Application of Intra-Osseous Access in the Critical Care of Patients With Severe Multiple Trauma

2021 ◽  
Author(s):  
Jun Shen ◽  
Du Chen ◽  
Peng Yang ◽  
Feng Xu
Keyword(s):  
Success Rate ◽  
Multiple Trauma ◽  
Skill Acquisition ◽  
Trauma Center ◽  
Venous Catheter ◽  
Observation Group ◽  
Central Venous ◽  
Severe Multiple Trauma ◽  
Cardio Pulmonary Resuscitation ◽  
The Relationship

Abstract ObjectiveThis study aimed to evaluate the efficacy of intra-osseous (IO) access in the treatment of patients with severe multiple trauma. MethodsThis was a retrospective study in trauma center of the First Affiliated Hospital of Soochow University. The clinical data of 94 patients were reviewed in emergency room (ER) from April 2018 to September 2020. We summarized advantages of IO access for the following aspects: puncture efficiency, the duration of puncturing and success rate. Besides, we analyzed the relationship with central venous catheter (CVC), tracheal intubation and cardio-pulmonary resuscitation (CPR). ResultsThe IO observation group presented a relatively good results in puncture efficiency (efficiency came into use within 15 minutes after being hospitalized: 36.17%), the duration of puncturing (less than or equal to 1 min: 93.62%), success rate (96.81%). ConclusionThe application of IO in the treatment of patients can shorten the time and improve the success rate in rescuing critically ill patients. It serves as a parallel rescue method and is worthy of clinical promotion and skill acquisition.

Prehospital and Intrahospital Specialized Management of Severe Multiple Trauma Cases

1985 ◽  
Vol 1 (S1) ◽  
pp. 149-150
Author(s):  
R Adams Cowley ◽  
Alasdair K.T. Conn
Keyword(s):  
Head Injury ◽  
Multiple Trauma ◽  
San Francisco ◽  
Cause Of Death ◽  
Trauma Center ◽  
Orange County ◽  
Traumatic Injury ◽  
Severe Multiple Trauma ◽  
Classical Studies ◽  
American Society

Multiple trauma is the leading cause of death of all Americans below the age of 37. The estimated cost to American society is between 70 and 80 billion dollars per year. In our present day society, one person in four will require the use of a trauma facility during his or her lifetime. Several studies have now been performed to demonstrate that the management of trauma is woefully inadequate. Stemming from the classical studies of Trunkey, Lim and West comparing San Francisco with Orange County, California; it was demonstrated that approximately 30% of fatalities resulting from traumatic injury were preventable in Orange County as compared to an extremely small percentage in San Francisco which does have a designated trauma center. Recent advances in the management of head injury may further increase this salvageable percentage.

scholarly journals Central Venous Catheter Types and Association with Bloodstream Infection in the Pediatric Intensive Care Unit: Experience of two Years

2021 ◽  
Author(s):  
Sevgi Topal ◽  
Özlem Sarac Sandal ◽  
Gökhan Ceylan ◽  
Gülhan Atakul ◽  
Mustafa Çolak ◽  
...  
Keyword(s):  
Intensive Care ◽  
Bloodstream Infection ◽  
Pediatric Intensive Care ◽  
Binary Logistic Regression ◽  
Venous Catheter ◽  
Binary Logistic Regression Analysis ◽  
Central Venous ◽  
Indwelling Catheters ◽  
The Relationship ◽  
Central Catheters

Objective: Central venous catheters (CVC) provides great convenience in pediatric intensive care units (PICUs). In this study, we aimed to prospectively examine patients who underwent CVC in the PICU in terms of catheter types and infections Methods: We conducted our monocentric, prospective, and cohort study by including patients between January 2019 and December 2020, involving all central catheters temporarily inserted, except port-line catheters, PICCs, indwelling catheters (cuffed and uncuffed tunnel catheters), and arterial catheters. The main issue we focus on is the rate of catheter-associated bloodstream infection (CLABSI). We analyzed the relationship between infection and risk factors using binary logistic regression analysis. Results: We included 26 CLABSIs with 196 CVCs. The incidence rate was 6.2/1000 catheter days. We found that the incidence of CLABSI increased in femoral catheters (OR: 0.04 p: 0.035, 95% CI: 0.49-3.49). Moreover, the incidence was increased in catheters with 3 lumens (OR: 0.06, p: 0.031, 95% CI: 0.34-1.69). The prolongation of the catheter also increases the risk of infection (OR: 0.06, p: 0.028, 95% CI: 0.56-2.36). Also, we found that the frequency of CLABSI increased in patients with underlying immunodeficiency (OR: 0.19, p: 0.007, 95% CI: 0.85-1.39) and in patients who were given total parenteral nutrition (OR: 0.02, p: 0.041, 95% CI: 0.063-2.38). Conclusion: The number of studies that directly compare catheter types in pediatric patients and their relationship with CLABSI is limited. Moreover, the comparison of unrelated studies is difficult because of heterogeneity in study populations. Multicenter pediatric prospective studies focused on identifying catheter-associated infections are needed.

scholarly journals Insertion of a 1.9F central venous catheter via the internal jugular vein in neonates

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092538
Author(s):  
Feixiang Luo ◽  
Xiaoying Cheng ◽  
Xiaofang Lou ◽  
Qin Wang ◽  
Xiaoyan Fan ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Success Rate ◽  
Internal Jugular Vein ◽  
Neonatal Intensive Care ◽  
Jugular Vein ◽  
Venous Catheter ◽  
Seldinger Technique ◽  
Central Venous ◽  
Minimal Trauma ◽  
The Right

Objective This study aimed to develop a technique for placing a 1.9 French (F) central venous catheter in the internal jugular vein of newborns. Methods In this retrospective study, punctures were performed with a modified ultrasound-guided Seldinger technique with 57 1.9F catheters in 48 newborns. Punctures were performed in the right internal jugular vein in 43 (75.4%) patients and in the left internal jugular vein in 14 (24.6%) patients. Results We included 33 (57.9%) boys and 24 (42.1%) girls, aged a median 38 days (range, 2–135 days). The puncture success rate was 100%. Catheterization duration was a median 14 days (range, 1–70 days). Among the catheters, 94.1% were removed after completion of therapy or upon death. Fifty-three (93%) patients experienced no complication, whereas a small amount of bleeding was observed in 2 (3.5%) patients, inflammation of puncture in 1 (1.8%) patient, and occlusion in 1 (1.8%) patient. The method of placement of 1.9F catheters in the internal jugular vein of newborns had a high success rate, with minimal trauma and few complications. Conclusions Our method of placing a 1.9F central venous catheter in the internal jugular vein is suggested for level III to VI neonatal intensive care units.

scholarly journals The curative effect analysis of peripherally inserted central venous catheter catheterization for tumor patients under the guidance of new medical guide wire

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Weizhu Xiao
Keyword(s):  
Success Rate ◽  
Guide Wire ◽  
Venous Catheter ◽  
General Information ◽  
Control Group ◽  
Observation Group ◽  
Curative Effect ◽  
Effect Analysis ◽  
Significant Difference ◽  
The Difference

Abstract Objective To report a method of PICC catheterization with the aid of a new medical guide wire, and to discuss the curative effect. Methods Five hundred and thirteen patients who visited our hospital from January 2013 to December 2019 for PICC catheterization were selected as study subjects. Random number method was used to group patients. General information was recorded for both groups. Patients in the observation group received catheterization with the aid of a new medical guide wire. The control group received catheterization via conventional guide wire. The success rate of the first catheterization, the success rate of the catheterization, the timing of the catheterization, the complications and the position of the catheter end were compared between the two groups. Results There was no significant difference in general information between the two groups. After analyzing the puncture situation of the two groups, it was found that the average catheterization time of the observation group was shorter than that of the control group, and the difference was statistically significant. Patients in the observation group had higher success rate of one-time catheterization and catheterization success rate, and the difference was statistically significant. The incidences of occult thrombosis, phlebitis and catheter blockage in the observation group were lower than those in the control group, and the difference was statistically significant. The incidence of dominant thrombosis and bleeding at puncture point in the observation group was also lower than that in the control group, but the difference was not statistically significant. Conclusion The new type of medical guide wire component is effective for PICC catheterization and worthy of further promotion.

Effect of Early Cannulation with Plastic Cannula on Arteriovenous Fistula Patency in Hemodialysis Patients

2019 ◽  
Vol 49 (1-2) ◽  
pp. 79-84 ◽  
Author(s):  
Kehui Shi ◽  
Hongli Jiang ◽  
Masanori Wakabayashi
Keyword(s):  
Regression Models ◽  
Cox Regression ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Primary Patency ◽  
Secondary Patency ◽  
Central Venous ◽  
Arteriovenous Fistulas ◽  
Kaplan Meier ◽  
The Relationship

Introduction: Plastic cannulas have been used to cannulate arteriovenous fistulas (AVFs) for hemodialysis (HD) in Japan for many years. However, the effect of early cannulation with plastic cannulas on AVF patency is not known. Objective: We analyzed the relationship between first cannulation time (FCT) and patency rates for AVFs cannulated with plastic cannulas and investigated whether early cannulation with plastic cannulas affects AVF patency. Methods: In total, 122 patients who underwent primary AVF construction were divided into an early cannulation group (FCT <10 days) and a late cannulation group (FCT ≥10 days). The Kaplan-Meier method and multivariable Cox regression models were used to investigate AVF patency. Results: Median FCT was 6 days. There was no statistically significant between-group difference in primary (p = 0.643) or secondary (p = 0.453) patency rates. Early or late cannulation was not significantly associated with primary patency (hazard ratio [HR] 1.21; 95% CI 0.71–2.05) or secondary patency (HR 0.46; 95% CI 0.08–2.77) after adjustment for age, sex, presence of diabetes mellitus or hypertension, and HD at baseline. Conclusions: Early AVF cannulation (<10 days from creation) with plastic cannulas does not affect access patency, and it may be possible to cannulate AVFs earlier than 10 days to decrease the need for use of a central venous catheter.

scholarly journals Filling the Void: Defining Invasive Bedside Procedural Competency for Internal Medicine Residents

2013 ◽  
Vol 5 (4) ◽  
pp. 605-612 ◽  
Author(s):  
Joshua D. Lenchus ◽  
Cristiane Mocelin Carvalho ◽  
Kaitlyn Ferreri ◽  
Jill Steiner Sanko ◽  
Kristopher L. Arheart ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Central Venous Catheter ◽  
Success Rate ◽  
Academic Medical Center ◽  
Venous Catheter ◽  
Catheter Insertion ◽  
Central Venous Catheter Insertion ◽  
Central Venous ◽  
Written Test ◽  
Procedural Outcomes

Abstract Background Residents perform invasive bedside procedures in most training programs. To date, there is no universal approach for determining competency and ensuring quality and safety of care. Objective We developed and implemented an assessment of central venous catheter insertion competency for internal medicine and internal medicine–pediatrics residents, using measurements for knowledge, skill, and attitude and linking them to procedural outcomes. Methods We conducted a cohort study of a 4-week, resident-run procedure service from July 2007 through June 2011 at a large academic medical center. Knowledge was assessed by using a written test, technical skill by using a checklist, and attitude by self- and supervisor assessments of residents' confidence and capability. Competence was defined as (1) a minimum written test score (70%); (2) a perfect checklist score; (3) a resident's self-assessed confidence and capability scores of 4 or 5 of 5; and (4) faculty rating of the resident's confidence and capability as 5 of 5. A composite success rate was based on procedural outcomes (eg, completed procedures, less than 3 forward needle passes, and complication rate) and was compared to the checklist scores. Results A total of 148 internal medicine and medicine–pediatrics residents inserted 639 catheters, and 53 (36%) achieved competence by the end of 4 weeks. Residents judged to be competent by checklist scores had a higher composite success rate than those deemed not competent. Conclusions Our multi-factorial criteria used to define central venous catheter insertion competency effectively discriminated between residents judged to be competent and those judged not competent, using data from procedural outcomes.

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