Maturation sutures for the paediatric tracheostomy – an extra safety measure

2005 ◽  
Vol 119 (12) ◽  
pp. 985-987 ◽  
Author(s):  
M F Craig ◽  
Y Bajaj ◽  
B E J Hartley
Keyword(s):  
Late Complications ◽  
Case Note ◽  
Safety Measure ◽  
Complication Rates ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Fatal Complication ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Case Note Review

Objective: Displacement of the tracheostomy tube in paediatric patients is a potentially fatal complication. We describe an extra safety measure which facilitates tube replacement.Setting: Tertiary referral specialist paediatric centre.Materials and methods: The method involves the placement of sutures between the anterior tracheal wall and skin to hasten the formation of a mature stoma (maturation sutures). We also undertook a retrospective case note review on patients from an academic tertiary referral centre. Thirty-five notes were reviewed. The most common indication for tracheostomy was airway obstruction (65 per cent). Fourteen patients had early and 10 had late complications with three tube displacements occurring. No added complications due to the use of sutures were found.Conclusions: Our complication rates compare well with those in the literature, and we recommend considering the use of such a technique.

Antipsychotics for BPSD: an audit of prescribing practice in a specialist psychiatric inpatient unit

2008 ◽  
Vol 20 (4) ◽  
pp. 790-799 ◽  
Author(s):  
Camilla Haw ◽  
Jean Stubbs ◽  
Graeme Yorston
Keyword(s):  
Psychological Symptoms ◽  
Psychiatric Inpatient ◽  
Case Note ◽  
Prescription Data ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
Psychiatric Inpatient Unit ◽  
Increased Risk ◽  
Prescribing Practice

ABSTRACTBackground: Antipsychotics are widely used for the treatment of behavioral and psychological symptoms of dementia (BPSD). In the light of the increased risk of cerebrovascular events, many countries have issued guidelines concerning their use in treating BPSD.Methods: We carried out an audit of antipsychotic prescribing practice for inpatients with BPSD at a tertiary referral centre using standards derived from two U.K. dementia guidelines. We collated case note and prescription data and interviewed consultant psychiatrists.Results: Of the 60 patients with dementia 50 (83%) had BPSD; of these, 28 (56%) were receiving antipsychotics. Those prescribed antipsychotics were more likely to have severe BPSD and to be aggressive and/or agitated. Audit of the 28 patients receiving antipsychotics for BPSD showed generally satisfactory results but there was room for improvement in case note documentation of off-label usage, screening for risk factors of cerebrovascular disease, consultation with relatives and use of an appropriate starting dose and slow titration of the antipsychotic.Conclusion: Audit of the use of antipsychotics for BPSD is important given the increased mortality associated with their use. Simple audit tools as used in this study can inform clinical practice. Even at a tertiary referral centre prescribing practice could be improved.

scholarly journals A retrospective case note review of laparoscopic versus open reversal of Hartmann’s procedure

2014 ◽  
Vol 96 (7) ◽  
pp. 539-542 ◽  
Author(s):  
CL Walklett ◽  
NP Yeomans
Keyword(s):  
Case Note ◽  
Hartmann’S Procedure ◽  
Reversal Rate ◽  
Teaching Hospitals ◽  
Laparoscopic Technique ◽  
Complication Rates ◽  
Retrospective Case ◽  
Hartmann's Procedure ◽  
The Uk ◽  
Case Note Review

Introduction First described in 1921, Hartmann’s procedure is the gold standard treatment for complicated sigmoid diverticular disease. It is also used commonly for other causes of perforation of the large bowel. However, the reversal rate in the UK is much lower than in comparable countries, at only 18–22%. Furthermore, laparoscopic reversal (LRH) is used far less frequently than open reversal (ORH) despite evidence that a laparoscopic technique reduces patient morbidity and decreases patient recovery time. Methods This retrospective case note review undertook an analysis of all the patients who had undergone Hartmann’s procedure at two centres in Leeds Teaching Hospitals NHS Trust between February 2007 and February 2012. Out of 305 patients, 235 were identified and included in the analysis. Comparisons were then drawn between LRH and ORH groups. Results The reversal rate was 21%. Three-quarters (76%) were performed using an open technique, 20% were laparoscopic and 5% were converted to an open procedure. The mean hospital stay was longer for the ORH group (9.82 days, standard deviation [SD]: 5.85 days, 95% confidence interval [CI]: 2.99 days) than for the LRH group (7.29 days, SD: 4.65 days, 95% CI: 11.58 days) p=0.006). Seven ORH patients (21%) were reoperated but only one LRH patient (13%) had a reoperation at six months. Five factors were found to have a significant effect on the likelihood of reversal of Hartmann’s procedure. Conclusions The overall reversal rate for Hartmann’s procedure remains low. Shorter hospital stays, lower 6-month reoperation rates and reduced 30-day complication rates are associated with LRH when compared with ORH.

Pre-operative overnight pulse oximetry to predict high dependency unit intervention in children undergoing adenotonsillectomy for obstructive sleep apnoea

2014 ◽  
Vol 128 (4) ◽  
pp. 360-364 ◽  
Author(s):  
K A Lightbody ◽  
A J Kinshuck ◽  
A J Donne
Keyword(s):  
Pulse Oximetry ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
High Dependency Unit ◽  
Referral Centre ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
High Dependency ◽  
Obstructive Sleep ◽  
Case Note Review

AbstractBackground:Post-operative high dependency unit beds are often requested for patients undergoing adenotonsillectomy for obstructive sleep apnoea. This study evaluated the utilisation of high dependency unit beds for such cases at our institution, a paediatric tertiary referral centre.Method:A retrospective case note review of patients admitted to the high dependency unit following adenotonsillar surgery for obstructive sleep apnoea, over a two-year period, was performed.Results:Sixty-six cases were identified. Thirty-nine patients underwent pre-operative overnight pulse oximetry; of these, 30 patients had desaturations noted. Seventeen patients had significant post-operative desaturations. These were predicted in all 11 patients who had undergone pre-operative pulse oximetry. The remaining six had not undergone pre-operative pulse oximetry. Nineteen patients required high dependency unit care; eight had experienced post-operative desaturations.Conclusion:High dependency unit care may be required following adenotonsillectomy for obstructive sleep apnoea. In this study, pre-operative overnight pulse oximetry had 100 per cent sensitivity in predicting post-operative desaturations, and may therefore aid the appropriate utilisation of high dependency unit beds for patients undergoing adenotonsillectomy for obstructive sleep apnoea.

scholarly journals Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study

2015 ◽  
Vol 172 (3) ◽  
pp. 243-250 ◽  
Author(s):  
L A Behan ◽  
M Sherlock ◽  
P Moyles ◽  
O Renshaw ◽  
C J T Thompson ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Plasma Sodium ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Retrospective Case ◽  
Tertiary Referral Centre ◽  
Significant Incidence ◽  
Cranial Diabetes Insipidus ◽  
Vasopressin Analogues

Context and objectivePatients with cranial diabetes insipidus (CDI) are at risk of developing both hypernatraemia and hyponatraemia, due to the condition itself or secondary to treatment with vasopressin-analogues or during administration of i.v. fluids. We aimed to assess the frequency and impact of dysnatraemias in the inpatient (INPT) and outpatient (OPT) setting in desmopressin-treated CDI, comparing those with normal thirst with those with abnormal thirst.DesignThe study included 192 patients with cranial diabetes, who were identified from the Beaumont Pituitary Database, a tertiary referral centre. Retrospective case note audit was performed and the clinical and biochemical information of 147 patients with CDI were available for analysis.ResultsA total of 4142 plasma sodium measurements for 137 patients with normal thirst, and 385 plasma sodium measurements for ten patients with abnormal thirst were analysed. In those with normal thirst, the most common OPT abnormality was mild hyponatraemia (pNa+ 131–134 mmol/l) in 27%, while 14.6% had more significant hyponatraemia (pNa+ ≤130 mmol/l). Of those patients with normal thirst, 5.8% were admitted due to complications directly related to hyponatraemia. Compared with patients with normal thirst, those with abnormal thirst were more likely to develop significant OPT hypernatraemia (20% vs 1.4%, P=0.02) and significant INPT hyponatraemia (50% vs 11.1%, P 0.02).ConclusionOPT management of CDI is complicated by a significant incidence of hyponatraemia. In contrast, OPT hypernatraemia is almost exclusively a complication seen in adipsic CDI, who also had more frequent INPT hyponatraemia. CDI associated with thirst disorder requires increased physician attention and patient awareness of potential complications.

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