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  • Book
    Sergio Sandrucci, Baudolino Mussa, editors.
    Summary: Indications for central venous cannulation in critically ill patients have increased dramatically in recent years owing to the use of more complex therapies unsuitable for delivery via peripheral veins. The main drawbacks of central venous access are morbidity and the growing scarcity of experienced operators. Ultrasound-guided peripheral venous access offers a solution, in that it reduces morbidity and can be performed by a dedicated nursing team. The aim of this book is to teach the fundamentals of this emerging technique. Advice is provided on the choice of materials and on vein selection. The advantages and disadvantages of peripherally inserted central venous catheters (PICC) in relation to other types of central venous catheter are discussed, and the principles of use and practical applications of ultrasound for venipuncture are explained. Maneuvers for PICC positioning, techniques for the evaluation of PICC tip placement, and the prevention, diagnosis, and management of complications are all described in detail. Advice is also provided on the organization of a dedicated PICC team within a hospital or a supportive care program, and psychological, legal, and economic issues are considered. Peripherally Inserted Central Venous Catheters will be of interest to a wide range of professionals, including nutritionists, oncologists, anesthesiologists, surgeons, registered nurses, nurse practitioners, physicians, physician assistants, and radiologists.

    Contents:
    Introduction and Overview of PICC History
    Which Material and Device? The Choice of PICC
    Vessel Health and Preservation: The Proactive Approach
    The Choice of a Vein in Critically Ill Patients: Cost-Effectiveness
    Advantages, Disadvantages, and Indications of PICCs in Inpatients and Outpatients
    Ultrasound Anatomy of Peripheral Veins and Ultrasound-Guided Venipuncture
    Evaluation Techniques of the PICC Tip Placement
    Frequency, Diagnosis, and Management of Occlusive and Mechanical PICC Complications
    Clinical Problems Associated with the Use of Peripheral Venous Approaches: Infections
    Clinical Problems Associated with the Use of Peripheral Venous Approaches in Clinical Practice: Thrombosis
    Maneuvers, Precautions, and Tricks for PICC Positioning Procedure
    The "Off-Label" Use of PICCs
    Venous Access Devices and Emotional Response in Oncologic Patients: Diagnostic and Management Aspects
    Peripheral Inserted Central Catheters: Medicolegal Aspects
    The PICC Team.
    Digital Access Springer 2014
  • Article
    Picaza JA, Hunter SE, Cannon BW.
    Appl Neurophysiol. 1977-1978;40(2-4):223-34.
    This is a study of the long range effects of pain suppression obtained by electrical stimulation of peripheral nerves. These cases were followed during 12--46 months and evaluated personally and by questionnaires. Selection for surgery was done exclusively on the basis of the results of a preoperative peripheral nerve stimulation test. Of 37 cases observations, 18 were considered significantly relieved; that is, more than 50% of the intensity and/or duration of pain was consistently admitted. The results obtained in the acute preoperative trial could be reproduced indefinitely in some cases for as long as 46 months. Correlation of the results with the disease producing the pain revealed as benefitting for painful syndromes associated with peripheral nerve disorders, amputation, soft tissue injuries (nerves?), and some recurrent lumbar disc surgeries. Sciatic, ulnar and occipital nerve implantations were particularly rewarding. The best and worse results were analyzed. The complications appear to be largely preventable and of no serious consequences. Our analysis suggests that most failures take place within 2 years from implantation. Experience seems to be accumulating showing that a number of patients may receive sustained relief beyond this period.
    Digital Access Access Options