RESUMEN
Though hemorrhaging pelvic arteries can be treated with transcatheter arterial embolization, difficulty in selection of injured arteries can lead to increased morbidity and mortality due to embolization of untargeted vasculature and prolonged time to hemostasis, resulting in unnecessary ischemic injury and prolonged hemorrhage. This report describes a balloon occlusion technique utilized in the setting of an unselectable hemorrhaging obturator artery.
RESUMEN
PURPOSE: To test operator exposures inside radiation protection garments in a simulated clinical setup, examining trends related to multiple characteristics. MATERIALS AND METHODS: Sixteen garment models containing lead or nonlead materials and a suspended device (Zero-Gravity) were tested for operator exposure from X rays scattered from an acrylic patient phantom. Weight and surface area were determined. The operator phantom was a wooden frame containing a dosimeter in its cavity. Garments were draped over the frame, and the setup was placed in a typical working position. RESULTS: There was substantial variability in exposures for all garments, ranging from 0.52 to 13.8 µSv/h (mean, 5.39 µSv/h ± 3.82), with a 12-fold difference for garments labeled 0.5 mm Pb equivalent. Most of the especially poor protectors were nonlead, even when not lightweight. Nonlead models were not more protective per weight overall. For closed-back garments labeled 0.5 mm Pb equivalent, mean exposures were lower for lead than for nonlead materials (mean, 1.48 µSv/h ± 0.434 vs 6.26 µSv/h ± 5.13, respectively). Density per exposure-1 was lower for lead than nonlead materials in the 0.5-mm Pb equivalent group, counter to advertised claims. Open-back configurations were lighter than closed (3.3 kg vs 6.0 kg, respectively), with similar mean exposures (5.30 µSv/h vs 5.39 µSv/h, respectively). The lowest exposure was 0.52 µSv/h (9.8% of the mean of all garments) for the suspended device. CONCLUSIONS: Operator exposure in a realistic interventional setup is highly variable for similarly labeled protective garments, highlighting the necessity of internal validation when considering nonlead and lightweight models.
Asunto(s)
Exposición Profesional/prevención & control , Salud Laboral , Etiquetado de Productos , Ropa de Protección , Dosis de Radiación , Exposición a la Radiación/prevención & control , Protección Radiológica/instrumentación , Radiografía Intervencional/efectos adversos , Radiólogos , Diseño de Equipo , Humanos , Ensayo de Materiales , Enfermedades Profesionales/etiología , Enfermedades Profesionales/prevención & control , Exposición Profesional/efectos adversos , Fantasmas de Imagen , Exposición a la Radiación/efectos adversos , Traumatismos por Radiación/etiología , Traumatismos por Radiación/prevención & control , Monitoreo de Radiación/métodos , Protección Radiológica/métodos , Dispersión de RadiaciónRESUMEN
A systematic review of the literature was completed by the Evidence-Based Practice Group for the Patient population, Intervention/Issue, Comparison Intervention, Outcomes, Timing (PICOT) question: "Does the use of a peripheral nerve block increase the risk for falls and difficulty ambulation in patients after lower extremity surgery through postoperative day 2?" A search of multiple databases using specified key terms resulted in 258 articles for total knee arthroplasty or total hip arthroplasty. These were reduced to 13 with exclusion criteria and became primary evidence. Numbers Needed to Harm and Numbers Needed to Treat (NNT) were calculated. Numbers Needed to Harm supported the PICOT question. Further research of postoperative falls and nursing interventions to reduce or prevent falls is suggested before creation of a Clinical Practice Guideline.