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PubMed1985

Supraclavicular central venous catheterization.

Percutaneous central venous catheterization is a well-accepted procedure for cardiac monitoring, total parenteral nutrition, and long-term drug therapy. The supraclavicular approach was used for 90 catheterizations in 81 gynecologic patients to evaluate ease of insertion, complication rate, and patient compliance. Anatomic considerations, insertion technique, and the rationale for the supraclavicular approach are discussed in detail. A successful catheterization rate of 91% was achieved with acceptable morbidity. There were three instances each of pneumothorax, catheter malposition, and catheter infection. Advantages of the supraclavicular approach include a wider target area, a more direct route to the superior vena cava, and less pain on insertion. With reliable and constant landmarks, relative ease of and comfort on insertion, and low complication rate, the supraclavicular technique is the preferred method when percutaneous central venous catheterization is indicated.

Adult↗

PubMed1990

Ultrasonography-guided early amniocentesis in singleton pregnancies.

Between October 1, 1986, and September 30, 1987, 1721 amniocenteses were performed at the University of California, Davis, Medical Center. Of these procedures 527 (30.6%) were early amniocenteses. Medical records were reviewed for maternal age, amniocentesis indication, color of amniotic fluid, gestational age, frequency of needle insertion, complications of amniocentesis and delivery, results of prenatal testing, and pregnancy outcome. Complete follow-up data were available for 517 (98.1%). There were 10 miscarriages before 28 weeks' gestation (1.9%), one loss after 28 weeks (0.2%), and one stillbirth (0.2%), resulting in a total postprocedural loss rate of 2.3%. Miscarriage within 2 weeks of amniocentesis occurred in four subjects (0.8%).

Abortion, Spontaneous↗

PubMed1992

Complications of the nitinol vena caval filter.

Simon nitinol vena caval filters were placed percutaneously in 20 patients. Follow-up (average, 14 months) data were available for 16 patients, and four patients were lost to follow-up. There were no proved or suspected cases of pulmonary embolism after filter insertion. Complications encountered included caval penetration (n = 5, one acute and four at follow-up), caval thrombus (n = 4, two determined radiologically and two clinically), postplacement deep venous thrombosis (n = 2, one radiologic and one clinical), filter migration (n = 1), and delayed fracture of a filter leg (n = 2). Although no deaths or significant morbidity resulted from any complication, the relatively high complication rate, especially of significant caval penetration (documented in 25% of filter insertions), merits continued short- and long-term assessment of patient status after filter placement.

Adult↗

PubMed1991

Use of femoral venous catheters in critically ill adults: prospective study.

OBJECTIVE: To determine the frequency of clinically important complications of femoral venous catheters. DESIGN: Prospective survey of major and minor complications. SETTING: A mixed medical/surgical ICU in a university hospital. PATIENTS: One hundred twenty-three patients admitted to the ICU who underwent femoral venous catheterization over a 2-yr period. MEASUREMENTS AND MAIN RESULTS: There were 150 catheters inserted in 123 patients for a mean duration of 6.4 days. There were no major complications including catheter-related sepsis. Minor complications consisted of arterial puncture (9.3%), local bleeding (10%), and local inflammation (4.7%). Critical care fellows had a significantly lower rate (6%) of insertion complications than interns or medical students (16%). We did not specifically look at the frequency of deep venous thrombosis. CONCLUSIONS: Femoral venous catheterization offers an alternative site of insertion to the subclavian and jugular veins for central venous access in the critically ill. The occurrence rate of clinically important complications is acceptably low.

Adult↗

PubMedDate not supplied

Chylothorax--a complication of subclavian vein catheterization.

Insertion complications of subclavian vein catheter placement are well documented. Thoracic duct injury is a potential problem which has rarely been reported. A patient with duct injury and resultant chylothorax is presented. The management of this problem is discussed with emphasis placed on chyle leakage from both the nutritional and mechanical aspect. The anatomy and function of the thoracic duct as well as the pathophysiology and treatment of chylothorax are detailed.

Aged↗

PubMed1992

Central venous catheterization in the critically ill patient.

Central venous catheter placement for access and monitoring purposes is one of the most commonly performed procedures in the intensive care unit. This article details the indications, techniques, and advantages and disadvantages associated with various approaches to central line insertion; complications associated with central venous line insertion are also reviewed briefly.

Catheterization, Central Venous↗

PubMed1992

Clinical evaluation of percutaneous insertion and long-term usage of a new cuffed polyurethane catheter for central venous access.

A new, long-term venous access catheter was evaluated in clinical practice and the insertion time, complication rate and prospective follow-up recorded. Fifty novel polyurethane catheters (Cuff-Cath) were inserted in 48 patients, for cytotoxic chemotherapy in 36, long-term total parenteral nutrition in five and miscellaneous indications in seven. All catheters were inserted by a percutaneous technique under local anaesthesia. The mean insertion time was 18 min. There were three insertion complications; failure to cannulate, pneumothorax and malposition. Seven catheters required removal (sepsis in five, subclavian vein thrombosis in two) and one catheter fell out. Total catheter days to date has been 6607 (mean 132, range 18-831 days). Eleven catheters are still in use a mean of 154 days (range 38-490 days) after insertion. Furthermore, a new technique has been described which prevents inadvertent displacement. This new catheter combines the mechanical advantages of polyurethane, together with those of a Dacron cuff. Early results suggest that this catheter may be a useful alternative to silicone catheters of the Hickman/Broviac type for long-term central venous access.

Antineoplastic Agents↗

PubMed1988

Prevention of complications in permanent central venous catheters.

As more patients are requiring permanent central venous catheters (PCC) for long term venous access, several associated complications have become evident, including: 1, sepsis; 2, thrombophlebitis; 3, insertion complications, such as unsuccessful placement, bleeding and pneumothorax, and 4, PCC transection with tip embolization. At our institution, 162 PCC were placed by way of cutdown or percutaneously. Sepsis occurred in 20 per cent (0.13 septic episodes per 100 catheter days), nearly always involving immunocompromised patients. Twenty-five per cent resolved with use of antibiotics and without removal of PCC. Two patients presented with clinical thrombophlebitis; both were treated with removal of PCC and anticoagulant medication. Failure of insertion was highest with the cephalic cutdown approach, and pneumothorax was highest with the subclavian approach. Transection of PCC is associated with the percutaneous subclavian approach and is heralded by intermittent catheter function and a "pinch-off" sign on roentgenogram. Methods of preventing these complications are emphasized herein.

Adolescent↗

PubMed1987

Invasive vascular catheterisation in the critically ill.

In order to identify potential problems and thereby minimise the risk of invasive vascular catheterisation, we conducted an analysis of these procedures in our medical intensive care unit with the aid of a computer database. During the 9-month study period 114 patients underwent 247 invasive vascular catheterisations, including pulmonary arterial (PA), central venous (CV) and arterial catheter insertions. Complications unique to PA catheterisation included burst catheter balloons (6%) and one serious episode of arrhythmia. The incidence of pneumothorax (2.8%) and inadvertent arterial puncture (2.2%) with PA and CV lines and our sepsis rate of 3.6% for all types of catheters are consistent with other studies. Arterial catheterisation proved to be relatively free of complications. Our study confirmed the safety of invasive vascular catheterisation. However, we review the precautions needed to limit potential complications.

Arteries↗

PubMed1986

Do insertion-related problems affect subsequent IUD performance?

This investigation compares the IUD performance of 372 women who had an insertion-related problem (most with moderate or severe pain) and 372 matched women who had no such problem; all women had interval insertion. A woman in the Problem Cohort and her matched counterpart in the Comparison Cohort were inserted with the same IUD type by the same insertor on the same day or on close dates. The six IUD types used by these women were Lippes Loop D, Copper-7, Copper T-200, Copper T-380 Ag, Multiload Copper 250 and Multiload Copper 375. Cumulative gross life-table rates of the pertinent events (accidental pregnancy, expulsion and medical removal for bleeding and pain), adjusted for age and parity, were calculated. Between the Problem Cohort and the Comparison Cohort, no differences were detected in the event rates that were of either statistical or practical significance. Results from this preliminary study suggest that the insertion-related problems usually encountered during interval insertion such as insertion pain, syncope and/or mild cervical laceration are not associated with an increased risk of IUD discontinuation due to pertinent events.

Adult↗

PubMed1987

Intrauterine devices and pelvic inflammatory disease: recent developments.

The potential relationship between use of intrauterine devices and pelvic inflammatory disease is one of the most important issues in contraception today. A number of large, sophisticated studies published since mid-1980 have clarified this association. All have consistently revealed an increased risk of pelvic inflammatory disease among intra-uterine device users, but the most objective of these studies indicate a relative risk compared to women using no method (1.5-2.6) lower than previous estimates. For most intrauterine device wearers, the increased risk of pelvic inflammatory disease persists for only a few months after insertion. The Dalkon Shield appears associated with a higher risk of pelvic inflammatory disease than the Lippes Loop, Saf-T-Coil, or copper devices. Careful selection of candidates for intrauterine devices may further reduce the risk of intrauterine device-associated pelvic inflammatory disease.

Female↗

PubMed1990

A randomized trial of the Gyne T 380 and Gyne T 380 Slimline Intrauterine Copper devices.

To facilitate manufacture and insertion of the Gyne T 380 IUD, design changes were instituted. Copper collars were seated flush at the ends of the horizontal crossbar of the device. A randomized study of the Gyne T 380 Slimline, the new design, was undertaken in comparison with the standard Gyne T 380. A total of 996 women were enrolled, with 698 Slimline insertions and 298 of the standard Gyne T. No statistically significant difference in ease of insertion or in performance was detected between the models. At one year, the pregnancy rate of each model was below 0.5 per 100 and the continuation rate was 79-80 per 100. Pelvic inflammatory disease or endometritis was found in one percent of subjects in the first year. This is the seventh multicenter randomized study of a collared T IUD with 380 mm2 of copper surface. In all seven, the one-year gross pregnancy rate has been 1.2 per 100 or lower.

Adult↗

PubMed1985

A comparison of prostaglandin E2 pessaries and laminaria tents for ripening the cervix before termination of pregnancy.

Forty primigravid women aged 15-45 years were randomly allocated to receive either an intravaginal pessary of 3 mg prostaglandin E2 (PGE2) or an intracervical 5-mm laminaria tent (LT) 12-16 h before termination of pregnancy at 6-14 weeks gestation. The degree of dilatation of the cervix at operation and its resistance to further dilatation during the procedure were assessed by a 'blind' operator. Laminaria tents were more effective in achieving dilatation and softening of the cervix than were PGE2 pessaries and in 40% of women no further dilatation was necessary. There were no associated side-effects or complications. A cervical tear occurred in two of 20 patients treated with PGE2 pessaries and all 20 required further dilatation of the cervix. Laminaria tents provide a simple, safe, acceptable and effective means of 'ripening' the cervix prior to termination of early pregnancy.

Abortion, Therapeutic↗

PubMedDate not supplied

Insertion and removal of Norplant contraceptive implants by physicians and nonphysicians in an Indonesian clinic.

This paper reports on a study in which the performances of physicians were compared to those of nonphysician health personnel in inserting and removing NORPLANT subdermal contraceptive implants. The study was conducted in Raden Saleh Clinic at the University of Indonesia, Jakarta, from September 1982 to August 1984. In a group of 828 women who accepted NORPLANT 285 insertions were performed by physicians and 543 by nonphysician health personnel. During the study period, 122 removals were performed (43 by physicians and 79 by nonphysicians). This small proportion of removals reflects the high continuation rate for NORPLANT. There was no significant difference between the two groups of acceptors regarding age, parity, education, or side effects. The average insertion times were 7.6 minutes for the physician group and 7.4 minutes for the nonphysician group (p greater than 0.1). The average removal times were 21.7 minutes for physicians and 21.8 minutes for nonphysicians (p greater than 0.9). Complications during and following insertion and removal were minimal for both groups, and no significant differences were found. It was concluded that nonphysician health personnel are qualified to administer the NORPLANT contraceptive implants.

Adult↗

PubMed1979

Immediate postabortion intrauterine contraception in nulliparous adolescents.

Immediate postabortion insertion of an intrauterine device (IUD) was performed in 162 nulliparous adolescents. No insertion failures occurred. Twelve-month continuation rates were 86.6% for the Copper-7 IUD, 75.4% for the Copper-T device and 48.2% for the Lippes loop. Overall complications were greater for the Lippes loop than for the other two devices. The results suggest that immediate postabortion insertion should be considered for poorly motivated or uneducated adolescent girls who have already failed in contraception and require abortion.

Abortion, Induced↗

PubMed1981

Pain response following insertion of a Gravigard (Copper-7) intrauterine contraceptive device in nulliparous women.

A total of 33 nulliparous women aged between 18 and 35 have been observed for related symptoms following insertion of an intrauterine contraceptive device. Seventy-five percent suffered some abdominal pain initially but this was reduced to 1% by the end of the week. The symptoms of cramp and backache showed a similar trend. There was no relationship between symptoms and the day of the cycle on which insertion was performed. It is concluded that careful insertion of the Copper-7 in this group of patients is well tolerated irrespective of the day of cycle on which insertion is performed. The initial dynamic response following IUCD insertion may be an additional factor in the assessment of the performance of an individual intrauterine contraceptive device.

Abdomen↗