In surgeries that require the implantation of a pacemaker, the endocardial pacemaker leads are introduced into the cardiac chambers through subclavian or axillary venous catheterization or cephalic vein cutdown. The drawback of this type of surgery is scarring of the pectoral area, which can be a serious cosmetic problem especially for young women. In this study, we report on 2 cases where a permanent pacemaker in two young women with symptomatic bradycardia was implanted using a transaxillary incision. Both patients successfully recovered with no complications and were asymptomatic for more than 17 months after the procedure. Therefore, we found that implantation of a pacemaker via transaxillary incision provided excellent cosmetic results and should be considered in young women that require this type of surgery.
Axilla ; Bradycardia ; Catheterization ; Catheters ; Cicatrix ; Cosmetics ; Female ; Humans ; Venous Cutdown

PURPOSE: Emergency procedures are highly dependent on the skill and experience of the physician performing them. Recent advances in light embalming techniques have enabled us to train students on more "realistic" cadavers. The purpose of this study was to report on or 3-year experience with lightly embalmed cadaver-based training and evaluate the student satisfaction with this approach. METHODS: Lightly embalmed cadavers were prepared by the Department of Anatomy. The course was held every March for 3 years. In 2007, we held a 6-hour course for 16 first-year emergency medicine residents from various hospitals. We had procedure and demonstration stations for airway management, tube thoracostomy, central venous catheterization, venous cutdown, pericardiocentesis, intraosseous insertion, open thoracostomy, and lumbar puncture. We evaluated the students' level of satisfaction with the course by giving pre- and post-course evaluations to all students. RESULTS: Based on our experience from the two prior courses, the 2007 curriculum was divided into three parts: didactic lecture, procedure stations and demonstration stations. Pre- and post-course scores were compared for the following: knowledge of the indications and contraindications for the procedures; ability and confidence in performing the procedures; and the ability to perform procedures on actual patients. For 26 items out of a total of 32 items(81.3%), the scores from the post-course evaluation were statistically higher than the scores from the pre-course evaluation. CONCLUSION: Lightly embalmed cadavers are excellent training models for emergency procedures. From our 3-year experience with this method, we were able to develop a training course that was satisfactory to students.
Airway Management ; Cadaver ; Catheterization, Central Venous ; Central Venous Catheters ; Curriculum ; Embalming ; Emergencies ; Emergency Medicine ; Humans ; Light ; Pericardiocentesis ; Spinal Puncture ; Thoracostomy ; Venous Cutdown

Percutaneous infraclavicular subclavian catheterization has been widely used for a total parenteral nutrition, hemodynamic monitoring and for venous access in difficult clinical situations. Many authors have claimed the infraclavicular cannulation of the subclavian vein in the tiniest infants can be performed with safety and ease, but there are always possibility of serious complications in this method. We present our experiences of peripheral venous cutdown with Broviac catheter. Author routinely introduced Broviac catheter into central vein via peripheral venous cutdown. There was no life threatening complications and no catheter related death. The complication rate was very low. The catheter related sepsis was documented in only two patient(4.7%). The average catheter longivity was 19.59 days. In view of the safety and low rate of complication, we think that peripheral venous cutdown with Broviac catheter should be the method of choice when central venous access is neccesary in infants. The infraclavicular subclavian catheterization should be reserved in infants with few accessable peripheral vein.
Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Hemodynamics ; Humans ; Infant ; Methods ; Parenteral Nutrition, Total ; Sepsis ; Subclavian Vein ; Veins ; Venous Cutdown

The usefulness of totally implantable central venous port for long-term intravenous infusion is widely accepted in children. Usually the catheters are placed through the internal or external jugular vein. In case of jugular vein cut-down, two separate incisions are needed for catheter and port respectively. Patients also feel uncomfortable as the catheter run through the neck. However these disadvantages can be overcome by using the cephalic vein (CV). We reviewed our experiences on CV cut-down for totally implantable central venous port in children. From January 2002 to December 2006, 201 patients (M:F=127:74) underwent 218 central venous port insertions. Mean age at operation was 5.9 years (2 months - 19 years). Indications included chemotherapy (N=167), long-term intravenous antibiotics infusion (N=36), and total parenteral nutrition (N=15). CV was selected preferentially. The incision includes the deltopectoral triangle laterally, and both the CV cut-down and port insertion were achieved with a single incision. The number of insertion through external, internal jugular vein, and CV was 77, 66 and 75, respectively. The median age, height and body weight were higher in CV cut-down group. The youngest age for CV cut-down was 8 months, the shortest height was 69 cm and the smallest body weight was 5.9 kg. Of 118 trials of CV cut-down, cut-down was successful in 75 cases (63.6 %). CV was absent in 10 cases(8.4 %) and CV was sacrificed after catheter tip malposition in 10 cases (8.4 %). There was only one complication, in which the catheter was inserted into the minute branch of subclavian artery. The CV cut-down method for totally implantable central venous port was safe and feasible in selected groups of patients in children. In addition, preservation of jugular vein and a more favorable cosmetic effect are other benefits of CV cut-down.
Anti-Bacterial Agents ; Body Weight ; Catheterization, Central Venous ; Catheters ; Child ; Cosmetics ; Humans ; Infusions, Intravenous ; Jugular Veins ; Neck ; Parenteral Nutrition, Total ; Subclavian Artery ; Veins ; Venous Cutdown