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SIMPLIFIED METHOD FOR PERCUTANEOUS ARTERIAL CATHETERISATION
1166
Methods and Devices SIMPLIFIED METHOD FOR PERCUTANEOUS ARTERIAL CATHETERISATION G. KOCH
It has proved much easier to carry out and less traumatic than the Seldinger method. The radial pulse was always palpable within one minute of arterial puncture and in most cases did not disappear at all. The patients had very little or no discomfort during the procedure, or after Fifteen patients had experienced a catheterisation. Seldinger type catheterisation previously, and all of them thought that the modified procedure was definitely less distressing. The procedure seems especially suitable for
children.
Department of Clinical Physiology, Karlskrona Central Hospital, Karlskrona, Sweden
REFERENCE 1.
INDWELLING catheters are usually inserted into peripheral arteries using Seldinger’s technique.1 This method uses a specially designed needle with an inner stylette. When the tip of the needle is located in the artery the flexible guide wire or plastic line stylette is replaced that is advanced into the artery and over which the catheter is threaded. A simplified, less traumatic technique using cheap disposable needles has proved most satisfactory. The needle is a disposable 1-0 or 1-2 mm. blood-sampling Strauss needle (Viggo AB, Helsingborg, Sweden), fitted with a 2-8 mm. long translucent plastic Luer cone. A sterile Perlon guideline (outer diameter 0-7 mm. for the 1-2 mm. and 0-5 mm. for the 1-0 mm. needle) is introduced via the tip into the needle and lightly attached to the cone by means of a sterile tape, leaving the distal (front) half of the needle free (see figure). The attachment must be firm
Seldinger,
S. I. Acta radiol. 1953,
39,
368.
Reviews of Books
by a
to prevent ejection of the guideline by the arterial bloodstream and light enough to permit it to be easily moved into the artery. The artery is punctured by advancing the needle slowly until blood rises into the plastic cone, showing that the tip is located in the artery. The partial obstruction of the needle by the guideline prevents bleeding. The guideline is easily advanced into the artery, the needle removed, and the procedure completed as described by Seldinger: the catheter is threaded over the guideline, both are then inserted into the artery and the guideline is finally removed. The advantages of this technique are obvious:
enough
(1) The use of disposable cheap needles with a consistently sharp tip. (2) Puncture of the posterior wall of the artery, very common when Seldinger or Cournand needles are used, is avoided, since successful puncture is promptly indicated by blood ascending in the needle
cone.
(3) Because of the absence of a stylette the needle’s outer diameter is reduced by about 30%, rendering the puncture less traumatic. (4) Since the guideline is already located in the needle its insertion into the artery is much easier. (5) The procedure avoids distressing the patient with the sight of arterial blood. This technique has been used for brachial-artery catheterisation in more than fifty cases (10-60 years old) for investigation of respiratory and haemodynamic function.
The Intervertebral Disc ANTHONY F. DE PALMA, M.D., professor of orthopedic surgery, and RICHARD H. ROTHMAN, M.D., PH.D., associate professor of orthopedic surgery, Jefferson Medical College, Thomas Jefferson University. Philadelphia and London: W. B. Saunders. 1970. Pp. 373.$16.50, E7.
THE authors have written this book on the basis of over twenty years’ experience of dealing with the problems of disc degeneration. In the introductory chapters the anatomy and pathology of the intervertebral disc are well With this foundation, the various clinical described. problems affecting the lumbar, dorsal, and cervical regions
(including hyperextension or whiplash injuries) are dealt with in detail. Methods of conservative and operative treatment are considered for each region. The approach is essentially within the limits of the personal experience of the authors, and some well-documented and commonly practised techniques of posterior spinal fusion are not mentioned. Of particular interest to the surgeon is the chapter on Complications, Failures and Tragedies of Operative Treatment of Lumbar Disc Disease, which is a salutary reminder of the problems that may result from poor judgment or operative technique. The text is well ilrustrated and provides a sound theoretical approach to the problems of the degenerate disc. Essentials of Medical Genetics CHARLES G. CRISPENS, JR., PH.D., professor of biology, University of Alabama in Birmingham, Alabama. New York: Row. 1971. Pp. 213.$9.95. Harper &
INTRODUCTORY books on medical genetics written by scientists who are not medically trained have special strengths and weaknesses. These make them most suitable for reading at the preclinical stage of the medical curriculum. Dr. Crispens’ book is one of these. For example, the accounts of meiosis and mitosis, of the structure of the chromosome, and of the effect of ionising radiation on mutation are clear and authoritative. In contrast, the references to medical conditions are less expert and not always up to date—e.g., the correction for method of ascertainment in estimating the risk to sibs in recessive conditions is oversimplified ; the large majority of cases of nephrogenic diabetes insipidus are X-linked intermediate and not autosomal dominant, and homocystinuria is an autosomal recessive disorder; the main consequence of assortative mating is not to increase the proportion of homozygotes, this being true of consanguineous mating. The discussion of quantitative genetics is inadequate, and the author implies that the genetics of characters such as " insanity" and " " intelligence are so complex as to defy analysis this far. They defy complete analysis, but much that is useful in practical counselling has been discovered.
Methods and Devices SIMPLIFIED METHOD FOR PERCUTANEOUS ARTERIAL CATHETERISATION G. KOCH
It has proved much easier to carry out and less traumatic than the Seldinger method. The radial pulse was always palpable within one minute of arterial puncture and in most cases did not disappear at all. The patients had very little or no discomfort during the procedure, or after Fifteen patients had experienced a catheterisation. Seldinger type catheterisation previously, and all of them thought that the modified procedure was definitely less distressing. The procedure seems especially suitable for
children.
Department of Clinical Physiology, Karlskrona Central Hospital, Karlskrona, Sweden
REFERENCE 1.
INDWELLING catheters are usually inserted into peripheral arteries using Seldinger’s technique.1 This method uses a specially designed needle with an inner stylette. When the tip of the needle is located in the artery the flexible guide wire or plastic line stylette is replaced that is advanced into the artery and over which the catheter is threaded. A simplified, less traumatic technique using cheap disposable needles has proved most satisfactory. The needle is a disposable 1-0 or 1-2 mm. blood-sampling Strauss needle (Viggo AB, Helsingborg, Sweden), fitted with a 2-8 mm. long translucent plastic Luer cone. A sterile Perlon guideline (outer diameter 0-7 mm. for the 1-2 mm. and 0-5 mm. for the 1-0 mm. needle) is introduced via the tip into the needle and lightly attached to the cone by means of a sterile tape, leaving the distal (front) half of the needle free (see figure). The attachment must be firm
Seldinger,
S. I. Acta radiol. 1953,
39,
368.
Reviews of Books
by a
to prevent ejection of the guideline by the arterial bloodstream and light enough to permit it to be easily moved into the artery. The artery is punctured by advancing the needle slowly until blood rises into the plastic cone, showing that the tip is located in the artery. The partial obstruction of the needle by the guideline prevents bleeding. The guideline is easily advanced into the artery, the needle removed, and the procedure completed as described by Seldinger: the catheter is threaded over the guideline, both are then inserted into the artery and the guideline is finally removed. The advantages of this technique are obvious:
enough
(1) The use of disposable cheap needles with a consistently sharp tip. (2) Puncture of the posterior wall of the artery, very common when Seldinger or Cournand needles are used, is avoided, since successful puncture is promptly indicated by blood ascending in the needle
cone.
(3) Because of the absence of a stylette the needle’s outer diameter is reduced by about 30%, rendering the puncture less traumatic. (4) Since the guideline is already located in the needle its insertion into the artery is much easier. (5) The procedure avoids distressing the patient with the sight of arterial blood. This technique has been used for brachial-artery catheterisation in more than fifty cases (10-60 years old) for investigation of respiratory and haemodynamic function.
The Intervertebral Disc ANTHONY F. DE PALMA, M.D., professor of orthopedic surgery, and RICHARD H. ROTHMAN, M.D., PH.D., associate professor of orthopedic surgery, Jefferson Medical College, Thomas Jefferson University. Philadelphia and London: W. B. Saunders. 1970. Pp. 373.$16.50, E7.
THE authors have written this book on the basis of over twenty years’ experience of dealing with the problems of disc degeneration. In the introductory chapters the anatomy and pathology of the intervertebral disc are well With this foundation, the various clinical described. problems affecting the lumbar, dorsal, and cervical regions
(including hyperextension or whiplash injuries) are dealt with in detail. Methods of conservative and operative treatment are considered for each region. The approach is essentially within the limits of the personal experience of the authors, and some well-documented and commonly practised techniques of posterior spinal fusion are not mentioned. Of particular interest to the surgeon is the chapter on Complications, Failures and Tragedies of Operative Treatment of Lumbar Disc Disease, which is a salutary reminder of the problems that may result from poor judgment or operative technique. The text is well ilrustrated and provides a sound theoretical approach to the problems of the degenerate disc. Essentials of Medical Genetics CHARLES G. CRISPENS, JR., PH.D., professor of biology, University of Alabama in Birmingham, Alabama. New York: Row. 1971. Pp. 213.$9.95. Harper &
INTRODUCTORY books on medical genetics written by scientists who are not medically trained have special strengths and weaknesses. These make them most suitable for reading at the preclinical stage of the medical curriculum. Dr. Crispens’ book is one of these. For example, the accounts of meiosis and mitosis, of the structure of the chromosome, and of the effect of ionising radiation on mutation are clear and authoritative. In contrast, the references to medical conditions are less expert and not always up to date—e.g., the correction for method of ascertainment in estimating the risk to sibs in recessive conditions is oversimplified ; the large majority of cases of nephrogenic diabetes insipidus are X-linked intermediate and not autosomal dominant, and homocystinuria is an autosomal recessive disorder; the main consequence of assortative mating is not to increase the proportion of homozygotes, this being true of consanguineous mating. The discussion of quantitative genetics is inadequate, and the author implies that the genetics of characters such as " insanity" and " " intelligence are so complex as to defy analysis this far. They defy complete analysis, but much that is useful in practical counselling has been discovered.