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Free skin grafts have long been used as an essential surgical procedure to treat skin defects due to burns, trauma or illness, requiring skin transfers from sufficient, non-marked areas. Usually, free skin grafts are covered by simple pressure dressings or tie-over dressings. However, under conditions of wide, concave or irregular wounds, graft removal has been problematic due to instability. We report a case in which gauze-based negative-pressure wound therapy using a Y-connector was indicated for the opportunity to cover both limbs with free skin grafts all around, providing successful wound care.

Supplemental Digital Content is available in the text., Objectives: Improvements in cannula removal techniques, and in particular a standardized decannulation technique with a suitable closure device, are needed to further improve patients’ outcomes after percutaneous cannulation. The decannulation techniques described so far are neither sufficiently standardized nor proven enough to be used in the large group of venoarterial extracorporeal membrane oxygenation patients. To meet this challenge, we have established a highly standardized and safe decannulation technique based on the Perclose ProGlide closure system (Abbott Vascular, Lake Bluff, IL). Design: Establishment of a highly standardized and safe decannulation technique based on the Perclose ProGlide closure system, which is described in detail with comprehensive instructions for the executive clinician and first application in the context of a pilot study. Measurements and Main Results: So far our technique has already been used successfully in seven patients since January 2019 as a standard procedure on our ICU with only one minor complication occurred after the first procedure, that is, a small pseudoaneurysm likely originating from antegrade perfusion puncture site which was sealed by thrombin injection. Conclusions: Our crossed ProGlide technique using a hemostasis valve Y connector ensuring no blood loss seems to be a very promising decannulation technique.

A postcolumn derivatization system was assembled using a commercially available Nano Y Connector with low dead volume for microcolumn liquid chromatography. Smooth baselines were achieved when postcolumn reagent solution and mobile phase were supplied by one microfeeder equipped with two syringes. Amino acids and inorganic anions were visualized by the postcolumn reaction with tolerable extracolumn band broadening.

The "Y connector" that is used in angioplasty has the following disadvantages: 1) it is not blood-tight; 2) we need to "screw and unscrew" every time we want to inject contrast material or measure the pressure; and 3) it does not allow the advancement of the guidewire or the balloon catheter during the injection of contrast material. We created a new type of connection composed of a cut sheath for the femoral artery, connected with a cut (at the "hub") guiding catheter. The aim of this study was to examine the feasibility, efficacy, and safety of the new method. Using the new technique we performed plain-balloon angioplasty, implantation of stent, and atherectomy in 350 patients. The technical success of the method was 100%, and no complications related to the method were seen. In conclusion, the novel connection that we created eliminated all the disadvantages of the "Y connector" and was found to have 100% technical success and safety.

To the Editor: Vacuum-assisted closure (VAC) is a well-recognized minimal invasive treatment method for various acute and chronic wounds. If there are a number of wounds are present in a given anatomic region, a Y connector can be used to join 2 wound suction dressings together. As an alternative to the Y connector, some authors proposed bridging separate wounds with a piece of sponge after draping the intact skin between them. Thus, VAC can be performed using only 1 unit and 1 TRAC pad (KCI Medical Ltd, Kidlington, UK). We also frequently used the same method in our clinic; and have noticed no difference between the use of a Y connector and a bridging sponge in effectiveness of managing multiple wounds. The new VAC sponges are fashioned as flat coils that are amenable to being cut to size or unrolled and extended when needed (Fig. 1A). In this letter, we

We investigated the use of a reservoir device for delivery of a MDI bronchodilator aerosol using a lung model of an intubated, mechanically ventilated adult. Methods Albuterol (Proventil) was delivered with a MDI using three methods. In method 1, the MDI was attached directly onto the ETT using a commercially available actuator/adapter. In method 2, the Monaghan AeroVent reservoir was placed on the inspiratory limb of the ventilator circuit just before the patient Y connector. In method 3, the AeroVent was placed between the patient Y connector and the ETT. Standardized ventilator settings with a Servo 900C were used for all three methods ( V ˙ o 2 = 9.6 L; respiratory rate=12 breaths per minute; T 1 = 20 percent or 1 s). Aerosol drug delivery was measured at the distal tip of the ETT using a spectrophotometric technique. Percentage of amount delivered was calculated from measured delivery of the MDI. Remits The MDI directly on the ETT delivered 7.3 percent of the total dose to the end of the ETT. The AeroVent on the inspiratory limb increased this to 32.1 percent and the AeroVent between the Y connector and the ETT delivered 29 percent. Both reservoir delivery methods delivered significantly more drug than direct placement of the MDI on the ETT (p 0.05). Conclusion Use of the AeroVent reservoir chamber significantly increased bronchodilator delivery by aerosol with an MDI in an adult lung model of an intubated patient on ventilatory support.

One hundred one continuous ambulatory peritoneal dialysis (CAPD) patients from a single North American center were analyzed in a retrospective and cross-over study for peritonitis rates using a standard system (Travenol System II) or a Y-shaped disconnect-disinfectant system (Travenol O-set). Twenty-one of 34 patients using the standard set (group I) had 53 episodes of peritonitis in 508 patient-months or one episode per 9.6 patient-months. Nine of 17 patients switching from the standard to the disconnect-disinfectant system (group II) experienced 22 episodes of peritonitis in 275 patient-months or one episode per 12.5 patient-months on the standard set, while six patients had 10 episodes of peritonitis in 275 patient-months or one episode per 27.5 patient-months on the disconnect-disinfectant system ( P P v group I). Exit-site infections (ESI) occurred in 35.3% of patients using the standard set versus 34.3% of those using the O-set. The presence of an ESI was not associated with a higher risk of peritonitis, but modified the bacteriological profile of subsequent peritonitis episodes in patients using the O-set, favoring the organisms isolated from the exit site. Decreases in peritonitis rates with the O-set were due to a reduction of peritonitis episodes secondary to most bacterial agents and not only to skin organisms. Diabetics using intraperitoneal insulin had similar peritonitis and ESI rates as nondiabetics. We conclude that, compared with a standard system, the O-set, a Y-shaped system with disinfectant, is associated with a twofold to threefold reduction in peritonitis rates. The presence of an ESI is not associated with a significantly higher peritonitis rate subsequently.

We have developed a force sensor for actual linear medical objects. The sensory principle of this force sensor is based on optically measuring how the linear object bends with force. We have assembled the sensor into a medical equipment Y-connector, so that the sensor can be used in surgery. In this paper, we introduce the sensing method, the sensor characteristics, and experimental results of a dummy aneurysm.

Liposuction appears to be one of the simplest aesthetic techniques to date, and its popularity has spread worldwide. The authors have been using a Y-connector that enables two plastic surgeons to work at the same with the same suction-assisted liposuction (SAL) machine. For 12 patients whose liposuction procedures were performed using one-cannula SAL, the mean surgical time was 114 ± 10.8 min, whereas for 11 patients whose liposuction procedures were performed with Y-connector SAL, the mean surgical time was 62 ± 7.8 min. This difference between the two groups is statistically significant (p 0.05). The authors believe the Y-connector may be a less tiring alternative for plastic surgeons who still think SAL is the gold standard for liposuction.This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Over the last few years the number of patients on continuous ambulatory peritoneal dialysis (CAPD) has increased remarkably, and this now considered an effective form of treatment for patients with end-stage renal disease.(1) The high incidence of peritonitis remains a factor which limits the widespread acceptance of CAPD even in the more experienced centers, and this complication comprises the patients’ clinical and social rehabilitation.(2) The most frequent route of bacterial invasion of the peritoneum is through the catheter lumen during the CAPD bag exchange; this type of infection is called intraluminal (36.5% of the total number of peritonitis episodes).(3) A lower incidence of peritoneal infections has been obtained with intermittent peritoneal dialysis (IPD), compared to CAPD.(4,5) but an explanation for this is not completely clear.

Background: The objective of this study was to observe that the effect on the elimination of apparatus dead space was different according to modes of ventilation. Methods: In 30 patients undergoing esophageal surgery, we placed a double-lumen endobronchial tube in the midtrachea and used the bronchial lumen with a conventional Y connector while the tracheal lumen was clamped for conventional ventilation (CV) or used both lumens with special connectors that separated the inspiratory limb and the expiratory limb for separated ventilation (SV). Four ventilation modes were used in each patient. Type CV10 is a mode with 10 ml/kg of tidal volume, and a frequency of 10/min, and type CV5 is a mode with 5 ml/kg of tidal volume, and a frequency of 20/min. Except for the special connectors, type SV10 and SV5 are the same as CV10 and CV5, respectively. Results: The means ﾅ standard deviations of PaCO2 in CV10, SV10, CV5, and SV5 were 34.8 K 5.7 mmHg, 32.3 5.1 mmHg, 39.2 6.6 mmHg, and 34.9 5.9 mmHg, respectively. The PaCO2 in SV10 and SV5 decreased significantly when compared with that seen in CV10 and CV5, respectively (P 0.001), showing the effect of the elimination of apparatus dead space. Moreover, the PaCO2 difference observed between CV5 and SV5 (4.4 4.1 mmHg) was significantly greater than that observed between CV10 and SV10 (2.5 2.4 mmHg) (P = 0.014). Conclusions: The elimination of apparatus dead space to improve CO2 removal can be more beneficial in a ventilation mode with 5 ml/kg of tidal volume, and a frequency of 20/min rather than in 10 ml/kg of tidal volume, and a frequency of 10/min.

sixty-one new continuous ambulatory peritoneal dialysis (CAPD) patients were allocated to a Y connector disinfectant (Amuchina, Italy) and 63 to standard systems (Baxter Systems II & III) in a randomized clinical trial addressing peritonitis rates in 8 CAPD programs in 6 Canadian cities. In the Y connector-disinfectant group, 15 patients experienced 21 episodes of peritonitis in 452 patient-months or 1 per 21.53 patient-months. In the standard systems group, 30 patients experienced 47 episodes of peritonitis in 467 patient-months or 1 per 9.93 patient-months ( p = 0.009). The peritonitis risk reduction was 61% (95% confidence limits 27–79%). Exit-site infections occurred in 36% of each group. Prior to the development of exit -site infection, the monthly risk for peritonitis was 3.12% for the Y connector disinfectant system and 7.37% for the standard system. After an exit -site infection, these probabilities increased to 6.15% and 15.47%, respectively. Skin organisms were responsible for peritonitis in 8/21 (38%) in the Y connector-disinfectant group and 30/47 (64%) in the standard group. There were 75 days hospitalized for peritonitis in the Y connector-disinfectant group compared to 257 days for the standard group. The Y connector disinfectant system decreases the peritonitis rate through its effect on skin organisms. Exit -site infections are a major source of organisms responsible for peritonitis.

We have already described (Lancet 1983, ii, 642) the results of a controlled study in two centres showing the efficacy of a Y-shaped connector, filled with sodium hypochlorite during the dwelling time, for the reduction of peritonitis: one episode every 33 patient-months in the treated group versus one episode every 11.3 patient-months in the control group using the standard method. During the past 2.5 years we have continued to use the Y-connector. All new patients referred to our hospital for initiation of CAPD program were trained to use the Y-connector, while those patients already on the standard Y-connector continued on it. From January 1983 to June 1985, among 18 non-diabetic patients using the standard bag-exchange method, there were 23 peritonitis episodes in 14 patients (78%) over a cumulative period of 257 months -one episode every 11.2 patient-months. In contrast, among the 92 patients using the Y-connector, there were 30 peritonitis episodes in 21 patients (22.8%) during 1354 months -one episode every 45.1 patient-months. When we exclude from this group the 10 diabetic patients adding insulin to the bags, the incidence of peritonitis fell to one episode every 92.2 patientmonths. These results confirm that the Y-connector is extremely effective in reducing the rate of peritonitis in patients on CAPD. The most widely accepted technique for prevention of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) is that described by Oreopoulos et al (I). However, to reduce further the risk of dialysis-fluid

An open trial of the Y connector system for peritoneal dialysis has been carried out in 62 patients and the results compared to those in 18 patients using the standard spike connector for dialysis fluid exchanges. The incidence of peritonitis was lower (14.5%) with the Y connector, and the interval until peritonitis occurred was longer. Diabetic patients had a higher frequency of infection. When this group was excluded the peritonitis rate was one episode every 110.2 patient-months in the Y connector group. Technical accidents with the system were infrequent and inconsequential except for transient pain. CAPD treatment was continued by 80% of these patients after 10.1 months.

The "Accutracker," a novel ambulatory blood pressure monitor based on auscultation triggered by the electrocardiographic R wave, was evaluated by comparing its blood pressure readings with those obtained by direct auscultation. Simultaneous measurements were made (in 24 volunteers, by 4 trained observers) using a Y connector so that the Accutracker and a mercury sphygmomanometer were in parallel. Average blood pressure by direct auscultation (215 readings) was 129.1 +/- 12.0/77.8 +/- 14.4, and by Accutracker was 130.9 +/- 13.0/75.9 +/- 14.5 mm Hg (P less than 0.01). The Accutracker overestimated systolic blood pressure by 1.7 +/- 5.8 and underestimated diastolic blood pressure by 1.9 +/- 7.6 mm Hg. The average difference between pairs of readings was 5.0 mm Hg for systolic and 5.5 mm Hg for diastolic pressure. These data indicate that the concordance of blood pressure readings recorded by Accutracker and direct auscultation is sufficient to justify its use in noninvasive ambulatory blood pressure monitoring.

Refinements in the small details of instituting cardiopulmonary bypass enable this surgical procedure to progress more smoothly, prevents occasional but often troublesome complications, and allows the surgeon to concentrate on less routine problems. Insertion, positioning, and securing the caval catheters is a "standard" maneuver. The following modifications have made easier placement and removal of these catheters. The catheter is first "formed" into a right angle by autoclaving the catheter in the metal catheter former* (Fig 1). The plastic will maintain this shape on cooling and removal. The metal formers prevent wall "kinking" and obstruction of the lumen of the catheter at the right angle. This shape of catheter has proved much easier to insert into the cava openings. The two catheters then lay side by side to the Y connector. This enables a "smooth lie" on the operative field. The major problem after positioning of the caval catheters is to

Oxygen is removed from the bronchial tree during suctioning. 02 removal may also occur when no suction is being applied to the catheter. (This occurs if the side port or Y connector is too small to allow adequate inflow of atmospheric air.) Seriously ill patients may have a low tolerance to decreased 02 tensions. Frequently, their arterial PO2 is within the 50-60 mm. Hg range, increasing the risk of arrhythmias if suctioning increases hypoxemia.