Ultrasound-guided supraclavicular cannulation of the right brachiocephalic vein in small infants: a consecutive, prospective case series

Abstract Background: Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in sporting populations. It accounts for between 6%-16% of all running injuries, and up to 53% of lower leg injuries in military recruits. Various treatment modalities are available with varying degree of success. In recalcitrant cases, surgery is often the only option.Objective: To evaluate whether ultrasound-guided injection of 15% dextrose for treatment of recalcitrant Medial Tibial Stress Syndrome decreases pain and facilitates a return to desired activity levels for those who may otherwise be considering surgery or giving up sport.Design: Prospective case seriesSetting: Private specialist CentrePatients: Eighteen patients: fifteen male and three female; (mean age=31.2 years) with MTSS were referred from sports injury clinics across the UK, having failed all available conservative treatment.Intervention: An ultrasound-guided sub-periosteal injection of 15% dextrose was administered by the same clinician (NP) along the length of the symptomatic area. Typically, 1 mL of solution was injected per cm of symptomatic area. Main Outcome Measures: Pain was assessed using a 10-cm visual analogue scale (VAS) at baseline, short-term, medium-term (mean 18 weeks) and long-term (mean one year) follow-up. Symptom resolution and return to activity were measured using a Likert scale at medium and long-term follow-up. Results: Patients reported a significant (p<0.01) reduction in median VAS pain score at medium and long-term follow-up compared to baseline. Median improvement per patient was 4.5/10. Patients rated their condition as ‘much improved’ at medium-term follow-up and median return to sport score was ‘returned to desired but not pre-injury level’ at medium-term and long-term follow-up. No adverse events were reported.Conclusions: Ultrasound-guided 15% dextrose prolotherapy injection has a significant medium-term effect on pain in MTSS. This benefit may be maintained long-term. More robust trials are required to validate these findings.Clinical Relevance: Clinicians should consider the use of ultrasound-guided injection of 15% dextrose as a viable treatment option to reduce pain and aid return to activity for patients with recalcitrant Medial Tibial Stress Syndrome.

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Oral Propranolol Therapy for Benign Capillary Hemangiomas in a Series of Adult and Pediatric Patients

Philippine Journal of Otolaryngology Head and Neck Surgery ◽

10.32412/pjohns.v32i2.75 ◽

2018 ◽

Vol 32 (2) ◽

pp. 34-37

Author(s):

Gerardo Aniano C. Dimaguila ◽

Emmanuel S. Samson

Keyword(s):

Head And Neck ◽

Pediatric Patients ◽

Case Series ◽

Lesion Size ◽

Capillary Hemangioma ◽

Clinical Resolution ◽

Prospective Case Series ◽

The Right ◽

Propranolol Therapy ◽

Oral Propranolol

Objective: To describe outcomes of oral propranolol therapy in a series of adult and pediatric patients diagnosed with benign capillary hemangioma of the head and neck. Methods: Design: Prospective Case Series Setting: Tertiary Government Hospital Participants: Ten (10) patients representing all patients clinically diagnosed with benign capillary hemangioma of the head and neck, enrolled in the study from 2012 to 2015. Results: Two (2) adults and eight (8) children were enrolled in the study. Although a decrease in lesion size was observed in half of the participants starting at three months, only one (1) attained complete resolution of the lesion-- a 12-year-old girl with hemangioma of the right parotid gland that attained clinical resolution of symptoms after four months of treatment. The remaining nine out of ten (9/10) participants did not attain complete clinical resolution; but there was a decrease in lesion size in four (4) of these participants. For the remaining five (5) participants, there was neither a decrease nor an increase in lesion size. Altogether, of the two adult participants, only one responded to therapy, while only 4 out of 8 pediatric participants responded to therapy. There were no noticeable differences between adult and pediatric patients in terms of resolution and plateau. Aside from mild bradycardia expected with propranolol, no adverse reactions were observed during the course of treatment. Conclusion: Although half of our participants responded to oral propranolol therapy, whether these observations may be attributable to oral propranolol alone cannot be concluded. Keywords: hemangioma, capillary; hemangioma; propranolol administration, oral; propranolol

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Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein in infants: a retrospective analysis of a case series

Pediatric Anesthesia ◽

10.1111/j.1460-9592.2012.03923.x ◽

2012 ◽

Vol 22 (11) ◽

pp. 1062-1067 ◽

Cited By ~ 31

Author(s):

Christian Breschan ◽

Manuela Platzer ◽

Robert Jost ◽

Haro Stettner ◽

Georg Feigl ◽

...

Keyword(s):

Retrospective Analysis ◽

Case Series ◽

Brachiocephalic Vein ◽

Ultrasound Guided

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A Retrospective Analysis of the Clinical Effectiveness of Supraclavicular, Ultrasound-guided Brachiocephalic Vein Cannulations in Preterm Infants

Anesthesiology ◽

10.1097/aln.0000000000001871 ◽

2018 ◽

Vol 128 (1) ◽

pp. 38-43 ◽

Cited By ~ 30

Author(s):

Christian Breschan ◽

Gudrun Graf ◽

Robert Jost ◽

Haro Stettner ◽

Georg Feigl ◽

...

Keyword(s):

Retrospective Analysis ◽

Real Time ◽

Preterm Infants ◽

Ultrasound Guidance ◽

Clinical Effectiveness ◽

Brachiocephalic Vein ◽

Ultrasound Probe ◽

Ultrasound Guided ◽

The Right ◽

Axis View

Abstract Background The aim of this retrospective analysis was to evaluate the clinical effectiveness of the supraclavicular ultrasound-guided cannulation of the brachiocephalic vein in preterm infants. Methods The ultrasound probe was placed in the supraclavicular region so as to obtain the optimum sonographic long-axis view of the brachiocephalic vein. By using a strict in-plane approach the brachiocephalic vein was cannulated by advancing a 22- or 24-gauge iv cannula from lateral to medial under the long axis of the ultrasound probe under real-time ultrasound guidance into the vein. Results One hundred and forty-two cannulations in infants weighing between 0.59 and 2.5 kg (median: 2.1; CI: 2.0 to 2.2) were included. Ultimate success rate was 94% (134 of 142). One cannulation attempt was required in 100 (70%) patients, two attempts in 21 (15%), and three attempts in 13 (9%). The smaller the weight of the infant the more attempts were needed. More attempts also were needed for the right brachiocephalic vein, which was primarily targeted in 75 (53%) neonates. One (1%) inadvertent arterial puncture was noted. Conclusions This supraclavicular, in-plane, real-time, ultrasound-guided cannulation of the brachiocephalic vein seems to be a convenient and effective method to insert central venous catheters in preterm infants.

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