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Wellington, New Zealand

Background Persistent left superior vena cava (PLSVC) occurs in approximately 1 in every 200 people, and with various malformations. Nurses who insert peripherally inserted central catheters (PICCs) may need to place a PICC line in this venous malformation. Aims To review the literature and assess the safety of positioning a PICC line in a PLSVC, and to also assess the ideal placement of a PICC line in a PLSVC with reference to a chest radiograph and intravenous electrocardiogram (IVECG) navigation. Methodology Literature search across 5 main databases, alongside hand-searched articles. Results No literature was found that prohibits placement of a PICC line in a PLSVC, unless the PLSVC enters the left atrium, and no literature was found that identifies an ideal position for the PICC tip in a PLSVC. Two approximate positions were highlighted: high in the PLSVC or passed through a bridging brachiocephalic vein to a right superior vena cava. Placing a PICC line in a PLSVC using IVECG navigation is shown to produce abnormal electrocardiogram readings. Conclusions A PICC line can be safely placed in a PLSVC as long as the PLSVC does not enter the left atrium, avoiding potential systemic embolization. Final positioning of the PICC tip on a chest radiograph is proposed to be in the midregion between the carina and the junction of the PLSVC/coronary sinus, with the aim of avoiding coronary sinus thrombosis and providing satisfactory dilution of infusate. If abnormal electrocardiogram readings during IVECG placement are seen, then PLSVC should be suspected. Further research and data are needed due to limited research in this area. © 2015 Association for Vascular Access. Source

Birch P.,Newborn Services | Ogden S.,Wellington Hospital | Hewson M.,Wellington Neonatal Unit
Archives of Disease in Childhood: Fetal and Neonatal Edition

Background: Infections are common complications of neonatal long lines. Heparin has been shown to prolong the effective duration of neonatal long lines and to reduce the ability of bacteria to adhere to foreign surfaces, but the effect of heparin on rates of infection is uncertain. Objective: The goal of this study was to evaluate the effect of heparin on the frequency of episodes of catheter-related sepsis (CRS) in infants receiving total parenteral nutrition (TPN) through a neonatal long line. Design/Methods: This randomised, controlled, double blind, single-centre clinical trial compared heparin at 0.5 IU/ml with no heparin in TPN infused through a neonatal long line, with episodes of CRS as the primary outcome. Results: 210 infants were enrolled (TPN with heparin n=102, TPN without heparin n=108). There was a statistically significant reduction in all episodes of culture-positive CRS in those infants with heparin added to the TPN compared with those without heparin (p=0.04; RR 0.57, 95% CI 0.32 to 0.98; number needed to treat 9, 95% CI 4.6 to 212.4). Conclusions: The addition of heparin at 0.5 IU/ml to TPN infused through a neonatal long line reduces the incidence of culture-positive CRS. Source

Whitbourn R.,St. Vincents Hospital | Harding S.A.,Wellington Hospital | Walton A.,Epworth Hospital

Aims: The aim of this study was to test the safety and performance of the Symplicity™ multi-electrode radiofrequency renal denervation system which was designed to reduce procedure time during renal denervation. Methods and results: The multi-electrode radiofrequency renal denervation system feasibility study is a prospective, non-randomised, open label, feasibility study that enrolled 50 subjects with hypertension. The study utilises a new renal denervation catheter which contains an array of four electrodes mounted in a helical configuration at 90 degrees from each other to deliver radiofrequency energy simultaneously to all four renal artery quadrants for 60 seconds. The protocol specified one renal denervation treatment towards the distal end of each main renal artery with radiofrequency energy delivered for 60 seconds per treatment. Total treatment time for both renal arteries was two minutes. The 12-month change in office systolic blood pressure (SBP) and 24-hour SBP was -19.2±25.2 mmHg, p<0.001, and -7.6±20.0 mmHg, p=0.020, respectively. There were three patients with access-site complications, none of which was related to energy delivery; all were treated successfully. No new renal artery stenosis or hypertensive emergencies occurred. Conclusions: The Symplicity multi-electrode radiofrequency renal denervation system was associated with a significant reduction in SBP at 12 months and minimal complications whilst it also reduced procedure time. © Europa Digital & Publishing 2015. All rights reserved. Source

Bomann S.,Wellington Hospital
The American journal of emergency medicine

Tako-tsubo transient cardiomyopathy (TCM) is a syndrome of specific myocardial wall motion abnormalities that appear in response to extreme physiological or emotional stress. The patients have normal coronary arteries and usually present as new-onset heart failure or acute coronary syndrome. We report on a 48-year-old woman with post-community cardiac arrest presenting as an acute myocardial infarction. An emergency physician-performed echocardiogram showed significant wall motion abnormalities, suggesting myocardial infarction. Cardiac catheterization revealed patent epicoronary circulation, and ventriculography demonstrated a rare and only recently described variant of TCM:" reverse" TCM. The patient subsequently died from a subarachnoid hemorrhage. Source

Tzaveas A.P.,Wellington Hospital | Villar R.N.,Wellington Hospital
HIP International

Acetabular chondral delamination is a frequent finding at hip arthroscopy. The cartilage is macroscopically normal but disrupted from the subchondral bone. Excision of chondral flaps is the usual procedure for this type of lesion. However, we report 19 consecutive patients in whom the delaminated chondral flap was re-attached to the underlying subchondral bone with fibrin adhesive. We used the modified Harris hip score for assessment of pain and function. Improvement in pain and function was found to be statistically significant six months and one year after surgery. No local or general complications were noted. Three patients underwent further surgery for unrelated reasons. In each, the area of fibrin repair appeared intact and secure. Our results suggest that fibrin is a safe agent to use for acetabular chondral delamination. © 2010 Wichtig Editore. Source

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