6 research outputs found
Optimization of Cannula Visibility during Ultrasound-Guided Subclavian Vein Catheterization, via a Longitudinal Approach, by Implementing Echogenic Technology
Objective. One limitation of ultrasound-guided vascular access is the technical challenge of visualizing the cannula during insertion into the vessel. We hypothesized that the use of an echogenic vascular cannula (EC) would improve visualization when compared with a nonechogenic vascular cannula (NEC) during real-time ultrasound-guided subclavian vein (SCV) cannulation in the ICU. Material and Methods. Eighty mechanically ventilated patients were prospectively enrolled in a randomized study that was conducted in a medical-surgical ICU. Forty patients underwent EC and 40 patients were randomized to NEC. The procedure was ultrasound-guided SCV cannulation via the infraclavicular approach on the longitudinal axis. Results. The EC group exhibited increased cannula visibility as compared to the NEC group (92%±3% versus 85 ± 7%, resp., P < 0.01). There was strong agreement between the procedure operators and independent observers (k = 0.9, 95% confidence intervals assessed by bootstrap analysis = 0.87 to 0.93; P < 0.01). Access time (12.1 s ± 6.5 versus 18.9 s ± 10.9) and the perceived technical difficulty of the ultrasound method (4.5 ± 1.5 versus 7.5 ± 1.5) were both decreased in the EC group compared to the NEC group (P < 0.05). Conclusions. Echogenic technology significantly improved cannula visibility and decreased access time and technical complexity optimizing thus real-time ultrasound-guided SCV cannulation via a longitudinal approach
Risk Factors for Acute Adverse Events During Ultrasound-guided Central Venous Cannulation in the Emergency Department
Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: A prospective randomized study
Objective: Subclavian vein catheterization may cause various
complications. We compared the real-time ultrasound-guided subclavian
vein cannulation vs. the landmark method in critical care patients.
Design: Prospective randomized study.
Setting: Medical intensive care unit of a tertiary medical center.
Patients: Four hundred sixty-three mechanically ventilated patients
enrolled in a randomized controlled ISRCTN-registered trial
(ISRCTN-61258470).
Interventions: We compared the ultrasound-guided subclavian vein
cannulation (200 patients) vs. the landmark method (201 patients) using
an infraclavicular needle insertion point in all cases. Catheterization
was performed under nonemergency conditions in the intensive care unit.
Randomization was performed by means of a computer-generated
random-numbers table and patients were stratified with regard to age,
gender, and body mass index.
Measurements and Main Results: No significant differences in the
presence of risk factors for difficult cannulation between the two
groups of patients were recorded. Subclavian vein cannulation was
achieved in 100% of patients in the ultrasound group as compared with
87.5% in the landmark one (p <.05). Average access time and number of
attempts were significantly reduced in the ultrasound group of patients
compared with the landmark group (p <. 05). In the landmark group,
artery puncture and hematoma occurred in 5.4% of patients,
respectively, hemothorax in 4.4%, pneumothorax in 4.9%, brachial
plexus injury in 2.9%, phrenic nerve injury in 1.5%, and cardiac
tamponade in 0.5%, which were all increased compared with the
ultrasound group (p <. 05). Catheter misplacements did not differ
between groups. In this study, the real-time ultrasound method was rated
on a semiquantitative scale as technically difficult by the
participating physicians.
Conclusions: The present data suggested that ultrasound-guided
cannulation of the subclavian vein in critical care patients is superior
to the landmark method and should be the method of choice in these
patients. (Crit Care Med 2011; 39: 1607-1612
Peripheral T-cell lymphoma presenting as an ischemic stroke in a 23-year-old woman: a case report and review of the literature
<p>Abstract</p> <p>Introduction</p> <p>Peripheral T-cell lymphoma of the unspecified variant is a highly aggressive subtype of T-cell non-Hodgkin's lymphoma. This is the first reported case of this type of lymphoma presenting as an ischemic stroke in a woman.</p> <p>Case presentation</p> <p>A previously healthy 23-year-old woman presented with fever and hemiplegia. She was subsequently intubated after scoring 7 out of 15 at the Glasgow Coma Scale. Brain computed tomography scans of the patient depicted a massive sylvian infarction while an abdominal computed tomography scan revealed multiple enlarged abdominal lymph nodes and a retroperitoneal mass adjacent to the left psoas muscle. A diagnostic work up for inherited thrombophilia yielded negative results. Blood and cerebrospinal fluid cultures for infectious agents also gave negative results. A biopsy of the retroperitoneal mass guided by computed tomography was inconclusive. A biopsy of an enlarged inguinal lymph node of the patient, combined with an immunophenotypic analysis, revealed an unspecified variant of peripheral T-cell lymphoma. The patient underwent chemotherapy but developed multiple organ failure. She died 26 days after she was admitted to our intensive care unit.</p> <p>Conclusion</p> <p>Peripheral T-cell lymphoma of the unspecified variant is a highly aggressive subtype of peripheral T-cell lymphomas. The latter exhibit no consistent immunophenotypic, genetic, or clinical features. Clinicians should be aware of atypical clinical presentations of the above lymphomas such as ischemic stroke.</p