Nursing Study on Reducing the Incidence of Bleeding and Exudation after PICC Catheterization by Blunt Separation Combined with Early Sheath Removal

Objective: To compare the effects of blunt separation combined with early sheath removal and conventional catheterization on the incidence of bleeding, exudation and subcutaneous congestion after peripherally inserted central catheter (PICC). Methods: 250 patients with PICC catheterization in our hospital were selected, including 125 in the control group and 125 in the observation group. The conventional catheterization method was used in the control group: The sheath was removed by scalpel skin expansion and complete tube delivery in place. The observation group used blunt separation combined with early sheath removal. The success rate of one-time sheath delivery, immediate bleeding, 24-hour bleeding and exudation were compared. Results: The success rate of sheath delivery in the observation group was 100%; The amount of immediate blood loss and blood loss 24h after catheterization in observation group was obviously lower than that in the control group, with statistical significance (P < 0.05). There were 6 cases of exudation in the control group and no exudation in the observation group. There was significant difference in the incidence between the two groups (P < 0.05); There were 10 cases of subcutaneous congestion in the control group and 2 cases of subcutaneous congestion in the observation group. There was significant difference in the incidence between the two groups (P < 0.05); Conclusion: Blunt separation combined with early sheath removal can reduce the occurrence of local blood and fluid leakage after PICC catheterization.

Use of Foley catheter in control of internal carotid hemorrhage during endoscopic endonasal surgery

Internal carotid artery (ICA) injuries during endoscopic endonasal surgery (EES) are rare life-threatening events. We describe a technique to manage ICA injuries based on the use of Foley catheters.A 26-year-old female underwent endoscopic transnasal trans-sphenoidal removal of pituitary adenoma. Cerebrospinal fluid leak occurred 4 days postoperatively. During repair procedure, accidental injury of ICA occurred. Emergency nasal packing through positioning of four Foley urologic catheters was successfully performed to stop bleeding. The patient did not report neurologic deficits.In author&rsquo;s opinion, Foley catheters are suitable to obtain immediate bleeding control since they are rapidly available and easily usable.

Pedunculated colorectal polyps with heads ≤ 1 cm in diameter can be resected using cold snare polypectomy

Background and study aims : Cold snare polypectomy (CSP) is not recommended for the resection of pedunculated colorectal polyp. The aim of this study was to examine the adequacy of CSP compared to hot snare polypectomy (HSP) for the complete resection of pedunculated polyps with heads ≤ 1 cm in diameter. Patients and methods : This was a retrospective study of a cohort of consecutive outpatients who had resection of pedunculated polyps with heads 6-10 mm in diameter using either dedicated CSP or HSP from 2014 through 2019. The primary outcome measure was occurrence of delayed bleeding. Secondary outcome measures included total procedure time, en bloc resection rate, immediate bleeding, and number of clips used. Results : 415 patients with 444 eligible polyps were enrolled; the CSP group (363 patients; 386 polyps) and HSP group (52 patients; 58 polyps). Patient characteristics, polyp characteristics and en bloc resection rate were similar between groups. The mean total procedure time and mean number (range) of hemostatic clips/patient used were significantly lower with CSP than with HSP (18± 8 min vs. 25± 9 min, P<0.001; 1.1 ± 0.6 (1-3) vs.3.1 ± 1.6 (1-5), respectively, P<0.001). Delayed bleeding occurred significantly less frequently in the CSP, 0% (0/363 vs.3.8% (2/52) in the HSP group (P<0.001), although immediate bleeding was significantly higher in CSP than HSP (84% (325/386) vs. 12% (7/58), P<0.001). Conclusion : Pedunculated colorectal polyps with heads ≤ 1 cm can be removed using CSP, which has several advantages over HSP.

ERCP-Related Bleeding

Clinically significant bleeding is an uncommon complication of diagnostic endoscopic retrograde cholangiopancreatography. But the endoscopists needs to be skilled at prevention and management. Post ERCP bleeding is most often seen following sphincterotomy. The overall risk of bleeding in patients undergoing sphincterotomy is approximately 1-2 percent. Most bleeding episodes are mild to moderate in severity. The risk of bleeding can be minimized by identifying patients at risk, correcting coagulation abnormalities and careful technique by skilled endoscopists in high-volume centers. Post-sphincterotomy bleeding often stops spontaneously and is rarely life-threatening, except in patients with a bleeding diathesis. Most clinically relevant bleedings can be managed with medical treatment and/or endoscopic therapy, which should be performed without delay in patients who have immediate bleeding. Endoscopic therapy options include epinephrine injection, hemostatic clips, thermal therapy and placement of full covered self-expandable metal stents. Angiography or surgery is usually reserved for patients with refractory bleeding and is rarely required.

A Novel Technique for the Management of Massive Hemoptysis: The Customized Endobronchial Silicone Blocker

Objective Massive hemoptysis (MH) has a high mortality rate. Therapeutic options include bronchoscopy for endobronchial lesions, bronchial artery embolization (BAE), and emergency surgery. Scant options exist for patients who are not candidates for these modalities. Culprit bronchial segment occlusion is an option to prevent “spillover flooding → hypoxia.” Applying this concept, we describe a case series of MH control using a novel bronchoscopically inserted customized endobronchial silicone blocker (CESB). We analyzed the safety and efficacy of CESBs in a select subset of patients with MH. Methods Inclusion criteria were patients with MH who were unstable for surgery/BAE, failed BAE, or relatively contraindicated/refused BAE. CESBs were manufactured on-site by modifying silicone stents, inserted using rigid bronchoscopy and reinforced with glue. The CESB was removed after 6 weeks when possible. A successful outcome was defined as immediate bleeding control with no recurrence after removal. Results Over 4.5 years, 13 episodes of MH in 12 patients meeting the criteria specified earlier were treated with CESBs. Seven of 12 patients had tuberculosis, 4 active and 3 inactive. One patient had mucormycosis, 1 post-lobectomy, 1 endobronchial renal cell carcinoma, 1 fibrosing mediastinitis, and 1 patient had metastatic laryngeal Ca. Eight of 12 patients were taken for primary-CESB placement. Four of 12 patients were sent for BAE, which was unsuccessful, and rescue-CESB was done for definitive management. The success rate, as defined earlier, was 92.3%, with no deaths from MH. Conclusions Innovative bronchoscopically inserted CESBs are an effective strategy in MH when patients are unstable or fail conventional management.

Self-expanding metal stents versus TIPS in treatment of refractory bleeding esophageal varices: a systematic review and meta-analysis

Background and study aims Refractory and recurrent esophageal variceal (EV) bleeding can be life threatening. Self-expanding metal stents (SEMS) have been used as a “bridge” therapy. However, their role in the treatment protocol is not established due to paucity in data. Methods We searched multiple databases from inception through May 2019 to identify studies that reported on SEMS and TIPS in refractory EV hemorrhage. Our primary goals were to analyze and compare the pooled all-cause mortality, immediate bleeding control and rebleeding rates. Results Five hundred forty-seven patients from 21 studies were analyzed (SEMS: 12 studies, 176 patients; TIPS: 9 studies, 398 patients). The pooled rate of all-cause mortality with SEMS was 43.6 % (95 % CI 28.6–59.8, I2 = 38) and with TIPS was 27.9 % (95 % CI 16.3–43.6, I2 = 91). The pooled rate of immediate bleeding control with SEMS was 84.5 % (95 % CI 74–91.2, I2 = 40) and with TIPS was 97.9 % (95 % CI 87.7–99.7, I2 = 0). The pooled rate of rebleeding with SEMS was 19.4 % (95 % CI 11.9–30.4, I2 = 32) and with TIPS was 8.8 % (95 % CI 4.8–15.7, I2 = 40). Conclusion Use of SEMS in refractory EV hemorrhage demonstrates acceptable immediate bleeding control with good technical success rate. Mortality and rebleeding rates were lesser with TIPS, however, its superiority and/ or inferiority cannot be validated due to limitations in the comparison methodology.