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Use of vena cava filters in the prevention of pulmonary emboli
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JOURNAL OF VASCULAR NURSING www.jvascnurs.net
1995, these systems have gained rapid acceptance among different surgical specialties for procedures needing the support of robotic arm and ancillary equipment. Aesop, Hermes, and Zeus devices were used in the first transatlantic surgery, laparoscopic cholecystectomy, on September 7, 2001. In this instance the surgeons were in New York, and the patient was in Strasbourg, France. The benefits of modern robotic systems for minimally invasive procedures are particularly applicable to complex technical reconstructions such as cardiac, vascular, gastrointestinal, and urologic surgical procedures. Robotic elements enable the surgeon to do more precise and delicate craftsmanship in highly technically demanding conditions and smaller surgical working spaces. As predicted, not only the surgeon but also the entire surgical team is confronted by a tremendous challenge in terms of training and adaptation to this modern technology. Leading our clinical application in 1998 was the use of the Aesop-Hermes Systems in minimally invasive aortic surgery and several other vascular procedures. In 2000, we initiated our robotic Zeus and da Vinci aortic protocol in the laboratory, which was completed in December 2002. We tested the two robotic systems side by side by performing a full endolaparoscopic aortic graft in the porcine model. We demonstrated that the da Vinci System provided an edge over the Zeus System. This study seemed to be the first of this kind in aortic robotic surgery. Our first endoscopic da Vinci-assisted thoracic outlet surgical decompression was performed in March 2003. At present, we have safely completed 11 similar procedures. Our robotic surgical program at St. Vincent Mercy Medical Center has completed approximately 40 da Vinci System-assisted surgical procedures in the first year. At the present time, with the past 6 years of our laboratory and clinical experience with robotic technology, we have completed the Federal and Drug Administration requirements to proceed with a Phase I da Vinci Assisted Aortic Protocol for Abdominal Aortic Aneurysm in 2004, supported by Intuitive Surgical, Inc. Why robotics? Because robotic or computerized technology has revolutionized safety in the automotive industry in the past 20 years, this technology has the potential to revolutionize patient safety in surgery.
Amputee support: creating a successful program Karen Groller, MSN, RN Lehigh Valley Hospital and Health Network Allentown, Pennsylvania Whether it is a traumatic injury or a congenital or diseaserelated process, losing a limb is a life-changing event that one should not go through alone. Support groups can be a powerful and positive way to help people help themselves. This was why an amputee support group was needed at Lehigh Valley Hospital. Recognizing this need, colleagues in a vascular medical-surgical unit formed the group. Literature was minimal on the subject of creating an amputee support group. On the basis of the group members’ needs, the authors’ short-term goal for the first 6 months was to focus on providing education and emotional support at monthly meetings. This was accomplished by having short presentations by various pros-
JUNE 2005
thetic companies, physical therapists, and a psychiatrist from the local amputee clinic. The long-term goal, also based on the group members’ needs, was to expand the support group and provide a visitation service to the acute amputee before discharge. The purpose of this peer visitation service was to acknowledge and discuss the changes and challenges with someone who has been through an amputation. The presenters identified five steps to attaining a successful amputee support group.
Clinical issues in vascular nursing Victora Fahey, MSN, RN, CVN, Northwestern Memorial Hospital Chicago, Illinois M. Eileen Walsh, PhD, APRN, CVN, Jobst Vascular Center Toledo, Ohio Janice Nunnelee, PhD, RN, CVN, ANP University of Missouri, St. Louis St. Louis, Missouri The presenters provided an opportunity for participants to discuss any clinical or professional issues they were interested in discussing. This session was an excellent tool for obtaining answers to questions and networking with other nurses.
Use of vena cava filters in the prevention of pulmonary emboli Victoria Latessa, MSN, ANP, ACNP Heart and Vascular Institute of Lenox Hill Hospital New York, New York The concept of interrupting the blood flow in the vena cava to prevent pulmonary embolism originated in the 1930s and 1940s. At that time the common femoral and superficial femoral veins were ligated. Because of the lack of venous return, this procedure resulted in lower limb edema, which could be disabling. As time progressed, ligation of the inferior vena cava (IVC) was performed to capture those thrombi located about the superficial femoral veins. Eventually, IVC ligation replaced superficial femoral vein ligation. However, a significant number of patients had immediate lower extremity swelling. In the 1960s, various methods of interrupting the flow in the vena cava while decreasing lower extremity venous stasis were used. These included suture plication and vena cava slips. Although lower limb extremity edema was reduced, the incidence of vena cava occlusion was 30% to 40%, which continued to result in significant morbidity. In 1967, the Mobin-Uddin umbrella filter was developed as a replacement for surgical ligation, caval plication, and vena cava slips to partially interrupt the flow in the IVC and prevent pulmonary emboli. Since then several filters have been developed. Recently, the concept of the retrievable (temporary) filter has emerged, and several are now on the market for use in preventing pulmonary emboli in high-risk patients.
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
1995, these systems have gained rapid acceptance among different surgical specialties for procedures needing the support of robotic arm and ancillary equipment. Aesop, Hermes, and Zeus devices were used in the first transatlantic surgery, laparoscopic cholecystectomy, on September 7, 2001. In this instance the surgeons were in New York, and the patient was in Strasbourg, France. The benefits of modern robotic systems for minimally invasive procedures are particularly applicable to complex technical reconstructions such as cardiac, vascular, gastrointestinal, and urologic surgical procedures. Robotic elements enable the surgeon to do more precise and delicate craftsmanship in highly technically demanding conditions and smaller surgical working spaces. As predicted, not only the surgeon but also the entire surgical team is confronted by a tremendous challenge in terms of training and adaptation to this modern technology. Leading our clinical application in 1998 was the use of the Aesop-Hermes Systems in minimally invasive aortic surgery and several other vascular procedures. In 2000, we initiated our robotic Zeus and da Vinci aortic protocol in the laboratory, which was completed in December 2002. We tested the two robotic systems side by side by performing a full endolaparoscopic aortic graft in the porcine model. We demonstrated that the da Vinci System provided an edge over the Zeus System. This study seemed to be the first of this kind in aortic robotic surgery. Our first endoscopic da Vinci-assisted thoracic outlet surgical decompression was performed in March 2003. At present, we have safely completed 11 similar procedures. Our robotic surgical program at St. Vincent Mercy Medical Center has completed approximately 40 da Vinci System-assisted surgical procedures in the first year. At the present time, with the past 6 years of our laboratory and clinical experience with robotic technology, we have completed the Federal and Drug Administration requirements to proceed with a Phase I da Vinci Assisted Aortic Protocol for Abdominal Aortic Aneurysm in 2004, supported by Intuitive Surgical, Inc. Why robotics? Because robotic or computerized technology has revolutionized safety in the automotive industry in the past 20 years, this technology has the potential to revolutionize patient safety in surgery.
Amputee support: creating a successful program Karen Groller, MSN, RN Lehigh Valley Hospital and Health Network Allentown, Pennsylvania Whether it is a traumatic injury or a congenital or diseaserelated process, losing a limb is a life-changing event that one should not go through alone. Support groups can be a powerful and positive way to help people help themselves. This was why an amputee support group was needed at Lehigh Valley Hospital. Recognizing this need, colleagues in a vascular medical-surgical unit formed the group. Literature was minimal on the subject of creating an amputee support group. On the basis of the group members’ needs, the authors’ short-term goal for the first 6 months was to focus on providing education and emotional support at monthly meetings. This was accomplished by having short presentations by various pros-
JUNE 2005
thetic companies, physical therapists, and a psychiatrist from the local amputee clinic. The long-term goal, also based on the group members’ needs, was to expand the support group and provide a visitation service to the acute amputee before discharge. The purpose of this peer visitation service was to acknowledge and discuss the changes and challenges with someone who has been through an amputation. The presenters identified five steps to attaining a successful amputee support group.
Clinical issues in vascular nursing Victora Fahey, MSN, RN, CVN, Northwestern Memorial Hospital Chicago, Illinois M. Eileen Walsh, PhD, APRN, CVN, Jobst Vascular Center Toledo, Ohio Janice Nunnelee, PhD, RN, CVN, ANP University of Missouri, St. Louis St. Louis, Missouri The presenters provided an opportunity for participants to discuss any clinical or professional issues they were interested in discussing. This session was an excellent tool for obtaining answers to questions and networking with other nurses.
Use of vena cava filters in the prevention of pulmonary emboli Victoria Latessa, MSN, ANP, ACNP Heart and Vascular Institute of Lenox Hill Hospital New York, New York The concept of interrupting the blood flow in the vena cava to prevent pulmonary embolism originated in the 1930s and 1940s. At that time the common femoral and superficial femoral veins were ligated. Because of the lack of venous return, this procedure resulted in lower limb edema, which could be disabling. As time progressed, ligation of the inferior vena cava (IVC) was performed to capture those thrombi located about the superficial femoral veins. Eventually, IVC ligation replaced superficial femoral vein ligation. However, a significant number of patients had immediate lower extremity swelling. In the 1960s, various methods of interrupting the flow in the vena cava while decreasing lower extremity venous stasis were used. These included suture plication and vena cava slips. Although lower limb extremity edema was reduced, the incidence of vena cava occlusion was 30% to 40%, which continued to result in significant morbidity. In 1967, the Mobin-Uddin umbrella filter was developed as a replacement for surgical ligation, caval plication, and vena cava slips to partially interrupt the flow in the IVC and prevent pulmonary emboli. Since then several filters have been developed. Recently, the concept of the retrievable (temporary) filter has emerged, and several are now on the market for use in preventing pulmonary emboli in high-risk patients.