Percutaneous access device

Wredling R, Adamson U, Lins PE, Backman L, Lundgren D. Experience of long-term intraperitoneal insulin treatment using a new percutaneous access device. Diabet Med 1991 8(6) 597-600. 

Percutaneous Access Devices Small Joint Replacements... 

Coatings for tissues intergrowth Percutaneous access devices Artificial tendons and ligaments Periodontal pocket obliteration... 

Dental implants Periodontal pocket obliteration Alveolar ridge augmentation Maxillofacial reconstmction Otolaryngologic applications Percutaneous access devices Spinal fusion... 

Two sets of blood cultures should be obtained, because two sets of cultures are required to rule out contamination. At least one should be drawn percutaneously and one drawn through each vascular access device, unless the device was recently (less than 48 hours) inserted. 

Catheters, in their simplest form, are merely tubes inserted into a body cavity for die purpose of fluid removal, injection, or both (Thomas, 1989). The term catheter has been expanded to include a number of tubing-based percutaneous interventional devices used for tasks such as stent delivery and deployment, clot removal, radio-frequency ablation, and intra-aortic balloon cardiac support Because of their prevalence and representative uses, the present section will be limited to vascular infusion catheters and access ports. Stenting and cardiac support applications utilizing catheter-based techniques are discussed elsewhere in this chapter. 

Central venous catheters are reluctantly used as blood access for hemodialysis because of safety concerns and frequent complications, for example sepsis, thrombosis, and vessel stenosis. Nevertheless, 20% or more of all patients rely on atrial catheters for chronic dialysis because of lack of other access. Potentially fatal risks related to central venous catheters include air embolism (1), severe blood loss (2), and electric shock (3). These specific risks have been substantially eliminated by the inherent design and implantation of Dialock (Biolink Corporation, USA). Dialock is a subcutaneous device consisting of a titanium housing with two passages with integrated valves connected to two silicone catheters. The system is implanted subcutaneously below the clavicle. The tips of the catheters are placed in the right atrium. The port is accessed percutaneously with needle cannulas. 

Nosocomial bloodborne infections in hospitalized patients are associated with a two- to threefold increase in mortality. The origin of infection is usually either cannula-related or infusate-related. Cannula-related infections include those derived from percutaneous devices used for vascular access (e.g., needles, hubs, and plastic catheters). Maki reports that between 5 and 25% of intravascular devices are microbially colonized at the time of vascular withdrawal [25]. Large numbers of microorganisms are observed on the intravascular portion of the cannula or its tip (Fig. 1). 

Catheter device selection is based on a number of factors, including the plarmed application and placement site, duration of implantation, composition of fluids infused, and frequency of access (Namyslowski and Patel, 1999). Vascular catheters can be divided into two genei groups shortterm, temporary catheters that are placed percutaneously, and long-term, indwelling vascular catheters that usually require a surgical insertion. Temporary catheters include short peripheral venous and arterial catheters, nontunneled central venous and arterial catheters, and peripherally inserted central catheters (Pearson, 1996). Tunneled central venous catheters and totally implantable intra-... 

Fig. 4.66 A Stylized Ulustratioii of axillary venipuncture using tbe guidewire as a landmark. B Radiograph of needle accessing the axillary vein using the guidewire as a landmark. (Shefer A, Lewis BS, Gang ES. The retropectoral transaxillary permanent pacemaker description of a technique for percutaneous implantation of an invisihle device. Pacing Chn Electrophysiol 1996 19(llPt 1) 1646-1651, with permission.)...

If a peroral route to the stomach outlet or duodenum is not feasible percutaneous gastrostomy using standard techniques (De Baere et al. 1997 Pinto et al. 2001) allows a more direct access. Using a stiff sheath successful catheterisation of the intestinal lumen beyond the obstruction is possible in virtually all cases and also stents mounted on shorter or relatively stiff introducing devices can then be implanted (Pinto 1997 Pinto et al. 2001 Keymling et al. 1993 Truong et al. 1992 Song et al. 1993). 

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