Tapping but Not Massage Enhances Vasodilation and Improves Venous Palpation of Cutaneous Veins

This paper investigated whether tapping on the median cubital vein or massaging the forearm was more effective in obtaining better venous palpation for venipuncture. Forty healthy volunteers in their twenties were subjected to tapping (10 times in 5 sec) or massage (10 strokes in 20 sec from the wrist to the cubital fossa) under tourniquet inflation on the upper arm. Venous palpation was assessed using the venous palpation score (0-6, with 0 being impalpable). Three venous factors―venous depth, cross-sectional area, and elevation―were also measured using ultrasonography. The venous palpation score increased significantly by tapping but not by massage. Moreover, all 3 venous measurements changed significantly by tapping, while only the depth decreased significantly by massage. The three venous measurements correlated significantly with the venous palpation score, indicating that they are useful objective indicators for evaluating vasodilation. We suggest that tapping is an effective vasodilation technique

Relationship between Tourniquet Pressure and a Cross-Section Area of Superficial Vein of Forearm

This study investigated the appropriate tourniquet pressure (TP) and duration of tourniquet application for venipuncture by calculating the venous cross-section (VCS) area on ultrasonography. Twenty healthy volunteers without cardiovascular risk factors were enrolled in this study. A target vein (either a cephalic or median cubital vein) was selected on ultrasonography. The pneumatic tourniquet was inflated using a rapid cuff inflator system at setting pressure for 120sec. TP strength was varied from 20mmHg to 100mmHg, in 20mmHg increments. The order of TP was randomized. Compari-sons among more than 3 groups were performed by one-way repeated-measures ANOVA and the Bonferroni method. The VCS area increased rapidly until 10sec after tourniquet inflation. The VCS area then increased gradually until 30sec after tourniquet inflation. After that, the VCS area did not increase remarkably. The VCS area increased with TP strength up to 80mmHg, but the VCS area at TP 100mmHg decreased to less than that at TP 40mmHg. Based on these results, we recommend a tourniquet pressure of 60mmHg, and duration of tourniquet application is 30 to 60sec for venipuncture

マッショウ ジョウミャク センシ ニ オケル ジョウミャク ドチョウ ヲ エル タメノ ホウホウ ニ カンスル チョウサ ホウコク

本研究では、前腕で静脈穿刺をする際に、静脈怒張を得るために実際に臨床で行われている方法を明らかにする目的で、質問紙を作成して実態調査を行った。回収率は70.5%であり、このうち309名の回答(有効回答率99.4%)を分析対象とした。静脈怒張を得るために最もよく行う方法として、割合が高い順にマッサージ(20.7%)、温める(20.1%)、クレンチング(18.4%)、叩く(15.9%)、手をしっかり握らせる(13.3%)の5つの方法に1割以上の支持が集まり、マッサージ、温める、叩く方法は、標準採血法ガイドラインが推奨する方法と一致していた。この他には、駆血帯をきつく締め直す方法(4.5%)と腕を下してから駆血する方法(3.6%)を提示したが、支持する人は少数であった。一方、これらの方法を行ったことがある人が感じる主観的効果が最も高かったのは、もっともよく行われるマッサージではなく、温める方法であった。このことから、多忙な臨床現場においては、すぐに実施できる方法を優先する傾向があり、それを試してみてから、手間や時間はかかるが効果のある方法を行っているのではないかと考えられる。また、それぞれの方法における手技は、回答者により様々であることが分かり、今後は、静脈怒張の効果を検証した上で、簡便で確実な手技を示すことが必要と考えられた

ジョウミャク センシ ニ ユウコウ ナ ジョウミャク ドチョウ ヲ エルタメノ テキセツ ナ クケツアツ ト ジョウミャク ドチョウ ニ カンヨスル キャッカンテキ シヒョウ ニツイテ

静脈穿刺時に有効な静脈怒張を得るための適切な駆血圧を検討すると共に、静脈怒張度の客観的指標を得ることを目的に、種々の駆血圧における触知静脈怒張度(怒張度)、および静脈断面積等の変化について検討した。対象者は健常成人46名、マンシェットを上腕に装着し、20〜100mmHgで1分間駆血した。駆血圧は順不同とした。駆血後の怒張度は駆血圧80mmHgまでは増加したが、100mmHgではやや減少した。駆血圧60mmHgと80mmHgの間には怒張度に有意な差がみられなかったが、他の駆血圧間では有意な差がみられた。怒張度は圧迫にて静脈が潰れ始める圧力(静脈触知した時の血管抵抗の指標)、静脈拡張比、静脈断面積の順で相関が高く、皮膚表面から静脈までの距離との間にはやや負の相関がみられた。以上より、駆血圧は60mmHgが適切であり、怒張度の客観的指標としては圧迫にて静脈が潰れ始める圧力が最も適切と考えられた。The purpose of this study was to examine appropriate tourniquet pressure to obtain effective vein distention for venipuncture, and discuss the objective indices for vein distention. Several parameters for vein distention, such as vein cross-section area, were calculated under different tourniquet pressures. Subjects (46healthy adults; 23men, 23women), had a pneumatic tourniquet (width 13cm) applied at the upper arm. and the tourniquet was inflated to 20, 40, 60, 80 or 100mmHg for one minute. The tourniquet pressure was randomized. Venous distention grade by palpation (VDGp) was increased up to 80mmHg of tourniquet pressure, but then slightly decreased at 100mmHg. VDGps for 60 and 80mmHg were not significantly different, but both were significantly higher than that of 20 and 40mmHg. VDGp correlated well with outer pressure, which begins to collapse the vein (index of venous resistance at palpation), the expansion ratio of vein cross-section area before and after tourniquet application, and the vein cross-section area successively.These data suggest that a tourniquet pressure of 60mmHg is appropriate for effective vein distention for venipuncture, and outer pressure, which begins to collapse the vein, is useful for an objective index of vein distention

カンタン ニ テキセツ ナ ツヨサ デ ソウチャク デキル ジョウミャク センシ ヨウ クケツタイ ノ カイハツ

看護師が前腕に静脈穿刺をする際にゴム管駆血帯を用いた場合の駆血圧は70-95mmHgが適切と報告されているが、看護師が駆血帯を装着する強さは幅広く分散しており、高すぎる傾向にある。この原因の一つとして、駆血帯には適切な目安が無く、意図した強さで装着することが難しいことが考えられた。そこで、適切なく血圧の指標となるメモリを付けた駆血帯を開発し、その性能について検討した。60名の対象者(平均年齢40.5歳、範囲21-78歳)に駆血帯を上腕周囲径より1-4メモリ短く装着した時の駆血圧の平均はそれぞれ45,76,110,144 mmHgであり、静脈の断面積は3メモリまでは増加したが、4メモリまで短くするとやや減少した。静脈穿刺可能な怒張が得られた対象者はそれぞれ30%,80%,90%,85%で、3メモリまでは増加したが、4メモリ短くするとやや減少した。この駆血帯では上腕周囲径より2-3メモリ短く装着するのが適切と考えられた。When nurses attempt venipuncture at the forearm, they apply a tourniquet at the upper arm to distend the forearm vein. Appropriate gum-tube tourniquet pressure is reported to be between 70-95mmHg. But tourniquet pressure applied by japanese nurses in clinical situations is often too high and widely distributed. One of the reason they do not apply tourniquets with appropriate pressure is that the tourniquets they use have no marks for applying the appropriate pressure. So, we developed a new tourniquet with marks for applying appropriate pressure, and we studied the effectiveness of this tourniquet. Sixty subjects (mean age40.5 years old, range:21-78 years old) were enrolled. When we applied tourniquets with tourniquet lengths 1, 2, 3, and 4 marks shorter than the circumference of the upper arm, mean tourniquet pressures were 45.1±6.7mmHg, 76.0±12.2mmHg,109.6±13.0mmHg, and 143.7±24.7mmHg respectively, and vein cross section area increased according to the stretch strength until 3 marks, then decreased slightly at 4 marks. The percentages of subjects with sufficient vein distention for venipuncture were about 30%, 80%, 90%, and 85% respectively. The results indicated that applying tourniquet with 2 marks or 3 marks shorter is appropriate for venipuncture, while 4 marks is too strong

Anticancer effects of a non-narcotic opium alkaloid medicine, papaverine, in human glioblastoma cells.

The interaction between high-mobility group box 1 protein (HMGB1) and receptor for advanced glycation end products (RAGE) is important for tumor cell growth. We investigated the tumor biological effects of HMGB1 and RAGE interaction. Previously, we identified an inhibitor of HMGB1/RAGE interaction, papaverine (a non-narcotic opium alkaloid), using a unique drug design system and drug repositioning approach. In the present study, we examined the anticancer effects of papaverine in human glioblastoma (GBM) temozolomide (TMZ; as a first-line anticancer medicine)-sensitive U87MG and TMZ-resistant T98G cells. HMGB1 supplementation in the culture medium promoted tumor cell growth in T98G cells, and this effect was canceled by papaverine. In addition, papaverine in T98G cells suppressed cancer cell migration. As an HMGB1/RAGE inhibitor, papaverine also significantly inhibited cell proliferation in U87MG and T98G cells. The effects of papaverine were evaluated in vivo in a U87MG xenograft mouse model by determining tumor growth delay. The results indicate that papaverine, a smooth muscle relaxant, is a potential anticancer drug that may be useful in GBM chemotherapy