Journal articles: 'Repeated cannulation'

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Iscan, Sahin, Habib Cakir, Bortecin Eygi, Ismail Yurekli, Koksal Donmez, Pınar Unde Ayvat, Derya Sarıkaya Pekel, and Mert Kestelli. "Dynamic alterations in cerebral, celiac and renal flows resulting from ascending aorta, subclavian artery and femoral artery cannulations of extracorporeal devices." Perfusion 32, no. 7 (May 18, 2017): 561–67. http://dx.doi.org/10.1177/0267659117706606.

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Introduction: The aim of this study was to assess the relationships among cardiac output, extracorporeal blood flow, cannulation site, right (RCa) and left carotid (LCa), celiac (Ca) and renal artery (Ra) flows during extracorporeal circulation. Methods: A mock circulatory circuit was assembled, based on a compliant anatomical aortic model. The ascending aorta, right subclavian and femoral artery cannulations were created and flow was provided by a centrifugal pump (Cp); cardiac output was provided by a roller pump (Rp). Five volume flow rates were tested. The Rp was set at 4 L/min with no Cp flow (R4-C0) and the basic volume flow rates of the vessels were measured. The flow of the Cp was increased while the Rp flow was decreased for other measurements; R3-C1, R2-C2, R1-C3 and R0-C4. Measurements were repeated for all cannulation sites. Results: The RCa flow rate at R4-C0 was higher compared to the R3-C1, R2-C2, R1-C3 and R0-C4 RCa flows with subclavian cannulation. The RCa flow decreased as the Cp flow increased (p<0.05). The RCa flow with ascending aortic and femoral cannulation was higher compared to subclavian cannulation. Higher flows were obtained with subclavian cannulation in the LCa compared to the others (p<0.05). R4-C0 Ca and Ra flows were higher compared to other Ca and Ra flows with femoral cannulation. Ca and Ra flows decreased as Cp flow increased. Flows of the Ca and Ra with ascending and subclavian cannulations were not lower compared to the R4-C0 flow (p<0.05). Conclusion: This study shows that prolonged extracorporeal circulation may develop flow decrease and ischemia in cerebral and abdominal organs with both subclavian and femoral cannulations.

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Giovannetti, S., A. Bigalli, L. Cioni, M. Della Santa, and P. L. Balestri. "Permanent Vein Cannulation for Repeated Hemodialysis." Acta Medica Scandinavica 173, no. 1 (April 24, 2009): 1–5. http://dx.doi.org/10.1111/j.0954-6820.1963.tb16497.x.

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Narayan, Kumar Shwetanshu, Gaurav Kumar Gupta, Sandeep Nijhawan, Sudhakar Pandey, Bhanwar Singh Dhandhu, Shekhar Puri, Awanish Kumar, and Deepak Sharma. "Is it Worth to Repeat Endoscopic Retrograde Cholangiopancreaticography after Failed Precut? Short Report from a Tertiary Care Hospital in North India." Journal of Digestive Endoscopy 08, no. 03 (July 2017): 129–31. http://dx.doi.org/10.4103/jde.jde_29_17.

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ABSTRACT Aim: The aim of this study is to determine the success rate of biliary cannulation in cases where endoscopic retrograde cholangiopancreatography (ERCP) is repeated after failed precut sphincterotomy. Materials and Methods: In this retrospective study, consecutive ERCPs performed between August 2013 and June 2017 were included. Data was analyzed for indication of ERCP, success rate at initial cannulation attempt, use of precut sphincterotomy, biliary access rate after precut, repeat ERCP rate, and associated complications. Results: A total of 1872 ERCPs were included in the study. Of these, 55% were done for common bile duct stones, 37% for malignant biliary obstruction, and 8% for biliary leak. During the initial ERCP, 84.9% cases had successful biliary cannulation. Nearly 86.8% cases undergoing precut sphincterotomy achieved biliary access. Repeat ERCP was done in 28 cases after a median interval of 3 days and biliary cannulation was achieved in 78.5% cases. Conclusion: Repeat ERCP after 3 days in cases of failed initial precut sphincterotomy should be practiced and recommended as this allows definitive biliary therapy in majority of such patients and prevents morbidity and mortality from other invasive alternative therapies.

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Laidlaw, R. S., and N. Little. "Repeated cannulation of umbilical hernia with Ventriculoperiotoneal shunt catheter." Journal of Surgical Case Reports 2014, no. 6 (June 5, 2014): rju059. http://dx.doi.org/10.1093/jscr/rju059.

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HAYWOOD, R. M., J. M. O’DONOGHUE, and P. J. REGAN. "Delayed Rupture of an Extensor Digitorum Tendon Following Repeated Attempts at Intravenous Cannulation." Journal of Hand Surgery 23, no. 4 (August 1998): 557. http://dx.doi.org/10.1016/s0266-7681(98)80151-4.

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Bala, Narayan, Vinay Pathak, Shilpa Goyal, and Nikhil Kothari. "Popliteal artery cannulation as a saviour during prone positioning." BMJ Case Reports 13, no. 6 (June 2020): e234370. http://dx.doi.org/10.1136/bcr-2020-234370.

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The cannulation of the peripheral artery is a prerequisite for invasive blood pressure monitoring and repeated arterial blood gas sampling. Radial artery is commonly used site for inserting an arterial cannula. Many times, either during the change of posture or during prone ventilation, the arterial cannula gets displaced, and it is challenging to reinsert the arterial cannula in the lateral or prone position. In such circumstances, an alternative site of arterial cannulation needs to be looked into; we report a case in which the popliteal artery was used for arterial cannulation while the patient was in a prone position.

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Kelly, Linda J., Austyn Snowden, Ruth Paterson, and Karen Campbell. "Health professionals' lack of knowledge of central venous access devices: the impact on patients." British Journal of Nursing 28, no. 14 (July 25, 2019): S4—S14. http://dx.doi.org/10.12968/bjon.2019.28.14.s4.

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Background: the literature on the patient experience of living with a central venous access device (CVAD) is growing, but remains sparse. It suggests that patients accept having a CVAD as it should reduce episodes of repeated cannulations. However, a recent doctoral study found the reality did not live up to this hope. Aim: the study objective was to uncover the global, cross-disease experience of patients with CVADs. Method: an online survey was sent to an international sample of people living with CVADs. Findings: 74 people from eight countries responded. Respondents corroborated the PhD findings: painful cannulation attempts continued after CVAD insertion because of a lack of clinical knowledge. Participants lost trust in clinicians and feared complications due to poor practice. Conclusion: clinicians often lack the necessary skills to care and maintain CVADs. This leads to a negative patient experience.

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Yamagami, Yuki, and Tomoko Inoue. "Patient Position Affects Venodilation for Peripheral Intravenous Cannulation." Biological Research For Nursing 22, no. 2 (December 13, 2019): 226–33. http://dx.doi.org/10.1177/1099800419893027.

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Background: Larger veins are associated with a higher rate of success of peripheral intravenous cannulation. Although patient position affects venodilation during central venous cannulation, the association between patient position and vein size for peripheral intravenous cannulation remains unclear. Purpose: We examined the effect of seated versus supine positioning on vein size during peripheral intravenous cannulation before and after tourniquet application. Methods: In the present study, we recruited 81 participants (20–64 years) and included 80 in the analysis. We measured outcomes before and after tourniquet application in the seated and supine positions. The primary outcome was the cross-sectional area of the target forearm vein (ultrasonography by a blinded assessor). Subgroup analysis was used to test the effects of positioning combined with difficult peripheral intravenous cannulation (DPIVC) defined as poor visibility and/or palpability of the target vein. Results: Results of paired t tests demonstrated that the venous cross-sectional area significantly increased in the supine position with tourniquet application compared with the seated position with tourniquet application. Subgroup analysis with two-way repeated measures analysis of variance revealed that the venous cross-sectional area was significantly larger in the supine position than in the seated position despite DPIVC. Conclusion: Vein size during tourniquet application was greater in the supine than in the seated position even in cases of DPIVC. We thus recommend the supine position over the seated position for peripheral intravenous cannulation.

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Zaki, Mohamed, Niamh Hynes, Mahmoud Alawy, Mohamed El Kassaby, Wael Tawfick, and Sherif Sultan. "The First Case Using Synthetic Vein for Jugular to Iliac Vein Bypass to Treat Superior Vena Cava Obstruction: Clinical Dilemma and Literature Review." Journal of the Association for Vascular Access 20, no. 2 (June 1, 2015): 92–96. http://dx.doi.org/10.1016/j.java.2015.01.004.

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Abstract Chronic refractory venous hypertension is a common complication following repeated central venous cannulation performed as a temporary vascular access for dialysis in patients with chronic renal failure. The symptoms of venous hypertension may diverge from being asymptomatic to severe edema, ulceration, headaches, bloating, and blackouts, especially if the patient has a surgical arteriovenous fistula for dialysis in any of his upper limbs. Treatment options for such patients are mainly directed toward endovascular management via balloon angioplasty and possibly stenting of the stenosed vein. Resistant lesions or cases with total venous occlusion coerce surgeons to consider surgical bypass. We present a case of a 43-year-old patient with history of renal impairment and repeated bilateral central venous cannulation for dialysis. The patient experienced superior vena cava syndrome with bilateral total occlusion of the internal jugular veins and both subclavian veins (with an occluded previously inserted stent) along with the superior vena cava. An extra-anatomical bypass was done from the left internal jugular vein to the left external iliac vein using a synthetic silver Dacron ringed graft. The procedure was successful and resulted in relief of the patient's symptoms and a dramatic improvement of the patient's quality of life. Superior vena cava syndrome represents 1 of the most challenging complications for patients with chronic renal impairment and repeated central venous cannulation. The endovascular approach is currently gaining popularity as the first line of treatment for such patients. However, surgical management is sometimes the only available option when the endovascular approach is not technically feasible. Our case, along with others, shows that an extra-anatomical synthetic graft bypass can be a reliable, less invasive option for the management of superior vena cava syndrome once surgical intervention is inevitable.

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Pasrija, Chetan, Daniel A. Bernstein, Maryjoe Rice, Douglas Tran, David Morales, Todd Grintz, Kristopher B. Deatrick, James S. Gammie, Ronson Madathil, and David J. Kaczorowski. "Sutureless Closure of Arterial Cannulation Sites." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 15, no. 2 (February 28, 2020): 138–41. http://dx.doi.org/10.1177/1556984519899940.

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Objective Percutaneous femoral cannulation for venoarterial extracorporeal membrane oxygenation (ECMO) is commonly performed but percutaneous removal of arterial cannulas has not been broadly accepted. We hypothesized that a system that allows endovascular access to ECMO circuits along with the MANTA® large-bore vascular closure device could be used to successfully close arterial ECMO cannulation sites in a large animal model. Methods Yorkshire swine (40 to 60 kg, n = 2) were used for this study. In the first swine, the infrarenal abdominal aorta was exposed. The aorta was cannulated once using a 15 Fr cannula and twice with a 19 Fr arterial cannula. A novel adaptor system that facilitates endovascular access to ECMO circuits was connected, and a 0.035″ Benston wire was placed through the adaptor and guided into the aorta. The cannula was removed over the wire and manual pressure was applied. The MANTA® sheath was inserted over the wire followed by the closure unit and was deployed. The process was repeated at 2 separate sites. A similar experiment was performed in a second swine, but through a median sternotomy to cannulate the ascending aorta. Results Good hemostasis was achieved at all cannulation sites. Angiography demonstrated unobstructed flow across all closure sites with no evidence of extravasation. Conclusions The data presented here support the use of the MANTA® vascular closure device for the closure of arterial cannulation sites following ECMO decannulation and demonstrates utility of a novel adaptor system for establishing endovascular access in this context.

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Wijeyesinghe, E. C. R., Y. Pei, S. S. A. Feritori, and P. R. Uldall. "Right Atrial Ball Thrombus as a Complication of Subclavian Catheter Insertion for Hemodialysis Access." International Journal of Artificial Organs 10, no. 2 (March 1987): 102–4. http://dx.doi.org/10.1177/039139888701000208.

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In two patients right atrial ball thrombi developed following prolonged subclavian cannulation for hemodialysis. One patient died, the other had the ball thrombus removed by open heart surgery. It appears that repeated friction of the catheter tip may have damaged the endothelium of the right atrial wall. This hitherto unrecognised complication might be prevented by ensuring that subclavian hemodialysis catheters are never allowed to reach as far as the right atrium.

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Wehle, B., M. Björnström, M. Cedgård, K. Danielsson, A. Ekernäs, A. Gutierrez, U. Petterson, and T. Lindholm. "Repeated Application of Emla Cream 5% for the Alleviation of Cannulation Pain in Haemodialysis." Scandinavian Journal of Urology and Nephrology 23, no. 4 (January 1989): 299–302. http://dx.doi.org/10.3109/00365598909180341.

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Yildirim, A., and Abdurrahman Kadayifci. "Repeated cannulation attempts or late precut: which is more risky for post-ERCP pancreatitis?" Endoscopy 48, no. 10 (September 26, 2016): 955. http://dx.doi.org/10.1055/s-0042-112578.

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Lee, Jun Kyu, Joo Kyung Park, Won Jae Yoon, Sang Hyub Lee, Kwang Hyuck Lee, Ji Kon Ryu, Yong-Tae Kim, and Yong Bum Yoon. "Risk for Post-ERCP Pancreatitis After Needle Knife Precut Sphincterotomy Following Repeated Cannulation Attempts." Journal of Clinical Gastroenterology 41, no. 4 (April 2007): 427–31. http://dx.doi.org/10.1097/01.mcg.0000225695.46874.b5.

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Kimoto, Takeo, Naofumi Nagasue, Hitoshi Kohno, Yu-Chung Chang, Hiroyuki Taniura, Akira Yamanoi, Masaaki Uchida, Yoshinari Takemoto, Yoshinari Makino, and Teruhisa Nakamura. "Repeated Hepatic Dearterialization for Unresectable Liver Metastases From Gastric Cancer: Review of Five Cases." HPB Surgery 8, no. 3 (January 1, 1995): 175–80. http://dx.doi.org/10.1155/1995/96946.

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A novel method of repeated hepatic dearterialization was evaluated in five patients with multiple metastases from gastric cancer in both hepatic lobes. After gastrectomy with extensive lymph node dissection (R2/3), all patients underwent implantation of a vascular occluder around the hepatic artery. Cannulation of the hepatic artery was added for later chemotherapy. The hepatic artery was occluded repeatedly for 1 hour twice daily in combination with intrahepatic infusion of anticancer drugs for as long as possible. Three of five patients demonstrated marked tumour regression with unexpectedly long survival (16 months in two patients and one still alive at 15 months). Carcinoembryonic antigen (CEA) levels decreased to almost normal in four patients who had initially high levels. The present experiences seems to indicate that long survival can be hoped for in patients with advanced gastric cancer with unresectable liver metastases.

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Bradley, N. A., G. Guthrie, and S. Suttie. "A case of dissection in an ACUSEAL-modified HeRO graft." Journal of Vascular Access 21, no. 6 (December 16, 2019): 1045–48. http://dx.doi.org/10.1177/1129729819894465.

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Background: The use of the HeRO system with the early-access ACUSEAL graft avoids the need for a tunnelled dialysis catheter as a bridge for vascular access. Established complications of this system include thrombosis, graft infection, haematoma, and pseudoaneurysm formation. Case Description: A 72-year-old patient found to have a dissection flap at the venous cannulation point (ACUSEAL component) of a right arm HeRO graft. The ACUSEAL was replaced in theatre and subsequent duplex imaging confirmed satisfactory graft function. Conclusion: This case demonstrates a serious yet previously undescribed complication of cannulation of an ACUSEAL graft. The trilaminar construction of the graft may increase the likelihood of disruption of the luminal layer during repeated needling and predispose it to dissection. Given the consequences of graft failure in such patients, urgent intervention is warranted when graft dissection is suspected.

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Gidenne, T., T. Bouyssou, and Y. Ruckebusch. "Sampling of digestive contents by ileal cannulation in the rabbit." Animal Science 46, no. 1 (February 1988): 147–51. http://dx.doi.org/10.1017/s0003356100003214.

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ABSTRACTA technique is described for the collection of digestive contents with a glass T-shaped ileal cannula, in rabbits fed ad libitum. Repeated samples of ileal contents were easily obtained by gravity from conscious animals lying in a hammock for 1 h, twice a week, over a period of 2 months. Analysis of the ileal contents showed no diurnal variations in concentrations of crude protein, neutral-detergent fibre, ammonia, and total short-chain volatile fatty acids. The fresh weight output was maximal at 09.00 h and minimal at 03.00 h. The transit time of phenol sulphone phthalein between mouth and ileum was 75 (s.d. 14) min and did not vary according to the time of day when measured (08.00 to 12.00 h, 14.00 to 18.00 h, 20.00 to 24.00 h).

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Testoni, Pier Alberto, Antonella Giussani, Cristian Vailati, Sabrina Testoni, Milena Di Leo, and Alberto Mariani. "Precut sphincterotomy, repeated cannulation and post-ERCP pancreatitis in patients with bile duct stone disease." Digestive and Liver Disease 43, no. 10 (October 2011): 792–96. http://dx.doi.org/10.1016/j.dld.2011.05.010.

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Petry, A. L., S. A. Gould, and J. F. Patience. "A procedure for dual simple t-cannulation in the small intestine of pigs using a single right flank laparotomy." Journal of Applied Animal Nutrition 8, no. 3 (November 15, 2020): 135–41. http://dx.doi.org/10.3920/jaan2020.0008.

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Singular cannulation in the small intestine of pigs is a common methodology for studying nutrient digestibility, delivering compounds into the gastrointestinal tract, or repeated tissue and digesta sampling. In that respect, it is an important tool for nutritionists and researchers. However, there is a dearth of detailed methodologies describing multiple intestinal cannulations using modern techniques. The objective of this experiment was to develop a single right flank laparotomy technique that allowed for imsertion of multiple cannulas in the small intestine, with minimal variation, and allowed for externalisation of both cannulas on the same lateral side as the laparotomy. Thirty gilts (L337 × Camborough) with an initial body weight of 30.2±0.78 kg underwent the procedure. Each gilt was equipped with a simple t-cannula in the terminal ileum, approximately 10 cm cranial to the ileocecal valve, and a second t-cannula in the jejunum 240 cm distal from where the duodenum is visually posterior to the transverse colon. The procedure used hallmarks of commonly implemented terminal ileal cannulation techniques, but modified the laparotomy location and cannula externalisation sites and used a novel approach for determining the more proximal cannula location to mitigate the need of a second laparotomy. Gilts were allowed to recover for a minimum of 7 d and were used for an average of 67 days in subsequent experimental trials. Cannula longevity was from 30 to 73 kg of body weight. Pigs were necropsied for surgical site gross examination and small intestine measurements at the end of the experiment. The jejunal cannula had a mean placement of 298.90±9.96 cm distal to the pyloric sphincter with a coefficient of variation of 3.33%. Hence, this procedure provided a single laparotomy technique for obtaining digesta from multiple locations of the small intestine, with minimal variation in proximal cannula placement.

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Šigutová, Pavla, Alena Lavičková, and Zdeňka Hajšmanová. "Repeated Administration of Idarucizumab to a Patient with Dabigatran Overdose." Hämostaseologie 38, no. 01 (February 2018): 39–42. http://dx.doi.org/10.5482/hamo-17-03-0015.

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SummaryIdarucizumab is designed to reverse the anticoagulant effect of dabigatran. This case report describes the administration of three independent doses of idarucizumab to a 76-year-old man suffering from atrial flutter being treated with dabigatran to prevent ischaemic stroke. The last dose of dabigatran was administered in the morning of the same day the patient was transferred to hospital because of the need for urgent pericardium puncture. Baseline dTT (dilute thrombin time) reached 700 ng/mL as glomerular filtration (GF) dropped to 0.19 mL/s. The first dose of idarucizumab was administered prior to puncture and the clinical state was stabilized for the next 24 hours although dTT climbed to 400 ng/mL. The need for cannulation before dialysis required a second dose of antidote and a third dose was given prior to removal of the pericardium drain. Monitoring of dabigatran recovery showed that the reverse effect of idarucizumab lasted 12 hours, which is sufficiently long and reliable for urgent situations. Idarucizumab administration is not limited by age and/or renal impairment. We recommend repeated dTT examinations when the dabigatran baseline level exceeds 200 ng/mL and the antidote has been administered.

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Siddiqui, Maruf, Nusrat Ghafoor, Rusmila Shamim Abdullah, Fahmida Naznine, and Vinayak B. Mahajan. "Pregnancy Following Laparoscopy Guided Hysteroscopic Tubal Cannulation in Bilateral Tubal Block After Failed IVF Attempts." Fertility & Reproduction 02, no. 04 (December 2020): 168–70. http://dx.doi.org/10.1142/s2661318220720019.

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Some infertile patients are diagnosed with unilateral or bilateral tubal block by hysterosalpingography (HSG). Laparoscopy is considered as the next step in its investigation and the tubes may be found patent in some of the cases confirming false positive for the HSG. Patients with confirmed bilateral tubal block (BLTB) have no option but to undergo in-vitro fertilization. IVF is a relatively expensive procedure. Many patients in Bangladesh are unable to proceed with repeated attempts if they fail to conceive in the first cycle. A significant proportion of these infertile women remain childless throughout their lives and become psychologically devastated. Laparoscopy guided hysteroscopic tubal cannulation can offer an alternative form of treatment in these groups of patients. Here we report a case in which BLTB was found both in HSG and laparoscopy. The patient then proceeded on to three unsuccessful embryo transfers. Following this, laparoscopy guided hysteroscopic tubal cannulation was performed and it was possible to successfully recanalize one tube. The patient became pregnant and delivered a healthy baby at term.

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Beaudoin, Francesca L., Roland C. Merchant, James Lincoln, Fenwick Gardiner, Otto Liebmann, and Jamieson Cohn. "Bedside ultrasonography detects significant femoral vessel overlap: implications for central venous cannulation." CJEM 13, no. 04 (July 2011): 245–50. http://dx.doi.org/10.2310/8000.2011.110482.

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ABSTRACTObjective:Our goal was to gain a better understanding of the femoral vessel anatomy as it relates to central venous cannulation. The primary objective of this study was to use bedside ultrasonography to determine the amount of exposed femoral vein at three sites corresponding to surface anatomy of the landmark-based procedure.Methods:This cross-sectional study enrolled a random sample of 180 adult patients presenting to a large urban academic emergency department. Subjects underwent standardized ultrasonography to identify and measure the depth and diameter of the femoral vessels and amount of exposed femoral vein at the level of the inguinal ligament (0 cm) 2 cm and 4 cm below. Repeated measures analysis of variance was used to determine significant relationships between vessel measurements and distance from the inguinal ligament.Results:The median age was 44.5 (range 19–90) years; 101 patients were male. The mean (± SD) percentage of exposed vein at the inguinal ligament was 83% (± 21). This decreased significantly (p< 0.01) with increasing distance from the inguinal ligament: 65% (± 25) at 2 cm and 56% (± 30) at 4 cm. At every distance away from the inguinal ligament, there were some subjects with no vein exposed.Conclusion:This study demonstrates significant overlap of the femoral vessels at sites where landmark-based femoral vein cannulation is often attempted. Our results suggest that ultrasound guidance would be beneficial as femoral vein cannulation may be difficult or impossible in certain individuals owing to anatomic variations.

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Shah, Ravish, Tushar J. Vachharajani, and Anil K. Agarwal. "Aneurysmal Dilatation of Dialysis Arteriovenous Access." Open Urology & Nephrology Journal 6, no. 1 (February 6, 2013): 1–5. http://dx.doi.org/10.2174/1874303x01306010001.

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Arteriovenous fistula is considered the “ideal vascular access” in patients with end stage renal disease (ESRD); however, its creation is not without complications. Aneurysmal dilatation is a poorly defined complication which, can potentially lead to access loss and life threatening hemorrhage. Increased venous pressure due to proximal venous stenosis along with repeated cannulations at the same site, are thought to play a significant role in pathogenesis. Given risk of substantial bleeding, it is recommended to avoid cannulation of aneurysmal area; however, as seen in our patient significant numbers of ESRD patients are at risk of being cannulated in the aneurysmal area. Nephrologist taking care of ESRD patients should be aware of its wide clinical spectrum along with signs of “unstable aneurysms” that would mandate an emergent surgical referral. Fistulogram often identifies a high grade proximal stenosis which can be treated by percutaneous angioplasty and perhaps halt the aneurysm progression. Although, endovascular interventions with stent graft placement can be considered in those with pseudoaneurysms related to arteriovenous grafts, it is often an interim measure in an attempt to prolong access longevity. With new surgical techniques and enhanced expertise, it is now possible to salvage the current AV access while simultaneously preserving the precious venous capital for the future AV accesses.

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Ellison, E. C., T. T. Pappas, W. G. Pace, and T. M. O'Dorisio. "Apparatus for long-term ventricular access in the awake canine." Journal of Applied Physiology 61, no. 1 (July 1, 1986): 368–72. http://dx.doi.org/10.1152/jappl.1986.61.1.368.

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An apparatus is described that permits lateral ventricular cerebrospinal fluid (CSF) to be sampled or an infusion to be performed into the ventricular system in the awake canine. The device has been used in 25 dogs. CSF was sampled, and experiments involving infusions into the lateral ventricle were performed over a 6- to 24-mo period. The maximum frequency of ventricular cannulation using the apparatus was once per week. Complications occurred in 10 dogs, all of which were successfully treated, permitting experiments to continue. Three fatal complications included meningitis in one animal at 24 mo and seizures in two animals, causing death at 12 and 18 mo. Administration of peptides, bombesin, and somatostatin into the ventricular system was followed by prompt rises in bombesin and somatostatin radioimmunoactivity in the CSF. There were no parallel increases of these peptides in the peripheral blood levels up to 2 h after infusion. Peptides of this molecular weight infused with this apparatus do not seem to leak into peripheral blood. The apparatus permits repeated ventricular cannulation in the awake canine for sampling of CSF and administration of biological substances to determine specific central nervous system action.

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Cantù, Paolo, Federica Villa, Stefania Baroni, and Sergio Brunati. "Comment to “Precut sphincterotomy, repeated cannulation and post-ERCP pancreatitis in patients with bile duct stone disease”." Digestive and Liver Disease 44, no. 7 (July 2012): 625–26. http://dx.doi.org/10.1016/j.dld.2012.02.011.

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Quale, J. M., N. V. Bergasa, and L. J. Mandel. "Determination of sulfobromophthalein excretion in rabbits." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 254, no. 6 (June 1, 1988): R1043—R1046. http://dx.doi.org/10.1152/ajpregu.1988.254.6.r1043.

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The excretion of sulfobromophthalein (BSP) is determined by hepatic uptake (storage capacity) and secretion (transport maximum). We calculated the BSP excretion data in six rabbits by measuring the rate of rise of BSP at various infusion rates. The relative storage capacity was determined to be 0.34 +/- 0.13 mg.mg-1.dl-1.kg-1. The transport maximum was calculated to be 0.91 +/- 0.12 mg.min-1.kg-1. These results compare closely with previously reported results using more direct measurements that require anesthesia and surgical cannulation of the biliary tree. Repeated studies were easily performed. Our method provides a reliable and simple technique to study the effects of various conditions or substances on BSP excretion in conscious, unanesthetized rabbits.

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Drysdale, David. "The Use of Intranasal Midazolam in a Special Care Dentistry Department: Technique and Cases." Primary Dental Journal 4, no. 2 (May 2015): 42–48. http://dx.doi.org/10.1177/205016841500400215.

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Intranasal (IN) administered midazolam has allowed patients who require conscious sedation but struggle to tolerate cannulation another option by which they can receive dental treatment. Studies have demonstrated that a mean bioavailability ( F) of more than 73% can be achieved with IN-administered midazolam. This is due to the high vascularity within the nose. These studies have also demonstrated that peak plasma concentrations can be reached within 10 minutes. This signifies a fast onset of action. The standard bolus dose of IN midazolam is 10mg; this bolus can be reduced or increased depending on the patient's age and susceptibility to benzodiazepines. The bolus can also be repeated if adequate sedation is not reached. A protocol for administering IN midazolam is outlined and two cases are discussed.

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Amen, Eva Maria, Muriel Brecheisen, Lisa Sach-Peltason, and Alessandra Bergadano. "Refinement of a model of repeated cerebrospinal fluid collection in conscious rats." Laboratory Animals 51, no. 1 (July 10, 2016): 44–53. http://dx.doi.org/10.1177/0023677216646069.

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The cannulation of the cisterna magna in rats for in vivo sampling of cerebrospinal fluid serves as a valuable model for studying the delivery of new drugs into the central nervous system or disease models. It offers the advantages of repeated sampling without anesthesia-induced bias and using animals as their own controls. An established model was retrospectively reviewed for the outcomes and it was hypothesized that by refining the method, i.e. by (1) implementing pathophysiological-based anesthesia and analgesia, (2) using state-of-the-art peri-operative monitoring and supportive care, (3) increasing stability of the cement–cannula assembly, and (4) selecting a more adaptable animal strain, the outcome in using the model – quantified by peri-operative mortality, survival time and stability of the implant – could be improved and could enhance animal welfare. After refinement of the technique, peri-operative mortality decreased significantly (7 animals out of 73 compared with 4 out of 322; P = 0.001), survival time increased significantly (36 ± 14 days compared with 28 ± 18 days; P < 0.001), as well as the stability of the cement–cannula assembly (47 ± 8 days of adhesion compared with 33 ± 15 days and 34 ± 13 days using two other cement types; P < 0.001). Overall, the 3R concept of Russell and Burch was successfully addressed and animal welfare was improved by (1) the reduction in the total number of animals needed as a result of lower mortality or fewer euthanizations due to technical failure, and frequent use of individual rats over a time frame; and (2) improving the scientific quality of the model.

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Ambesh, Sushil P., Jyotish C. Pandey, and Prakash K. Dubey. "Internal Jugular Vein Occlusion Test for Rapid Diagnosis of Misplaced Subclavian Vein Catheter into the Internal Jugular Vein." Anesthesiology 95, no. 6 (December 1, 2001): 1377–79. http://dx.doi.org/10.1097/00000542-200112000-00016.

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Background During subclavian vein catheterization, the most common misplacement of the catheter is cephalad, into the ipsilateral internal jugular vein (IJV). This can be detected by chest radiography. However, after any repositioning of the catheter, subsequent chest radiography is required. In an effort to simplify the detection of a misplaced subclavian vein catheter, the authors assessed a previously published detection method. Methods One hundred adult patients scheduled for subclavian vein cannulation were included in this study. After placement of subclavian vein catheter, chest radiography was performed. While the x-ray film was being processed, the authors performed an IJV occlusion test by applying external pressure on the IJV for approximately 10 s in the supraclavicular area and observed the change in central venous pressure and its waveform pattern. The observations thus obtained were compared with the position of catheter in chest radiographs, and the sensitivity and specificity of this method were evaluated using a 2 x 2 table. Results In 96 patients, subclavian vein cannulation was successfully performed. In four patients, cannulation was unsuccessful; therefore, these patients were excluded from the study. There were six misplacements of venous catheters as detected by radiography. In five (5.2%) patients, the catheter tip was located in the ipsilateral IJV, and in one (1.02%), the catheter tip was located in the contralateral subclavian vein. In the patients who had a misplaced catheter into the IJV, IJV occlusion test results were positive, with an increase of 3-5 mmHg in central venous pressure, whereas the test results were negative in patients who had normally placed catheters or misplacement of a catheter other than in the IJV. There were no false-positive or false-negative test results. Conclusion The IJV occlusion test successfully detects the misplacement of subclavian vein catheter into the IJV. However, it does not detect any other misplacement. The test may allow avoidance of repeated exposure to x-rays after catheter insertion and repositioning.

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Omar, MohammedA, and AlaaA Redwan. "Dose needle-knife precut sphincterotomy and repeated cannulation correlate with post-ERCP pancreatitis in patients with bile duct stone disease?" Egyptian Journal of Surgery 35, no. 1 (2016): 24. http://dx.doi.org/10.4103/1110-1121.176794.

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Pacilli, Maurizio, Catherine J. Bradshaw, and Simon A. Clarke. "Use of 8-cm 22G-long peripheral cannulas in pediatric patients." Journal of Vascular Access 19, no. 5 (March 12, 2018): 496–500. http://dx.doi.org/10.1177/1129729818761278.

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Introduction: Medium-term intravenous access in children is normally achieved by means of repeated multiple peripheral intravenous cannula insertions or peripherally inserted central catheters. Long peripheral cannulas might offer an alternative to these devices in children. Our aim was to clarify whether long peripheral cannulas provide reliable medium-term intravenous access avoiding the need for multiple peripheral intravenous cannulations or peripherally inserted central catheter insertion in children undergoing surgery. Methods: Following ethical approval, we prospectively collected data in children requiring medium-term intravenous access. The 22G-8-cm-long peripheral cannulas were inserted with a Seldinger technique in a peripheral vein. Position was checked by flushing and aspirating the catheter. Results are reported as mean ± standard deviation. Results: A total of 18 children were included. Indications for medium-term intravenous therapy included perforated appendicitis (n = 14), infected central venous port (n = 2), fungal infection (n = 1) and septic arthritis (n = 1). In all, 15 (83%) patients underwent the procedure under general anaesthetic. The procedure failed in an 8-year-old patient. Insertion time was 8 ± 3.7 min. Age at insertion was 6.3 ± 4.9 years. Duration of intravenous therapy was 6.4 ± 5.1 days. About 13 (76%) patients completed the treatment with no complications. Three (17%) lines occluded by day 3 needed removal; one (7%) line needed removal on day 3 because of redness/pain noted around the insertion site. Conclusion: Long peripheral cannulas represent a valid option for medium-term intravenous access in children undergoing surgery. Majority of patients will be successfully treated with one long peripheral cannula for the duration of their treatment without the need for further cannulation.

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Zoghbi, Sami S., and Alexander Gottschalk. "206 THE CHRONIC CANNULATION OF RAT JUGULAR VEIN TO INSURE INTRAVENOUS INJECTION AND TO SIMPLIFY REPEATED DOSE DELIVERY OR BLOOD WITHDRAWAL." Investigative Radiology 21, no. 9 (September 1986): S52. http://dx.doi.org/10.1097/00004424-198609000-00224.

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Frank, Edmund, Erik Kohler, and Larry Hein. "A Modification of the Brown-Roberts-Wells Stereotactic Frame for Implantation of Ventricular Access Reservoirs." Neurosurgery 25, no. 5 (November 1, 1989): 839–42. http://dx.doi.org/10.1227/00006123-198911000-00028.

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Abstract A ventricular catheter and connected subcutaneous reservoir (ventricular access reservoir) allows easy, repeated access to the cerebrospinal fluid for a multitude of purposes. In situations in which the ventricles are small or displaced, insertion of a ventricular catheter may be difficult. Multiple passes to cannulate the ventricle may damage the brain and manipulation of the catheter and reservoir may cause migration of the catheter, possibly compromising its function. A stereotactic method for insertion of ventricular access reservoirs using a device that attaches to the Brown-Roberts-Wells stereotactic system has been developed. With this device the catheter and reservoir are guided into place as a single unit, utilizing a guide attached to the Brown-Roberts-Wells frame. This technique has been useful in inserting ventricular access reservoirs into patients with small ventricles or in whom there is some abnormality of the brain or skull that renders classical landmarks for ventricular cannulation useless.

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Archibugi, Livia, Alberto Mariani, Gabriele Capurso, Mariaemilia Traini, Maria Chiara Petrone, Gemma Rossi, Sabrina Gloria Giulia Testoni, Pier Alberto Testoni, and Paolo Giorgio Arcidiacono. "Needle-knife fistulotomy vs. standard biliary sphincterotomy for choledocholithiasis: common bile duct stone recurrence and complication rate." Endoscopy International Open 07, no. 12 (December 2019): E1733—E1741. http://dx.doi.org/10.1055/a-1024-3789.

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Abstract Background and study aims With common bile duct (CBD) stones, access to the CBD can be achieved through the papilla orifice followed by standard biliary sphincterotomy (SBS), or through precut fistulotomy (PF) in case of difficult cannulation. The two methods alter papilla anatomy differently, potentially leading to a different rate of stone recurrence. No data have been published on stone recurrence after PF in patients with CBD stones. The aim of this study was to evaluate CBD stone recurrence, reintervention rate after PF versus SBS, and complications. Patients and methods This was a retrospective single-center cohort study including patients undergoing for the first time endoscopic retrograde cholangiopancreatography (ERCP) for CBD stones with PF in case of failed repeated cannulation attempts, matched for sex/age to patients with SBS randomly extracted from our database. T-test and Fisher’s tests were used for continuous and categorical variable comparison. Recurrence probability was calculated with Kaplan–Meier curve. Factors associated with ERCP repetition were evaluated with logistic regression through a Cox’s proportional hazards model. Results Eighty-five patients with PF were included, with 85 matched controls (mean age 68.7 years, 45.9 % males). Overall, patients with PF had the same reintervention rate as those with SBS (14.1 % vs. 12.9 %) with a hazard ratio (HR) of 1.11 (95 % CI 0.49 – 2.50; P = 0.81), but mean time to reintervention was significantly lower (74.9 ± 74.6 vs. 765.6 ± 961.3 days; P < 0.0001), with 100 % of stones recurring within the first year in the PF group vs. 54.5 % in the SBS group (P = 0.01). The only factor associated with ERCP repetition risk was incomplete CBD clearing. Complications, including pancreatitis, did not differ significantly. Conclusions The reintervention rate was significantly higher in the short term after PF. Therefore, closer follow-up in the first 6 to 12 months after ERCP might be appropriate for patients underoing PF.

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Guenette, Jordan A., William R. Henderson, Paolo B. Dominelli, Jordan S. Querido, Penelope M. Brasher, Donald E. G. Griesdale, Robert Boushel, and A. William Sheel. "Blood flow index using near-infrared spectroscopy and indocyanine green as a minimally invasive tool to assess respiratory muscle blood flow in humans." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 300, no. 4 (April 2011): R984—R992. http://dx.doi.org/10.1152/ajpregu.00739.2010.

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Near-infrared spectroscopy (NIRS) in combination with indocyanine green (ICG) dye has recently been used to measure respiratory muscle blood flow (RMBF) in humans. This method is based on the Fick principle and is determined by measuring ICG in the respiratory muscles using transcutaneous NIRS in relation to the [ICG] in arterial blood as measured using photodensitometry. This method is invasive since it requires arterial cannulation, repeated blood withdrawals, and reinfusions. A less invasive alternative is to calculate a relative measure of blood flow known as the blood flow index (BFI), which is based solely on the NIRS ICG curve, thus negating the need for arterial cannulation. Accordingly, the purpose of this study was to determine whether BFI can be used to measure RMBF at rest and during voluntary isocapnic hyperpnea at 25, 40, 55, and 70% of maximal voluntary ventilation in seven healthy humans. BFI was calculated as the change in maximal [ICG] divided by the rise time of the NIRS-derived ICG curve. Intercostal and sternocleidomastoid muscle BFI were correlated with simultaneously measured work of breathing and electromyography (EMG) data from the same muscles. BFI showed strong relationships with the work of breathing and EMG for both respiratory muscles. The coefficients of determination ( R2) comparing BFI vs. the work of breathing for the intercostal and sternocleidomastoid muscles were 0.887 ( P < 0.001) and 0.863 ( P < 0.001), respectively, whereas the R2 for BFI vs. EMG for the intercostal and sternocleidomastoid muscles were 0.879 ( P < 0.001) and 0.930 ( P < 0.001), respectively. These data suggest that the BFI closely reflects RMBF in conscious humans across a wide range of ventilations and provides a less invasive and less technically demanding alternative to measuring RMBF.

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Ohshita, Naohiro, Kaname Tsuji, Hiroaki Yoshida, Hiroki Shibata, Yoshiko Matsuda, Yasuo M. Tsutsumi, and Yoshihiro Momota. "Anesthetic Management of Patient With Dravet Syndrome: A Case Report." Anesthesia Progress 66, no. 3 (September 1, 2019): 156–58. http://dx.doi.org/10.2344/anpr-66-02-03.

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Dravet syndrome (DS) is a rare and severe form of epilepsy that begins in infancy. This is particularly burdensome because repeated epileptic seizures lead to cognitive decline. We describe the case of a 12-year-old girl who was diagnosed with DS and was scheduled to have gingival reduction around her mandibular molars. Despite the patient being intellectually disabled, she was able to cooperate somewhat during medical procedures, including intravenous cannulation. Under the assumption that the major problem with anesthesia for DS would be the regulation of body temperature–induced seizures, we used body temperature management equipment to maintain the patient's body temperature during the procedure. We opted for intravenous sedation and administered a total dose of 4.5 mg midazolam throughout the procedure. Anesthesia was completed within 1 hour and 20 minutes without any adverse events. To the best of our knowledge, no previous studies have documented the anesthetic management of DS. In this case, no adverse events occurred perioperatively. However, the patient's temperature rose to that which indicated a slight fever despite the use of a standard cooling technique.

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Coe, J. Y., P. M. Olley, F. Hamilton, T. Vanhelder, and F. Coceani. "A method to study pulmonary vascular response in the conscious newborn piglet." Canadian Journal of Physiology and Pharmacology 65, no. 5 (May 1, 1987): 785–90. http://dx.doi.org/10.1139/y87-126.

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New methods for chronic instrumentation of the newborn piglet are described, which allow continuous monitoring of not only pressures in the pulmonary artery and aorta but also in the left and right atria, pulmonary vein, as well as main branch pulmonary artery flows. Changes in pulmonary vascular tone to short-acting vasoactive agents can be recognized by redistribution of flow between lungs and localized to the precapillary vessels or pulmonary veins. Furthermore, vasoactive response in small pulmonary veins may be investigated as well as selective metabolic studies across the right lung. Methods are also described for the chronic cannulation of the neck vessels permitting repeated introduction of catheters on separate study days in the conscious piglet. The pulmonary circulation of the piglet constricts briskly to moderate hypoxemia ([Formula: see text], 1 Torr = 133.32 Pa) with little change in cardiac output or systemic resistance. The piglet demonstrated responses to dilator and constrictor prostaglandins generally similar to the lambs and other species. None of these agents significantly affect pulmonary venous tone.

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Tominaga, Masamune, Thomas A. Stekiel, Zeljko J. Bosnjak, and John P. Kampine. "Contribution of carotid chemoreceptors to mesenteric venoconstriction during acute hypercapnia in rabbits." American Journal of Physiology-Heart and Circulatory Physiology 277, no. 6 (December 1, 1999): H2305—H2310. http://dx.doi.org/10.1152/ajpheart.1999.277.6.h2305.

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The contribution of carotid chemoreceptors to hypercapnia-induced mesenteric venoconstriction was examined in 12 α-chloralose-anesthetized rabbits (1.0–1.6 kg). Surgical preparation consisted of a tracheotomy, femoral arterial and venous cannulation, and a midline laparotomy through which a 13-cm loop of ileum was exteriorized and superfused with physiological salt solution. Mesenteric vein diameter and intravenous pressure (using a servo-null measurement system) were measured in 500- to 1,000-μm mesenteric veins during 40-s periods of 15%, 20%, and 25% CO2 inhalation. Measurements were then repeated following bilateral ablation of the carotid chemoreceptors. Before denervation, mesenteric vein diameter constricted 6.5 ± 1.1%, 11.9 ± 1.1%, and 17.9 ± 2.2% during the 15%, 20%, and 25% CO2 inhalation, respectively. After denervation, these values were reduced to 5.0 ± 0.9%, 6.9 ± 1.2%, and 8.4 ± 1.3%, respectively. We conclude that activation of the carotid chemoreceptors by hypercapnia induces active mesenteric venoconstriction. After denervation of the carotid baroreceptors and chemoreceptors, there was also a small decrease in venule diameter proportional to the level of inspired CO2. We further conclude that noncarotid body chemoreceptor activation contributes to mesenteric venular constriction.

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Nowakowski, Przemyslaw, Piotr Buszman, Stefan Kiesz, and Pawel Buszman. "Iatrogenic occlusion of bilateral jugular veins, subclavian vein, and superior vena cava after repeated jugular cannulation associated with Arnold-Chiari malformation: Successful endovascular treatment." Journal of Vascular Surgery Cases and Innovative Techniques 6, no. 1 (March 2020): 18–20. http://dx.doi.org/10.1016/j.jvscit.2019.09.006.

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Hermann, Elvis J., Hans-Holger Capelle, Christoph A. Tschan, and Joachim K. Krauss. "Electromagnetic-guided neuronavigation for safe placement of intraventricular catheters in pediatric neurosurgery." Journal of Neurosurgery: Pediatrics 10, no. 4 (October 2012): 327–33. http://dx.doi.org/10.3171/2012.7.peds11369.

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Object Ventricular catheter shunt malfunction is the most common reason for shunt revision. Optimal ventricular catheter placement can be exceedingly difficult in patients with small ventricles or abnormal ventricular anatomy. Particularly in children and in premature infants with small head size, satisfactory positioning of the ventricular catheter can be a challenge. Navigation with electromagnetic tracking technology is an attractive and innovative therapeutic option. In this study, the authors demonstrate the advantages of using this technology for shunt placement in children. Methods Twenty-six children ranging in age from 4 days to 14 years (mean 3.8 years) with hydrocephalus and difficult ventricular anatomy or slit ventricles underwent electromagnetic-guided neuronavigated intraventricular catheter placement in a total of 29 procedures. Results The single-coil technology allows one to use flexible instruments, in this case the ventricular catheter stylet, to be tracked at the tip. Head movement during the operative procedure is possible without loss of navigation precision. The intraoperative catheter placement documented by screenshots correlated exactly with the position on the postoperative CT scan. There was no need for repeated ventricular punctures. There were no operative complications. Postoperatively, all children had accurate shunt placement. The overall shunt failure rate in our group was 15%, including 3 shunt infections (after 1 month, 5 months, and 10 months) requiring operative revision and 1 distal shunt failure. There were no proximal shunt malfunctions during follow-up (mean 23.5 months). Conclusions The electromagnetic-guided neuronavigation system enables safe and optimal catheter placement, especially in children and premature infants, alleviating the need for repeated cannulation attempts for ventricular puncture. In contrast to stereotactic techniques and conventional neuronavigation, there is no need for sharp head fixation using a Mayfield clamp. This technique may present the possibility of reducing proximal shunt failure rates and costs for hydrocephalus treatment in this age cohort.

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Al-Anazi, Abdul, and Mark Bernstein. "Modified stereotactic insertion of the Ommaya reservoir." Journal of Neurosurgery 92, no. 6 (June 2000): 1050–52. http://dx.doi.org/10.3171/jns.2000.92.6.1050.

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✓ Ommaya reservoirs are used primarily for the repeated injection of intrathecal chemotherapy for leptomeningeal metastasis from hematopoietic and solid malignancies. Insertion of this device in a relatively large nondisplaced ventricle is not a difficult task, but challenges arise when the ventricle is small and/or displaced. Different techniques have been developed to overcome this difficulty, most of which include the use of stereotactic frames. Further improvements would be beneficial.The technique described in this paper depends on a stereotactic frame; however, the modification proposed by the authors removes the arc system from the surgical field before the actual surgical procedure is begun. Removal of the arc improves access to the surgical field as well as preparation and draping of the surgical site and minimizes potential breaks in sterile technique, which ultimately reduces the incidence of infection. A twist-drill hole along the path of the chosen trajectory becomes an external guide for the ventricular catheter. The technique is easy, user friendly, and results in an unencumbered sterile field and reliable cannulation of small ventricles.A simple stereotactic technique for Ommaya reservoir insertion has been described. It should lower the chance of infection in this group of patients, most of whom have suppressed immune systems.

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Wang, Yan, Xiujuan Fu, Lifang Huang, Xi Wang, Zuneng Lu, Fan Zhu, and Zheman Xiao. "Increased Asics Expression via the Camkii-CREB Pathway in a Novel Mouse Model of Trigeminal Pain." Cellular Physiology and Biochemistry 46, no. 2 (2018): 568–78. http://dx.doi.org/10.1159/000488624.

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Background/Aims: Migraine is a disabling condition that severely impacts socioeconomic function and quality of life. The focus of this study was to develop a mouse model of trigeminal pain that mimics migraine. Methods: After undergoing dural cannulation surgery, mice were treated with repeated dural doses of an acidic solution to induce trigeminal pain. Results: The method elicited intermittent, head-directed wiping and scratching as well as the expression of both the c-FOS gene in the spinal trigeminal nucleus caudalis and calcitonin gene related peptide (CGRP) in the periaqueductal grey matter. Interestingly, the acid-induced trigeminal pain behaviour was inhibited by amiloride, an antagonist of acid-sensing ion channels (ASICs), but not by AMG-9810, an inhibitor of transient receptor potential cation channel V1(TRPV1). In addition, the relative mRNA and protein expression levels of ASIC1a and ASIC3 were increased in the acid-induced trigeminal nociceptive pathways. Furthermore, blocking CaMKII with KN-93 significantly reduced the acid-induced trigeminal pain behaviour and c-FOS gene expression. Conclusion: The data suggested that chronic intermittent administration of an acidic solution to mice resulted in trigeminal hypersensitivity and that dural acid-induced trigeminal pain behaviour in mice may mechanistically mimic migraine. The observations here identify an entirely novel treatment strategy for migraine.

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Salinger-Martinovic, Sonja, Sinisa Stojkovic, Milan Pavlovic, Zoran Perisic, Slobodan Obradovic, Svetlana Apostolovic, Milan Zivkovic, and Nenad Bozinovic. "Successful retrieval of an unexpanded coronary stent from the left main coronary artery during primary percutaneous coronary intervention." Srpski arhiv za celokupno lekarstvo 139, no. 9-10 (2011): 669–72. http://dx.doi.org/10.2298/sarh1110669s.

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Introduction. Dislodgement and embolization of the new generation of coronary stents before their deployment are rare but could constitute a very serious complication. Case Outline. We report a case of a stent dislodgement into the left main coronary artery during the primary coronary intervention of infarct related left circumflex artery in a patient with acute myocardial infarction. The dislodged and unexpanded bare-metal stent FlexMaster 3.0x19 mm (Abbot Vascular) was stranded and bended in the left main coronary artery (LMCA), probably by the tip of the guiding catheter, but stayed over the guidewire. It was successfully retrieved using a low-profile Ryujin 1.25x15 balloon catheter (Terumo) that was passed through the stent, inflated and then pulled back into the guiding catheter. After that, the whole system was withdrawn through the 6 F arterial sheath via the transfemoral approach. After repeated cannulation via the 6F arterial sheath, additional BMW and ATW guidewires were introduced into the posterolateral and obtuse marginal branches and a bare-metal stent Driver (Medtronic Cardiovascular Inc) 3.0x18 mm was implanted in the target lesion. Conclusion. Stent dislodgement is a rare but potentially life-threatening complication of the percutaneous coronary intervention. This incident occurring in the LMCA in particular during an acute myocardial infarction requires to be urgently resolved. The avoidance of rough manipulation with the guiding catheter and delivery system may help in preventing this kind of complications.

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Elias, Agustin, Carlos Casado, Ana Mayordomo, Rianseres Garcia, Diego Solis, and Blanca Ramirez. "Anticoagulation management in neonatal and pediatric ECMO." Revista Española de Perfusión, no. 67 (December 2019): 29–36. http://dx.doi.org/10.36579/rep.2019.67.3.

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Introduction: Despite significant advances in the materials, components and techniques used for extracorporeal life support in recent years, the management of anticoagulation in ECMO remains controversial, the objective of this protocol is to develop an update for anticoagulation and its control for infants ECMO. Development: Unfractionated heparin is the drug of choice for anticoagulation in ECMO. The heparin dose used in pediatrics have been mostly adapted from the experience in adults without a corresponding validation, as well as limiting the absence of randomized clinical trials in children. After the assessment of the patient and a possible correction of coagulopathies, prior to establishment of ECMO, as well as decide the administration of a heparin bolus of 50-100 IU/kg of body weight at the time prior to cannulation. At 5-10’ of beginning ECMO a ACT control is made, if the value is greater than 300 sg, ACT is repeated at 30-60’. Once the ACT is less than 300, an infusion starts between 10-20 IU/kg/h, in the absence of major bleeding. Controls will be carried out every 30’ to stabilize the ACT in the chosen range. For the control, the ACT will be used, mainly, and the APTT, with better results the higher the child's age, although the anti-Xa test is the only laboratory test that shows a strong correlation with the heparin dose administered in ECMO.

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Uluer, Mehmet S., Mehmet Sargin, and Betül Başaran. "Comparison of the effect of the right lateral tilt position and Trendelenburg position on the right internal jugular vein in healthy volunteers: A prospective observational study." Journal of Vascular Access 20, no. 6 (April 12, 2019): 672–76. http://dx.doi.org/10.1177/1129729819838169.

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Background: Central venous cannulation is an invasive procedure commonly used by many physicians. The aim of this study was to evaluate the effects of the right lateral tilt position on the cross-sectional area and size of the right internal jugular vein, and the relationship between the right internal jugular vein and the carotid artery. Method: Forty healthy volunteers aged over 18 years were included in this prospective, observational study. The right internal jugular vein cross-sectional area and the anatomic relationship with the carotid artery were assessed using ultrasound imaging. This measurement was repeated for four positions (baseline position, 10° right tilt position, 10° Trendelenburg position, and 10° right tilt + 10° Trendelenburg position). The head was rotated 30° to the contralateral side in all patients. Results: The mean (standard deviation) right internal jugular vein cross-sectional area, transverse diameter, and anteroposterior diameter were significantly increased with the Trendelenburg position and 10° right tilt + 10° Trendelenburg position (p < 0.05). There were no significant differences in right internal jugular vein cross-sectional area, transverse diameter, and anteroposterior diameter between the baseline position and 10° right tilt position (p > 0.05). Conclusion: We found that the right lateral tilt position had no effect on the internal jugular vein cross-sectional area and that the Trendelenburg position was still the most valid position for safely increasing the right internal jugular vein cross-sectional area.

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Sievert, C. E., T. J. Potter, A. S. Levine, J. E. Morley, S. E. Silvis, and J. A. Vennes. "Effect of bombesin and gastrin-releasing peptide on canine sphincter of Oddi." American Journal of Physiology-Gastrointestinal and Liver Physiology 254, no. 3 (March 1, 1988): G361—G365. http://dx.doi.org/10.1152/ajpgi.1988.254.3.g361.

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This study reports the effects of bombesin and gastrin-releasing peptide (GRP) on the canine sphincter of Oddi using a method that allows repeated cannulation of the biliary sphincter in the unanesthetized animal through a Thomas cannula placed opposite the biliary papilla. Immediately after intravenous administration of bombesin or GRP, phasic sphincter contractions disappeared, basal sphincter pressures fell, and common bile duct pressures rose. Because bombesin releases cholecystokinin (CCK) and CCK resulted in a similar pattern to that of bombesin, the bombesin effect on the sphincter of Oddi may have been secondary to CCK's effect on the sphincter. To test if the bombesin effect on the sphincter of Oddi was due to the release of CCK, we blocked CCK release by administration of somatostatin, having first established that somatostatin blocked endogenous CCK release in our animal model by use of an intraduodenal infusion of lipid. Exogenous administration of bombesin failed to alter sphincter of Oddi or common bile duct pressures in dogs treated with somatostatin. Somatostatin did not, however, block CCK's effect on gallbladder contraction, since exogenous administration of CCK after somatostatin injection resulted in the pressure changes in the biliary tree typical of CCK-induced gallbladder contraction. Thus bombesin administration appears to result in sphincter relaxation and gallbladder contraction by the release of endogenous CCK rather than by a direct effect. The increase in common bile duct pressures was due to gallbladder contraction, since this rise in pressure was abolished by cholecystectomy. The peptide effect on sphincter contraction and basal sphincter pressure were unaffected by cholecystectomy.

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Lewis, Johanne M., Tiago S. Hori, Matthew L. Rise, Patrick J. Walsh, and Suzanne Currie. "Transcriptome responses to heat stress in the nucleated red blood cells of the rainbow trout (Oncorhynchus mykiss)." Physiological Genomics 42, no. 3 (August 2010): 361–73. http://dx.doi.org/10.1152/physiolgenomics.00067.2010.

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The retention of a nucleus in the mature state of fish red blood cells (RBCs) and the ability to easily collect and manipulate blood in nonterminal experiments make blood an ideal tissue on which to study the cellular stress response in fish. Through the use of the cGRASP 16K salmonid microarray, we investigated differences in RBC global gene transcription in fish held under control conditions (11°C) and exposed to heat stress (1 h at 25°C followed by recovery at 11°C). Repeated blood sampling (via a dorsal aorta cannula) enables us to examine the individual stress response over time. Samples were taken preheat stress (representing individual control) and at 4 and 24 h postheat stress (representing early and late transcriptional regulation). Approximately 3,000 microarray features had signal above threshold when hybridized with RBC RNA-derived targets, and cannulation did not have a detectable effect on RBC mRNA expression at the investigated time points. Genes involved in the stress response, immune response, and apoptosis were among those showing the highest dysregulation during both early and late transcriptional regulation. Additionally, genes related to the differentiation and development of blood cells were transcriptionally upregulated at the 24 h time point. This study provides a broader understanding of the mechanisms underpinning the stress response in fish and the discovery of novel genes that are regulated in a stress specific manner. Moreover, salmonid transcripts that are consistently dysregulated in blood in response to heat stress are potential candidates of nonlethal biomarkers of exposure to this particular stressor.

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Vijayan, M. M., and T. W. Moon. "The stress response and the plasma disappearance of corticosteroid and glucose in a marine teleost, the sea raven." Canadian Journal of Zoology 72, no. 3 (March 1, 1994): 379–86. http://dx.doi.org/10.1139/z94-054.

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The objective of the study was to examine the physiological response to stress in a marine species with a sluggish life-style. The sea raven (Hemitripterus americanus), a marine benthic predator, did not produce elevated catecholamine levels when handled for blood removal, which facilitated repeated blood sampling from the same fish without cannulation. However, this species did release catecholamines in response to an acute stress (1 min of air exposure followed by 1 min of chasing), suggesting a high threshold (degree of external stimulation) for catecholamine release in this species. Plasma cortisol concentration increased significantly only after 1 h and remained elevated 4 h post-stress, showing a delayed response compared with salmonids. Plasma glucose concentration increased significantly at 0.5 h post-stress and remained elevated even at 24 h, while lactate levels dropped between 4 and 24 h post-stress. The delayed cortisol increase may not be due to altered plasma clearance, as no change in the plasma disappearance or tissue uptake of cortisol-derived radioactivity occurred with confinement stress in this species. Also, confinement stress did not alter the plasma disappearance or tissue uptake of radioactivity derived from glucose, indicating a higher production of glucose during stress. Food deprivation significantly increased the plasma disappearance and tissue uptake of both cortisol- and glucose-derived radioactivity in the sea raven. These results indicate that the hormonal response to stress in the sea raven is different from that of salmonids. This altered response may be an adaptation to prevent excess energy mobilization in a species with an inactive life-style and low metabolic activity.

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Karzai, Waheedullah, Jörg Haberstroh, Wolfgang Müller, and Hans-Joachim Priebe. "Rapid increase in inspired desflurane concentration does not elicit a hyperdynamic circulatory response in the pig." Laboratory Animals 31, no. 3 (July 1, 1997): 279–82. http://dx.doi.org/10.1258/002367797780596257.

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The effects of a rapid increase in inspired desflurane concentration on systemic haemodynamics and plasma catecholamines were studied in seven pigs (22-30 kg). Following premedication (flunitrazepam 0.4 mg/kg i.m.), anaesthesia was induced (propofol 2.5 mg/kg i.v., vecuronium 0.2 mg/kg i.v.), the trachea orally intubated, and ventilation controlled. Anaesthesia was maintained with N2O/O2 (70%/30%), propofol (50 μg/kg/min), desflurane 12% end-tidal concentration), and vecuronium (0.3 mg/kg/h). After cannulation of both femoral arteries for subsequent simultaneous systemic pressure measurements and blood sampling for determination of epinephrine (E) and norepinephrine (NE) plasma levels, N2O and propofol were discontinued, and FiO2 and end-tidal concentration of desflurane increased to >0.9 and 3%, respectively. Forty minutes later, the inspired concentration of desflurane was abruptly increased to 15%. Mean arterial pressure (MAP), heart rate (HR), and plasma concentrations of E and NE were determined before and 1, 2, 4, 8, 16, and 32 min after increasing the desflurane concentration. Plasma concentrations of E and NE were determined by high performance liquid chromatography (HPLC) with electrochemical detection. Data were analysed by repeated measures ANOVA (significance level P<0.05). The abrupt increase in inspired desflurane concentration caused an insignificant increase (11%) in HR at 1, 2 and 4 min. There was an immediate decrease in MAP. Plasma levels of E and NE remained unchanged throughout. In conclusion, in contrast to findings in humans, a rapid increase in inspired desflurane concentration does not cause a hyperdynamic circulatory response in the pig.

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Hogan, Quinn H., Alexander Kulier, Zeljko J. Bosnjak, and John P. Kampine. "Sympathetic and Mesenteric Venous Responses to Baroreceptor or Chemoreceptor Stimulation during Epidural Anesthesia in Rabbits." Anesthesiology 85, no. 6 (December 1, 1996): 1413–21. http://dx.doi.org/10.1097/00000542-199612000-00023.

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Background Baroreceptor and chemoreceptor reflexes maintain homeostasis through mechanisms that involve sympathetic activation. Because sympathetic control of the mesenteric veins plays a central role in hemodynamic responses to stress, the effects of epidural blockade on reflex responses to hypoxia and bilateral carotid occlusion (BCO) were examined by monitoring direct measures of splanchnic sympathetic neural traffic and mesenteric venous capacitance. Methods Rabbits were studied during alpha-chloralose anesthesia and mechanical ventilation. Sympathetic efferent nerve activity to the mesenteric vessels was measured by surgically placed electrodes, and mesenteric venous diameter was measured by videomicroscopy. Heart rate and mean arterial pressure were monitored by intraarterial cannulation. Intraluminal venous pressure was monitored by a servo-null micropressure technique. Responses were recorded during repeated administration of three different stresses, F1O2 = 0% for 40 s, F1O2 = 11% for 2.5 min, and BCO for 60 s. Animals received either thoracolumbar epidural blockade (0.4 ml/kg lidocaine 1.5%; n = 7) or 15 mg/kg intramuscular lidocaine (n = 7). Results Hypoxia and BCO produced sympathetic stimulation and active constriction of mesenteric veins. Epidural anesthesia accentuated the mean arterial pressure decrease from F1O2 of 0%, caused the 11% response to F1O2 to become depressor instead of pressor, and decreased the pressor effect BCO. Sympathetic efferent nerve activity and venous diameter responses to hypoxia and BCO were attenuated or eliminated. Conclusions The hemodynamic effects of hypoxia result from a combination of direct depression and reflex activation. Thoracolumbar epidural anesthesia in rabbits impairs compensatory reflexes invoked by chemoreceptor stimulation and eliminates response to baroreceptor stimulation. Loss of splanchnic control of mesenteric capacitance contributes to the inhibition of the hemodynamic response to hypoxia or BCO during epidural anesthesia in rabbits.

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Journal articles on the topic 'Repeated cannulation'

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