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Obstetrical hemorrhage is a relatively frequent obstetrical complication and a common cause of maternal morbidity and mortality worldwide. The majority of maternal deaths attributable to hemorrhage are preventable, thus, developing rapid and effective means of treating postpartum hemorrhage is of critical public health importance. Intrauterine devices are one option for managing refractory hemorrhage, with rapid expansion of available devices in recent years. Intrauterine packing was historically used for this purpose, with historical cohorts documenting high rates of success. Modern packing materials, including chitosan-covered gauze, have recently been explored with success rates comparable to uterine balloon tamponade in small trials. There are a variety of balloon tamponade devices, both commercial and improvised, available for use. Efficacy of 85.9% was cited in a recent meta-analysis in resolution of hemorrhage with the use of uterine balloon devices, with greatest success in the setting of atony. However, recent randomized trials have demonstrated potential harm associated with improvised balloon tamponade use In low resource settings and the World Health Organization recommends use be restricted to settings where monitoring is available and care escalation is possible. Recently, intrauterine vacuum devices have been introduced, which offer a new mechanism for achieving hemorrhage control by mechanically restoring uterine tone via vacuum suction. The Jada device, which is is FDA-cleared and commercially available in the US, found successful bleeding control in 94% of cases in an initial single-arm trial, with recent post marketing registry study described treatment success following hemorrhage in 95.8% of vaginal and 88.2% of cesarean births. Successful use of improvised vacuum devices has been described in several studies, including suction tube uterine tamponade via Levin tubing, and use of a modified Bakri balloon. Further research is needed with head-to-head comparisons of efficacy of devices and assessment of cost within the context of both device pricing and overall healthcare resource utilization.

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Background: Airway obstruction in a child requires expedite management in addition to comprehensive discussion between the Otolaryngology and Anaesthesiology team to formulate a treatment plan to ensure safe airway. Juvenile-onset recurrent respiratory papillomatosis (JORRP) is an exophytic benign laryngeal lesion which poses a great challenge when presented with respiratory distress. Objective: This paper presents a novel, safe and cost-effective approach to temporary tracheal ventilation of the obstructed airway in a child with juvenile-onset recurrent respiratory papillomatosis using the laryngeal suction tube connected to general anaesthetic (GA) machine. Result and Conclusion: Rigid laryngeal suction tube is placed through the side-port of Lindholm laryngoscope and connected to breathing circuit of GA machine. Manual bagging ventilation with 100% FiO2 achieved good oxygenation throughout the debulking of the papilloma without hindering the surgical field. Our technique utilizes the readily available equipment whilst enabling safe anaesthesia and providing good surgical field during excision of obstructive papillomatous airway lesion.

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PURPOSE: This study aimed to investigate the effect of placement of double-lumen irrigation-suction tubes (DLIST) on the closure of anastomotic defect (AD) after rectal cancer surgery. METHODS: The study was carried out at two centers managed by one surgeon, both adopted the same treatments. Patients with postoperative AD after rectal cancer surgery from January 2011 to June 2020 were eligible and were divided into a passive drainage (PD) group and a DLIST group according to whether the PD, placed in the rectal cancer surgery, had been replaced with the DLIST. The effect of DLIST on the AL was evaluated. RESULT: There distributed 76 patients in the DLIST group and 52 in the PD group. A higher closure rate was reported in the DLIST group (46 patients in DLIST group, for a closure rate of 60.5%, and 21 patients in PD group, for a closure rate of 40.4%. HR = 3.05; 95% CI: 1.79-5.19; P < 0.001). Both length of stay and costs of the treatment in the DLIST group were lower (54 days [interquartile range, IQR: 41-17] days vs. 112 days [IQR: 66-27] days, P = 0.005; and $18,721 [IQR: $14,982-4,960] vs. $40,840 [IQR: $20,932-50,529], P < 0.001). CONCLUSION: Placement of DLIST might serve as an effective method for treating AD following rectal cancer surgery. In comparison with PD, it costs lower to apply DLIST in the treatment of AD and the length of stay is shorter.

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Objective: We designed a novel intraoperative malleable adjustable continuous suction tube to obtain clear surgical fields, reduce intracranial pressure, and lower the temperature of the surgical area. Methods: This device consists of six parts: continuous suction tube head and cotton patty, suction tube, fixed wire position, fixed clip, spiral plastic pressure regulating valve, and tail. It can continuously extract blood, cerebrospinal fluid, and rinsing solution from surgical fields, with minimal contact and trauma to tissues, nerves, and blood vessels, while also having a negligible impact on the surgeon's focus and procedure. Result: The excellent and safe performance (simple, malleable, adjustable, space-saving, inexpensive, safe, and effective) of this device in clearing the operating field has been proven in more than 2000 neurosurgical operative procedures. We encountered no complications associated with this device, such as cerebral hematoma, postoperative low intracranial pressure, or vascular and nerve injuries. Conclusion: The newly innovated intraoperative malleable adjustable continuous suction tube is effective and safe for microneurosurgery.

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Background: An essential surgical tool in neurosurgery is the suction tube. The skillful and accurate use of a suction tube facilitates the neurosurgical operation. Objective: This study is to verify the practicality of an adjustable pressure suction tube (APS tube) and to explore the ideal APS tube diameter and tip negative pressure for different intracranial structures. Methods: APS tubes were used to aspirate brain tissues and carotid arteries of rats. Laser speckle contrast imaging (LSCI) was used to record the blood flow velocity (BFV). We measured APS tube diameter, air inlet size, tip negative pressure and central negative pressure and calculated the correlation between them. In our department, intraoperative real-time parameters including APS tube diameter, length, air inlet size, and central negative pressure were recorded, and the tube tip negative pressure suitable for different intracranial structures and parts was calculated. Results: All experiments were carried out using APS tubes. Experiments on rats objectively reflected a severe structural damage to the brain and blood vessels by the suction tube, which might even result in an irreversible reduction in blood flow., Rat carotid arteries and brain tissue suffered severe damage when the tip negative pressure exceeded 33.4 ± 1.8 and 29.2 ± 2.0 kPa, respectively. BFV failed to return to the preoperative level 3 min after the operation (p < 0.05), and this decrease was more pronounced when the suction tube diameter was large (p < 0.05). The tip negative pressure was positively and negatively correlated with central negative pressure and the air inlet size, and was independent of APS tube diameter. A total of 50 operations including 39 tumor resection operations and 11 moyamoya disease bypass operations were recorded. Large-diameter APS tubes (3.5 mm) with an closed air inlet were frequently used to maintain a greater tip negative pressure before the incision of dura mater. When important structures such as motor cortex and brainstem were involved, 1.5- or 2.0-mm-diameter APS tubes were mostly used, and an air inlet was opened up to 0.7-2.1 mm to maintain a safe tip negative pressure (7.4-27.9 kPa). Conclusion: APS tubes with a mechanical knob provide stable and precise adjustment of the tip negative pressure, avoiding excessive negative pressure that causes serious damage to the intracranial structure. And, this allows the surgeon to hold the suction tube more freely and operate at any angle with an appropriate fulcrum near the incision to achieve efficient atraumatic suction and enhance surgical safety.

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OBJECTIVE: To assess feasibility and acceptability of a novel, low-cost "Suction Tube Uterine Tamponade" (STUT) treatment for refractory postpartum hemorrhage (PPH). METHODS: We allocated patients with refractory PPH by randomly ordered envelopes to STUT or routine uterine balloon tamponade (UBT, Ellavi free-flow system) in 10 hospitals in South Africa. In the STUT group, a 24FG Levin stomach tube was inserted into the uterine cavity and vacuum created with a vacuum pump or manual vacuum aspiration syringe. RESULTS: For this internal pilot study, 12 participants were allocated to STUT and 12 to UBT. Insertion failed in one of each group and was recorded as difficult in 3/10 STUT and 4/9 UBT insertions respectively (five missing data). There were two laparotomies and one intensive care unit admission in the UBT group. Pain during STUT insertion was graded as none/mild in 9/10 and severe in 1/10. The experience of the STUT procedure was graded as fine in 4/11 and "uncomfortable but acceptable" in 7/11. CONCLUSION: STUT is feasible and acceptable, justifying continuation of our trial. These data will also inform a large World Health Organization trial to test effectiveness of uterine tamponade methods. The numbers are too small to support any clinical recommendation.

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Ventilator-associated pneumonia (VAP) is one of the most common infectious diseases in patients undergoing mechanical ventilation in intensive care unit (ICU). Although the use of closed sputum suction tube for sputum suction is the most common nursing measure for patients with tracheal intubation in ICU, and it is also an important measure to reduce the occurrence of VAP, the existing clinical technology still needs to use external flushing solution for humidification and flushing. In the process of use, the flushing operation has the risk that the amount of flushing fluid cannot be controlled, resulting in a large amount of flushing fluid entering the patient's airway, causing the patient to suffocate. The sputum attached to the wall of the sputum suction tube cannot be completely flushed, and the prolonged retention of the sputum leads to the proliferation of colonized bacteria, aggravating the infection of patients. Repeated pipe flushing not only increases consumables, but also increases the workload of medical staff. For this reason, the author has designed a fully enclosed sputum suction tube flushing device, which has obtained the National Utility Model Patent of China (patent number: CN 2019 2 1198740.5). This device is an integrated design, and the materials used for sputum suction, humidification and flushing are fully enclosed, without air exposure, and can be operated strictly without bacteria. Pulse flushing with syringe can clean the sputum attached to the inner wall and reduce the incidence of VAP. The volume of flushing fluid can be effectively controlled during use to ensure patient safety and reduce waste. It is worth popularizing and applying in clinical practice to optimize the operation steps and reduce the workload of medical staff.

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In the last few decades, there has essentially been an explosion in the use of lasers in medicine, especially in the area of cosmetic dermatology. Potentially harmful substances are liberated when tissues are vaporized with laser. This creates numerous risks, including the spread of infectious disease. Smoke evacuators are devices that capture and filter laser plume, thereby maintaining a safe environment for the surgical team and patient. Our aim was to characterize the microbial community structure within the suction tube and funnel of the smoke evacuator system, identify their origin, and evaluate pathogenicity. Dust particles were collected from the instruments with a cotton swab. DNA was extracted from the swabs and the transport media, and sequencing was performed using the Illumina HiSeq Xplatform. Metagenomic analysis was conducted using the Empowering the Development of Genomics Expertise (EDGE) Bioinformatics pipeline and custom Python scripts. The most abundant bacterial species were Micrococcus luteus and Brevibacterium casei in the suction tube, and Dermacoccus sp. Ellin 185 and Janibacter hoylei in the suction funnel. A total of 15 medium- to high-quality metagenome-assembled genomes (MAGs) were constructed where we found 104 antibiotic-resistant genes (ARGs) and 741 virulence factors. Findings indicate that the suction tube and funnel are likely a reservoir of virulence factor genes and ARGs, which can possibly be passed on to other bacteria via horizontal gene transfer. We would like to emphasize the health risk these microorganisms pose and the need to reevaluate the current hygiene standards with regard to the smoke evacuator system.

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BACKGROUND: This study aimed to investigate the effect of double-lumen irrigation-suction tube (DLIST) in the management of surgical site infections (SSIs) after enterocutaneous fistula (ECF) excisions. METHOD: From January 2016 to December 2017 medical records of patients with ECF excisions were reviewed. Patients with primary superficial SSI were divided into group a (treated with DLIST) and b (treated with delayed primary closures). Patients with primary deep SSI were divided into group A (treated with DLIST) and B (treated with vacuum-assisted closure [VAC]). The effect of the DLIST was evaluated. RESULTS: There were 32 in group a and 27 in group b. The therapeutic time and cost in group a were lower (13.13 ± 2.37 d vs. 24.89 ± 7.44 d; p < .001; $1456 ± 302 vs.$2784 ± 583; p < .001). There were 21 in group A and 23 in group B. While the therapeutic time of group A was longer, the cost was lower ($1717 ± 404 vs. $2636 ± 592; p < .001). CONCLUSIONS: Placing DLIST is an effective and cheap method to treat superficial SSI after ECF excisions. The cost of DLIST in treatment of deep SSI is lower, while the effect of VAC is better.

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Uterine balloon tamponade (UBT) is widely used to treat postpartum haemorrhage (PPH). Randomised trials of UBT are scarce: those of improvised condom UBT in low-resource settings found more harm than good. Uterine suction tamponade (UST) is more aligned with the physiological mechanism of uterine haemostasis (contraction), but purpose-designed devices may be unaffordable or unavailable when needed. We describe a technique of UST using an inexpensive Levin suction catheter. Use of the described technique as a last resort in three cases of life-threatening PPH resulted in prompt cessation of bleeding. We emphasise the need for randomised trials to confirm effectiveness.

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OBJECTIVE: To identify an inexpensive catheter suitable for uterine suction tamponade (UST) for postpartum hemorrhage and assess its functionality. METHODS: Randomized, single-center, double-blind feasibility study in East London, South Africa, among 45 women undergoing cesarean delivery between October and November 2018. A search of medical supply websites for catheters with predefined characteristics (inexpensive, flexible, wide-bore, circumferentially-arranged side apertures, rounded tip) identified the FG36 Levin stomach tube. During cesarean, the tube was placed in the uterus and connected transvaginally to a suction unit. Participants were randomized via a computer-generated random sequence to early (after uterine closure; n=24) or delayed (after skin closure; n=21) UST. RESULTS: The tube functioned well with respect to stability in the uterus and aspirating blood from the uterine cavity without blockage. Blood loss was similar between the groups (mean difference, 7.3 mL; 95% confidence interval, -61 to 75; P=0.433), as were secondary outcomes. There were no complications. Absolute effectiveness was not tested because there was no non-suction group. CONCLUSION: The FG36 Levin tube was found to be a suitable device for "suction-tube uterine tamponade". There was no difference in functionality between early and late UST. Future trials should assess the effectiveness of this approach for postpartum hemorrhage. CLINICAL TRIAL REGISTRATION: Registered in the Pan African Clinical Trial Registry as PACTR201809584199573.

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BACKGROUND: Bloodless dry fields are indispensable for successful and safe neurosurgical operations using microscopes. Appropriate irrigation and suction systems are needed to obtain clear surgical fields. We invented a novel malleable continuous suction tube to address this need. METHODS: We developed a malleable tube (MT) made of ultrathin stainless-steel foil (≈5 µm in thickness, 3.0 mm in diameter, 15 cm in length) contained between ultrafine stainless-steel wire mesh (50 µm in diameter) woven tubes. The MT was applied in an intraoperative continuous fluid suction system, connecting it to a conventional vacuum system through a device. RESULTS: The MT can be placed at any part of the operative field, preferably close to its edges, without disturbing surgeon manipulation. This continuous suction system has been tested in neurosurgical operations and has shown excellent potential for maintaining the operative field clear and dry without any side effect or trauma on adjacent tissues. CONCLUSIONS: The newly developed malleable suction tube is effective for microsurgery.

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Once incision and drainage of fascial space abscess is performed, irrigation of deep spaces with saline and antibiotic solution should be done daily for effective elimination or reduction of infection. Various advocated aids for irrigation into deeper areas are: small pediatric nasogastric feeding tubes, French catheter, polyethylene irrigation tubes and scalp vein infusion set. All these aids have major inherent disadvantages like, they tend to kink inside the deep spaces limiting the reach of irrigating solution into deeper spaces, are not readily available in dental departments and have to be discarded after every use. Overcoming these disadvantages, a simple yet an effective method is proposed here-use of a Frazier suction tube.

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Endoscopic septoplasty has become the favored approach for the treatment of a deviated septum. Careful septal dissection results in less bleeding, clear endoscopic view, shortened operative time, and fewer postoperative complications. We describe our 5-year experience of using an 8 French Frazier suction tube for submucosal dissection compared with the traditional septoplasty. A total of 434 patients who underwent septoplasty were recruited. The patients in the study were divided into two Groups 1 and 2 based on the employed surgical techniques to treat deviated nasal septum: traditional septoplasty (Group 1: 105 patients) and suction-tube-assisted endoscopic septoplasty (Group 2: 329 patients). All the patients were followed up for a minimum of 6 months. No statistically significant differences could be traced between the groups in any demographic factor, regarding the gender, age, and the intraoperative and postoperative complications. A significantly shorter operative time was found in Group 2 (P < 0.001). The overall incidence of minor complications was 6.6% in Group 1 and 4.6% in Group 2. The suction-tube-assisted dissection technique is found to be a surgical alternative, effective with a significantly shorter operating time, and economical option in septal surgery.

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Objective To observe the impact of improving the compliance of ventilator bundle on morbidity of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients undergoing mechanical ventilation (MV) guided by context of Joint Commission International (JCI) settings, and to study the oral care efficacy of suction tube sponge brush. Methods A prospective study was conducted. The patients who needed MV admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Xiamen University from January 2013 to December 2016 were enrolled. In the context of JCI settings, necessary measurements were taken to enhance the compliance of ventilator bundle each year. In 2013, the preventive measures were set up and the education was strengthened. In 2014,the compliance of hand hygiene and bedside elevation was strengthened. In 2015, a control study was conducted to evaluate the effect between the traditional cotton dipped in chlorhexidine and the suction tube sponge brush rinsed with chlorhexidine on oral health impact parameters. The suction tube sponge brush rinsed with chlorhexidine oral care was introduced to improve compliance. In 2016, electronic bundle checklist for daily self-audits was conducted. The annually morbidity of VAP through the software of hospital and ICU was collected and calculated. The annual incidence of VAP was indicated by the VAP cases per 1000 MV days. Based on the VAP incidence rate in 2013 as 1, the VAP incidence-rate ratio (IRR) of each year was calculated. Results During the study period, a total of 2733 patients admitted to the ICU, including 1403 patients undergoing MV. Ninety-four of the 1403 patients with community-acquired pneumonia (CAP), aspiration pneumonia, back elevation ban, incomplete information, and withdrew from the study were excluded. 1399 patients undergoing MV were enrolled in the final analysis, with total MV days of 11012 days, and 94 patients occurred VAP. The annual incidence of VAP was progressively declined from 2013 to 2016, and the VAP cases per 1000 MV days were 17.0, 10.0, 5.9, 3.5 cases, respectively. Based on the VAP incidence rate in 2013, the IRR of VAP from 2014 to 2016 was also progressively declined, which was 0.59 [95% confidence interval (95%CI) = 0.35-0.98], 0.35 (95%CI = 0.18-0.64), and 0.21 (95%CI = 0.09-0.41), with statistical significance (all P 0.05). Conclusion Ventilator bundle can effectively reduce the morbidity of VAP in the context of JCI settings, and the oral care by using suction tube sponge brush and chlorhexidine can effectively improve oral hygiene.

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Cupping, with an ancient name of horn method, possessed other different names and operational approaches through the history. There was wrong information about cupping which was passed on due to unawareness of predecessors. Through probing into the literature and history, this article summarizes and studies warming cupping, cupping over needles, water boiled cupping and fire cupping.

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Objective To explore the application value of chlorhexidine combined with disposable combined type sputum suction tube in ventilator-associated pneumonia(VAP).To provide an effective method for prevention and control of hospital infection in ICU.Methods 104 patients with mechanical ventilation were randomly divided into the observation group(55 cases) and control group(49 cases).During the period of hospitalization,the incidence rates of oral infection and VAP of the two groups were observed.At the time of admission and in-hospital,clinical pulmonary infection scores (CPIS) of the two groups were evaluated.Results Oral herpes,ulcer incidence rates of the observation group were 3.64%,9.09%,which were lower than the control group,the differences were statistically significant (χ2 =4.802,4.494,all P<0.05).After 3 days and 7 days of mechanical ventilation,VAP incidence rates of the observation group were 3.64%,12.73%,which were lower than the control group,the differences were statisti-cally significant (χ2 =5.945,4.037,all P<0.05).After 3 days and 7 days of mechanical ventilation,the results of CPIS of the observation group were (4.94 ±0.76) points,(5.29 ±0.91) points,which were lower than the control group,the differences were statistically significant (t=3.812,3.295,all P<0.05).Conclusion The medical care of chlorhexidine combined with disposable combined type sputum suction tube showes significant effect on patients with mechanical ventilation,has high value in clinical application.

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Cupping, with an ancient name of horn method, possessed other different names and operational approaches through the history. There was wrong information about cupping which was passed on due to unawareness of predecessors. Through probing into the literature and history, this article summarizes and studies warming cupping, cupping over needles, water boiled cupping and fire cupping.