1
|
Liu N, Sun B, Xu J, Xu J, Zhao K, Xu S, Su X, Zhou W. Evaluation of blood evacuation efficiency using 99mTc-RBC imaging: a comparative study of exsanguination tourniquet rings and Esmarch bandages. Nucl Med Commun 2024:00006231-990000000-00330. [PMID: 39211998 DOI: 10.1097/mnm.0000000000001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVE The objective of this study is to compare the effectiveness of the Esmarch bandage and exsanguination tourniquet rings (ETRs) in blood evacuation procedures using a controlled intra-subject design involving healthy volunteers. METHODS A total of 20 healthy adult volunteers (12 males, 8 females) were recruited from the community. Participants underwent blood evacuation procedures on both legs, using the Esmarch bandage on one leg and the ETR on the other. The order of the procedures was randomized. Blood evacuation time, overall blood evacuation rate, and calf blood evacuation rate were measured using 99mTc-labeled red blood cell imaging. Paired t-tests were conducted to compare the effectiveness of the two methods. RESULTS The ETRs demonstrated a significantly faster blood evacuation time compared to the Esmarch bandage (mean difference = -41.72 s, P < 0.0001). The overall blood evacuation rate was slightly higher for the ETRs (mean difference = 1.717%), though not statistically significant (P = 0.3680). The calf blood evacuation rate was significantly higher for the ETRs (mean difference = 6.86%, P = 0.0225). No significant discomfort or adverse reactions were reported by any participants. CONCLUSION ETRs are more efficient in terms of blood evacuation time and calf blood evacuation rate compared to the Esmarch bandage, without causing significant discomfort or adverse reactions. These findings suggest that ETRs could be a preferable option in clinical settings for blood evacuation procedures.
Collapse
Affiliation(s)
- Ninghu Liu
- Department of Nuclear Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Binbin Sun
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, China
| | - Jianjie Xu
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, China
| | - Jianqiao Xu
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, China
| | - Keqi Zhao
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, China
| | - Shaonan Xu
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, China
| | - Xinhui Su
- Department of Nuclear Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Weifeng Zhou
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, China
| |
Collapse
|
2
|
Xu J, Zhao K, Xu S, Xu J, Sun B, Tong S, Yao W, Bi Q, Yang Z, Zhou W. Comparison of exsanguination and hemostasis devices for Limb surgery: a multicenter randomized controlled study. BMC Musculoskelet Disord 2024; 25:679. [PMID: 39210304 PMCID: PMC11360307 DOI: 10.1186/s12891-024-07770-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Excessive intraoperative bleeding remains a challenge in limb surgeries. The exsanguination tourniquet ring has emerged as a potential solution for effective exsanguination and hemostasis. This study aims to evaluate its efficacy and safety compared to the conventional exsanguination and hemostasis approach (pneumatic tourniquet combined with Esmarch bandage). METHODS This randomized controlled trial evaluates the exsanguination tourniquet ring's effectiveness and safety versus the conventional approach in 220 participants undergoing various limb surgeries. Allocation included experimental and control groups, assesses through efficacy (including intraoperative and total blood loss, hemoglobin levels, and exsanguination and hemostasis effectiveness) and safety (adverse event occurrence) indicators. RESULTS The experimental group (n = 110) utilizes the exsanguination tourniquet ring, while the control group (n = 110) employs the conventional approach. As for intraoperative blood loss, the experimental group is non-inferior to the control group (p-value < 0.001). While no significant difference is found in total blood loss (for the full analysis set, p-value = 0.442; for the per protocol set, p-value = 0.976) and differences in postoperative and preoperative hemoglobin levels (for the full analysis set, p-value = 0.502; for the per protocol set, p-value = 0.928). Regarding exsanguination and hemostasis effectiveness, the full analysis set reveals significantly superior ratings in the experimental group compared to the control group (p-value = 0.002 < 0.05), while the per protocol set analysis indicates no significant difference between the groups (p-value = 0.504). As for safety indicators, adverse events related to the device are minimal in two groups, with only one severe event unrelated to the device. CONCLUSIONS The exsanguination tourniquet ring is an effective and safe device for intraoperative blood loss control in various limb surgeries. TRIAL REGISTRATION Comparison of Exsanguination and Hemostasis Devices for Limb Surgery A Prospective Multicenter Randomized Controlled Study, ChiCTR2300077998, 11/27/2023.
Collapse
Affiliation(s)
- Jianjie Xu
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China
| | - Keqi Zhao
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China
| | - Shaonan Xu
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China
| | - Jianqiao Xu
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China
| | - Binbin Sun
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China
| | - Songlin Tong
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China
| | - Wangxiang Yao
- Department of Orthopedics, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Zhejiang, 310006, China.
| | - Qing Bi
- Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, 310014, China.
| | - Zhengming Yang
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang, 310009, China.
| | - Weifeng Zhou
- Department of Orthopedics, Cixi People Hospital Medical Health Group (Cixi People Hospital), Zhejiang, 315300, China.
| |
Collapse
|
3
|
Rattanathanya T, Adulkasem N, Wongcharoenwatana J, Ariyawatkul T, Chotigavanichaya C, Eamsobhana P. Perioperative blood loss reduction using a sterile exsanguination tourniquet for orthopedic femoral-related surgeries in children: a randomized controlled study. J Orthop Surg Res 2023; 18:580. [PMID: 37553565 PMCID: PMC10408137 DOI: 10.1186/s13018-023-04046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES The sterile exsanguination tourniquet (SET) could be an alternative for providing bloodless surgeries in orthopedic femoral-related surgeries in pediatric patients where the standard pneumatic tourniquet would not be feasible. This randomized-controlled study aimed to evaluate the efficacy of SET in decreasing total perioperative blood loss and blood transfusion. METHODS We conducted an unplanned interim analysis of data from a randomized-controlled trial. At the time of the analysis, 31 pediatric patients had been randomly assigned to undergo surgery with the SET application (the SET group, 15 patients) and without the SET application (the control group, 16 patients). An intention-to-treat analysis was performed to evaluate the total perioperative blood loss, postoperative blood transfusion, estimated intraoperative blood loss, total drainage volume, postoperative hemoglobin level, and operative time according to the significance level adjusted for multiplicity (p < 0.029). RESULTS There was a borderline statistically significant lower body weight-adjusted TBL in the SET group (SET = 14.1 (7.7, 16.9) ml/kg vs. control 18.3 (14.8, 37.2) ml/kg, p-value = 0.027). The body weight-adjusted transfusion volume was statistically significantly greater in the control group (SET = 0.0 (0.0, 0.0) ml/kg vs. control = 2.1 (0.0, 9.7) ml/kg, p = 0.017). Body weight-adjusted estimated intraoperative blood loss was significantly lower in the SET group (SET = 0.8 (0.2, 3.5) ml/kg vs. control = 5.6 (3.4, 21.5) ml/kg, p < 0.001). In addition, the operative time was lower in the SET group with borderline statistical significance (SET = 105 (85.0, 125.0) vs. control = 130 (101.3, 167.5), p = 0.039). CONCLUSION Utilization of a sterile exsanguination tourniquet (SET) significantly reduced an estimated intraoperative blood loss while preventing the need for blood transfusion after pediatric orthopedic femoral-related surgeries. Trial registration TCTR20220412003.
Collapse
Affiliation(s)
- Terapat Rattanathanya
- Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Nath Adulkasem
- Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Jidapa Wongcharoenwatana
- Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Thanase Ariyawatkul
- Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Chatupon Chotigavanichaya
- Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Perajit Eamsobhana
- Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok Noi, Bangkok, 10700, Thailand.
| |
Collapse
|
4
|
Impaired maturation of distal radio-cephalic fistula for haemodialysis: a review of treatment options. J Nephrol 2016; 30:45-51. [DOI: 10.1007/s40620-016-0332-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/28/2016] [Indexed: 11/26/2022]
|
5
|
Narrow Elastic Disposable Tourniquet (Hemaclear®) vs. Traditional wide Pneumatic Tourniquet for Creation or Revision of Hemodialysis Angioaccesses. J Vasc Access 2016; 17:205-9. [DOI: 10.5301/jva.5000520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2015] [Indexed: 11/20/2022] Open
|
6
|
Transposition, Elevation, Lipectomy and V-Wing for Easy Needling. J Vasc Access 2015; 16 Suppl 9:S108-13. [DOI: 10.5301/jva.5000353] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose The purpose of this study is to report surgical techniques to facilitate cannulation of deep matured veins. Methods and Results 1) Basilic vein tunnel superficialization with rerouting in an anterior tunnel is mandatory for brachial-basilic arteriovenous fistula (AVF), mostly performed in a second surgical stage. The elevation technique, which could necessitate cannulation of the vein through the overlying scar, is not advisable. 2) Femoral vein superficialization is a one-stage surgical operation. Complications of this high-flow AVF are distal ischemia (diabetes and occlusive arterial disease are contraindications), iliac vein stenosis due to intimal hypertrophy and cardiac issues. Nevertheless, we have achieved high long-term patency rates (N = 70). Primary patency rates at 1 and 9 years were 91% ± 4% and 45% ± 11%, respectively. Secondary patency rates at 1 and 9 years were 84% ± 5% and 56% ± 9%, respectively. 3) Lipectomy for superficialization of the forearm radial-cephalic AVF is described for obese patients. Subcutaneous tissues are resected using two transverse incisions. Mobilization of the vein is avoided. At 3 years (N = 49), we recorded 63% ± 8% and 88% ± 7% primary and secondary patency rates, respectively. Anterior transposition of the forearm basilic vein is not necessary when using microsurgery for creation of distal ulno-basilic AVF. 4) VWING is a novel surgically implanted device to help buttonhole technique cannulation. It is too early to draw any conclusion from the preliminary published reports. Conclusions Tunnel-transposition and lipectomy are efficient techniques to allow easy needling of deeply situated upper-arm basilic vein, and cephalic vein in obese patients, respectively.
Collapse
|
7
|
Jengojan S, Kovar F, Breitenseher J, Weber M, Prayer D, Kasprian G. Acute radial nerve entrapment at the spiral groove: detection by DTI-based neurography. Eur Radiol 2015; 25:1678-83. [PMID: 25576227 DOI: 10.1007/s00330-014-3562-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 11/24/2014] [Accepted: 12/09/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study evaluated the potential of three-tesla diffusion tensor imaging (DTI) and tractography to detect changes of the radial (RN) and median (MN) nerves during transient upper arm compression by a silicon ring tourniquet. METHODS Axial T2-weighted and DTI sequences (b = 700 s/mm(2), 16 gradient encoding directions) of 13 healthy volunteers were obtained. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the MN and RN were measured at the spiral groove and further visualized in 3D by deterministic tractography (thresholds: FA = .15, angle change = 27°). RESULTS Local/lesional RN FA values increased (p = 0.001) and ADC values decreased (p = 0.02) during a 20-min upper arm compression, whereas no significant FA (p = 0.49) or ADC (p = 0.73) changes of the MN were detected. There were no T2-w nerve signal changes or alterations of nerve trajectories in 3D. CONCLUSIONS Acute nerve compression of the RN leads to changes of its three-tesla DTI metrics. Peripheral nerve DTI provides non-invasive insights into the "selective" vulnerability of the RN at the spiral groove. KEY POINTS • DTI-based neurography detects nerve changes during acute nerve compression. • Compression leads to a transient increase in local radial nerve FA values. • DTI provides insights into radial nerve vulnerability at the spiral groove.
Collapse
Affiliation(s)
- Suren Jengojan
- Department of Biomedical Imaging and Image-guided Therapy, Division of Neuro- and Musculosceletal Radiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
8
|
Tips and Tricks in Creation of Forearm Arteriovenous Fistulae. J Vasc Access 2014; 15 Suppl 7:S45-9. [DOI: 10.5301/jva.5000230] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2014] [Indexed: 11/20/2022] Open
Abstract
Forearm arteriovenous fistula (AVF) is a direct anastomosis between the radial artery and the cephalic vein or the ulnar artery and the basilic vein, which are small-caliber vessels. The surgical technique must be precise to avoid postoperative stenosis of the anastomosis which may result in early thrombosis or nonmaturation. In our experience, microsurgery and preventive hemostasis are two major contributions to creation of forearm AVF. Using these techniques, construction of a radial-cephalic fistula was possible in 78% of children in our hospital, with 60% secondary patency rates at 4 years. In a personal unpublished series, 69% of the first arteriovenous angioaccess of adult patients were forearm fistulae, with 63% and 91% primary and secondary 1-year patency rates, respectively. Finally, 68% primary patency and 96% secondary patency rates at 1 year were reported by Pirozzi et al. in adults with an internal diameter of <1.6 mm in the radial artery.
Collapse
|
9
|
Liposuction for Superficialization of Deep Veins after Creation of Arteriovenous Fistulas. J Vasc Access 2014; 15:358-63. [DOI: 10.5301/jva.5000217] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose Many individuals with end-stage renal disease (ESRD) have adequate arteries and veins for construction of an arteriovenous fistula (AVF) but the fistula may be too deep to cannulate because of overlying adipose tissue. This study evaluated the safety and efficacy of liposuction to superficialize deep AVFs. Methods Between September 2009 and January 2011, 13 patients participated in the study. Mean body mass index (BMI) was 39.1 kg/m2. The study was limited to brachiocephalic and radiocephalic fistulas. Mean fistula depth was 8.1 mm. The primary endpoint was the date of the first successful cannulation with two 17-gauge needles. Patients were followed for 12 mo. Results Eleven subjects (85%) underwent successful two-needle cannulation a mean of 33.7 days after the procedure. One patient died of endocarditis and one developed a hematoma and wound necrosis that required surgical elevation to enable cannulation. Projection and palpability of the fistulas tended to increase over time. Mean tissue removed was 243 mL and correlated positively with the number of days to cannulation (r=0.74, p=0.01). Greater BMI correlated positively with more surgical site complications and delays in cannulation. At 12 mo, primary patency after liposuction was 50% and secondary patency was 83%. Conclusions Most subjects had prompt, uncomplicated cannulation but a few had wound necrosis, large hematomas and prolonged time until cannulation. Liposuction is effective in enabling cannulation of deep vein fistulas but because of the substantial risk of serious surgical site complications, it may not be the ideal method.
Collapse
|