Dariusz Kosson

Regional anaesthesia, referred to as regional blocks, is one of the most frequently used methods of anaesthesia for surgery and for pain management. Local anaesthetic drug should be administered as close to the nerve as possible. If administered too far away, this may result in insufficient block. If it is administrated too close, severe nerve damage can occur. Neurostimulation techniques and ultrasound imaging have improved the effectiveness and safety of blockade, but the risk of nerve injury with permanent nerve disfunction has not been eliminated. Intraneural administration of a local anaesthetic damages the nerve mechanically by the needle and the high pressure generated by the drug inside the nerve. In many studies, injection pressure is described as significantly higher for unintended intraneural injections than for perineural ones. In recent years, the concept of combining techniques (neurostimulation + USG imaging + injection pressure monitoring) has emerged as a method increasing safety and efficiency in regional anaesthesia. This study focuses on the contribution of nerve identification methods to improve the safety of peripheral nerve blocks by reducing the risk of neural damage.

Midline catheters (MCs) are used to deliver intravenous therapy lasting over 5 days to patients in hospitals. However, the constant development of home and outpatient care is challenging medical teams to provide effective and safe planned therapy to patients under such conditions. We describe the first time an MC was used in outpatient pain management in Poland. A 60-year-old man presented to the Pain Management Clinic with a history of RCC of the left kidney and lumbar back pain radiating to the left knee joint. The person whose case is described below had poor peripheral veins. He intravenously received lidocaine for 10 days via a midline catheter with a good response.

Introduction. Midline catheters (MCs) are an option for vascular access alongside the commonly used short peripheral intravenous catheters, centrally and peripherally inserted central catheters. Aim. The aim of this study was to evaluate the solution implemented during the COVID-19 pandemic in a centre where MC access had not been used before. Material and method. It was an observational retrospective evaluation of the 98 medical registries of adult patients. Results. The mean time from hospital admission to midline catheter insertion was 15 days. The most common indications for the catheter implementation were: difficult intravenous access (83%) and expected time hospital stay >6 days (17%). The mean dwell time of the catheters was 9 days. The most common reasons for removal were: the end of intravenous therapy (44%) and catheter blockages (36%). Conclusions. A high level of prematurely removed catheters was observed, despite the existence of a hospital protocol. The high percentage of MCs removed before the end of intravenous therapy may be indicative of the poor quality of care and the need for continuous education of medical staff. The results obtained should be confi rmed in a prospective study planned on their basis in order to identify interventions which are necessary to improve the quality of vascular access care.