Percutaneous driveline lead and pocket sites are potential sources of drainage that can lead to infection. Some patients experience a slower closure of tissue growth into the driveline. The management of chronically open and or draining driveline wounds is a challenge. The KCI vacuum-assisted closure (VAC) device is a noninvasive negative-pressure therapy that promotes the healing of wounds not responding to conventional treatment. Vacuum-assisted closure therapy has proven safe, effective, and cost efficient by decreasing the number of dressing changes and length of stay. The left ventricular assist device (LVAD) team initiated VAC therapy in 3 patients. The tunneling method allowed the wound to heal from the inside out. The dressing was changed every 3 days, and the size and depth of the wound was monitored. Patients may be sent home using a portable VAC device until wound closure is obtained, which decreases the hospital length of stay. Our experience with three patients suggests the VAC device can be used for draining and tunneling LVAD driveline-site wounds and may prevent fistula formation. It is especially useful for patients with ascites that may be draining along the driveline tract. The sites showed increased granulation, decreased drainage, and a reduced bacterial burden after having the device in place.
Key wordsCARDIOPIJLMONARY RESUSCITATION: complication, endotracheal intubation, mouth-to-mouth ventilation.Effective management of the cardiopulmonary arrest victim includes adequate control of the airway and delivery of oxygen. Techniques employed range from head and neck extension with mouth-to-mouth ventilation to advanced techniques such as endotracheal intubation in association with gas powered oxygen delivery devices, a Gastric rupture and pneumoperitoneum associated with these manoeuvres is a rare occurrence. During the past three years, we have seen two cases of gastric rupture during cardiopulmonary resuscitation. In two other cases the clinical presentation was highly suggestive of gastric rupture although confirmation of this complication was lacking.From the Department of Anaesthesia, University of Manitoba, Winnipeg, Manitoba.Address correspondence to: Nell Donen rio, Department of Anesthesia, St. Boniface General Hospital, 409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6. Case reports Case 1A 75-year-old woman presented to the emergency department with symptoms and signs of an acute brain stem stroke. While awaiting transfer to the ward the patient suffered a cardiopulmonary arrest. Resuscitative measures were instituted. Airway management involved immediate attempts at endotracheal intubation. Initially, the oesophagus was intubated and the patient manually ventilated with a bag-valve unit (resuscitation bag) for approximately 15 seconds. The second attempt at tracheal intubation was successful. During the resuscitation it was noted that the patient's abdomen had become grossly distended and tympanitic. Following reestablishment of a stable cardiac rhythm, reexamination of the abdomen confirmed these findings. Chest x-ray revealed air under both diaphragms (Figure 1). A subsequent abdominal x-ray confirmed the massive pneumoperitoneum.The etiology of the abdominal distention was uncertain. An exploratory ]aparotomy was postponed because of the severe brain stem lesion. The patient expired 24 hours later. Autopsy findings confirmed the recent mid-brain infarction. Examination of the stomach revealed a full thickness tear on the lesser curvature, close to the cardia. Case 2A 78-year-old woman sustained an in-hospital cardiopulmonary arrest. Resuscitative measures were instituted. Initial airway management ineluded mouth-to-mouth ventilation, insertion of an oral airway and manual ventilation with a hag-valve unit and mask. Attempts at endotracheal intubation resulted in intubation of the oesophagus and the patient was manually ventilated for a short period of time before the error was noted and the trachea CAN ANAESTH SOC J 19S4 1 3l: 3 / pp319-322
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