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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 11 (1995), S. 47-50 
    ISSN: 1573-2614
    Keywords: Equipment: catheters, indwelling ; Infiltration ; Infusions, intravenous ; Thrombophlebitis ; Vascular resistance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Objective. The objective of our study was to determine if clinical observation of pressure-flow relationships (PFR) can differentiate between partial external obstruction (obstruction) and infiltration as a cause of poor performance of gravity-fed infusions.Methods. A total of 24 patients with functional intravenous cannulae in situ had obstruction simulated by the application of a tourniquet proximal to the cannula. The change in flow (ΔF) for a discrete change in pressure (ΔP) was determined in each case by counting drop rates at two different elevations of the fluid reservoir level, 10 cm apart. The same process was repeated in 15 patients in whom the cannula was in an extra vascular location (infiltration). Three sizes of cannula—16-gauge, 18-gauge, and 20-gauge—were examined, with equal distribution of sizes in each group. The effect on flow rates of inflating a blood pressure (BP) cuff proximally on the cannulated limb was assessed. The ratio ΔP/ΔF is the total resistance of the infusion system, and by subtracting known values for resistance of infusion tubing and cannula, the venous or tissue resistance was calculated.Results. There was a statistically significant difference between the change in flow for obstructed compared with infiltrated cannulae for the same change in pressure for each cannula size. The mean venous resistance was 23 mm Hg/L/hr, while that of tissue was 280 mm Hg/L/hr, with no overlap between groups. There was no effect on flow rate with blood pressure cuff inflation in the infiltrated group whereas flow progressively fell in the obstructed group.Conclusions. Clinical observation of PFRs in poorly functioning gravity-fed IV infusions can assist in detecting infiltration as a cause. Inflation of a blood pressure cuff will further impair flow where the cannula is intravascular, but will have no effect in an extravascular location.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1573-2614
    Keywords: Veins ; Veins: catheterization ; Fluid therapy ; Intravenous infusions ; Indwelling catheters ; Infiltration ; Extravasation of intravenous fluids
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Resistance to fluid infusion can be derived from measurements of pressure at two or more flow rates. We measured resistance in 31 patients using a pressure-monitoring infusion pump (Model 560, IVAC) by recording pressure at five flow rates (0, 50,100, 200, and 300 mL/hr), and computing resistance as the slope of the pressure versus flow curve. Resistance was measured subcutaneously (Rtissue) and intravenously (Rvein) immediately after unsuccessful or successful IV catheter placement. In all patients, Rtissue was always greater than Rvein. The difference ranged from 23 resistance units (RU) to 4166 RU, with a mean difference of 1147 RU (p 〈 0.0001, Student'st-test). Unpaired analysis of the data was performed to assess the ability of resistance to indicate extravasation in the absence of prior Rvein measurement. The median value for Rvein was 62 RU (range −13.6 to 420 RU), and for Rtissue, 544 RU (range 65.7 to 4170 RU). Receiver operating characteristic (ROC) analysis revealed that a 200-RU threshold detected infiltration with 0.90 sensitivity and 0.91 specificity. We conclude that elevated resistance during fluid infusion is an important early and easily measurable finding in fluid extravasation.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 12 (1996), S. 331-337 
    ISSN: 1573-2614
    Keywords: Veins ; Veins: catheterization ; Fluid therapy ; Intravenous infusions ; Indwelling catheters
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract We evaluated the resistance to fluid infusion in the veins of 118 adult patients after intravenous catheter insertion prior to elective surgery. Hydraulic resistance in veins was defined as the slope of the pressure-flow relationship obtained by measuring venons pressure at several fluid flow rates. A resistance unit (RU) was defined as 1 mmHg/L/hr. Resistance in veins ranged from −12.1 to 732 RU, with 50th and 95th percentiles being 22 and 198 RU, respectively. Venons resistance was not significantly affected by site of catheter insertion, tissue characteristics at the insertion site, age, sex, patient anxiety, American Society of Anesthesiologists physical status, or catheter size. This report provides a distribution of resistance to fluid infusion in arm veins of adult patients.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 5 (1989), S. 100-104 
    ISSN: 1573-2614
    Keywords: Anesthesia machines ; Ventilation: positive end-expiratory pressure; tidal volume ; Monitoring: oxygen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract In clinical practice, the addition of positive end-expiratory pressure (PEEP) into a standard anesthesia circle circuit decreases the delivered tidal volume (DTV) to a patient. We studied the magnitude of the ΔDTV/ΔPEEP relationship in two commonly used anesthesia systems. In addition, the magnitude of the ΔDTV/ΔPEEP relationship varies with both pulmonary compliance and volume of gas contained in the patient's breathing system between the ventilator and PEEP valve site, and this was also evaluated. Routine monitoring of expired tidal volume should be used whenever PEEP is added to an anesthesia circuit.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 5 (1989), S. 123-134 
    ISSN: 1573-2614
    Keywords: Equipment: intravenous systems, intravenous infusion ; Physiology: veins and tissues
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract This article describes a model designed to provide an understanding of fluid flow in intravenous systems and human subjects. Experiments were developed which demonstrate that the model can represent common clinical situations. The model depicts physical devices as ideal resistors, pressure sources, and flow sources. The patient's venous system is depicted as a combination of ordinary and Starling resistors. For flows between 0 and 300 ml/hr, both physical devices and patients are adequately represented by a straight line representing the pressure-flow relationship (PFR): pressure = opening pressure + flow × resistance, where the slope is the resistance to fluid flow and the intercept is the opening pressure. The PFR for a normal vein is characterized by a flat slope (vein resistance =22±20 mm Hg/L/hr, mean ± SD) and a low intercept (opening pressure =15±8 mm Hg). The PFR for a partially obstructed vein has a resistance equal to that of an unobstructed vein and an opening pressure elevated approximately equal to the pressure obstructing the vein. For perivascular tissue, the PFR has a steep slope (tissue resistance =1,125±1,376 mm Hg/L/hr), while tissue opening pressure depends on the amount of fluid infused. At the onset of fluid extravasation (infiltration), tissue pressure usually is lower than venous pressure (8±8 versus 15±8 mm Hg), until fluid fills the distensible tissue compartment. In clinical practice, when infiltration or obstruction occurs, flow decreases and the clinician adjusts the roller clamp until correct flow resumes; no problem is obvious. The combined model for the intravenous tubing and venous systems explains the behavior of current clinical infusion devices.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 7 (1991), S. 271-273 
    ISSN: 1573-2614
    Keywords: Measurement techniques: capnography mass spectrometry ; Monitoring: anesthetic gas
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Although multipatient monitoring with a timeshared mass spectrometer provides considerable cost advantages, failure of one component in a shared system can disrupt gas monitoring at all sites. We describe a simple method for linking two central mass spectrometer systems to provide continual monitoring during failure of one unit, without the need for time-consuming reconfiguration of individual patient sample line and display connections.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 2 (1986), S. 151-154 
    ISSN: 1573-2614
    Keywords: Monitoring ; auscultation ; Equipment ; stethoscope ; monitoring ; electronic
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract A prototype electronic monitoring stethoscope was constructed from readily available, high-quality components. It consisted of a conventional precordial or esophageal probe connected to a microphone by a rubber adapter. The microphone was connected by lightweight wire to an amplifier and headphones. Twenty-one anesthesia clinicians evaluated the stethoscope and responded to a multiple-choice preference questionnaire. The electronic stethoscope was judged to perform better than the conventional stethoscope in most categories evaluated. The electronic device was perceived to be louder, clearer in sound reproduction, more efficacious for monitoring, and easier to use continuously, and its head-phones were considered more comfortable than the conventional carpiece. Based on our results, we conclude that amplified stethoscopes have the potential to improve monitoring. Further development of electronic stethoscope monitoring seems warranted and is continuing.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1573-2614
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 9 (1993), S. 211-211 
    ISSN: 1573-2614
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Journal of clinical monitoring and computing 7 (1991), S. 175-180 
    ISSN: 1573-2614
    Keywords: Measurement techniques: mass spectrometry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Medicine
    Notes: Abstract Spurious readings from a mass spectrometer have been reported following the administration of aerosol bronchodilators. We quantified the response of various respiratory gas analyzers to the aerosol propellant of albuterol inhalant (Proventil). The mass spectrometer systems tested, two Advantage systems, a SARA system, and a Model 6000 Ohmeda system, all displayed artifactual readings in response to the albuterol propellant. Each metered dose of the Proventil brand of albuterol contains 4 ml of Freon 11 (trichloromonofluoromethane) and 11 ml of Freon 12 (dichlorodifluoromethane). The concentration of propellant was expressed in doses/L, where each liter of gas contains 0.4 vol % of Freon 11 and 1.1 vol % of Freon 12 per dose. In proportion to the concentration of albuterol propellant, the two Advantage systems showed substantial readings of isoflurane (%) when no isoflurane was present (13% and 16% per dose/L) and reduced readings of enflurane (−8% and −10% per dose/L) and carbon dioxide (CO2) (−3 and +5 mm Hg per dose/L). The SARA system showed substantial CO2 readings when no CO2 was present (5 mm Hg per dose/L) and displayed small enflurane readings (0.1% per dose/L) when no enflurane was present. The Model 6000 unit showed CO2 readings when no CO2 was present (5 mm Hg per dose/L). Neither the Raman spectrometer, the infrared spectrometers, nor the piezoadsorptive analyzer we tested showed an artifactual effect of albuterol propellant on any of its readings. Simulation and clinical tests demonstrated that a single dose of albuterol propellant into a breathing circuit at the onset of inspiration resulted in concentrations of 0.8 and 0.3 dose/L, respectively. The phenomenon may be clinically useful, by allowing the anesthetist to verify the uptake of an inhalant into a patient.
    Type of Medium: Electronic Resource
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