Palatal injection technique.
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OBJECTIVE: The aim of the current study was to assess the puncture resistance and stiffness of nitrile and latex dental examination gloves. METHODS: Puncture resistance was measured by employing an adapted version of ASTM F1342-91 using both a 316 stainless steel puncture probe (0.8 mm diameter) and a dental injection needle (0.45 mm diameter) interfaced to a tensile testing apparatus. Glove specimens (12 cm length, 1.5 cm breadth) were removed for modulus (M100) evaluation by assessing the force required to elongate the specimen to 100% of the original length. Glove samples were also aged to investigate whether puncture resistance and M100 values varied with aging at 70 degrees C for 7 days in an air-circulating oven. RESULTS: The nitrile glove types were assessed to have significantly higher puncture resistance compared with the latex glove type when the steel puncture probe was the pentrometer when using the one way analysis of variance (ANOVA) at the 95% significance level. Interestingly the puncture resistance for the latex glove type was significantly higher (P < 0.001) when a dental injection needle was used as the pentrometer compared with the nitrile glove types. The M100 values were significantly higher for the nitrile glove types for which the stiffness increased when the gloves were aged (P < 0.001). CONCLUSIONS: The higher stiffness values resulted in increased puncture resistance when the nitrile glove specimens were aged irrespective of the pentrometer type. However, the ability of latex to re-seal itself on puncture may be beneficial when considering the protection potential of each glove type against breaches in cross infection. For clinicians that have experienced an adverse reaction to natural latex gloves, the results of the current study indicate that nitrile gloves are available at reasonable cost and offer the clinician comparable resistance to puncture with latex gloves.
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UNLABELLED: Newborn heelstick blood collection can be a painful procedure in part because of the time required to obtain sufficient quantity of blood. No previous studies have determined whether local vasodilatation using topical nitroglycerine ointment (NGO) would facilitate heelstick blood collection. OBJECTIVE: To determine if the topical application of NGO would reduce the time needed to collect the required amount of blood for newborn metabolic screening and, in turn, reduce the pain/distress of the procedure. STUDY DESIGN: In a randomized, prospective, placebo controlled and blinded fashion, term newborns in a well nursery received either topical nitroglycerine or placebo ointment 10 minutes prior to heelstick. Total time and number of heelsticks required to complete the collection were measured along with crying time, heart rate and blood pressure. RESULTS: In all, 50 were studied, 25 in each group. There was no statistical difference between groups in collection time, crying time or number of heelsticks required for completion. Heart rate increased significantly and equally in both groups. Blood pressures were unchanged. CONCLUSIONS: Topical NGO did not facilitate heelstick blood collection or reduce the pain/distress of the procedure.
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BACKGROUND: Universal precautions are a set of guidelines which aim to protect health care workers from blood-borne infections. Community nurses often have to deliver care to people in less than ideal home conditions, their ability to comply with all universal precautions may therefore be compromised. AIMS AND OBJECTIVES: This paper presents the findings of a questionnaire survey which aimed to explore community nurses' experience and practices of using universal precautions. DESIGN AND METHODS: A questionnaire survey was used for this study. All community learning disability nurses, community mental health nurses and generic community nurses from one Welsh Health Authority were surveyed (n = 543) with a response rate of 70%. RESULTS: The majority of community nurses reported compliance with universal precautions, although a small number of nurses stated that they re-sheathed needles, inappropriately stored sharps containers, inadequately wore gloves and experienced difficulties in handwashing. CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE: Community nurses work in a unique and unpredictable environment, which may result in nurses being unable to comply with existing universal precautions guidelines. The production of new infection control guidelines for the community by the National Institute of Clinical Excellence in June 2003, has addressed some of the difficulties faced by community nurses.
Retrobulbar haemorrhage is an uncommon but well-documented complication of retrobulbar anaesthetic blocks in ocular surgery. Peribulbar anaesthesia has been advocated to be equally effective but safer. The incidence of retrobulbar haemorrhage with peribulbar blocks is very low. We report a case in which a peribulbar anaesthetic for cataract surgery resulted in sight-threatening retrobulbar haemorrhage within the medial rectus muscle and required an anterior orbitotomy and direct decompression of the muscle. The surgery was successful. This case illustrates a potentially serious complication of peribulbar anaesthesia, with the successful outcome achieved by rapid definitive diagnosis and intervention.
BACKGROUND: Needle sticks are one of the most common and feared occupational hazards that surgeons face. OBJECTIVE: To devise a safer and more efficient suturing method. METHODS: A cuticular stitch that minimizes direct contact with the needle is described. The literature is searched for similar suturing methods. RESULTS: Decreased direct contact with the needle lowers the risk for inadvertent sticks. Efficiency is improved when superfluous steps are eliminated from the suturing technique. CONCLUSION: Single-handed needle holder loading enhances safety while optimizing efficiency during the placement of cuticular stitches.
The animal virus, vesicular stomatitis virus (VSV), and the bacterial virus, phi 6, were inactivated by greater than 4 log10 in response to incubation with 13 to 14 mL of 1.4 mmol per L (65 micrograms/mL) to 1.6 mmol per L (75 micrograms/mL) of overlaid ozone in virus-spiked, dilute, red cell suspensions. Virus inactivation was greatly inhibited when ozone was overlaid in the presence of high-hematocrit red cells or, to a lesser degree, high levels of plasma. At hematocrits at which 5 to 6 log10 of VSV were inactivated, ozone caused 30-percent hemolysis, as measured by the loss of total cellular hemoglobin. Unexpectedly, this level of hemolysis could not be observed in supernatants because of the ozone-induced destruction (bleaching) of extracellular hemoglobin. These results suggest that ozone may have little biological specificity for damaging viruses over red cells.
Since the first deliberate open heart operation was performed on a patient known to be carrying HIV, much has been learned. The fear that cardiopulmonary bypass might cause acceleration of the disease has not been borne out. Patients infected with HIV have shown considerable tolerance to major cardiac and pulmonary surgery. Indeed, the extraordinary fruits of a massive research effort have made it reasonable to perform elective surgery and to offer major surgery to patients with the full-blown syndrome of AIDS. The concern that the operators would be exposed to significant risk of acquiring the infection during surgery has proved to be unfounded. This has been in part due to the widespread adoption of universal precautions against the passage of microorganisms from patient to operator. However, there remain surgeons who ignore these precautions. The price they pay is the risk of acquiring hepatitis, which is far more easily transmitted than AIDS and may be fatal.
Thanks to a worldwide collaborative effort among health care providers, academia, governments, and industry, our knowledge base about infection caused by the human immunodeficiency virus (HIV) has expanded exponentially. During the past 2 decades, we have learned about its pathogenesis, virology, immunology, epidemiology and treatment. In the developed world, the approach to persons with HIV disease has evolved from palliative disease care to use of a chronic disease model, where survival is measured by decades, not months or years. More and more, clinical decision-making for HIV-infected patients is driven by comorbidities, including cardiothoracic disease. Thus, our clinically stable HIV population is increasingly accessing those health care services required by any maturing population, including the usual services of cardiothoracic surgeons. In this article, we review the basic facts of HIV disease, with an emphasis on occupational risks and infection control procedures.
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A distraction intervention for pain management and behavioral distress was implemented for six children with chronic illnesses and their parents as the children underwent repeated needle sticks. The children ranged in age from two to eight years. Several different cognitive distractors were used for the children based on their respective developmental levels. The needle stick procedures during which treatment was implemented included intramuscular injections, implanted port accesses, and intravenous placements. Nine sessions of distraction were provided in which a therapist taught parents to coach their children to use distraction techniques. Dependent measures included the child's behavioral distress and heart rate, parent ratings of the child's fear before the procedure, parent self-ratings of feeling upset during the procedure, and nurse ratings of the child's cooperation. Reductions in child behavioral distress during the distraction treatment program were observed in five out of the six cases. Concomitant improvements in parental reports of child distress, nurse estimates of child cooperation, and parents' self-report of feeling upset during the medical procedures also were found. Follow-up data were available for one of the successfully treated children. His improvements were maintained for both intramuscular injections and portacatheter accesses over 16 weeks without therapist involvement.
We present a rare case of saccular aneurysm localised in the arm of a breast-feeding baby, secondary to accidental arterial puncture. Colour Doppler echography showed a cystic lesion with turbulent arterial flow related to the humeral artery. Complete surgical resection of the aneurysm was achieved.
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