Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Jan 2007
Comment[Placement of central venous catheters and patient safety].
Placement of a central venous catheter is one of the most common invasive procedures and is associated with septic and mechanical complications, such as bleeding and pneumothorax. Up to 30% of attempts to cannulate the central vein fail. Correct positioning of the patient can help to maximise the success rate. ⋯ The use of ultrasound has been shown to increase the success rate and avoid mechanical complications when placing a catheter in the internal jugular vein. It may also increase the success rate in subclavian vein catheterisation. To increase patient safety, the use of ultrasound when placing a central venous catheter should be embraced and become the standard of care.
-
Ned Tijdschr Geneeskd · Jan 2007
[Optimal patient position for catheterisation of the subclavian vein: in the Trendelenburg position without a rolled towel between the shoulder blades].
To determine the optimal patient position for subclavian-vein catheterisation. ⋯ For successful catheterisation of the subclavian vein, the patient should be placed in the Trendelenburg position without a rolled towel between the shoulder blades, and the puncture should be preferably on the right side.
-
Ned Tijdschr Geneeskd · Jan 2007
Case Reports[Fatigue, loss of appetite and anuria due to retroperitoneal fibrosis].
Two men aged 58 and 76, respectively, presented with fatigue and loss of appetite followed by anuria. Laboratory tests showed anaemia, elevated ESR and renal failure. CT of the abdomen revealed obstruction of the ureters by retroperitoneal fibrosis. ⋯ Treatment with prednisone is preferable, followed by immunosuppressive therapy or tamoxifen in case of resistance to steroids. Relief of the obstruction by means of temporary nephrostomy catheters often makes surgery unnecessary. Retroperitoneal fibrosis is an uncommon disease that deserves more attention in view ofthe favourable therapeutic options following timely diagnosis.
-
Ned Tijdschr Geneeskd · Jan 2007
Case Reports[Myocardial contusion after blunt thoracic trauma: possible indication for rhythm observation].
A 65-year-old man had a pneumohaemothorax and fractured ribs after an automobile accident. Troponine concentrations were normal and the initial electrocardiographic abnormalities resolved within 24 hours. A 46-year-old man who was also in an automobile accident developed a seat-belt haematoma and lung oedema. ⋯ A combination oftroponine and electrocardiography is necessary to differentiate between risk categories. Echocardiography has a role in haemodynamically unstable patients and whenever the clinical condition of the patient deteriorates. A structured approach to screening and evaluation, as presented in an algorithm, can be used as a guide in the follow-up of patients with myocardial contusion.