The high incidence of bleeding after peripherally inserted central catheter (PICC) catheterization increases the risk of puncture site infection and unplanned extubation. Hemostatic dressings should be used in the early stages of catheterization to reduce blood infiltration. However, new hemostatic dressings have various types and advantages, which makes them difficult to choose dressings for medical staff. This paper introduces the types and hemostatic characteristics of novel functional hemostatic dressings, reviews the hemostatic mechanism and hemostatic effect of chitosan, cyanoacrylate gum, alginate, gelatin sponge and oxycellulose dressings in PICC puncture respectively, and prospects the development of new functional hemostatic dressings. It is expected that future hemostatic dressings will move towards multifunctionality and compositeness.
Humans ; Bandages ; Catheterization, Peripheral/instrumentation* ; Hemorrhage/prevention & control* ; Hemostatics/therapeutic use*

OBJECTIVETo study the efficiency of electrocardiogram (ECG) monitor for positioning the catheter tip in the placement of peripherally inserted central catheter (PICC) in neonates.

METHODSA total of 160 neonates who were admitted to the neonatal intensive care unit (NICU) from January 2015 to December 2017 and underwent the PICC placement via the veins of upper extremity were enrolled. They were randomly divided into an observation group and a control group, with 80 neonates in each group. The neonates in the control group were given body surface measurement and postoperative X-ray localization, while those in the observation group were given body surface measurement, ECG localization, and postoperative X-ray localization. The two groups were compared in terms of general information, one-time success rate of PICC placement, and time spent on PICC placement.

RESULTSThere were no significant differences between the two groups in sex composition, gestational age, age in days at the time of PICC placement, disease type, and site of puncture (P>0.05). Compared with the control group, the observation group had a significantly higher one-time success rate of PICC placement (95% vs 79%; P<0.05) and a significantly shorter time spent on PICC placement (P<0.05). Localization under an ECG monitor during PICC placement had a sensitivity of 97% and a specificity of 100%.

CONCLUSIONSDuring the PICC placement in neonates, the use of ECG monitor to determine the position of catheter tip can improve the one-time success rate of placement and reduce the time spent on placement.

Catheterization, Central Venous ; instrumentation ; Catheterization, Peripheral ; methods ; Catheters, Indwelling ; Electrocardiography ; instrumentation ; Female ; Humans ; Infant, Newborn ; Male

INTRODUCTIONIntraosseous access is an alternative to conventional intravenous access when access is difficult or impossible in the adult population. The EZ-IO is a novel intraosseous access device designed for use in adults, utilising a powered driver.

MATERIALS AND METHODSA prospective, observational study involving a convenience sample of 25 medical students, physicians and nursing staff recruited as study subjects to secure intraosseous access using the EZIO powered drill device, on a bone model.

RESULTSTwenty-three (92%) of the 25 study subjects required only 1 attempt at placing the EZ-IO. There were 24 (96%) successful placements of the EZ-IO. The average time taken to place the EZ-IO was 13.9 seconds. Twenty (87%) of 23 participants reported easier placement with the EZ-IO than an intravenous cannula. The average time taken for the physicians, nursing staff and medical students was 3.71 (+/- SD 1.70) seconds, 7.88 (+/- SD 4.02) seconds and 33.7 (24.5), respectively. Overall mean difficulty of insertion score (VAS) was 3.1 (+/- SD 1.9).

CONCLUSIONThe intraosseous access device evaluated in this study appears to be easy to use with high success rates of insertion with inexperienced participants. There is potential for use in the Emergency Department.

Adult ; Catheterization, Peripheral ; instrumentation ; Catheters, Indwelling ; Equipment Design ; Humans ; Infusions, Intraosseous ; instrumentation ; Professional Competence ; standards ; Prospective Studies ; Resuscitation ; methods ; Shock ; therapy

OBJECTIVETo analyze major probable causes, locations and remedies of lead fractures in implanted pacemaker and implanted cardioverter defibrillator (ICD) .

METHODSFrom January 1982 to November 2004, on all the pacemakers and ICDs implanted at this hospital, lead fractures were detected timely by regular telemetric programmed testing, chest radiography and electrocardiography. Appropriate remedial actions were given and follow up visits were done to verify the results.

RESULTSOf all the 4698 pacemakers and 161 ICDs, there were 29 lead fractures on 31 leads with an incidence rate of 0.6%. The incidence rate of lead fracture was 0.9% for pacemakers/defibrillators implanted by subclavian venipuncture, while it was 0.4% for pacemakers/defibrillators implanted by cephalic venotomy (P = 0.04). Fracture locations: 22 cases at the sub clavicle, 6 cases in the pacemaker pocket, and 1 case in the right ventricle. Among the 29 cases, 24 were implanted with additional new leads, 3 cases whose atrial leads were fractured were switched from DDD mode to VVI. All the patients were followed up for an average of 5.6 months +/- 16.1 months. In one patient, the lead was removed through thoracotomy due to infection of exposed lead.

CONCLUSIONSCephalic venotomy is the first choice for pacemaker and ICD implantation, and the second choice is subclavian venipuncture in the outer part of subclavian vein, which has a higher incidence rate of lead fracture. Most lead fractures are detected at the region of medial subclavian. Regular follow-up can help timely detect fractures, so that the cases can be dealt with properly.

Adult ; Catheterization, Peripheral ; instrumentation ; Defibrillators, Implantable ; Equipment Failure ; Female ; Humans ; Male ; Middle Aged ; Pacemaker, Artificial