Catheter insertion

Ca.rdia.c-AssistDevices. The principal cardiac-assist device, the intra-aortic balloon pump (lABP), is used primarily to support patients before or after open-heart surgery, or patients who go into cardiogenic shock. As of the mid-1990s, the lABP was being used more often to stabilize heart attack victims, especially in community hospitals which do not provide open-heart surgery. The procedure consists of a balloon catheter inserted into the aorta which expands and contracts to assist blood flow into the circulatory system and to reduce the heart s workload by about 20%. The disposable balloon is powered by an external pump console. 

Percutaneous coronary intervention (PCI) is one of a host of techniques performed by using a catheter inserted via a major limb artery that aims to relieve nanowing of coronary arteries. For example, percutaneous transluminal coronary angioplasty (PTCA) is the classic PCI that uses a catheter-directed balloon to dilate a stenotic coronary artery, and more recent PCIs include stent implantation, rotational atherectomy, and laser angioplasty. 

The indications for pulmonary artery catheterization are controversial. Because there is a lack of a well-defined outcome of data associated with this procedure, its use is presently best reserved for complicated cases of shock not responding to conventional fluid and medication therapies. Complications related to catheter insertion, maintenance, and removal include damage to vessels and organs during insertion, arrhythmias, infections, and thromboembolic damage. 

Disadvantages include risks associated with catheter insertion, use, and care. Central venous access has a greater potential for infection. 

After 24-h exposure to 0.1 ppm PCP, goldfish(av. 70 g) were transferred into the urine collecting apparatus and a catheter inserted Into the urinary bladder from the urogenital cavity. Approximately 13 ml of urine was collected from each fish for 24 h. The urine collected from 14 fish was pooled and used for the determination of PCP. 

Bleeding at superficial sites, such as venous injection sites, catheter insertion sites, venous cutdowns, arterial punctures, and sites of recent surgical procedures, gingival... 

Carefully monitor all needle puncture sites and catheter insertion sites for bleeding... 

Wientjes KJC, Grob U, Hattemer A, Hoogenberg K, Jungheim K, Kapitza C, Schoonen AJM. Effects of microdialysis catheter insertion into the subcutaneous adipose tissue assessed by the SCGM1 system. Diabetes Technology Therapeutics 2003,5,615-620. 

Catheter insertion should be carried out under the most aseptic conditions possible. 

Cordoni, A., and Cordoni, L. E. (2001), Eutectic mixture of local anesthetics reduces pain during intravenous catheter insertion in the pediatric patient, Clin. J. Pain, 17, 115-118. 

Figure la. Cryogenic heart catheter inserted into vein at the groin and advanced to the right atrium. 

A 48-year-old obese woman had a 22G interscalene catheter inserted under local anesthesia via a short-bevel stimulating needle. Anesthesia was achieved using 0.6% ropivacaine 40 ml followed by an infusion of ropivacaine 0.2% for effective analgesia. On day 3, she reported blurred vision and a painful neck swelling. She had developed a hematoma around the catheter insertion site (confirmed by ultrasound) and had an ipsilateral Homer s syndrome including myosis, ptosis, enophthalmos, ipsUateral anhidrosis, and conjunctival hyperemia. 

Thrombophlebitis can be identified by heat, swelling or the presence of any exudate around the catheter insertion site or a palpable thrombus ("corded" feel) in the catheterized vein. Catheter-ized veins should be examined at least daily. 

Pneumothorax Collapsed lung (caused by catheter insertion)... 

Physical assessment should include examination of all common sites of infection, including mouth/pharynx, nose and sinuses, respiratory tract, gastrointestinal tract, urinary tract, skin, soft tissues, perineum, and intravascular catheter insertion sites. 

Brachial plexus injury Injury to the nerve during catheter insertion, or injury secondary to catheter malposition or extravasation of a hypertonic solution... 

Figure 12.2 Subject wired for microdialysis with catheters inserted into the mucosa in the inside of the cheek. Only short-term studies are practical using this...

Circulating radiolabeled platelets adhered and aggregated on two polyethylene catheters inserted retrograde into the carotid arteries. Increasing platelet retention is shown in the sequence A through EThe beginning of thrombus dissolution is seen in F . The small platelet collection is best shown in the precatheter sample (A). Blood was drawn... 

---