by Christian Emeka Amadi and Justina Omoikhefe Alegbeleye
Original Research
Background: Peripheral Intravenous Cannulation is a routine invasive procedure in clinical practice with various associated complications including cannula fracture. Objective: To evaluate the incidence of peripheral intravenous cannula fracture and its management. Materials and Methods: This was a prospective cross-sectional study conducted at the University of Port Harcourt Teaching Hospital between April 1, 2019, and December 31, 2021. A data collection tool designed specifically for the study was used to obtain information on the size of the cannula, cadre of doctor that inserted the cannula, the brand of the cannula, history of reinsertion of the introducer needle during cannulation, duration of the intravenous cannulation, time of presentation and successful retrieval rate. Results: There were 15 cases of broken peripheral IV cannulae. The patients were aged 25-44years, consisting of 1 (6.67%) male and 14 females (93.33%). All the cannulae were 16G (gray) and were inserted mostly preoperatively for caesarean section, 7 (46.67%) of them were inserted by consultants, 4 (26.67%) by Senior Registrars and 4 (26.67%) by Registrars. All the 16G cannulae were made by the same manufacturer. The introducer needle was reinserted in 4 (26.67%) cases. On the average, the cannulae lasted between 3-5days intravenously, 10 (66.67%) of the cases presented within 24hours while 5 (33.33%) presented after 24hoours. Most 12 (80%) of the fractured cannulae segments were successfully retrieved while 3 (20%) had migrated. These peripheral cannula fractures were more prevalent in the first year of the study, where 12 cases were reported. The hospital management was notified of the increase in the rate of peripheral cannula fracture and the use of the brand of peripheral cannula was discontinued. Conclusion: Though technical error during insertion is an issue, the quality of the cannula in these cases appeared to contribute to the increased rate of cannula fracture. Hence, timely presentation is key to successful retrieval.
American Journal of Clinical Medicine Research. 2024, 12(1), 13-17. DOI: 10.12691/ajcmr-12-1-2
Pub. Date: March 19, 2024
by Chidiebere Vincent Ali, Boniface N Ejikeme, Eziaha E Ede, Michael Okoh Orji, Ayodele Adegbite Olaleye, John C Irechukwu, Nwabunike Ekene Okeke, Chidi Ikenna Ebere and Emmanuel Onyekelu
Original Research
Background: Impaired placentation with its associated increased impedance to blood flow in the uterine arteries is associated with complications in pregnancy such as pre-eclampsia and intra-uterine growth restriction (IUGR) among others. These complications are identified causes of maternal/perinatal morbidity and mortality. The uterine artery Doppler has potentials for screening for these pathological processes that are associated with impaired placentation. Objective: This study was designed to evaluate the predictive value of Doppler investigations of the uterine circulation in the second trimester (20-24 weeks of gestation) with regard to the development of some pregnancy complications such as pre-eclampsia and IUGR. Methods: This was a prospective longitudinal cross-sectional study of 354 low-risk women attending antenatal care at Alex Ekwueme Federal University Teaching Hospital Abakaliki. The study population was subjected to uterine artery Doppler study at 20-24 weeks gestation. The mean uterine artery Doppler indices such as pulsatitity index (PI), resistance index (RI) and presence of early diastolic notch (EDN) were obtained, and the outcomes of pre-eclampsia and intra-uterine growth restriction (IUGR) were studied. Data analysis was done using statistical package for social science (IBMSPSS) software (version 21, Chicago II, USA) at a statistical significance level of p < 0.05. Results: Out of the 354 women, 21(5.9%) developed pre-eclampsia and 27 (7.6% developed intra-uterine growth restriction. For pre-eclampsia, the resistance index showed a sensitivity of 66.7%, specificity of 91.9%, positive predictive value (PPV) of 34.2% and negative predictive value (NPV) of 97.8%; its pulsatility index showed a sensitivity of 71.4%, specificity of 95.5%, PPV of 50.0% and NPV of 98.2%; while for early diastolic notch had sensitivity of 66.7%, specificity of 94.3%, PPV of 42.4% and NPV of 97.8%. For intra-uterine growth restriction, resistance index showed a sensitivity of 59.3%, specificity of 92.4%, PPV of 39.0% and NPV of 96.5%; pulsatility index showed a sensitivity of 77.8%, specificity of 97.3%, PPV of 70.0% and NPV of 98.2%; while early diastolic notch had a sensitivity of 85.2%, specificity of 96.9%, PPV of 69.7% and NPV of 98.8%. Conclusion: The high negative predictive values indicated that women with normal Doppler velocimetry were unlikely to develop pre-eclampsia or intra-uterine growth restriction. Uterine artery Doppler, being non-invasive, can be included during routine sonography to identify patients at risk of developing pre-eclampsia or intra-uterine growth restriction. Early screening for pre-eclampsia and intra-uterine growth restriction will help in individualized antenatal surveillance and initiation of prophylactic therapy, and will help to reduce the adverse maternal and foetal complications of pre-eclampsia and intra-uterine growth restriction.
American Journal of Clinical Medicine Research. 2024, 12(1), 1-12. DOI: 10.12691/ajcmr-12-1-1
Pub. Date: March 10, 2024