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 145 records · Page 8Linked to original sources
PubMed1996

Is lidocaine-prilocaine cream (EMLA) always useful for venous puncture in preoperative autologous blood donation?

PURPOSE: The goal of the present study was to evaluate in adults the benefit of the Eutectic Mixture of Local Anesthetics (EMLA) for preoperative autologous blood donation. METHODS: Twenty-six adult patients requiring three blood samples were studied. The pain of venipuncture was assessed by the patient using a 100 mm Visual Analogue Scale (VAS) and a four-category Verbal Rating Scale (VRS). The first puncture was performed without anaesthesia, as a "reference puncture". The second and third punctures were performed with EMLA and placebo in a double-blind cross-over randomization. For statistical analysis, the patients were allocated to two groups according to the VAS scores of the reference puncture: (Group 1) VASref < 20 mm; (Group 2) VASref > or = 20 mm. RESULTS: For the whole 26 patients, the VAS and the VRS pain scores were lower for EMLA puncture than for both the placebo and reference punctures (P < 0.05). Twenty patients had a VASref < 20 mm and six patients a VASref > or = 20 mm. In Group 1, there was no difference between EMLA and placebo for both the VAS and VRS scores. In contrast, in Group 2, the VAS score was lower for EMLA than for both the placebo and the reference punctures (respectively 11 +/- 7.1, 28.9 +/- 7.9, 29.1 +/- 6.4; P < 0.01); the VRS score was also lower for EMLA puncture than for placebo puncture (P < 0.05). CONCLUSION: In adults requiring repeated venous punctures, pain from cannulation may be evaluated at the first puncture with a Visual Analogue Scale, thus indicating or not the need for EMLA.

Adult↗
PubMed1996

[Intraosseous puncture in preclincal emergency medicine. Experiences of an air rescue service].

UNLABELLED: In prehospital emergency treatment, the timely establishment of a secure vascular access, especially in infants and small children, can be difficult or even impossible. An alternative to the puncture of peripheral or central veins is intraosseous (IO) puncture However, experience with this method in prehospital emergency medicine within the Federal Republic of Germany is extremely limited at present. After intensive theoretical and practical training of our trauma anaesthesiologists, IO puncture was introduced in our rescue helicopter program "Christoph 22" as an alternative to peripheral or central venous puncture in the prehospital treatment of patients up to 6 years of age. IO puncture is indicated after a maximum of three failed peripheral venous puncture attempts. The purpose of this study was to collect data and summarise first-hand experience on the prehospital use of the IO method as well as the practicability of our prescribed IO puncture algorithm in order to subject them to critical review and evaluation. MATERIALS AND METHODS: A restrospective study by the rescue helicopter service "Christoph 22" was carried out for the period 1 June 1993-31 August 1995. RESULTS: In a total of 1,455 primary rescue missions flown, the proportion of patients < and = 6 years of age, was 6.2% (n = 90). Ten patients in this partial collective (11.1%) were subjected to IO puncture (Fig. 3). In all of these cases (10/10), the first IO puncture attempt was successful. A standardized puncture technique was performed using the proximal tibia. The time required to successful placement of the IO infusion line was < and = 60 s in all cases. Complications, especially incorrect needle position, did not occur during the study period. Materials infused by IO infusion before hospitalisation included crystalloids (Lactated Ringer's, Päd OP) as well as colloids (hydroxyethylstarch, human albumin), adrenaline, atropine, ketamine, thiopentone, diazepam, fentanyl, succinylcholine, and vecuronium (Table 3). Prehospital induction of general anaesthesia using the IO infusion line was required by 2/10 children; dosage and onset of administered drugs was described by the trauma anaesthesiologists as being similar to that using an i.v. infusion line. Seven of the patients had been treated prior to the arrival of the rescue helicopter team by other emergency medical personnel; in all of these cases multiple peripheral and in 3 additional central venous puncture attempts had failed (duration of attempts: 10-50 min). Upon arrival of the rescue helicopter, 5 of these patients had been pulseless and non-breathing (Table 2). CONCLUSION: The IO infusion technique has proven to be a simple, fast, and safe alternative method of emergent access to the vascular system.

Aircraft↗
PubMed2001

An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients.

We report a prospective audit of 100 parturients who experienced accidental dural puncture by a Tuohy needle, while attending a tertiary referral obstetric unit during the period 1993-1999. The post dural puncture headache rate was 81% and the diagnosis of dural puncture was delayed until presentation of the headache in 27% of these cases. The incidence of unrecognised dural puncture was not influenced by the technique used for identification of the epidural space. Intraspinal opioid administration after dural puncture was associated with a significant reduction in the incidence of headache (P < 0.04). There was no association between mode of delivery and post dural puncture headache. Deliberate cannulation of the subarachnoid space with an epidural catheter at the time of dural puncture, for continuous spinal analgesia or anaesthesia, did not affect the incidence of post dural puncture headache but was associated with a significantly reduced rate of epidural blood patch (43% versus 80%, P < 0.01). Of those who developed post dural puncture headache, 48% were classified 'severe' and in 49% the headache presented within 24 h of dural puncture. There was a trend to earlier onset of headache (either immediate or within 24 h) when the epidural identification technique was loss-of-resistance to air rather than saline (54% versus 33%, P = 0.07). Twenty-eight percent of those suffering from post dural puncture headache were treated expectantly and 72% received a therapeutic blood patch. Of seven parturients who received sumatriptan, six found it ineffective and five subsequently received a blood patch.

Journal Article↗
PubMedDate not supplied

Retrograde vs. antegrade puncture for infra-inguinal angioplasty.

This study was done to compare antegrade punctures with a retrograde puncture technique for infrainguinal angioplasty. A group of 100 consecutive patients (71 men, 29 women) were randomized for antegrade puncture or retrograde puncture of the common femoral artery. Following retrograde puncture the guidewire was 'turned' and placed into the superficial femoral artery. The time for gaining access, screening time, radiation dose, patient height, weight and complications were recorded. All patients were reviewed the day after the procedure and within 3 months. Data from 46 patients (34 males and 12 females) in the retrograde group and 44 (28 males and 16 females) in the antegrade group were available for analysis. Mean procedure time, screening time, radiation dose, height and weight were 8.3 minutes (range 3-22), 2.1 minutes (0.3-6.5), 7950 mGy cm(-2) (820-71250), 169 cm (149-204) and 79 kg (32-108) for retrograde puncture and 8 min (2-60), 0.7 min (0.0-3.2), 1069 mGy cm(-2) (0-15400), 169 cm (152-186) and 75 kg (39-125) for antegrade punctures, respectively. An average of 1.2 (1-2) punctures was required for retrograde and 1.75 (1-8) for antegrade. Seven small hematomas occurred with antegrade and three for retrograde puncture. Retrograde puncture is technically easier with a tendency to fewer complications but results in a higher radiation dose. This technique should be used in difficult patients at high risk of haematoma formation.

Aged↗
PubMed1998

Alteration of follicular dynamics and superovulatory responses by gonadotropin releasing hormone and follicular puncture in cattle: a field trial.

A field experiment was conducted to determine the influence of follicular alteration on superovulatory responses. Ultrasonography was performed once daily over 4 d prior to gonadotropin treatment (Day 0), on the day of estrus during superstimulation, and on the day of embryo collection to monitor follicular development. Animals were superstimulated between Days 8 and 12 of the estrous cycle. Follicular status was altered 2 d prior to initiation of superstimulation (Day 0) with GnRH (Cystorelin, 200 micrograms i.m.) administered with (GnRH-puncture group, n = 31) or without (GnRH-no puncture group, n = 52) concomitant removal of the largest follicle by follicular aspiration. Responses were compared with those of an untreated control group superovulated 8 to 12 d after estrus (n = 102). The proportion of animals with a high number (> or = 2) of large follicles (> = 7 mm) on Day 0 was lower (P < 0.001) in the 2 GnRH-treated groups than in the control group, while the increase in the number of medium size follicles (4 to 6 mm) on Day 0 was greater (P < 0.02) in the GnRH-puncture group. During superstimulation, the proportion of superovulatory cycles with a high follicular (> or = 10 follicles) response was similar in the control and GnRH-no puncture groups. Within the GnRH-treated animals, follicular and ovulatory responses were greater in the GnRH-puncture than in the GnRH-no puncture group (P < 0.001 to P < 0.02). Despite these changes in follicular and ovulatory responses, however, the mean number of embryos produced did not differ (P < 0.1) among treatments (4.3 +/- 0.4, 3.7 +/- 0.7, and 5.4 +/- 0.8 in control, GnRH-no puncture, and GnRH-puncture groups, respectively). This was due primarily to an increase in the mean numbers of unfertilized ova (P < 0.005) and in degenerated embryos (P < 0.06) in the GnRH-puncture group. Results indicate that the beneficial effects of treatment with GnRH and follicular puncture 2 d prior to superstimulation on follicular and ovulatory responses were limited by an increase in the number of unfertilized ova and degenerated embryos.

Animals↗
PubMed1996

The effect of prior dural puncture on cisternal cerebrospinal fluid morphine concentrations in sheep after administration of lumbar epidural morphine.

Combined spinal epidural anesthesia has become increasingly popular as a method of providing rapid onset of analgesia or surgical block with access for further administration of analgesics or anesthetics. No in vivo studies have evaluated the relationship between dural puncture and drug transfer from the epidural space to the cerebrospinal fluid (CSF). To determine whether morphine administered in the epidural space adjacent to a dural puncture results in increased CSF concentrations at the cisterna magna (CM), 12 adult ewes were studied. Each animal was assigned to one of three groups. Animals in Group 1 served as a control and received no dural puncture. Animals in Group 2 received a dural puncture with a 25-gauge (G) Whitacre needle, while Group 3 animals received a dural puncture with an 18-G Tuohy needle. One hour after dural puncture, each animal was given epidural morphine, 0.2 mg/kg. Six hours after the administration of epidural morphine, CSF from the CM was sampled and analyzed by gas chromatography-mass spectrometry for morphine concentration. The mean morphine concentration at the CM for Group 1 (control) was 22 +/- 12 ng/mL, whereas animals with 25-G and 18-G dural punctures had concentrations of 154 +/- 32 ng/mL and 405 +/- 53 ng/mL, respectively (P = 0.0005). These data demonstrate that a significant increase in CSF morphine concentration at the brainstem will occur when lumbar epidural morphine is administered adjacent to a dural puncture. Furthermore, the increase in CSF morphine concentration is positively correlated with the size of the needle producing the dural puncture. These findings highlight the potential for delayed respiratory depression when epidural opiate administration follows a dural puncture.

Analgesics, Opioid↗
PubMed1998

The effect of prior dural puncture on cerebrospinal fluid sufentanil concentrations in sheep after the administration of epidural sufentanil.

UNLABELLED: Sufentanil is a highly lipid soluble opioid that provides potent analgesia when administered in the subarachnoid space. Unfortunately, the penetration of sufentanil into the cerebrospinal fluid (CSF) after epidural administration is poor, and limits its effectiveness for epidural analgesia. Dural puncture may enhance the movement of epidural sufentanil into the subarachnoid space and increase its effectiveness. To determine whether the administration of epidural sufentanil adjacent to a dural puncture results in significantly greater CSF concentrations, 18 adult ewes were studied. Animals in the control group had an epidural catheter placed at the superior border of the pelvis without dural puncture. Animals in the study group had an epidural catheter placed, followed by a dural puncture performed using an 18-gauge Touhy needle. The dural puncture was performed one interspace cephalad to the epidural catheter. One hour after dural puncture, each animal received a loading dose of 0.35 microg/kg of sufentanil (5 microg/mL) through the epidural catheter, followed by an infusion of epidural sufentanil 0.15 microg x kg(-1) x h(-1) for a period of 4 h. After 4 h, CSF was sampled from a site one interspace caudad to the epidural catheter as well as at the cisterna magna. The mean CSF concentration of sufentanil at the level of the pelvis for animals with a dural puncture was 12.1 +/- 3.0 ng/mL compared with 1.8 ng/mL in controls with intact dura. Sufentanil concentrations at the cisterna magna were below the level of detection (0.08 ng/mL) for all animals in both groups. We conclude that an 18-gauge dural puncture significantly increases movement of sufentanil from the epidural to the intrathecal space. This increase in sufentanil concentration at the level of the pelvis was not associated with detectable levels of sufentanil at the brainstem. IMPLICATIONS: This study addresses the effect of dural puncture on spinal fluid concentrations of sufentanil after epidural administration. A sheep model was used to measure drug concentrations in the spinal fluid at the levels of the pelvis and brainstem after epidural administration. Dural puncture significantly enhanced movement of sufentanil into the spinal fluid at the level of the pelvis, but brainstem concentrations were below the level of detection. Analgesic concentrations of spinal sufentanil in the clinical setting, as well as brainstem concentrations associated with respiratory depression, have yet to be defined.

Analgesia, Epidural↗
PubMed2001

Endoscopic puncture of ureterocele as a minimally invasive and effective long-term procedure in children.

OBJECTIVES: Over the past years the surgical approach to ureterocele has evolved from complicated major surgery to minimally invasive endoscopic treatment. Because of the high rate of secondary surgery in some recently reported series, an upper pole partial nephrectomy is again recommended as the procedure of choice. We have retrospectively evaluated the long-term results of endoscopic puncture of a ureterocele and its long-term effectiveness and applicability in children. METHODS: Over the past 8 years, 34 patients (20 female, 14 male) were treated in our service with primary endoscopic puncture of a ureterocele. The mean age of the patients was 1.1 +/- 4.3 (mean +/- SD) years. Mean follow-up was 6.1 +/- 2.4 years. Antenatally ultrasound detected the ureterocele in 5 (14%) patients, fetal hydronephrosis leading to the postnatal diagnosis in 13 (38%), and 16 (48%) children presented with symptoms of urinary tract infection (UTI). The ureteroceles presented as part of renal duplication in 31 patients (91%), 3 (9%) in a single system and 1 child had bilateral ureteroceles of a duplex system. Twenty (58%) children had intravesical ureteroceles and the remaining 14 (42%) ectopic ureteroceles. Very poorly functioning upper pole moiety presented in 26 (75%) of the cases and nonfunctioning upper poles in 5 (14%). Twenty of 34 children (58%) had initial vesicoureteral reflux (VUR) to the lower moiety, either to the ipsi (60%) or contralateral kidney (40%). A cold knife incision was carried out in 4 (11.7%), puncture by a 3-french Bugbee electrode in 20 (58%), and the stylet of a 3-french ureteral catheter was utilized to puncture the ureterocele in the remaining 10 patients (30.3%). RESULTS: Complete decompression of the ureterocele was observed in 32 of 34 children (94%). Two patients required secondary puncture 2 years following the primary procedure and are doing well. Upper pole moiety function improved postoperatively in 2 infants and remained stable in all 32 patients, no patient presented with deterioration of the renal function. Six of 20 (30%) patients who had initial VUR to the lower pole, accompanied with recurrent UTI, required surgery. Three underwent ureteric reimplantation and another 3 submucosal polytetrafluoroethylene paste (Teflon) injection. Eight (40%) patients presented with spontaneous resolution of VUR to the lower moiety following puncture of the ureterocele. An additional 6 (17.6%) patients developed VUR to the upper moiety following the puncture of the ureterocele, 3 after cold knife incision and 3 after simple puncture. In 2, submucosal Teflon injection solved the VUR and the remaining 4 patients were maintained on prophylactic antibiotics. In 1 child the reflux resolved spontaneously, and none of them presented with UTI. In 2 cases with nonfunctional upper poles, partial nephrectomy was performed due to symptomatic UTI in spite of complete collapse of the ureterocele 1 and 2 years, respectively, following the initial puncture. No difference was observed in the re-operation rate between the patients with ectopic versus intravesical ureterocele (p<0.05). CONCLUSION: We found that endoscopic puncture of a ureterocele presents an easily performed procedure which allows the release of obstructive ureters and avoids major surgery in the majority of the cases even after a long follow-up.

Adolescent↗
PubMed1992

Histological changes in the orbital region of rats after orbital puncture.

To contribute to the assessment of the degree of discomfort in rats after orbital puncture, we have examined the histological changes in the intraorbital tissues caused by this technique of blood sampling. Orbits were studied from rats euthanized either within 1 min, 4 days, 28 days or 56 days after puncture while under diethyl-ether anaesthesia. The techniques of 2 animal technicians were compared, one using a broken haematocrit capillary and the other using an intact Pasteur's pipette. Non-punctured orbits served as controls. Microscopic slides containing the eye in situ at 2 horizontal levels in the orbital region were examined for 37 parameters; the slides were scored blind and in random order. Orbital puncture caused haemorrhages in the puncture track and, depending on the technique used, also in the periosteum. Four days after puncture, inflammatory reactions were present in the puncture track. Depending on the technique of puncture, these reactions were also seen in the eye muscles and periosteum or in the Harderian gland. Within 4 weeks after puncture, the lesions had healed without detectable scars. The different histological effects of the 2 techniques of orbital puncture are discussed in the light of the characteristics of these techniques.

Animals↗
PubMed1992

[Puncture catheterization of central veins--experiences from a primary care clinic].

BACKGROUND: We introduced in the years 1984-1989 317 central venous catheters. Our results and conclusions for using those catheters in smaller hospitals are described. MATERIAL AND METHODS: 4 physicians inserted under standardized conditions 317 central venous catheters in the intensive care unit using the transmuscular way for puncturing the V. jugularis interna and the infraclavicular way for puncturing the V. subclavia. RESULTS: Puncturing the V. basilica complications were not registered. By the V. subclavia route a Pneumothorax rate of 1.7% and an arterial puncture rate of 4.1% were found compared with a 4% arterial puncture rate using the V. jugularis interna. We couldn't find the V. subclavia in 3.4% and the V. jugularis interna in 8%. The complication rate decreased with increasing experience of the physicians. The positions of the catheters in the venous system were not appropriate in 46.9% of the cases after puncture of the V. basilica and in 1.3% after puncture of V. subclavia. Wrong catheter positions were not found after puncturing the V. jugularis interna. Complications as thrombophlebitis were observed in 6.5% after puncturing the V. basilica and 1.1% of the cases after V. subclavia puncture. CONCLUSIONS: Central venous catheters can be safely used also in smaller hospitals if applied by a standardized method. A limited team of physicians can get enough experiences also in a slight number of patients, so that complication rates as low as in international statistics were found.

Catheterization, Central Venous↗
PubMed2005

[Possibility of cauda equina nerve root damage from lumbar punctures performed with 25-gauge Quincke and Whitacre needles].

OBJECTIVE: To assess the possibility of puncturing nerve roots in the cauda equina with spinal needles with different point designs and to quantify the number of axons affected. MATERIAL AND METHODS: We performed in vitro punctures of human nerve roots taken from 3 fresh cadavers. Twenty punctures were performed with 25-gauge Whitacre needles and 40 with 25-gauge Quincke needles; half the Quincke needle punctures were carried out with the point perpendicular to the root and the other half with the point parallel to it. The samples were studied by optical and scanning electron microscopy. The possibility of finding the needle orifece inserted inside the nerve was assessed. On a photographic montage, we counted the number of axons during a hypothetical nerve puncture. RESULTS: Nerve roots used in this study were between 1 and 2.3 mm thick, allowing the needle to penetrate the root in the 52 samples studied. The needle orifice was never fully located inside the nerve in any of the samples. The numbers of myelinized axons affected during nerve punctures 0.2 mm deep were 95, 154, and 81 for Whitacre needles, Quincke needles with the point held perpendicular, or the same needle type held parallel, respectively. During punctures 0.5 mm deep, 472, 602, and 279 were affected for each puncture group, respectively. The differences in all cases were statistically significant. CONCLUSIONS: It is possible to achieve intraneural puncture with 25-gauge needles. However, full intraneural placement of the orifice of the needle is unlikely. In case of nerve trauma, the damage could be greater if puncture is carried out with a Quincke needle with the point inserted perpendicular to the nerve root.

Cauda Equina↗
PubMed1993

Role of local anesthesia during lumbar puncture in neonates.

Local anesthesia decreases physiologic responses to pain in neonates but has not been used routinely during lumbar punctures in newborns, as it might obscure anatomical landmarks. However, local anesthesia may decrease newborns' struggling during lumbar puncture, thus facilitating the procedure and increasing its success rate. The success rate of lumbar punctures was compared in neonates allocated prospectively to 0.2 to 0.5 mL of 1% lidocaine anesthesia (n = 48) or a control group (n = 52). Newborns were held in a modified lateral recumbent position (neck not flexed) and their struggling response to the various steps in the lumbar puncture was scored by the holder. The newborns' struggling motion score increased in response to lidocaine injection, but response to the subsequent spinal needle insertion was significantly decreased. Despite this decreased motion, no differences were noted in the number of attempts per lumbar puncture (1.9 +/- 0.2 [SEM] in lidocaine and 2.1 +/- 0.2 in control groups), rate of lumbar puncture failure (15% in lidocaine and 19% in control groups), or the number of traumatic lumbar punctures (46% in both groups). The success rate of lumbar puncture was not dependent on level of training of physicians performing the procedure. No acute complications, cerebrospinal fluid contamination, or subsequent meningitis was noted in either group. It is concluded that local anesthesia with lidocaine decreases the degree of struggling but does not alter the success rate of lumbar puncture in neonates. The practice of withholding lidocaine anesthesia from neonates undergoing lumbar punctures cannot be justified by arguing that it makes the procedure more difficult to perform.

Child Behavior↗
PubMed1999

Second stage pushing correlates with headache after unintentional dural puncture in parturients.

PURPOSE: To determine the association between bearing down, postdural puncture headache (PDPH) and epidural blood patch (EBP) following single 17 gauge unintentional dural puncture (UDP) in parturients. METHODS: The charts of 60 parturients identified with UDP in our institutional database during epidural placement were independently reviewed. Patients were divided into categories based on the anesthetic record: well-documented single punctures; well-documented multiple punctures; catheter-related puncture; unclear category (not clear if more than one puncture occurred or if dural puncture had occurred at all) and no evidence of dural puncture. Patients with single 17 gauge punctures were divided into those who had pushed (Group 1) and those who had not (Group 2). Group 2 patients had undergone Cesarean section before reaching second stage labour. The incidence of PDPH, EBP, and cumulative duration to delivery after UDP were compared between groups. RESULTS: Thirty-three patients with well-documented single punctures were identified: 23 had engaged in active pushing as part of second stage labour (Group 1); 10 had not (Group 2). Seventy-four percent of Group1I developed PDPH compared with 10% in Group 2 (P < 0.002). Fifty-seven percent of Group 1 received an EBP compared with 0% in Group 2 (P < 0.002). Increasing the duration of pushing was associated with an increasing incidence of PDPH; the majority of women who pushed > 30 min developed headache. CONCLUSIONS: An increased incidence of PDPH and EBP after UDP occurs in women bearing down in 2nd stage labour when compared with those who never pushed. There was also an association between the cumulative duration of bearing down and the incidence of PDPH.

Adult↗
PubMed2004

Puncture resistance and stiffness of nitrile and latex dental examination gloves.

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.

Analysis of Variance↗
PubMed2005

Optimal puncture site of the right internal jugular vein after laryngeal mask airway placement.

BACKGROUND: Puncturing of the internal jugular vein (IJV) after placement of a laryngeal mask airway (LMA) is difficult. Overlapping of the right internal jugular vein (IJV) and common carotid artery (CCA) after placement of an LMA-Classic (Laryngeal Mask Company, Henley-on-Thames, United Kingdom) was investigated using an ultrasound scanner. A study was conducted to determine the optimal puncture site in the case of puncturing the right IJV after LMA-Classic placement. METHODS: The subjects in this study consisted of 114 patients (60 men and 54 women) scheduled to undergo LMA-Classic placement (size 4 for men and size 3 for women). Overlapping between the IJV and CCA was investigated at three points (high, middle, and low points) on the right side of the neck after LMA-Classic placement. A test puncture was also made at the right low (supraclavicular) point after LMA-Classic placement. RESULTS: (1) The degree of overlapping of the right IJV and CCA after LMA-Classic placement was clearly greater than before LMA placement. (2) With the exception of some measurements, there were many cases in which the right IJV and CCA were completely overlapping after LMA-Classic placement. Furthermore, the CCA was not observed in the vicinity of the right IJV at the right low point. (3) There were no complications (including pneumothorax and accidental arterial puncture) during supraclavicular IJV puncture after LMA-Classic placement. CONCLUSION: After placement of the LMA-Classic, overlapping of the IJV and CCA increased at the high and middle puncture points of the IJV; however, at the lower puncture point, the position of the vessels remained unaffected. Therefore, during IJV puncture at high or middle points, ultrasound guidance is advisable to avoid CCA puncture.

Adult↗
PubMed2003

Consequences of transvaginal follicular puncture on well-being in cows.

The purpose of this study was to evaluate the impact of repeated follicular puncture used in the ovum pick-up technique on the welfare of cows. The evaluation relies on the physiological measurement of stress, milk production criteria, immune status, and the histological examination of ovaries. Two groups of five Holstein cows were submitted to epidural anaesthesia and genital palpation with insertion of an intravaginal ultrasound probe for transvaginal puncture (the puncture was not performed in the control group). Animals were manipulated twice a week for 8 weeks (16 manipulation sessions). The blood cortisol concentrations increased after each session; however, the concentrations were the same in both the control and the punctured groups. Two adrenocorticotrophic hormone challenge tests, performed before the first session and after the last session, showed an unchanged adrenal sensitivity through repeated puncture sessions. The transvaginal puncture did not affect milk production, or blood and milk somatic cell counts. Ovariectomies were performed on another group of four Holstein cows at various intervals (0 to 30 days) after five similar puncture sessions. Histological examination of the ovaries 4 days after puncture revealed blood-filled follicles and haemorrhagic foci in ovarian stroma, but the examination 30 days after the last puncture session demonstrated very limited, if any, fibrosis. On the basis of the criteria chosen for this study, repeated transvaginal follicular puncture on its own does not impact adversely on the welfare of cows.

Animals↗
PubMed1989

Ultrasound-guided puncture of cystic tumors in the lower pelvis of young women.

During the period from 1984 through 1986, 72 ultrasound-guided cyst punctures were performed in 60 young women (less than or equal to 40 years). Thirty-one punctures were performed using the transabdominal route and 41 punctures under the guidance of endovaginal scanning. General or local anesthesia were used in 97% of the transabdominal punctures while the corresponding figure for the endovaginal technique was 49%. Seventy-seven percent (46/60) of the women developed no new cysts within one year of the last puncture. Thirteen percent (8/60) had to be punctured twice and 3% (2/60) three times. No complications occurred in any of the 72 punctures. Of those women with cyst relapses and/or persistent abdominal pain, 7 were subjected to laparotomy and 5 to laparoscopy. Ultrasound-guided puncture of cystic tumors in the lower pelvis of young women seems to be an alternative to laparoscopically guided puncture or laparotomy. As compared to surgery, the ultrasound-guided technique may mean less risk for pelvic adhesions in young women with unproven fertility.

Adolescent↗
PubMed1996

[CT-guided puncture].

Sonographic and CT-guided punctures allow the evaluation of suspected lesions in the head, thorax, abdomen, retroperitoneum and skeletal system. The size of the lesion to be evaluated determines the size and the diameter of the puncture needle. The quantity of the material obtained will be defined by the diameter of the needle, i.e. fine-needle biopsy is more adequate for cytological than for histological evaluation. Strict adherence to the indications and contraindications for puncture and painstaking performance of the procedure go a long why towards minimizing the complications. The advantage of CT-guided puncture, in contrast to an ultrasound-guided procedure, is visualization during the puncture procedure free from overshadowing. This permits punctures of lesions located deep in the thorax or the abdomen which are overshadowed by the lungs, by air in the small or large bowel or by bone structures. Moreover, this technique yields much more information about the tissues and organs surrounding the suspected lesion. This information is much more investigator-related with ultrasound-guided puncture. Therefore, the CT-guided puncture has become mandatory in the evaluation of suspected lesions. Moreover, using the same technique, percutaneous drainage of fluids in the interpleural space, abscesses in organs, hematomas, lymphoceles and urinomas; ablation of metastases; and sympathicolysis can be carried out. CT-guided puncture thus changes from a minimally invasive diagnostic procedure to a minimally invasive therapy.

Biopsy, Needle↗