| 1. |
|
|
| 2. |
- Frykholm, Peter, et al.
(författare)
-
Clinical guidelines on central venous catheterisation
- 2014
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 58:5, s. 508-524
-
Forskningsöversikt (refereegranskat)abstract
- Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs.
|
|
| 3. |
- Lindgren, Sophie, 1971, et al.
(författare)
-
Survey of central venous catheterisation practice in Sweden.
- 2013
-
Ingår i: Acta anaesthesiologica Scandinavica. - : Wiley. - 1399-6576 .- 0001-5172. ; 57:10, s. 1237-44
-
Tidskriftsartikel (refereegranskat)abstract
- Clinical guidelines on central venous catheterisation were introduced by the Swedish Society of Anaesthesiology and Intensive Care Medicine in 2011. The purpose of this study was to investigate current national practice and assess to what extent these guidelines influence clinical routines in Swedish operating wards and intensive care units.
|
|
| 4. |
- Ludvigsson, A, et al.
(författare)
-
Morning conferences for anaesthesiologists - to be or not to be?
- 2013
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 57:8, s. 971-977
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The main objectives of this study were to clarify the contents of and attitudes to morning conferences for physicians at Swedish departments of anaesthesiology and intensive care medicine. METHODS: A prospective cross-sectional three-part study was carried out. Heads of departments responded to a national survey on the structure and content of morning conferences. A questionnaire on attitudes to and general contents of morning conferences was filled out by anaesthesiologists in the Scania region in southern Sweden. Furthermore, telephone interviews were made with anaesthesiologists on primary night call in the Scania region to obtain information on whether their needs to report had been met and on how the conferences had actually been carried out and attended by the physicians. RESULTS: Information was obtained from 52 departmental heads (80%), 113 anaesthesiologists (53%), and 83 physicians on primary call (92%). Issues most frequently brought up were reports from physicians on night call, discussions of clinical matters, issues of staffing, and organizational matters. Daily morning conferences were strongly favoured for intercollegial solidarity and contacts, and were mainly and regularly used for reports from physicians on night call. At 95% of them, physicians on night call considered themselves to have been allowed to report what they wanted or needed to. CONCLUSIONS: Daily morning conferences enable regular exchange of information and professional experience, and are considered by Swedish anaesthesiologists to be most valuable for intercollegial solidarity and contacts. Before changes are being made in frequency or duration of morning conferences, their actual structure and content should be carefully evaluated and critically challenged to fit specific needs of that individual department.
|
|
| 5. |
- Pikwer, Andreas
(författare)
-
Clinical aspects on central venous cannulation
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Central venous catheters are mainly being used for reliable infusion of fluids and potentially irritant drugs, for haemodialysis, and for assessment of right atrial or central venous pressure (RAP/CVP). Current guidelines state that central venous catheterization should be followed-up by immediate anterior-posterior chest X-ray to confirm appropriate positioning and to detect iatrogenic pneumothorax. However, the appropriate position is still questioned, and pneumothorax requiring therapeutic intervention may be detectable from clinical signs. A rare but serious complication of central venous cannulation is inadvertent arterial catheterization. Traditional pull and press techniques are associated with considerable risks when applied in noncompressible areas or when large bore catheters have been used. Repair of intrathoracic arteries may require extensive surgical or sophisticated endovascular approaches. The RAP/CVP have been reported to correlate with central venous return of blood and with peripheral venous pressure (PVP). Cuff-occluded rate of rise of peripheral venous pressure (CORRP), reflecting changes in PVP during proximal venous occlusion, has been proposed to predict hyper- or hypovolemia in dogs. In Study I patients with central venous cannulations were recorded prospectively. Individual radiographic records of corresponding routine control X-ray procedures were evaluated retrospectively. There were few complications from malpositioned catheter tips associated with short-term use. In Study II echocardiographic, and central and peripheral venous pressure measurements were made in patients with renal failure before and after haemodialysis. The changes in CORRP were found to correlate linearly with the volumes of fluid removed, whereas changes in RAP/CVP and PVP correlated with each other. In Study III inadvertent arterial catheterization after failed central venous cannulation was retrospectively found to be associated with obesity, emergency puncture, severe hypovolemia or lack of ultrasonic guidance, and to be successfully managed by endovascular therpeutic techniques. In Study IV records of routine control x-ray procedures after central venous catheterization were evaluated retrospectively, together with study protocol and medical charts. All iatrogenic pneumothoraces requiring therapeutic intervention were associated with clinical signs of respiratory distress or hypoxia. In conclusion, the results of this thesis indicate that routine post-procedural X-ray may be replaced by optional X-ray in selected patients, that CORRP (but not RAP/CVP) may predict changes in fluid balance, and that endovascular management is a feasible and safe therapeutic option in inadvertent arterial catheterization.
|
|
| 6. |
- Pikwer, Andreas, et al.
(författare)
-
Complications associated with peripheral or central routes for central venous cannulation.
- 2012
-
Ingår i: Anaesthesia. - : Wiley. - 1365-2044 .- 0003-2409. ; 67:1, s. 65-71
-
Tidskriftsartikel (refereegranskat)abstract
- We undertook a review of studies comparing complications of centrally or peripherally inserted central venous catheters. Twelve studies were included. Catheter tip malpositioning (9.3% vs 3.4%, p = 0.0007), thrombophlebitis (78 vs 7.5 per 10,000 indwelling days, p = 0.0001) and catheter dysfunction (78 vs 14 per 10,000 indwelling days, p = 0.04) were more common with peripherally inserted catheters than with central catheter placement, respectively. There was no difference in infection rates. We found that the risks of tip malpositioning, thrombophlebitis and catheter dysfunction favour clinical use of centrally placed catheters instead of peripherally inserted central catheters, and that the two catheter types do not differ with respect to catheter-related infection rates.
|
|
| 7. |
- Pikwer, Andreas
(författare)
-
Depersonalization disorder may be related to glutamate receptor activation imbalance.
- 2011
-
Ingår i: Medical Hypotheses. - : Elsevier BV. - 1532-2777 .- 0306-9877. ; 77, s. 593-594
-
Tidskriftsartikel (refereegranskat)abstract
- Low-dose ketamine administration mimics, both clinically and on gross neuroimaging, depersonalization disorder. The perceptual effects of ketamine may be due to secondary stimulation of glutamate release and lamotrigine, possibly by inhibited glutamate release, may reduce some of ketamine's so-called dissociative effects. However, lamotrigine does not seem to be useful in the treatment of depersonalization disorder. Glutamate release in prefrontal cortex is increased by subanaesthetic doses of ketamine, resulting in increased inhibition, possibly via intercalated GABAerg cells, of projections from amygdala, affecting structures critically involved in depersonalization. I speculate that, in depersonalization disorder, the increased glutamate activity in prefrontal cortex is due to intrinsic imbalance, resulting in long-term potentiation, at the postsynaptic glutamate receptors on the GABAerg interneurons while the same receptor abnormality at the synapses on the intercalated GABAerg cells of the amygdala result in long-term depression in the case of either normal or high glutamate release.
|
|
| 8. |
- Pikwer, Andreas, et al.
(författare)
-
Endovascular intervention for central venous cannulation in patients with vascular occlusion after previous catheterization.
- 2010
-
Ingår i: Journal of Vascular Access. - 1129-7298. ; 11, s. 323-328
-
Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT Objectives: This study was designed to assess endovascular intervention for central venous cannulation in patients with vascular occlusion after previous catheterization. Methods: Patients referred for endovascular management of central venous occlusion during a 42-month period were identified from a regional endovascular database, providing prospective information on techniques and clinical outcome. Corresponding patient records, angiograms, and radiographic reports were analyzed retrospectively. Results: Sixteen patients aged 48 years (range 0.5-76), including 11 females, were included. All patients but 1 had had multiple central venous catheters with a median total indwelling time of 37 months. Eleven patients cannulated for hemodialysis had had significantly fewer individual catheters inserted compared with 5 patients cannulated for nutritional support (mean 3.6 vs. 10.2, p<0.001) before endovascular intervention. Preoperative imaging by magnetic resonance tomography (MRT) in 8 patients, computed tomography (CT) venography in 3, conventional angiography in 6, and/or ultrasonography in 8, verified 15 brachiocephalic, 13 internal jugular, 3 superior caval, and/or 3 subclavian venous occlusions. Patients were subjected to recanalization (n=2), recanalization and percutaneous transluminal angioplasty (n=5), or stenting for vena cava superior syndrome (n=1) prior to catheter insertion. The remaining 8 patients were cannulated by avoiding the occluded route. Conclusions: Central venous occlusion occurs particularly in patients under hemodialysis and with a history of multiple central venous catheterizations with large-diameter catheters and/or long total indwelling time periods. Patients with central venous occlusion verified by CT or MRT venography and need for central venous access should be referred for endovascular intervention.
|
|
| 9. |
- Pikwer, Andreas, et al.
(författare)
-
Fatal arterial complications following ultrasound-guided attempt of internal jugular vein catheterization
- 2013
-
Ingår i: European Surgery: Acta Chirurgica Austriaca. - : Springer Science and Business Media LLC. - 1682-4016. ; 45:3, s. 179-183
-
Tidskriftsartikel (refereegranskat)abstract
- Puncture of the posterior venous wall during ultrasound-guided internal jugular vein cannulation seems to be common, making underlying artery at risk of injury. Two cases of injury through the posterior wall of the internal jugular vein and an injury to the underlying artery are reported. In case number 1, a small injury of the carotid arterial wall resulted in a retrograde dissection of the common carotid artery and ascending part of the aorta, causing a fatal cardiac tamponade-a sequence of events never previously described. In case number 2, an unexpected injury to the thyrocervical trunk in a severely thrombocytopenic patient caused an extensive hematoma that compromised the upper airway, eventually leading to a fatal outcome. These two reported fatal arterial complications during ultrasound-guided cannulation of the internal jugular vein add to other publications of complications after central vein catheterization. It is important to increase awareness of these avoidable serious complications.
|
|
| 10. |
- Pikwer, Andreas, et al.
(författare)
-
Fluid balance monitoring by cuff-occluded rate of rise of peripheral venous pressure in haemodialysis patients.
- 2012
-
Ingår i: Anaesthesia. - : Wiley. - 1365-2044 .- 0003-2409. ; 67:8, s. 894-898
-
Tidskriftsartikel (refereegranskat)abstract
- Cuff-occluded rate of rise of peripheral venous pressure has been proposed to reflect volume changes in experimental studies. The aim of this study was to evaluate changes in cuff-occluded rate of rise of peripheral venous pressure associated with fluid removal by haemodialysis in six adult patients with chronic renal failure on intermittent haemodialysis. Measurements were carried out before and after each haemodialysis session. The volume of fluid removed (indexed to body surface area) linearly correlated with changes in cuff-occluded rate of rise of peripheral venous pressure (r = 0.84; r(2 ) =( ) 0.70; p = 0.037). Cuff-occluded rate of rise of peripheral venous pressure may be feasible for future clinical monitoring of individual fluid balance.
|
|
