• Journal of Trauma and Injury
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• v.28 no.4
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• pp.292-294
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• 2015

Central venous catheterization is one of the most important procedures for initial resuscitation of hemodynamically unstable patients including multiple trauma patients. Inadvertent arterial placement of the large caliber central venous catheter can results in resuscitation failure as well as unnecessary invasive treatment. Here, we report an arterial puncture during central venous catheterization which may lead to inadvertent arterial catheterization. We recommend that arterial catheterization should be evaluated before dilator insertion during Seldinger's method. Ultrasound can help in preventing the inadvertent arterial catheterization of central venous catheter.

• Journal of radiological science and technology
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• v.42 no.3
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• pp.195-199
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• 2019

Most of the vascular procedures performed for various diagnoses and treatments of various abdominal intervention procedures performed by the Department of Radiology and Angiography are performed by puncture of the femoral artery. For this reason, patients should undergo blood-related tests such as prothrombin time (PT) and partial thromboplatin time (PTT). Therefore, many patients are instructed to take precautions such as putting a sandbag on the puncture site to prevent delayed hemorrhage after hemostasis of the femoral artery puncture site, and not to bend the leg of the treated area for about 3 hours. Because of this, many patients have complained of pain during the procedure and inconvenience during the absolute bed rest time in the ward. The purpose of this study was to compare the safety of balloon ancillary devices with sandbags placed on the hemostasis site to prevent delayed hemorrhage after arterial puncture. We compared the safety of each patient with the results of medical records in consideration of the problem that the patient could not press with the focus, the position of the patient was changed depending on the patient's body shape, and the problem of falling down according to the location of the puncture site. As a result, the use of a balloon type ancillary device improves the effect of continuous hemostasis, reduces discomfort during the patient's absolute stabilization time, increases the patient's satisfaction, and is a good alternative to the existing sandbag.

• Archives of Plastic Surgery
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• v.41 no.1
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• pp.81-84
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• 2014

In this article, we present two cases of femoral pseudoaneurysm (PA) at the femoral arterial puncture site followed by necrotizing fasciitis, which is rare but can be fatal when not managed appropriately. PA was revealed by lower-extremity angiography and color-flow Doppler ultrasonography. Hematoma removal, thrombolysis, and bleeder ligation with Gelfoam were repeatedly performed by a vascular surgeon. When necrotizing fasciitis developed, aggressive surgical drainage and creation of a viable wound bed for reconstruction were mandatory. We adopted a vacuum-assisted closure device (Kinetics Concepts International) as the standard treatment for complicated, serious, infected PA of the puncture site. Excellent clinical outcomes were obtained.

• The Korean Nurse
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• v.33 no.1
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• pp.37-51
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• 1994

The cutaneous stimulation is an independent nursing intervention used in various painful conditions, and is explained by gate control theory. This study was aimed at identifying the effect of cutaneous stimulation on reduction of arteriovenous fistula puncture pain of hemodialysis patients. One group repeated measurement post test research was designed. Forty-five hemodialysis patients who received arteriovenous fistula puncture regulary in hemodialysis units of an attacted D hospital to K university have been studied from August 16 to 21, 1993. First the arteriovenous fistula puncture pain of control period was measured, and then the arteriovenous fistula puncture pain of experimental period(with cutaneous stimulation) was measured. The instrument used for this study were visual analogue pain scale as subjective pain measurement, objective pain behavior checklist and Spielberger's Trait Anxiety Inventory as intervening variables. Analysis of data was done by use of paired t-test, t-test, ANOVA and Perarson correlation coefficient. The results of this study were summarized as follows; 1) The first hypothesis that the subjective pain score of arteriovenous fistula puncture pain in experimental period(with cutaneous stimulation) will be lower than in control period was partly supported. The subjective pain score of arterial line was rejected(paired t=-0.28, p=0.77) and the subjective pain score of venous line was supported(paired t=2.61, p=0.01). 2) The second hypothesis that the objective pain behavior score of arteriovenous fistula pain in experimental period(with cutaneous stimulation) will be lower than in control period was rejected(arterial line paired t=-0.45, p=0.65; venous line paired t=-0.36, p=0.72). 3) The third hypothesis that the cardiopulmonary signs of arteriovenous fistula puncture pain in experimental period(with cutaneous stimulation) will be lower than in control period was rejected(pulse paired t=-0.8, p=0.42; systolic BP paired t=0.98, p=0.33; diastolic BP paired t=0.43, p=0.66). Further experimental studies with simple intravenous injection patients will be recommended in order to identify the effect of cutaneous stimulation.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.109-115
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• 1995

High frequency Jet ventilation (HFJV) via cricothyroid membrane puncture contols frequency of ventilation as 20-200/min and persuits adequate gas exchange. HFJV was known to have advantages such as improvement of PaO$_2$, lesser barotrauma, stable hemodynamic effects, good operative field and lesser movement of head. The purpose of this study was to clarify the advantages of HFJV in cases of microlaryngeal surgery which operating time was expected even within 30 minutes. Twenty-eight patients were divided two groups : 1)control group : general endotracheal Intubation anesthesia. 2)experimental group : HFJV via cricothyroid membrane puncture with intravenous anesthesia, frequency 40/min, I/E ratio 40%, driving pressure 40 psi. We analyzed blood pressure, arterial blood gas, score of general condition and recovery time after operation. In conclusion, HFJV via cricothyroid membrane puncture had a good score of general condition and rapid recovery of consciousness, although some accumulation of P$CO_2$and elevation of blood pressure.

• Journal of Chest Surgery
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• v.26 no.4
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• pp.316-319
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• 1993

Although Behcet`s disease, characterized by oro-genital ulceration and ocular abnormalities, is rare and unfamiliar disease to thoracic surgeon, one must remember that it can cause serious complications on the vascular system such as thrombophlebitis,thrombotic obstuction and aneurysm.We report a case of multiple arterial aneurysms with Behcet`s disease. This 31 year-old female had five times surgical interventions during short period[19 months]. 6 aneurysms were developed in this case, 3 were spontaneous aneurysms, 2 were anastomotic aneurysms and 1 was false aneurysm due to arterial puncture.

• Clinical and Experimental Pediatrics
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• v.45 no.4
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• pp.449-453
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• 2002

Purpose : Arterial blood gas analysis is frequently performed in neonatal intensive care unit (NICU) to evaluate ventilation and the metabolic state of critically ill infants. In occasions when umbilical arterial catheterization is not available, frequent arterial puncture is mandatory. This requires some technical skill and may occasionally have side effects. So we studied the validity of capillary blood gas analysis which can be performed conveniently compared with arterial blood. Methods : Twenty-four neonates admitted to NICU during April to Aug. 2001 were studied. They were more than two weeks old without indwelling arterial catheters. Thirty-six times, simultaneous arterial, and capillary blood gases were drawn by puncture and the pH, $pCO_2$ and $pO_2$ of each sample was measured. Blood pressure and body temperature was checked before sampling to rule out impaired peripheral circulation. Capillary blood was collected from warmed heels. Results : There was a strong correlation between capillary and arterial pH(r=0.91, P<0.05). The absolute value of the difference between arterial and capillary pH was less than 0.05. Also capillary $pCO_2$ showed correlation with arterial $pCO_2$(r=0.77, P<0.05). Despite a statistically significant correlation between capillary and arterial $pO_2$(r=0.68, P<0.05), the absolute value of the difference was more than 10 mmHg in 92% of cases. Conclusion : Capillary blood gases accurately reflected arterial pH and $pCO_2$ and showed a relative correlation with $pO_2$. Capillary blood gas analysis can be a useful alternative to arterial blood when continuation of the umbilical arterial catheter is no longer available.

• The Korean Journal of Pain
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• v.20 no.1
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• pp.66-70
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• 2007

No definitive etiology or risk factors have been identified that predispose individuals to developing complex regional pain syndrome (CRPS). We experienced two cases of CRPS developed after arterial and venous puncture which were done in regular medical work. A 35-years old female patient was suffered from pain and allodynia with swelling at right hand and wrist after radial artery puncture for monitoring of blood pressure during general anesthesia. A 24-years old male patient had pain and swelling with allodynia at the right fingers and arm after median cubital vein puncture for blood sampling. They did not have proper pain management as CRPS patients in the past weeks and months after their pain occurred. They were diagnosed as CRPS and started undergoing various interventional procedures, which led to improve their pain condition. Our cases suggest that CRPS could develop without any proved tissue damage in routine medical practice. In conclusion, health care workers should be educated in knowledge about the uncommon medical condition and proper consultation to pain specialist when it happens.

• Journal of Korean Neurosurgical Society
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• v.64 no.1
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• pp.60-68
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• 2021

Objective : Until recently, the transfemoral approach (TFA) was used as the primary method of arterial approach in acute ischemic stroke (AIS). However, TFA resulted in longer reperfusion times and worse outcomes in the mechanical thrombectomy (MT) of patients with complex aortic arches and significant carotid tortuosity. We found that the transradial approach (TRA) is a more favorable alternative approach for MT in such cases. Methods : We performed a retrospective review of our institutional database to identify 202 patients who underwent MT for AIS between February 2015 and December 2019. Patient characteristics, cause of TFA failure, procedure time, intra-procedural complications, and outcomes were recorded. Results : Eleven (5.4%) of 202 patients, who underwent MT for AIS, crossed over to TRA for recanalization, and eight (72%) of 11 achieved successful recanalization (≥modified Treatment in Cerebral Infarction 2b). The mean age (mean±standard deviation [median]) was 82.3±6.6 (76) years, and five of the 11 patients were male. The last seen normal to puncture time was 467.9±264.72 (264) minutes; baseline National Institutes of Health Stroke Scale score was 28.9±14.5 (16). Six (55%) of the 11 patients had right vertebrobasilar occlusions, and the remaining five (45%) had anterior circulation occlusive disease. The time from groin puncture to final recanalization time (overall procedural time) was 78.0±20.1 (62) minutes. The mean crossover time from TFA to TRA was 45.2±10.5 (41) minutes. The mean time from radial puncture to final recanalization was 33.8±10.5 (28) minutes. Distal thrombus migration events in previously unaffected territories occurred in 3/8 patients (37%). At 90 days, three patients (28%) had a favorable clinical outcome. Conclusion : Although rare, failure of TFA has been known to occur during MT for AIS. Our results demonstrate that TRA may be an alternative option for AIS intervention for select patients with subsequent timely revascularization. However, the incidence of distal thrombus migration was high, and the first puncture to reperfusion time was prolonged because of the time taken for the crossover to TRA after failure of TFA. This study provides some evidence that the TRA may be a viable alternative option to the TFA for MT of AIS.

• Journal of Korean Neurosurgical Society
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• v.57 no.1
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• pp.54-57
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• 2015

A 66-year-old woman presented with intermittent paraparesis and generalized tonic-clonic seizure. Cerebral angiography demonstrated dural arteriovenous fistula (AVF) involving superior sagittal sinus (SSS), which was associated with SSS occlusion on the posterior one third. The dural AVF was fed by bilateral middle meningeal arteries (MMAs), superficial temporal arteries (STAs) and occipital arteries with marked retrograde cortical venous reflux. Transfemoral arterial Onyx embolization was performed through right MMA and STA, but it was not successful, which resulted in partial obliteration of dural AVF because of tortuous MMA preventing the microcatheter from reaching the fistula closely enough. Second procedure was performed through left MMA accessed by direct MMA puncture following small decortications of cranium overlying the MMA using diamond drill one week later. Microcatheter could be located far distally to the fistula through 5 F sheath placed into the MMA and complete obliteration of dural AVF was achieved using 3.9 cc of Onyx.