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Failed attempts at vein cannulation can be frustrating for both patients and clinicians, increasing patient discomfort and adding stress to medical staff. When a cannulation attempt fails, evaluating the cause and employing specific troubleshooting techniques can significantly improve the success of subsequent attempts. Below, we provide a comprehensive guide on common problems in vein cannulation failure and actionable steps for healthcare providers to take. Understanding common reasons for cannulation failure Failed cannulation can arise from various issues, such as improper needle position, vein occlusion, and patient positioning. Here’s a breakdown of the most common challenges: Incorrect needle position: The needle may be positioned too shallow or misaligned, resulting in the catheter pressing against the vein wall. Vein occlusion: Clotted or thrombosed veins prevent the needle from entering smoothly. Immediate bleeding: Removing a failed catheter can cause bleeding at the insertion site. Tourniquet removal: Releasing the tourniquet prematurely may collapse the vein, complicating future attempts. Strategies for troubleshooting failed cannulation Check needle position Problem: If the needle does not penetrate the vein, it may be positioned either adjacent to or below it. This often results from insufficient depth, with the catheter being pushed against the vein wall rather than entering the vein lumen. Interventions: Increase counter traction: Apply counter traction on the skin to stabilize the vein and improve control during insertion. Adjust needle angle: Modifying the angle can help the needle enter the vein more precisely. Try lowering or raising the needle to achieve better alignment with the vein. Change insertion site or arm position: To improve access, reposition the patient’s arm or choose a different vein. Consider starting with larger, more superficial veins to enhance success rates. Check for vein occlusion Problem: Difficulty inserting the needle could indicate vein occlusion, often signaled by a “rolling” vein that does not permit […]
December 10, 2024
Total hip arthroplasty (THA) is a common orthopedic procedure, and effective postoperative pain management is crucial for enhancing recovery. Regional anesthesia techniques, such as the pericapsular nerve group (PENG) and lateral quadratus lumborum block (QLB), are designed to reduce opioid use while providing pain relief. This study compares the efficacy of these two techniques in managing postoperative pain and reducing opioid consumption after THA. Study objective and methods The primary objective of this randomized controlled trial was to assess whether the PENG block, when combined with a lateral femoral cutaneous nerve (LFCN) block, provided superior analgesia compared to the lateral QLB in patients undergoing elective THA. A total of 106 patients participated in this study, all of whom were randomly assigned to receive either the PENG + LFCN block or the lateral QLB. Primary outcome: The cumulative opioid consumption was measured over 72 hours post-surgery, using intravenous morphine milligram equivalents (MMEs) to standardize results. This allowed for a direct comparison of opioid use between the two groups. Secondary outcomes: Additional outcomes included postoperative pain scores during both movement and rest, time to ambulation, length of hospital stay, and functional outcomes. Functional outcomes were assessed using the Hip Disability and Osteoarthritis Outcome Score (HOOS JR) and the Patient-Reported Outcome Measures Information System (PROMIS-10). Key findings Opioid consumption: At 72 hours post-surgery, patients in the QLB group consumed significantly fewer opioids than the PENG + LFCN group (mean difference of 33 mg, p = 0.001). Statistically significant differences in opioid consumption were also observed at 36 hours (mean difference of 18 mg, p = 0.040), 48 hours (23 mg, p = 0.011), and 60 hours (28 mg, p = 0.004). Pain with movement: The lateral QLB group reported lower pain scores during movement from 36 to 72 hours postoperatively. Resting pain scores: […]
December 5, 2024
A recent study by Hallo-Carrasco et al. highlights the potential dangers of gadolinium-based contrast media (GCM) in interventional pain medicine. This research, published in Regional Anesthesia & Pain Medicine (2024), investigates adverse events linked to using GCM during spine procedures where inadvertent intrathecal administration is a risk. Here’s a comprehensive look at the findings, implications, and best practices surrounding GCM use in these procedures. Overview of gadolinium-based contrast media (GCM) Gadolinium-based contrast agents are an alternative for patients with documented allergies to iodinated contrast media (ICM). While traditionally safer for imaging, GCM carries specific risks: Toxicity risks: Gadolinium ions (Gd3+) are inherently toxic; chelating agents stabilize the compound and reduce these risks. Neurotoxicity: When inadvertently injected into the intrathecal (spinal) space, GCM can cause severe neurotoxic effects. Brain retention: There are concerns about gadolinium deposits in brain tissues following repeated exposure. Key findings Conducted via a retrospective review of medical records, the study investigated 508 patients who received GCM for spine-related procedures between 2019 and 2022. Here’s what was uncovered: Adverse event rate: 23 patients (3.3%) experienced adverse events potentially related to GCM. Common symptoms included severe pain, dizziness, headache, and, in one case, multifocal stroke. Patient demographics: A significant majority of patients were white females with a mean age of 67.55 years. Indications for GCM use: The predominant reason for using GCM was a documented iodine-related allergy. However, only 1% of these cases involved high-risk allergy reactions that could justify substituting ICM. Severity of adverse events: While most were manageable, some cases required hospitalization. The study documented one severe incident of stroke following GCM administration. Adverse reactions and symptoms Adverse effects following inadvertent intrathecal injection of GCM included: Severe pain: Reported within days of the procedure, sometimes requiring hospitalization. Headaches: Particularly postural headaches, which align with findings from other […]
December 3, 2024
