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At least 595 records · Page 33Linked to original sources
PubMed2003

Laser-assisted fluoroscopic puncture: a new technique for accessing the kidney.

PURPOSE: We developed a laser pointer device that is mounted on the image intensifier of a C-arm fluoroscope. The laser-assisted fluoroscopic puncture technique (LAFPT) is an alternative method of accessing the kidney. MATERIALS AND METHODS: The LAFPT was assessed both in an in vitro model and in a series of cases. The in vitro model was composed of Foley balloons filled with contrast medium of different volumes (2-6 mL) embedded in silicone pads. The total fluoroscopy times and attempts required for a successful puncture with LAFPT were compared with those of conventional fluoroscopic access. RESULTS: The number of attempts required to puncture the 2-mL balloons was significantly greater with the conventional fluoroscopic technique than with LAFPT. The fluoroscopy time in vitro was reduced 50% with LAFPT. However, there was no statistically significant difference in the time required for the two techniques in the clinical series. CONCLUSION: The laser-assisted fluoroscopic puncture technique allows accurate positioning of a needle with reduced radiation exposure.

Adult↗
PubMed2004

Unintentional arterial puncture during cephalic vein cannulation: case report and anatomical study.

BACKGROUND: The cephalic antebrachial vein is often used for venous access. However, superficial radial arteries of the forearm are known and unintentional arterial puncture can result from attempts to cannulate the lateral veins of the arm. METHODS: Accidental puncture of a superficial radial artery during peripheral venous cannulation prompted us to study the anatomy of 26 specimens and to assess the relationship between the radial artery and the cephalic vein in the forearm. RESULTS: In two cases, we found accessory branches of the radial artery close to the cephalic forearm vein. Venous cannulation at the lateral wrist carries a small risk of arterial puncture if arterial anomalies are present. CONCLUSIONS: If venous cannulation is attempted at the radial side of the wrist, palpation for pulsation should reduce the danger of arterial puncture.

Aged↗
PubMed1996

Alternative puncture site for implantable permanent haemodialysis catheters.

BACKGROUND: Vascular access represents a major problem in long-term haemodialysis patients. In patients without patent internal arteriovenous fistula, the implantation of cuffed catheters to provide a temporary or permanent central venous access is often necessary. Catheterization of the subclavian vein should be avoided because of the high risk of stenosis or thrombosis. The puncture of the internal jugular vein can be impossible in cases with stenosis or thrombosis due to previous catheterization. To overcome these limitations we evaluated an alternative puncture site for implantation of permanent central venous catheters. METHODS: The very low, most central jugular approach, first described by Rao et al., with the site of puncture just above the medial notch of the clavicle, was used to introduce Dacron cuffed dialysis catheters into the innominate vein in four chronic dialysis patients with impeded conventional vascular access. RESULTS: In all four patients puncture of the internal jugular vein using Rao's technique was successful at the first attempt. All four catheters were introduced without any problems. Even in a case with thrombosis of the internal jugular vein and the ipsilateral subclavian vein, this technique was successfully applied. No complications such as haematoma, pneumothorax, or catheter-associated infection were observed. The catheters remained in situ for 2-12 months with excellent blood flow and without clinical evidence of venous stenosis or thrombosis. CONCLUSIONS: In case of failure to cannulate the internal jugular vein by a conventional approach, the technique of Rao et al. can be used before sacrificing the subclavian vein or changing to exotic techniques such as translumbar, transfemoral or transhepatic methods.

Adult↗
PubMed2006

Nerve puncture and apparent intraneural injection during ultrasound-guided axillary block does not invariably result in neurologic injury.

BACKGROUND: Nerve puncture by the block needle and intraneural injection of local anesthetic are thought to be major risk factors leading to neurologic injury after peripheral nerve blocks. In this study, the author sought to determine the needle-nerve relation and location of the injectate during ultrasound-guided axillary plexus block. METHODS: Using ultrasound-guided axillary plexus block (10-MHz linear transducer, SonoSite, Bothel, WA; 22-gauge B-bevel needle, Becton Dickinson, Franklin Parks, NJ), the incidence of apparent nerve puncture and intraneural injection of local anesthetic was prospectively studied in 26 patients. To determine the onset, success rate, and any residual neurologic deficit, qualitative sensory and quantitative motor testing were performed before and 5 and 20 min after block placement. At a follow-up 6 months after the blocks, the patients were examined for any neurologic deficit. RESULTS: Twenty-two of 26 patients had nerve puncture of at least one nerve, and 21 of 26 patients had intraneural injection of at least one nerve. In the entire cohort, 72 of a total of 104 nerves had intraneural injection. Sensory and motor testing before and 6 months after the nerve injections were unchanged. CONCLUSIONS: Under the conditions of this study, puncturing of the peripheral nerves and apparent intraneural injection during axillary plexus block did not lead to a neurologic injury.

Adolescent↗
PubMed1980

Vessel puncture with epidural catheters. Experience in obstetric patients.

The reported incidence of blood vessel puncture after placement of a needle and catheter into the lumbar epidural space in obstetric practice appears to vary between 1 and 10%. This study was undertaken to assess the incidence of blood vessel puncture related to catheter insertion. Two methods of catheter placement were used to see if there were any difference in the incidence of vessel puncture. The incidence of blood vessel puncture after direct catheter placement was found to be 9% compared to 3% after prior injection of 10 ml of 0.5% plain bupivacaine into the epidural space. (p = 0.05).

Adolescent↗
PubMed1992

Spinal anaesthesia for urological surgery. A survey of failure rate, postdural puncture headache and patient satisfaction.

A survey was conducted on 100 consecutive patients who underwent spinal anaesthesia in our urology operating theatres. Details of the spinal technique were recorded in the operating theatre. In 25% of patients, more than one attempt at subarachnoid puncture was required and 16% of this group went on to require general anaesthesia. The patients were visited between 24 and 48 h postoperatively by one of the authors. On questioning, 24% of patients reported a headache, which had the characteristics associated with dural puncture; 62% of these headaches were described as moderate or severe and lasted between 12 and 24 h. Patients were significantly (p < 0.05) more likely to develop a postdural puncture headache if more than one attempt at subarachnoid puncture was made.

Aged↗
PubMed1988

Successful treatment of dural puncture headache with epidural saline infusion after failure of epidural blood patch. Case report.

A case is presented of a 30-year-old female with a 4-month history of post-lumbar puncture headache (PLPHA) resulting from an accidental dural puncture during an attempted epidural anesthetic for cesarean section. Epidural blood patches were attempted at 4 days and 3 months post-lumbar puncture, but were unsuccessful. At 4 months post-lumbar puncture, a 24-h epidural saline infusion relieved the PLPHA for 48 h, but the headache returned. Finally, a second epidural saline infusion was done, followed by an epidural blood patch, which permanently cured the PLPHA. Follow-up to 4 months showed no return of the PLPHA. The rationale for epidural blood and saline patches is discussed.

Adult↗
PubMed1995

Pulsed Doppler sonography for the guidance of vein puncture: a prospective study.

Blind deep venous puncture is an invasive procedure with risks of serious complications compromising the availability of veins for future punctures or endangering the patient's life. We designed a new hand-held pulsed Doppler probe for coaxial guidance of the puncture needle and a dedicated pulsed Doppler device displaying the depth of the measurement volume. We used this technique prospectively in two independent centers (the nephrology department and the intensive care unit) involving senior as well as junior staff members. Either the non-Doppler or the Doppler method were randomly selected for subclavian vein catheterization in 100 patients and for internal jugular vein catheterization in 30 patients. The success rate on the first attempt was 86.2% for the non-Doppler method versus 96.8% for the Doppler method (p = 0.03). The failure rate of the non-Doppler method used by junior staff members was 9.2%, reduced to 1.5% (p = 0.05) by secondary use of the Doppler method and/or help from a senior staff member (rescue procedure). Pulsed Doppler guidance reduced significantly the failure rate of venous punctures especially when used by seniors or by juniors after a training period.

Adult↗
PubMed1992

Frequency of glove puncture in the post mortem room.

The post mortem room is a potential source of danger from contamination caused by glove punctures. The objective of this study was to assess the incidence of hand injury and hand contamination during post mortem examinations. A prospective study of injury and glove puncture rate was conducted during post mortem examinations performed in 1990 on adults in Northwick Park Hospital mortuary. Four pathologists and two assistants performed a total of 44 post mortem examinations on adults. All participants completed a questionnaire after each examination, recording the total number of gloves used and the number of hand injuries and glove perforations sustained. Just over 8.3% of gloves were punctured; 31.8% of these punctures went unnoticed. Evisceration was the procedure most likely to result in hand contamination. The study highlights a significant risk which could be reduced by more care, frequent glove changes, and hand washing during post mortem examinations. In particular, gloves should be changed and hand washed when evisceration has been completed.

Autopsy↗
PubMed1986

The double puncture: an effective percutaneous technique for removing complex, multiple renal calculi.

Percutaneous nephrostolithotomy, which can require a double puncture, is presently the method of choice in our institution for the removal of renal stones. Patients that underwent this procedure were evaluated to identify the possible reasons for the double puncture. Of 200 patients evaluated, 14 needed a second tract. The three variables that determined whether a second puncture was needed, in order of importance, were number and size of the stones, with second tracts needed in patients with multiple stones and staghorn calculi; anatomical variations of the renal collecting system itself, with bifid systems the most significant anatomic variation; and the dexterity of the radiologist in performing the puncture and the ability of the urologist to extract the stone. Second tracts were needed more frequently in patients who presented with stones in both the lower and middle poles of the collecting systems.

Humans↗
PubMed1985

[Spirometric monitoring of the effects of puncturing thoracic pain points in asthmatic disease].

The effects of puncture of thoracic pain points on ventilatory abnormalities were studied in 17 asthmatic subjects. For the tested group (n = 8), the painful character of the points was the only criterion for the choice of puncture sites. References to classical acupuncture points were not made. The points chosen for the control group (n = 9) were in extrathoracic zones (lower limbs). VEMS was significantly higher (p less than 0.05) after puncture of thoracic pain points whereas no shift was observed after puncture in the extrathoracic zone. VC was not modified by either technique.

Acupuncture Therapy↗
PubMed2006

Effect of needle puncture and electro-acupuncture on mucociliary clearance in anesthetized quails.

BACKGROUND: Acupuncture therapy for obstructive respiratory diseases has been effectively used in clinical practice and the acupuncture points or acupoints of Zhongfu and Tiantu are commonly-used acupoints to treat patients with the diseases. Since the impaired mucociliary clearance is among the most important features of airway inflammation in most obstructive respiratory diseases, the effect of needle puncture and electro-acupuncture at the specific acupoints on tracheal mucociliary clearance was investigated in anesthetized quails. METHODS: Mucociliary transport velocity on tracheal mucosa was measured through observing the optimal pathway, and fucose and protein contents in tracheal lavages were determined with biochemical methods. In the therapeutic group, needle puncture or electro-acupuncture stimulation to the acupoints was applied without or with constant current output in 2 mA and at frequency of 100 Hz for 60 minutes. In the sham group, electro-acupuncture stimulation to Liangmen was applied. RESULTS: Our present experiments demonstrated that the electro-acupuncture stimulation to Zhongfu and Tiantu significantly increased tracheal mucociliary transport velocity and decreased the content of protein in the tracheal lavage, compared with the control group. Moreover, either needle puncture or electro-acupuncture stimulation to Zhongfu and Tiantu significantly reverted the human neutrophil elastase-induced decrease in tracheal mucociliary transport velocity and human neutrophil elastase -induced increase in the contents of fucose and protein in the tracheal lavage, compared with the control group. CONCLUSION: These results suggest that either needle puncture or electro-acupuncture stimulation to the effective acupoints significantly improves both airway mucociliary clearance and the airway surface liquid and that the improvements maybe ascribed to both the special function of the points and the substantial stimulation of electricity.

Acupuncture Therapy↗
PubMed2005

Postdural puncture headache with abdominal pain and diarrhea.

Dural puncture or a rent in the dura with prolonged cerebrospinal fluid leakage may cause noninfectious arachnoiditis and may be associated with urinary and fecal incontinence. Visceral dysfunction is common for patients with noninfectious arachnoiditis of the lumbosacral nerve roots after dural puncture. We report a case of postdural puncture headache associated with abdominal pain and diarrhea. An epidural blood patch was performed, and all symptoms resolved after 5 days. After exclusion of organic and psychological disorders, this treatment might be considered for patients who are experiencing abdominal pain and diarrhea after dural puncture.

Abdominal Pain↗
PubMed1999

[Computed tomography-guided diagnostic puncture in abdominal pathology].

Technological improvements (short-time acquisition and reconstruction, CT, spiral technique) together with better puncture material and a general trend towards less invasive surgical procedures have had a combined effect to a wider scope of applications for percutaneous punctures under CT-guidance. In this paper, we analyze and discuss recent data in the literature on puncture material, indications and results. The relevant choice of the needle model and its diameter, depending on the organ and suspected pathology, as well as the point of entry and the puncture track are key factors granting procedure safety, ambulatory use and good diagnostic results.

Abdomen↗
PubMed1999

Puncture wounds of the foot. Evaluation and treatment.

Puncture wounds of the foot are a common injury, often occurring in the warmer months. Various objects have been described as the penetrating source in these wounds; however, nails and glass are the most common cause of pedal puncture wounds. All puncture wounds should be evaluated thoroughly and treated aggressively to reduce the risk of complications. Viewing this injury lightly may cause complications, and is often a source of litigation. A systematic approach to the evaluation and treatment of puncture wounds limits complications and results in a satisfactory outcome for the patient and physician.

Anti-Bacterial Agents↗
PubMed2001

[Liver sonography and ultrasound-guided puncture of the gallbladder in pigs: new possibilities for the diagnosis of mycotoxicosis].

60 pigs representing all age groups (suckling pigs, weaner pigs, hogs, gilts and sows; thereof 37 females, 2 males, 21 castrated males) were examined by ultrasound of the liver and by ultrasound guided gallbladder puncture. The visibility of the liver and gallbladder was strongly influenced by the size of the animals. The thickness of the abdominal and thoracic walls in older animals proved to be a highly ultrasound-absorptive medium, which limited the ability to assess the underlying tissue structures. As a result, gallbladder puncture of these animals was possible only with a certain degree of technical difficulty. The gallbladder puncture procedure itself posed little risk to the animal. The primary risk resulted from the general anesthesia required. Autopsy showed no pathological findings due to gallbladder puncture with the exception of minimal, rapidly healing, local infectious processes. The bile proved to be a suitable medium of the detection of mycotoxins and their metabolites. Selective accumulation of these toxins in bile provide a more reliable diagnostic tool than the standard mycotoxicological tests of feed.

Animals↗
PubMed2002

[Puncture gastrostomy in oncologic patients].

Puncture gastrostomies--percutaneous endoscopic gastrostomy and radiologically assisted gastrostomy--are minimally invasive methods to ensure an approach for the administration of enteral nutrition. These methods replaced the insertion of tubes during surgery (surgical gastrostomy). Percutaneous endoscopic gastrostomy (PEG) is inserted by means of a gastroscope, usually by the pull method, radiologically assisted gastrostomy (RAG) is implemented after insufflation of the stomach by a thin tube directly across the abdominal wall by the push method. In oncological patients it is preferable to administer enteral nutrition via puncture gastrostomy in case of obstruction of the upper portion of the digestive tract (oral cavity, larynx, pharynx, oesophagus), in deglutition disorders caused by cerebral tumours or in order to improve the nutritional status of patients with tumour cachexia. In the authors group in 1995-2000 a total of 53 puncture gastrostomies were made in 53 patients, 37 men and 16 women, mean age 62 years (32-94 years, incl. 38 PEG and 15 RAG. In 30 patients the reason was obstruction of the upper digestive tract, in 11 patients impaired swallowing associated with a cerebral tumour and in 12 patients the cause was tumourous cachexia. Puncture gastrostomies are well tolerated by the attending staff and patients, in oncology they can be used for administration of enteral nutrition under hospital and domiciary conditions.

Adult↗
PubMed1976

Puncture of the gallbladder during peritoneoscopy - technique and diagnostic relevance (author's transl).

Peritoneoscopic puncture of the gallbladder for transvesical cholecysto-cholangiography and for aspiration of bile for chemical and bacteriological analysis is performed rather rarely because of a seemingly high rate of complications. The risk however is low if an appropriate technique is used. In our series the gallbladder was punctured in 110 cases; a local peritonitis subsiding under conservative treatment occured as a complication in only one case. Peritoneoscopic puncture of the gallbladder is indicated in the following conditions: extrahepatic occlusion of the bile duct system of unknown origin, nonvisualization of the gallbladder during cholangiography, biliary dyskinesia, typical biliary colics with normal X-ray findings. In addition, gallbladder puncture should be done if any suspicion of gallbladder disease arises during peritoneoscopy. The procedure as well as technical variations for cholecysto-cholangiography and for X-ray investigation of the pancreatic duct system are described.

Bile↗