Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Sep 1984
Percutaneous catheterization of the brachial vein for central venous access.
A method of percutaneous central venous catheterization involving the brachial vein is described. A constant anatomic location and large diameter of brachial vein render a high chance of successful veinpuncture. The gradual increasing size of venous catheters with initial small needle puncture minimizes the possibility of a complication. This technique is recommended when usual percutaneous central venous access is not available.
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Air embolism--the most dangerous complication of central venous catheterization--may occur in several ways. The most frequent is from disconnection of the catheter from the related intravenous tubing. An embolism may present with a sucking sound, tachypnea, air hunger, wheezing, hypotension and a "mill wheel" murmur. ⋯ Immediate treatment includes placing the patient in the left lateral and Trendelenberg positions, administration of oxygen and aspiration of air from the heart. Cardiac massage and emergency cardiopulmonary bypass may be necessary. Most instances can be prevented by inserting the cannula with the patient in the Trendelenberg position, occluding the cannula hub except briefly while the catheter is inserted, fixation of the catheter hub to its connections and occlusive dressing over the track after removal of the catheter.
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Surg Gynecol Obstet · Aug 1984
Comparative Study Clinical TrialEndoscopic control of upper gastrointestinal hemorrhage with a bipolar coagulation device.
It has been difficult to determine the real efficacy of endoscopic treatment for upper gastrointestinal tract bleeding sites for several reasons. First, since 80 per cent of an unselected group are expected to stop bleeding spontaneously, it is important to focus upon those individuals who continue to bleed instead of a group in whom bleeding would have stopped spontaneously in the majority. Second, it is difficult, if not impossible, to have comparable groups of patients with similar lesions and similar rates of bleeding who can be randomized into different treatment groups. ⋯ This modality is relatively cheap compared with other devices, is theoretically less complicated and has minimal risk to the individual patient. Because of these considerations, it is a technique which deserves wider application and may become the endoscopic treatment of choice for control of upper gastrointestinal tract hemorrhage. Patients with endoscopic control of upper gastrointestinal tract bleeding avoid perioperative morbidity, have a lower transfusion requirement and may have a shorter hospital stay than comparable individuals who require operative control of bleeding sites.
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The use of a Tiemann curved tip urethral catheter for repeated nasotracheal suction in 120 instances of postoperative pulmonary complications was proved to be more efficient than the use of a regular suction catheter. The curved tip is better adapted to the anatomy of the nasotracheobronchial tract and allows easy selective catheterization of the trachea and major bronchi.
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Surg Gynecol Obstet · Apr 1984
ReviewThe importance of acid-base management for cardiac and cerebral preservation during open heart operations.
The basic physiologic characteristics of acid-base equilibria during hypothermia were briefly reviewed. By graphic analysis, four possible clinical strategies for managing the acid-base status of the patient undergoing H-CPB were documented. The effect of hemodilution on buffer capacity was charted in a manner applicable to common current operative procedures. ⋯ However, the need for preservation of the hypoxic heart is overwhelming and, thus, the best acid-base management for cardiac hypothermic operations is significant respiratory alkalosis. The most appropriate sites for the collection of blood samples for gas analysis and measuring temperatures were discussed; "body temperature" is the most unreliable parameter measured. The major characteristics of an "ideal" cardiopreservative solution were described.(ABSTRACT TRUNCATED AT 400 WORDS)