Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Jan 1995
[Central venous catheter. Better routine for placing of catheters].
Malposition of a central venous catheter is a major cause of serious complications such as perforation and cardiac tamponade. To prevent such complications it is necessary to confirm that the catheter tip is in the correct position. ⋯ With a minimum of extra equipment and training, we have tested the electrocardiography technique applied to our standard central venous catheter equipment (Secalon Seldy and Hydrocath). Our experience is that this technique makes catheter tip placement distal to the right atrium more easy to achieve.
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The "modern" hospice movement was established at the beginning of the 1960s in Great Britain. Philosophical issues and a holistic treatment model have been emphasized in order to meet the physical, emotional, social and psychological needs of dying patients. Less time has been devoted to research. ⋯ It is also important to increase the teaching about palliative medicine at medical school. The first unit of palliative has been established at the University Hospital, Trondheim. Similar clinics should be established at the other university hospitals in Norway.
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One specific institution reports 310 cases of reuse of pacemakers from 1974 to 1993. 111 were obtained after replacement, and 199 after the death of the first user. The average duration of the primary implant was 12 months (0-53 months). 177 functioned up to time of death, 43 months (0-177 months). In 107 cases the cause of death was unrelated to use of a pacemaker, was unknown in 61, and was sudden in 9 patients. 64 pacemakers were replaced, 14 because of infections or skin erosions. The causes of death and the prevalence and indications for generator replacement coincided with those in our population of new pacemaker-users in 1988-93. ⋯ Pacemaker re-use in our hospital is safe and cost-effective.
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Both MRI, CT and sonography will give a good presentation of fluid collection in pleura and pericardium. Sonography is the ideal imaging method for monitoring interventional procedures. Its ability to visualize superficial fluid collection and its real-time capability allows precise control of needle and catheter insertions. ⋯ If complications occur, it is mainly the pneumothorax that has to be treated. This can be managed directly under the procedure as the drainage catheter is attached to continuous pleural suction, or a catheter can be inserted in the pleural space after diagnostic punction. Patients with coagulation abnormalities must be evaluated especially before any intervention, otherwise there are no contraindications for these image-guided percutaneous procedures.