of complications after SA with regard to PPDPH and backache.

Aged↗
PubMed1999

Local vascular response during organ elevation. A model for cerebral effects of upright position and dural puncture.

BACKGROUND: Dural puncture can be followed by postural headache and, in patients with cerebral infections, by brain stem herniation. The present study evaluates whether these complications may be related to the changes in hydrostatic pressure generated by the spinal fluid column when the dural sac surrounding the cerebrospinal tissue has been punctured. METHOD: An isolated cat skeletal muscle enclosed in a plethysmograph connected to a tube served as a model imitating the brain, the cranium and the spinal canal. We investigated effects of organ elevation on tissue pressure, venous collapse (venous outflow resistance) and tissue volume with closed "spinal" tube (intact dural sac) and open "spinal" tube (dural puncture), and effects of compliance of the draining veins. RESULTS: Organ elevation with closed "spinal" tube induced a decreased tissue pressure, whereas tissue pressure remained unchanged if arterial inflow pressure to the muscle was kept constant. Organ elevation with the "spinal" tube opened distally caused a significantly larger decrease in tissue pressure, venous dilation and disappearance of venous outflow resistance. Transcapillary filtration increased, and the filtration rate was higher with high than with low venous compliance. CONCLUSION: If our results are applicable to the brain, changing to an upright position following a lumbar dural puncture may generate a negative hydrostatic force and a negative interstitial cerebral pressure, causing an increased transvascular pressure and dilation of the cerebral outflow veins. The corresponding increase in cerebral blood volume may induce post-spinal headache, and the increased transcapillary pressure may cause increased fluid filtration and brain oedema if the blood-brain barrier is disrupted.

Animals↗