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Background and aim Transilluminator device allow healthcare professionals to visualize peripheral veins without using tourniquet. Aim of the study was to test the ability of three devices (Christie VeinViewer Flex (Christie, Lake Mary, Florida, USA), ICEN IN-G090-2 (ICEN Technology Company Limited, Guangdong, China) and AccuVein AV400 (AccuVein, New York, USA)) to present quality images thought defined criterion. Materials and methods Study was designed as a comparison of technical characteristics, evaluation of image quality and assessment of applicability in different conditions (different viewing angels, conditions of lightning and image visibility under interference of humidity and body lotions) in reference person on two venipuncture sites. Results Devices have different technical characteristics and vary in optimal distance for good quality image (18–30 cm), number of presented veins (1–4), image dimension (6.0–90.3 cm2), length (1.5–8.0 cm) and thickness (2–5 mm) of the dominant blood vessel. Devices present different image visibility under different viewing angels, conditions of lightning and interference of humidity and body lotions (from good quality to unusable images). Conclusion Transillumination devices differ in their technical characteristics and performance. The choice of the device should be based on the needs of the particular patient population and the intended use of the device.

BACKGROUND: Dilated veins are associated with increased success of peripheral intravenous cannulation, due to their improved visibility and palpability. We compared three strategies to achieve venodilation (tourniquet, electrical stimulation, or a combined strategy) on increase in venous size.METHODS: A total of 54 volunteers participated in this cross-over observational study with healthy adults, measuring venous cross-sectional area and diameter at six different sites of the upper extremity. Measurements were performed with ultrasound after performing any dilation strategy and compared with non-dilated venous size. An increased cross-sectional area of 25 square millimeters was denoted as clinically relevant, which was detected with paired t-test, Wilcoxon signed rank test, or ANOVA.RESULTS: The cephalic vein was the greatest at all sites (t=12.43, df=39, PCONCLUSIONS: In general, the largest sized veins are situated in the upper arm, of which the cephalic vein has the largest cross-sectional area and diameter. The combination of electrical stimulation followed by tourniquet application resulted in the greatest increase in venous size and is therefore considered as the most effective to improve peripheral intravenous cannulation success.

This case report deals with a sharp force suicide case, which may challenge the experience of many forensic pathologists as well as the studies published to date. An overview of the published cases shows that sharp force suicides account only for 1.6%–3% of all suicides and the self‐inflicted injuries are usually localized on the body parts easily accessible with one's hand including the neck, thorax, or upper extremities, as well as in locations of major vascular bundles or vital organs. Reported, however, is a case in which the victim relied on the knowledge of her medical condition and used a kitchen knife to incise her varicose veins, which resulted in fatal bleeding. The case is rare on a number of grounds: incision of varicose veins is rarely the method of choice in suicide cases, injuries of peripheral veins are rarely fatal, and so are injuries of isolated veins where no damage to arteries is suffered.

STUDY OBJECTIVE: The three-dimensional shape of the ultrasound beam produces a thicker scan plane than most users assume. Viewed longitudinally, a needle placed lateral to a vessel just outside the central scanning plane can be displayed incorrectly in the ultrasound image as if placed intravascularly. This phenomenon is called the beam width artefact, also known as the elevation or slice thickness artefact. The goal of this study was to demonstrate the potential negative effect of the beam width artefact on the performance of in-plane ultrasound-guided vascular access procedures, and to provide a solution.DESIGN: Randomized, double-blinded study SETTING: Department of anaesthesiology and intensive care of a teaching hospital PARTICIPANTS: 31 experienced (anesthesiologists and intensivists) and 36 inexperienced (anesthetic nurses) ultrasound users INTERVENTIONS: We developed an acoustic lens that narrows the scan plane to reduce the beam width artefact. The lens was tested in a simulated vascular access study.MEASUREMENTS: The primary endpoint was first pass success. Secondary endpoints were the number of punctures and needle withdrawals, procedure time, needle visibility and operator satisfaction.MAIN RESULTS: First pass success was highly enhanced using the acoustic lens, with a success rate of 92.5% versus 68.7% without the lens (difference 23.8, 95% confidence interval 11.0-35.3, p < 0.001). The total number of punctures needed to obtain intravenous access was also reduced using the lens (1.10 versus 1.38, difference 0.27, 95% CI 0.11-0.43, p = 0.002). Procedure time, needle withdrawals, needle visibility and satisfaction were similar. Both inexperienced and experienced users benefited from the acoustic lens.CONCLUSIONS: The beam width artefact has a significant effect on the performance of ultrasound-guided needle-based procedures. The efficacy of in-plane superficial vascular access procedures can be enhanced by narrowing the imaging plane using an acoustic lens.

Introduction: As the COVID-19 pandemic reaches, its zenith a worrying trend has been noticed of late, that is arterial and venous thrombosis in patients presenting with COVID-19. Arterial and venous thrombosis was found in patients with asymptomatic state to severe affliction and most of them had a delayed presentation. Materials and Methods: An observational study was carried out by the Department of Vascular Surgery, Madurai Medical College. There were around 15200 total admissions between March 15, 2020, to September 30, 2020, in corona specialty hospital and trauma care center affiliated to Madurai medical college, out of which: (1) Acute deep venous thrombosis (DVT) was seen in 349 patients. (2) Acute limb ischemia (ALI) was found in 75 patients, out of which 70 patients had lower limb involvement and 5 patients had upper limb involvement. (a) Class 3–50 patients. (b) Class 2b–15 patients, (c) Class 1–10 patients. (3) Acute mesenteric ischemia was seen in 8 patients. Conclusion: COVID-19 is associated with an increased incidence of arterial and venous thrombosis of peripheral vascular system wherein arterial thrombosis, presenting, as ALI is profound and has a multi fold increased incidence than in non-COVID-19 patients and venous thrombosis is much higher than the non COVID-19 state.

Stasis ulcers of the gaiter zone are difficult to heal due to deoxygenated blood congestion in peripheral areas and lack of oxygenated blood supply. Venous ulcers occur due to insufficiency of distal peripheral veins in legs. This manuscript refers to three cases of nonhealing venous leg ulcers treated with local application of Apamarga Kshara Taila along with some oral drugs. Three patients of nonhealing venous ulcer of the gaiter zone were treated with ayurvedic treatment protocol. In all patients after Panchavalkala Kwatha wound wash, Apamarga Kshara Taila was applied locally on wound once daily up to complete wound healing. In this series, wound healing was achieved in 96 days, 27 days, and 38 days, with a unit healing time of 4.311, 7.287, and 3.677 days/cm3, respectively. For the past 8 months, all three patients are living symptom-free life without any reoccurrence. On the basis of these cases, it can be said that Ayurveda principles of ulcer management have shown a promising role in wound healing and resuming improved quality of life without any untoward effects.

Background: Elderly is a decrease in cardiovascular function. Sstructural and functional changes occur in the peripheral vascular system responsible for variations in blood pressure. The study aims at finding out attitude, family supervision, level of knowledge, and efforts to control hypertension in working area Puskesmas Saptosari Gunungkidul. Method: The study was descriptive research with cross-sectional. Samples were selected using a purposive sampling. The number of the sample 38 repondent. The research instrument used a questionnaire. The data analysis used was univariate. Result: The majority of women (94.7%), aged 60-70 years (84.2%), and hypertension stage I (68.4%). Most of the attitudes have the right attitude (94,7%), family supervision (89,5%), and inadequate level of knowledge (76,3%). In controlling efforts, most were in a good category (94,7%). Conclusion: Almost all respondents have the right attitude and supervision from the family. Even though they have an inadequate level of knowledge, control efforts are mostly reasonable.

Newborns in intensive unit receives a number of invasive procedures that would causeschanges in sensitizationof pain and possible long-term effects on child’s subsequentdevelopmental period. This encourages the need for pain measurement that could reflectthe actual pain responses especially in blood sampling.The purpose of this review is tooverview pain responses in newborns receiving procedures invasive of blood samplingusing advance pain measurement. Literature search was conducted through threeonline database, namely EBSCO (CINAHL and MEDLINE), Scopus, and Wiley, withinrelated keyword applied are invasive procedure, neonate, newborn, pain assessment andpain intensity. Twelve articles were identified for critical review. This literature studyprovides an overview of responses to blood collection procedures through measurementsof behavioral and skin conductance activities in neonates. Pain response with behavioralmeasurement shows the range of mild-moderate pain in the procedure of blood samplingthrough peripheral veins, the range of moderate-severe pain in heel pricking, and therange of severe pain in arterial blood sampling. Skin conductance measurement reflectsympathetic activity to pain stimulus through sweat gland activity in the superficiallayer of the skin, and is expected to be an objective method of pain measurement forneonates in clinical practice.

Background: Several studies have described the use of ultrasound for the placement of peripheral intravenous catheters (PIV); however, visual and tactile inspection remains the primary clinical tool for the identification of infiltration. An improperly positioned PIV is an avoidable cause of significant morbidity and mortality to a patient. Case: We describe a technique using point of care ultrasound for the assessment of two PIV to confirm functionality in a 68-year-old male scheduled for an above the knee amputation. This technique can be used for both superficial and deep peripheral veins where the detection of catheter infiltration by physical exam alone is often challenging. Conclusion: The ubiquitous use of ultrasonography has revolutionized the field of medicine. Point of care ultrasound for the evaluation of questionable peripheral catheters can help prevent harm to a patient, especially during transitions of care.

Peripheral vein catheterization is the most common invasive hospital procedure, which, however, may be accompanied by the development of various complications.The aim of the study was to assess the frequency of complications associated with peripheral vein catheterization, and to compare two types of peripheral catheters in surgical patients.Materials, methods and results. The study was conducted at the Department of Anesthesiology and Intensive Care at the National Cancer Institute. The study included 122 patients of both sexes who were scheduled for surgery. In the operating room with compliance of the aseptic rules the peripheral veins of the patients upper extremities were catheterized. Intravenous catheters of two types were used for catheterization of the peripheral vein: made of fluoroethylenepropylene (FEP) (FEP IV CannulaVogt Medical with wings and port, size 16-18 G) and of polyurethane (PU) (PU IV CannulaVogt Medical with wings, size 16-18 G) according to the diameter of the punctured vein. The frequency of complications was investigated and the causes of problems with catheterization of peripheral veins were considered. The clinical manifestations of phlebitis were evaluated on the Infusion Nurses Society Phlebitis Scale (INS) scale. The total complication rate in our study was significantly different between the two groups and amounted to 32.6% in gr. 1 and only 7% in gr. 2.Conclusion. The study shows that one of the risk factors may be the design of the instrument and the material from which the peripheral catheter is made. Despite the positive characteristics of both catheters, the impact of which we investigated in our work, the use of PU catheters contributes to reducing the number of complications and increases the duration of their use compared to FEP catheters.

The clinical examination is an important part of any patient consultation. After the primary survey and taking the patient history, a more in-depth examination is sometimes required to aid making a working diagnosis and help negate other differential diagnoses. The extent of this depends on the stability of the patient and may not be possible in time-critical circumstances. However, clinical examination is an increasing part of paramedic practice owing to the continued expansion of the scope of the paramedic role in both urgent and emergency care. Education on clinical examination concerning each of the main body systems is now an integral part of undergraduate paramedic curricula. This clinical examination series provides a step-by-step overview for each of the main body systems. Continuing professional development (CPD) is an essential requirement for all clinicians to maintain and demonstrate they are staying up to date and advancing in their roles. This series gives an overview of each type of examination to support students, newly qualified paramedics and paramedics wishing to use these articles as a CPD development activity and an aide-memoire for clinical practice. This article, which explores the peripheral vascular system, gives an overview of initial examination considerations, including first impressions.

Amyloid β proteins, including toxic soluble oligomers (SPOs) are not only found in the brain duringAlzheimer’s, but also in the peripheral vascular system. The precise mechanism linking increasedcirculating levels of SPOs and vascular dysfunction remains unknown. We hypothesized that SPOslead to endoplasmic reticulum (ER) stress, further release of SPOs and vascular injury. Mesentericresistance arteries (MRAs) from 14 weeks old, male and female C57BL/6 mice were used forvascular function. Agonists were acetylcholine and phenylephrine (1nM-10mM). In acuteconditions, SPOs (0.1μM) caused pathologically exacerbated endothelium-dependent vasodilationcompared to vehicle (F12 media) [Male: EC50: SPOs: -7.0 ± 0.1 (n=4), vs. Vehicle -6.6 ± 0.1 (n=7)p=0.03; Female: EC50: SPOs: -7.3 ± 0.06 (n=5) vs. Vehicle -6.7 ± 0.1 (n=6), p=0.001]. Thisphenotype was similar to the positive control tunicamycin (5mg/ml) [Male: EC50: Tunicamycin: -7.3(n=4), vs. Vehicle -6.6 (n=7) p=0.2; Female: EC50: Tunicamycin: -7.7 (n=4) vs. Vehicle -6.8 (n=5)p=0.04]. To determine whether SPO’s cause ER stress, arteries were treated with ER stressinhibitor 4-Phenylbutyric acid (2mM). The ER stress inhibitor prevented the exacerbatedvasodilation induced by SPOs showing SPOs trigger ER stress in acute conditions independent ofsex. To determine whether SPOs are a consequence of ER stress, arteries were incubated withtunicamycin in the presence of the SPO inhibitor K01-162 (10mM). Interestingly, K01-162 did notprevent the tunicamycin-induced exacerbated vasodilation in arteries from male mice. However,this response was decreased in arteries from female mice showing that inducing ER stress leadsto the release of SPOs, escalating a feed-forward mechanism of further SPO release. There wereno changes in vascular contraction with tunicamycin or SPOs irrespective of sex. ER stress wasconfirmed with anti-KDEL antibody staining, specific for ER resident chaperones Grp78/94 andvisualized with multiphoton fluorescent confocal microscopy. These results demonstrate that SPO’sexacerbate endothelium-dependent vasodilation acutely and may contribute to brain and peripheralvascular edema and loss of autoregulation observed during cardiovascular and Alzheimer’sdisease.

Background There are well-recognized relationships between thyroid hormones, heart and peripheral vascular system. Thyroid hormones have relevant actions on the heart and circulation, generate multiple effects including hemodynamic changes and exert mediated effects on cardiac cells through gene expression. Clinical case We present a 64-year-old woman with diagnosis of dilated cardiomyopathy with reduced ejection fraction, in whom coronary disease was thought of as the most probable etiology by clinical antecedents but in the evolution, other possible etiologies were to appear. Conclusions Numerous complementary diagnostic studies were carried out, such as cinecoronariography, cardiac nuclear magnetic resonance imaging, laboratory analysis, to name a few, and it was concluded that the etiological cause was due to primary hypothyroidism.

The choice of an intravascular cannula (catheter) is a rather difficult and important issue in modern medicine, especially in the anesthesiology and intensive care unit. In today’s market there are many variants of cannulas, which differ in size and material. As for the size of the cannula, the issue is resolved. The American Medical Device Manufacturers Association proposed measuring the outer diameter of cannulas in “gauge” G. The European Standard ISO 10555.5 regulates the outer diameter of cannulas in millimeters and states that each catheter should have a color marker indicating the nominal outer tube. Color marking helps to find quickly the right size of cannula in extreme situations. The marking of cannulas in “gauge” G and mm is made on the packaging of the product. As to the choice of material, the question remains open. Therefore, in this article, we decided to cover the issue of choice of intravascular cannulas on the material. We have also developed some practical guidelines that facilitate catheterization of peripheral veins and allow cannula to stay longer in the vein. This article will be interesting for doctors and nursing staff.

Patients with diffuse large B cell lymphoma (DLBCL) who have failed to achieve complete remission with first-line therapy can subsequently receive salvage therapy. However, there is no definite consensus on the use of salvage therapy, and little information on the optimal treatment regimen. The present study retrospectively analyzed data from 131 patients diagnosed with DLBCL between April 2002 and November 2017 who relapsed and received salvage therapy. Primary treatment included R-CHOP or R-CHOP-like regimens. The most common salvage regimen was R-DeVIC (42%), followed by R-ESHAP (23%), other aggressive regimens (12%) and palliative therapy (23%). The median overall survival (OS) was 45.7 months for R-DeVIC, 41.8 months for palliative therapy, 29.4 months for R-ESHAP, and 28.5 months for aggressive regimens (P=0.937). A total of 25 patients underwent autologous stem cell transplantation (ASCT), and the OS was 75.6 months for these patients compared with 33.5 months (range, 25.6-45.6 months) for patients who did not undergo ASCT (P=0.033). Following the establishment of an outpatient chemotherapy unit in 2014, R-DeVIC use became more common, increasing from 37% prior to 2014 to 46% after 2014, whereas R-ESHAP use decreased (31 to 17%). The present study did not identify the optimal salvage regimen for patients with DLBCL. However, salvage ASCT improved the outcome, and regimens administered via peripheral veins were demonstrated to be more common in outpatient chemotherapy settings.

Background: Chronic exposure to whole body vibration can affect the gastrointestinal system, the lumbar spine, the peripheral veins and the vestibulocochlear system.Aims/Objectives: The aim of this...

INTRODUCTION Obtaining vascular access (VA) is a critical part of the therapeutic apheresis (TA) treatment plan. Currently, there are no guidelines for VA decision-making and maintenance related to TA procedures. MATERIALS AND METHODS A 28-question survey to gather qualitative information regarding VA practices was distributed to the American Society for Apheresis (ASFA) 2018 Annual Meeting attendees and all ASFA members for voluntary participation. The descriptive analyses were reported as the number and frequency of responses for each question. RESULTS Total participation was 206 with 147 (71.4%) answering some or all 16 VA focused questions. The majority of respondents were nurses or physicians (89.0%) at sites providing ≥100 procedures. The most common TA procedures were plasma exchange, red cell exchange, and leukocytapheresis. The VA evaluation was predominantly performed by the TA service (80.3%, 118/147). The majority of TA physicians and/or providers do not insert (91.7%, 132/144) or remove (81.2%, 117/143) VA catheters. When an emergent TA procedure is needed, the majority of respondents felt

Purpose: In clinical settings, ultrasonography (US) has recently been used to aid in the insertion of peripheral intravenous catheters (PIVCs). This cross-sectional study aimed to verify the reliability and validity of a tablet-type device in assessing vein size and depth for catheter site selection and detecting thrombus with resultant subcutaneous edema as a cause of catheter failure using US. Methods: Adult patients receiving infusions via a PIVC at a university hospital between January and February 2017 were included. All participants underwent US at the PIVC site. An expert sonographer and a nurse blinded to all information, except for ultrasonograms, evaluated the data. Intraclass correlation with 95% confidence interval (CI) was used to evaluate interrater and intrarater reliability of US assessment. To assess criterion-related validity, a high-end US notebook device was used for reference data collection. Pearson's correlation coefficient was used to evaluate criterion-related validity. Results: We observed 21 patients with 26 catheters. Intraclass correlations (95% CI) for the measured vein diameters and depths were as follows: intrarater reliability, 0.92 (0.57–0.98) and 0.78 (0.10–0.95); interrater reliability, 0.95 (0.78–0.99) and 0.94 (0.77–0.99); and Pearson's correlation coefficient for criterion-related validity, 0.74 (P = 0.02) and 0.77 (P = 0.02), respectively. However, the analysis of causes of catheter failure did not show reliable validity. Conclusion: This pilot study suggests that the tablet-type device is useful for assessing peripheral veins in clinical settings.

Norms for assessing the functional state of the peripheral vascular system are developed, as a rule, without regard to age, gender and somatotype. The purpose of the study is to establish features of the indicators of crus rheogram in practically healthy girls and boys of different somatotypes, residents of the Podillia region of Ukraine. Rheographic indicators of the cohort of 108 practically healthy girls aged from 12 to 15 years old and 103 boys aged from 13 to 16 years and 103, urban residents of the Podillia region of Ukraine, were determined using a cardiology computer diagnostic complex. Anthropometric survey was conducted in accordance with the scheme of V. V. Bunak (1941). To evaluate the somatotype of adolescents, the mathematical scheme of J. Carter and B. Heath (1990) was used. The statistical processing of the obtained results was carried out in the license package "Statistica 5.5" using nonparametric methods for evaluating the obtained results. As a result of the research, it was found that most of the amplitudes and some of the derived indicators of the crus rheogram in girls of the mesomorphic somatotype are significantly lower or tend to be smaller than those of other somatotypes, while the time of the rising part of the rheogram and the time of slow blood filling are significantly higher than at representatives of an ectomorphic somatotype. In boys of mesomorphic somatotype, the basic impedance and amplitude of the systolic wave and the average speed of fast and slow blood flow of the rheogram are significantly lower or tend to be lower than those of other somatotypes, while the time of the ascending part and fast blood flow of rheograms and the diastolic index are significantly greater than in the representatives of the ecto-mesomorphic somatotype. It has also been found that almost half of the amplitude and derivative indices are significantly higher in girls than in boys of corresponding somatotypes, and most of the time - on the contrary, in boys, than in girls of corresponding somatotypes. Thus, indicators of crus rheogram in practically healthy girls and boys of different somatotypes, inhabitants of the Podillia region of Ukraine have pronounced differences mainly between the representatives of mesomorphic and ectomorphic somatotypes. Established pronounced manifestations of sexual dimorphism of indicators of crus rheogram between adolescents of corresponding somatotypes.

Right heart thrombus accompanied by chronic thromboembolic pulmonary hypertension is a rare entity. Right heart thrombus may develop in the peripheral veins or in situ within the right heart chambers. The diagnosis of right heart thrombus is challenging, since its symptoms are typically non-specific and its imaging features resemble those of cardiac masses. Here, we report two cases of right heart thrombus with chronic thromboembolic pulmonary hypertension that presented as right ventricular masses initially. Both patients underwent simultaneous pulmonary endarterectomy and resection of the ventricular thrombi. Thus, when mass-like features are confirmed by imaging, right heart thrombus should be suspected in patients with chronic thromboembolic pulmonary hypertension, and simultaneous right heart thrombus resection is required along with pulmonary endarterectomy.

Anesthesiologists are often asked to assist with peripheral IV placement in patients who are at difficult vascular access. In such situations, there are typically no visible peripheral veins, so anesthesiologists must rely on knowledge of vascular anatomy to look for potential IV sites. This chapter discusses common locations and reviews such anatomy.

Pediatric venous disease is increasing in incidence in both inpatient and outpatient populations. The widespread use of central venous access devices as well as the rising incidence of thromboembolic events in pediatrics is leading to more systemic venous occlusions in both the central and peripheral veins. This review focuses on the etiology, presentation, workup, and general technical considerations of recanalization as well as procedural complications related to pediatric systemic venous occlusive disease. The potential role for pediatric interventional radiology guided treatments will be discussed in detail.

Background: This study was conducted to measure the hemoglobin (Hb) levels, erythrocytes, and related measurements (particularly mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC], and hematocrit) in healthy individuals donating blood at the National Blood Transfusion Center (NBTS) in Asmara city, Eritrea. Methods: Venous blood samples were taken from the candidates' peripheral veins into the EDTA tube and examined for red blood cell(RBC) count, Hb, hematocrit (%),MCV, MCH, MCHC, and red cell distribution width (RDW), analyzed and measured by automated blood analyzer. Results: The mean Hb level was 14.428 ± 1.485g/dl, RBCs count was 4.744 ± 0.482 × 10 12 /L, HCT was 41.929 ± 3.75%, RDW mean was 13.571 ± 0.744%, MCV was 88.582 ± 4.0558 Femtoliter, MCH was 30.470 ± 2.188picogram, and MCHC was a mean of 34.393 ± 1.347g/dl. The difference between males and females in MCV and MCHC was significant in favor of female donors. A correlation of a weak positive naturewas found between the ages and genders of donors and the Hb level. All measured values were found to be within the global referenced ranges. Conclusion: Hb, RBCs count, and RBCs indices of apparently healthy Eritrean blood donors were measured for reference, and all values were found to be within the normal reference ranges.

Emergency access to the venous system is vitally important to all veterinary practitioners. This access most commonly requires catheterization of peripheral veins to facilitate treatment of patients in shock or cardiopulmonary arrest. Oftentimes, venous access is challenging and difficult because of poor perfusion, the size of the patient, exotic veterinary species, edematous patients, obesity, or the lack of technical skills of the veterinarian or technician. Peripheral veins continue to be the primary sites for emergency placement of catheters. These sites include the jugular, cephalic, medial saphenous, and lateral saphenous veins. When these veins are unavailable, the most logical site depends on the need for emergency access. Intravenous use of catheters involves the selection of a catheter, proper vein selection, preparation of the venipuncture site, insertion, bandaging, maintenance of the catheter, and an awareness of potential complications. The need for an intravenously placed catheter should be assessed daily. At present, intravenously placed catheters are usually changed every 72 hours.

Hospitalization rate in India is increasing over years and treatment is given mostly via intravenous route.Moist heat therapy for identifying vein before cannulation will reduce number of attempts for cannulation,supply costs and will improve patient satisfaction. AIM: To assess the efficacy of moist heat therapy onvisibility and palpability of peripheral veins prior to intravenous cannulation. SETTINGS: Day care unit(chemotherapy ward), Medicine and Orthopaedic wards of GGS hospital, Faridkot. MATERIAL ANDMETHODS: Using Quasi experimental research design and convenient sampling 60 patients undergoingI.V.cannulation whose veins were not visible and palpable were randomly assigned to experimental (n=30)and conventional group (n=30). In experimental group moist heat therapy with conventional tourniquettechnique and in conventional group only tourniquet was used then post assessment was checked by VeinAssessment Scale in both the groups. RESULTS: In experimental group, the post intervention vein assessmentscore improved from pre intervention score 1-2 to 3-5 and in conventional group from score 1-2 to 1-4. Afterintervention, in experimental group majority of subjects had vein score 4(vein visible and palpable), whereasin conventional group majority scored vein score 3(vein barely visible and palpable). 7(23.3%) subjects ofexperimental group scored vein score 5(vein clearly visible and palpable) whereas in conventional group nosubject scored 5 vein score. Also, 2(6.7%) subjects of this group had vein score 1 that remained unchangeddespite of routine technique. Difference between post intervention scores of experimental and conventionalgroup was found to be significant (?2= 20.06 and p-value 0.00) at p-value

Diabetic foot (DF), is one of the most serious and prevalent complications of diabetes mellitus (DM). Disruption in tissue oxygenation due to atherosclerosis in peripheral veins has an important place in DF development. In recent years, phosphodiesterase type 5 (PDE5) inhibitor drugs like sildenafil, which cause peripheral vasodilation, are used commonly in cases of erectile dysfunction, pulmonary hypertension and cardiac insufficiency. In that sense, PDE5 inhibitors, which cause vasodilation in peripheral veins, can increase blood build up in tissues of patients with DF and its stand-alone usage or its usage with already used treatments can increase tissue healing speed and quality.

Background Autologous and allogeneic hematopoietic stem cell transplantation of cytokine-mobilized peripheral blood stem cells (PBSCs) is increasingly used to treat patients with hematologic disorders. Different types of vascular access have been exploited for the apheresis procedure, including peripheral veins (PV) and central venous catheter (CVC). In some cases, PV access is unavailable. There are few published data on the efficiency and quality of harvesting with different types of vascular access. This study brings out complications and morbidity of this procedure linked to these different access. Methods We performed a comparative, retrospective, single-center study of hematopoietic stem cell collection using these two types of vascular access. We compared the efficiency and complication rate for 617 adults apheresis sessions in 401 patients and healthy donors, for PBSC collection via PV or CVC between 2010 and 2016. The quality of the HSC product was evaluated in terms of the total CD34 + count and neutrophil contamination. Results The PV and CVC groups did not differ significantly in terms of the quality of the apheresis product, mean ± SD CD34 + cells collected in PV group was 383.1 ± 402.7 × 10e6 and 298.8 ± 372.7 × 10e6 and the level of neutrophil contamination was 21.0 ± 17.8% in the PV group and 20.6 ± 18.4% in the CVC group. The complication rate did not differ between the two groups. Conclusion The type of vascular access for apheresis hematopoietic stem cell harvesting must be determined by trained staff. Successful harvesting can be performed via PV then CVC is not needed or not available.

Peripheral veins often contain tortuosities and valves that hinder the effective passage of intravenous catheters to the full extent of catheter length. This report describes a methodology termed flick-spin that has proven efficacious for venous catheter passage in tortuous and valve-rich peripheral veins. The method relies on (1) applying longitudinal tension to the vessel in an attempt to straighten it, (2) rotating or spinning the catheter along its longitudinal axis, and (3) flicking the skin or visible vein just beyond the catheter tip, all during catheter advancement. Additionally, lateral pressure may also be applied to the vessel—ie, proximal to the catheter tip and during catheter advancement—to fine-tune catheter tip direction. The report contains multiple illustrations to communicate the anatomic, physiologic, and technical underpinnings of the technique, as well as instructions for troubleshooting common problems.

Chronic venous insufficiency (CVI) is the most common pathology of the peripheral vascular system. One of the main principles of conservative treatment for both small and complicated forms is pharmacotherapy with the use of venoactive drugs. The effectiveness of therapy is largely associated with the choice of phlebotrophic drug. The article discusses approaches to systemic and topical drug therapy depending on the form and stage of CVI.

The abundance of, and reliance upon, human electro-muscular incapacitation (HEMI) devices, especially in law enforcement, has generated scrutiny and examination of these technologies. The purpose of this study was to examine cardiovascular effects resulting from typical (5 sec) and longer activation (20 sec) HEMI applications studying myocardial function and peripheral vascular system using a combination of invasive cardiovascular catheters and transesophageal echocardiography (TEE). Six healthy swine (Sus scrofa)3–5 months in age and weighing between 60 and 86 kg were anesthetized and exposed to the TASER Model X26 waveform while transesophageal echocardiography was performed. Stroke volume was shown to statistically decrease during HEMI application indicating an increase in systemic vascular resistance, but HEMI application did not result in myocardial dysfunction ( “cardiac stunning”).

The aim of this study was to compare flucloxacillin concentrations between two specimens collected simultaneously during continuous infusion. One specimen was collected from a peripherally inserted central catheter (PICC) and the other collected simultaneously by peripheral venepuncture. We conducted a prospective study in seven patients who were enrolled in our outpatient parenteral antibiotic therapy (OPAT) service at John Hunter Hospital, Australia, and who were receiving continuous flucloxacillin infusions from an elastomeric device. Blood samples were drawn simultaneously from a PICC and a peripheral vein in each patient. Plasma drug concentrations were measured and compared by paired t test. Flucloxacillin concentrations from the patient’s PICC sample were disproportionately higher than the peripheral sample with a mean difference of 28.4 mg/L (95%CI 2.48 to 54.4; p = 0.037). Plasma flucloxacillin concentrations taken from central catheters are falsely elevated as compared with those from peripheral veins.

Early detection of extravasation is important, but conventional methods of detection lack objectivity and reliability. This study evaluated the predictive validity of thermography for identifying extravasation during intravenous antineoplastic therapy. Of 257 patients who received chemotherapy through peripheral veins, extravasation was identified in 26. Thermography was performed every 15 to 30 minutes during the infusions. Sensitivity, specificity, positive predictive value, and negative predictive value using thermography were 84.6%, 94.8%, 64.7%, and 98.2%, respectively. This study showed that thermography offers an accurate prediction of extravasation.

Fur die bildgebende Darstellung der Bein- und Beckenvenen gibt es mehrere Verfahren. Bei Verdacht auf Beinvenenthrombose wird eine reine B‑Bild-Kompressionssonographie durchgefuhrt, deren Genauigkeit heute ausreicht, um den Verdacht ohne zusatzliche Bildgebung zu bestatigen bzw. auszuraumen. Die Untersuchung der Beckenstrombahn erfordert allerdings die Hinzunahme der Flussinformation aus dem Pulsed-wave-Doppler bzw. Farbdoppler. Bei Verdacht auf eine Armvenenthrombose genugt in den meisten Fallen ebenfalls die Sonographie. Fur die Darstellung der zentralen Abschnitte des Venensystems, das heist der V. brachiocephalica beidseits sowie der V. cava superior und inferior, stehen Schnittbildverfahren zur Verfugung. Die genauere Ortsauflosung der Gefasdurchgangigkeit besitzt die computertomographische Angiographie, in Bezug auf das umgebende Gewebe ist dagegen die Magnetresonanztomographie uberlegen. Die klassische Kontrastmittelphlebographie kommt heute nur noch im Zusammenhang mit Interventionen bei proximalen oder zentralen Venenverschlussen zur Anwendung. Eine weitere Indikation fur die Bildgebung ist die chronische venose Insuffizienz. Sowohl die differenzialdiagnostische Abklarung als auch die Behandlungsplanung bei Varikose kann sich vollstandig auf die Sonographie stutzen.

Imaging infections with radiolabeled WBC requires precise strategies in order to differentiate them from sterile inflammatory conditions. Indeed, radiolabeled neutrophil, when injected into peripheral veins, has a peculiar biodistribution characterized by a short transit through the lungs (usually 30–60 min), followed by rapid accumulation into liver, spleen, and bone marrow with slow migration into infection sites. This migration process is slower in chronic, low-degree infections and faster in acute, high-degree infections, and it is believed that it is driven by the local production of chemotactic factors.

Objective The objective of this study was to report the midterm outcomes of the brachial arterio-arterial prosthetic loop (AAPL) as an alternative permanent vascular access in strictly selected patients with end-stage renal disease. Methods This single-center prospective observational study was conducted between January 2014 and June 2017 and included 89 brachial AAPL procedures. Primary, assisted primary, and secondary patency rates were calculated using Kaplan-Meier analysis. Results Exhausted peripheral veins were the most common indication for brachial AAPL. Patients were followed up for a mean period of 28.7 ± 4.9 months. Nineteen grafts developed thrombosis, 13 grafts developed pseudoaneurysms, 9 grafts developed hematoma, and 6 grafts were abandoned because of infection. The primary, assisted primary, and secondary patency rates were 62% ± 5.2%, 71.2% ± 4.9%, and 89.6% ± 3.3% at 24 months, respectively. Conclusions Brachial AAPL can offer a simple, safe, and efficient alternative as a permanent hemodialysis access in a selected subset of end-stage renal disease patients, with acceptable durability and rate of complications. Because of its unique specifications, cooperation between vascular surgeons and dialysis staff is mandatory.

Background Cyanoacrylates are fast-acting adhesives used in procedural medicine including closure of superficial wounds, embolization of truncal vessels pre-operatively, vascular anomalies, visceral false aneurysms, endoleaks, gastrointestinal varices and gastrointestinal bleeding. More recently, catheter-directed cyanoacrylate adhesive closure was introduced as an alternative to endovenous thermal ablation (ETA) to occlude superficial veins of the lower limbs. Objectives To formulate policies for the safe and effective delivery of cyanoacrylate adhesive closure procedures in Australasia, based on current experience and evidence. Methods A panel of phlebologists including vascular surgeons, interventional radiologists, dermatologists and research scientists systematically reviewed the available data on cyanoacrylate products used in medicine and shared personal experience with the procedure. The reviewed material included bibliographic and biomedical data, material safety data sheets and data requested and received from manufacturers. Results and recommendations: Cyanoacrylate adhesive closure appears to be an effective treatment for saphenous reflux with occlusion rates at 36 months of 90–95%. We recommend a maximum dose of 10 mL of cyanoacrylate per treatment session. Serious complications are rare, but significant. Hypersensitivity to acrylates is reported in 2.4% of the population and is an important absolute contraindication to cyanoacrylate adhesive closure. 1 Post-procedural inflammatory reactions, including hypersensitivity-type phlebitis, occur in 10–20% of patients. 2 In the long term, cyanoacrylate adhesive closure results in foreign-body granuloma formation within 2–12 months of the procedure. We recommend against the use of cyanoacrylate adhesive closure in patients with uncontrolled inflammatory, autoimmune or granulomatous disorders (e.g. sarcoidosis). Caution should be exercised in patients with significant active systemic disease or infection and alternative therapies such as thermal ablation and foam sclerotherapy should be considered. Conclusions Cyanoacrylate adhesive closure appears to be an effective endovenous procedure, with short-term closure rates comparable to ETA and therefore greater efficacy than traditional surgery for treating superficial veins of the lower limbs. Ongoing data collection is required to establish the long-term safety.