Navegando por Palavras-chave "Punções"

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    Avaliação do posicionamento da agulha de veress durante o estabelecimento do pneumoperitônio pela técnica fechada, em porcos
    (Colégio Brasileiro de Cirurgiões, 2004-10-01) Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Guindalini, Rodrigo Santa Cruz [UNIFESP]; Azevedo, Otávio Cansanção [UNIFESP]; Paiva, Vanessa Carla [UNIFESP]; Delorenzo, Aline; Moreira, Márcia Bento [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Sociedade Brasileira de Cirurgia Laparoscópica; Hospital do Servidor Público do Estado de São Paulo
    BACKGROUND: To establish reliable evidence regarding the adequate positioning of the tip of a Veress needle in the interior of the peritoneal sac during the establishment of the pneumoperitoneum by the closed technique. METHODS: In 11 pigs, the needle was introduced in the peritoneal sac through the left hipocondrium. Tests of positioning of the tip of the instrument were carried out. Gas (CO2) was injected, and pressures, flows and volumes were registered periodically. The correct intraperitoneal position of the needle was confirmed and, subsequently, removed, being reintroduced in the right hipocondrium and placed under direct vision in the pre-peritoneal space. The same parameters were surveyed. RESULTS: The test of the draining was always positive in the peritoneum. Resistance to the infusion of serum in the peritoneal sac was not observed, but resistance was detected on 45.5% of cases in the pre-peritoneal space. Some serum was recouped in 63.5% of cases in the peritoneal sac and in 54.5% in the pre-peritoneal space. The dripping flowed freely in 66.6% of cases in the peritoneal sac and in 45.5% in the pre-peritoneal space. In the peritoneal sac, = 5mmHg initial pressure increased gradually during 120 seconds until reaching 15 mmHg. In the pre-peritoneal space, the initial pressure was of 15mmHg and oscillated between 12 and 15mmHg. The volume of gas injected was of 1500 ml in the peritoneal sac and of 100 ml in the pre-peritoneal space. CONCLUSION: Initial pressure of ±5mmHg is indicative of the tip of the needle being placed in the peritoneal sac, inside of which there should fit ten times more gas than in the pre-peritoneal space. When the tip of the Veress needle is placed in the interior of the peritoneal sac, the increase of intraperitoneal pressures and volumes can be predicted by statistics.
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    Acesso aberto (Open Access)
    Evaluation of tests performed to confirm the position of the Veress needle for creation of pneumoperitoneum in selected patients: a prospective clinical trial
    (Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2006-12-01) Azevedo, Otávio Cansanção [UNIFESP]; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Sorbello, Albino Augusto; Miguel, Gustavo Peixoto Soares [UNIFESP]; Wilson Junior, Jorge Luis [UNIFESP]; Godoy, Antônio Cláudio de; Universidade Federal de São Paulo (UNIFESP); HSPE Service of Surgical Gastroenterology Division of Laparoscopy; HSPE Service of Surgical Gastroenterology
    PURPOSE: To evaluate tests performed to confirm the position of the Veress needle inserted into the left hypochondrium for creation of pneumoperitonium. METHODS: One hundred patients were submitted to laparoscopic procedure with left hypochondrium puncturing. Needle positioning tests were evaluated. The aspiration test was considered positive when organic material was aspirated; the injection test was considered positive when no increased resistance to liquid injection was observed; the recovery test was considered positive when the liquid injected was not recovered; the saline drop test was considered positive when drops of saline in the syringe disappeared quickly; the initial intraperitoneal pressure test was considered positive when pressure levels were £ 8 mmHg. A positive aspiration test indicated iatrogenic injury, whereas a positive result in any of the other tests indicated that the tip of the needle was correctly positioned in the peritoneal cavity. Sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of the tests were calculated by correlating results considered true positives (a), false positives (b), false negatives (c) and true negatives (d), according to the formulas: SE = [a/(a + c)] x 100; SP = [d/(b + d)] x 100; PPV = [a/(a + b)] x 100; NPV = [d(c + d)] x 100. RESULTS: With regard to the aspiration test, SE and PPV were not applicable, SP was 100% and NPV was 100%. With regard to the injection test, SE was 0%, SP was 100%, PPV was inexistent and NPV was 90%. Both recovery and saline drop tests yielded the following results: SE was 50%, SP was 100%, PPV was 100% and NPV was 94.7%. The initial intraperitoneal pressure test yielded the following results: SE, SP, PPV and NPV were 100%. CONCLUSIONS: When inserting the Veress needle into the left hypochondrium, a negative aspiration test guarantees the absence of iatrogenic injury; the injection test is not reliable to determine incorrect needle positioning, but it accurately detects correct needle positioning; recovery and saline drop tests are not reliable to determine correct needle positioning, but they accurately detect incorrect needle positioning; the initial intraperitoneal pressure test is reliable to determine both correct and incorrect needle positioning, and proved to be the most reliable of the tests analyzed.
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    Acesso aberto (Open Access)
    Evaluation of the positioning of the tip of the Veress needle during creation of closed pneumoperitoneum in pigs
    (Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2006-02-01) Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Guindalini, Rodrigo Santa Cruz [UNIFESP]; Sorbello, Albino Augusto [UNIFESP]; Silva, Cássio Edvan Paulino da [UNIFESP]; Azevedo, Otávio Cansanção [UNIFESP]; Aguiar-Yamaguchi, Gilmara Silva [UNIFESP]; Menezes, Francisco Julimar Correia de [UNIFESP]; Delorenzo, Aline [UNIFESP]; Pasqualin, Rubens Campana [UNIFESP]; Kozu, Fábio Okutani [UNIFESP]; EAES; Universidade Federal de São Paulo (UNIFESP); HSPE Division of Laparoscopy
    PURPOSE: Erroneous punctures and insufflations are frequent with the use of the Veress needle. Mistaken injections of gas in the preperitoneal space are not rare. The purpose of this research is to evaluate the correct positioning of the tip of the needle during creation of pneumoperitoneum. METHODS: The needle was inserted into the peritoneal cavity. Tests to assess the positioning of the needle tip were carried out. Pressure, flow rate and volume were periodically recorded and the needle was removed, being immediately reinserted into the right hypochondrium and placed in the preperitoneal space. RESULTS: The liquid flow test was always positive in the peritoneal cavity. No resistance to saline injection into the peritoneal cavity was observed, but increased resistance to saline injection into the preperitoneal space was observed in 45.5% of the cases. Some saline was recovered in 63.5% of the cases in the peritoneal cavity, and in 54.5% in the preperitoneal space. Saline drop test was positive in 66.6% of the cases in the peritoneal cavity and in 45.5% in the preperitoneal space. In the peritoneal cavity, initial pressure lower than 5 mm Hg was observed, and this pressure gradually increased during 123 seconds until reaching 15 mm Hg. In the preperitoneal space, initial pressure was 15 mm Hg. CONCLUSIONS: Aspiration, liquid flow and saline drop tests are important, whereas recovery test is inconclusive. Initial pressure of approximately 5 mm Hg indicates that the tip of the needle is in the peritoneal cavity. The peritoneal cavity should hold ten times as much volume of gas as the preperitoneal space. The increase in pressure and volume in the peritoneal cavity can be predicted by statistics.
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    Impacto da punção do seio esfenoidal no diagnóstico e no tratamento dos pacientes com rinossinusite hospitalar
    (Universidade Federal de São Paulo (UNIFESP), 2011-06-29) Mendes Neto, José Arruda [UNIFESP]; Gregório, Luiz Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To evaluate the diagnostic and therapeutic effect of the endoscopically-guided sphenoid sinus puncture performed at the bedside of the patients with infective rhinosinusitis hospitalized in an Intensive Care Unit of a high complexity care hospital. Methods: Retrospective study to evaluate patients undergoing mechanical ventilation with fever of unknown origin and computed tomographic signs of rhinosinusitis. They were divided in two groups. On group A, patients were submitted to maxillary sinus puncture (standard diagnosis and treatment), whereas on group B patients were submitted to both maxillary sinus puncture and sphenoid sinus. Results: The total study sample consisted of 54 patients (72,2% male, mean age 42 years), distributed in 27 per group. The most common Intensive Care Unit admission diagnosis was head trauma and stroke. On computed tomographic scans, the paranasal sinuses most affected were the sphenoid sinus (82,4%) and the maxillary sinus (75,9%). Purulent drainage was seen in the middle meatus (27,5%) and in the sphenoethmoid recess (37,5%). In group A and B there was fever reduction in 70,4% of the patients after the punctures (p<0,001). Comparing the two groups in relation to this same variable, no statistically significant difference was found (p = 1.000). Most commonly found organisms in sinus aspirates were Pseudomonas aeruginosa and Acinetobacter baumannii. The average number of organisms recovered from the punctures of the patients of group B was significantly higher than in group A. In group B there was a higher occurrence of Enterobacteria. On patients in group B 57,1% of the punctured sides showed no endoscopic signs of rhinosinusitis, despite the positive culture. Conclusion: The endoscopically-guided sphenoid sinus puncture performed at the bedside of the patients has shown to be an important diagnostic tool. It didn’t contribute to increase the success rate of fever control in critically ill patients.
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    Acesso aberto (Open Access)
    Parâmetros eficientes do posicionamento adequado da ponta da agulha de veress durante o estabelecimento de pneumoperitônio
    (Colégio Brasileiro de Cirurgiões, 2006-08-01) Azevedo, Otávio Cansanção [UNIFESP]; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Sorbello, Albino Augusto [UNIFESP]; Miguel, Gustavo Peixoto Soares [UNIFESP]; Guindalini, Rodrigo Santa Cruz [UNIFESP]; Godoy, Antônio Cláudio de; Hospital do Servidor Público do Estado de São Paulo Serviço de Gastroenterologia Cirúrgica; Universidade Federal de São Paulo (UNIFESP); Universidade de Lyon; Hospital do Servidor Público do Estado de São Paulo Setor de Videocirurgia
    BACKGROUND: To evaluate the possibility of establishing reliable parameters for the appropriate positioning of Veress needle tip in the peritoneal cavity during pneumoperitoneum creation. METHODS: In 100 selected patients Veress needle tip were introduced in the peritoneal cavity and the insufflators were programmed for a flow of 1,2L/min and with final maximum pressure of 12mmHg. At the beginning of the insufflation and at every 20 seconds the intraperitoneal pressure (IP) and the total volume injected (TVI) were recorded. Data was treated by statistical correlation between moments and IP, and moments and TVI. The forecast values of IP and TVI at the end of each one of the four first insufflation minutes were also established, using the following estimated formulas: IP = 2.3083 + 0.0266 x time + 8.3x10-5 x time³ - 2.44x10-7 x time³; TVI = 0.813 + 0.0157 x time. RESULTS: IP and TVI showed a correlation between pre-established moments of pneumoperitoneum creation when a strong adjustment became apparent: IP = -2E - 07 x time³ + 8E - 05 x time² + 0.0266 x time + 2.3083, with a coefficient of explanation: (R2) = 0.8011; TVI = 0.0157 x time + 0.1813, with R2=0.9604. The forecast of IP and TVI showed: IP (mmHg): 1min=4.15; 2 min=6.27; 3 min=8.36; 4 min=10.10 and TVI (L): 1min=1.12; 2 min=2.07; 3 min=3.01; 4 min=3.95. CONCLUSION: Reliable parameters for IP and TVI can be established during pneumoperitoneum creation when the Veress needle tip is located in the peritoneal cavity in a given insufflation moment.
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    Acesso aberto (Open Access)
    Valor das provas de posicionamento da ponta da agulha de veress em punção do hipocôndrio esquerdo na instalação do pneumoperitônio
    (Colégio Brasileiro de Cirurgiões, 2006-10-01) Azevedo, Otávio Cansanção [UNIFESP]; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Sorbello, Albino Augusto; Miguel, Gustavo Peixoto Soares [UNIFESP]; Guindalini, Rodrigo Santa Cruz [UNIFESP]; Godoy, Antônio Cláudio de; Hospital do Servidor Público do Estado de São Paulo Serviço de Gastroenterologia Cirúrgica; Universidade Federal de São Paulo (UNIFESP); Hospital do Servidor Público do Estado de São Paulo Setor de Videocirurgia
    BACKGROUND: To evaluate tests for Veress needle tip placement intraperitoneally in the left hypochondrium for creating a pneumoperitoneum. METHODS: Needle tip placement tests were evaluated in one hundred patients using the left hypochondrium area. It was considered positive when: aspiration test (PA) -returned organic material; resistance test (PRes) - a low pressure was pushed on the syringe for the liquid infusion; recovery test (PRec) - no liquid was recovered after infusion; dripping test (PG) - drops drained quickly; test for initial intraperitoneal pressure (PPII) - levels were <= 8mmHg. Positive PA suggested bowel injury, while positive PRes, PRec, PG and PPII indicated that needle tip was adequately located in the peritoneal cavity. The Sensitivity ( SE) and Specificity ( SP ), as well as their predictive positive values (PPV) and predictive negative values ( PNV) of these tests were calculated using results correlation which were true-positives (a), false-positives (b), false-negatives (c) and true-negatives (d), accordingly to the formulas: SE =[a/ (a+c)]x100; SP =[d/(b+d)]x100; PPV=[a/(a+b)]x100; PNV=[d(c+d)]x100. RESULTS: If a positive PA had returned, SE and PPV did not fit, and SP=100% and PNV =100%. In the PRes, SE =0%, SP =100%, PPV = did not exist and PNV =90%. Both in the PRec and in the PG, results were for SE =50%, SP =100%, PPV =100% and PNV =94.7%. In the PPII test results were for SE, PPV and PNV =100%. CONCLUSION: Left hypochondrium negative PA guaranteed that bowel was not perforated; PRes test is a not accurate test for detection of the needle tip bad placement, however it accurately indicates its good positioning; PRec and the PG tests do not detect the adequate positioning, but they detect very well the inadequate positioning; PPII test shows with reliability both bad and good positioning of the needle, being the most trustworthy test among those studied.
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    Acesso aberto (Open Access)
    Veress needle insertion in the left hypochondrium in creation of the pneumoperitoneum
    (Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2006-10-01) Azevedo, Otávio Cansanção [UNIFESP]; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Sorbello, Albino Augusto; Miguel, Gustavo Peixoto Soares [UNIFESP]; Guindalini, Rodrigo Santa Cruz [UNIFESP]; Godoy, Antônio Cláudio de; Universidade Federal de São Paulo (UNIFESP); Hospital of the State of São Paulo
    PURPOSE: To test the efficacy of the puncture in the left hypochondrium as an alternative method. METHODS: Sixty-two patients randomly distributed into two groups were studied: Group LH, puncture in the left hypochondrium (n=30), and Group ML, puncture in the abdominal midline (n=32). The following were assessed: needle positioning tests, number of failed attempts at needle insertion, and time needed for creation of pneumoperitoneum. Gas flow, volume and intraperitoneal pressure were recorded at every 20 seconds, until a 12 mmHg pressure was reached inside the peritoneal cavity. RESULTS: A similar number of positive results for the needle positioning tests were observed in both groups. Two failed attempts to reach the peritoneal cavity were observed in Group ML and one in Group LH. The time necessary for the creation of pneumoperitoneum was on average 3 minutes and 46 seconds for Group LH, and 4 minutes and 2 seconds for Group ML. Average gas flow, volume and pressure were equivalent for both groups. CONCLUSION: Puncture in the left hypochondrium was as effective as puncture in the abdominal midline for the creation of pneumoperitoneum.