bluuebunny/crossref_metadata_2025 huggingface dataset:
Drilling Efficiency Optimization (DEO) in Casing while Drilling Operations in the Sultanate of Oman
Authors: Sanchez F. , Smith M. , Al Kindy M , Gray D. , Aderele S.
Published: October 2011

The industry acknowledges that well engineers in the Sultanate of Oman identified long ago a number of technical challenges when drilling through the Fiqa formation. The most daunting is wellbore instability which results in hundreds of unproductive rig-hours when drilling wells for both exploration/appraisal and development campaigns. But more recently, Casing while Drilling (CwD) was recognized as the most cost-effective mitigation system against the risk of stuck-pipe, continuous back- reaming and unplanned casing setting depths in such highly reactive, time-dependent shale. In consequence, current portfolio of deep and ultra-deep wells in Northern Oman (Figure 1) mandates CwD as the new conventional approach for drilling large- diameter surface sections, instead of the drill-pipe method.

Figure 1 Operator's Fields located at the Northern of Oman (red arrow)

During the trial-phase of CwD (2009–2010), the Drilling Efficiency Optimization (DEO) concept and a few related tools/techniques were rarely utilized. The reason responds to the fact that operator's major objective was to prove the CwD- concept in deep surface sections with minimum well-design integrity risk; in which the critical challenge was the delivery of a wide range of drilling performance optimization ideas. Nonetheless, a more systematic DEO approach during the phases of well planning, execution, and post-drill analysis was utilized in the subsequent ‘CwD Implementation Campaign’ to improve overall performance through the most-top formations in four different fields across the North.

The operator identified a few critical areas of opportunity that led to successful operations, such as specialized rig-crew training sessions, real-time management of drilling parameters, optimum mud properties and hydraulic energy, wellbore strengthening quality, bottom-hole-assembly (BHA) design, and mechanic energy surveillance. All enabling technologies and resources dedicated to these areas combined aided to accelerate well delivery time by up to 58% and reduce cost per meter drilled-and- cased by over 25%. A main conclusion is that CwD technology deployment with DEO approach is the best-in-class, value creative solution through troublesome, most top formations in Northern Oman.
Drilling Hazard Mitigation Technology Enables Drilling Conventionally Undrillable Prospect
Authors: Hamoudi I. , Kartobi K. , Vieira P. , Saad M. A. , Torres F. , Qutob H.
Published: October 2011

The Nezla Field is a faulted anticline that makes conventional drilling challenging due to the presence of fractured and high pressure formations in the Triassic and Ordovician groups, representing trouble zones that jeopardize well objectives, adding costs and operational risks to the drilling process. This adverse condition was observed in the offset wells drilled with problems related to wellbore instability, lost-circulation zones and over-pressured formations leading to kick/loss well control scenarios that endangered the drilling operations and incurred significant Non-Productive Time (NPT). A Drilling Hazard Mitigation (DHM) approach was implemented to offset the risks of both deviating from the well objective and drilling plan.

The constraint to drill the planned 12-1/4" section in the well was the unpredictability of the pore/fracture pressure in the transition zone between Tags and Sandy Tags formations, representing a high level operational risk. The most optimum and reliable solution to achieve the goal of drilling this zone without loss of hole size was to set 9¬5/8" casing shallower than planned and then isolate the lower section of Tags formation (abnormally pressurized) with an Open Hole Expandable Liner. Drilling the next hole section through the low pressure formations to set the 7" casing shoe was to be resumed as per the original plan. This allowed the 6" reservoir hole section to be drilled under the Managed Pressure Drilling (MPD) mode.

The CBHP (MPD technique) was planned to drill the 6" section through the tectonically fractured Sandstone Hamra Quartzite maintaining the ECD within the drilling window limits initially defined by the predicted formation pressure and the average mud hydrostatic with which fluid losses were experienced in the offset wells. While drilling, these limits were ascertained within the range of 1.26 SG EMW - gas influx and 1.32 SG EMW - fluid losses. The CBHP drilling mode enabled to manage the ECD in between influxes and losses only adjusting the well head pressure to obtain instantaneous changes in the Bottom Hole Pressure while circulation was in progress. During the pumps-off periods, back pressure was applied on the MPD choke by pumping mud across the top of the well to compensate the Annular Friction Loss pressure. Once these limits were reached, drilling progressed with managing simultaneously small gas influxes and tolerable losses; then TD was called since the risk of simultaneous total losses and gas Influxes in the underlying Hamra fault was increasing.

This paper describes in detail the DHM technology implemented in this well and presents the successful application of such technique to enhance Nezla field exploitation. Lessons learnt and challenges encountered will be also discussed.
Novel Quantitative Method for Estimating Breaker Filter Cake Cleaning Efficiency
Authors: Fakhreldin Y.
Published: October 2011

Drilling operations including drilling and completion fluids are the primary source of the reservoir rock damage. Drilling fluid filtrate accumulates around the near well-bore and decreases the reservoir rocks permeability; this can reduce the oil and natural gas flow. Drilling fluid filter cake usually consists of a biopolymer such as xanthan gums, starch along with bridging materials like sized calcium carbonate particles. Polymers are used for improving the carrying capacity of the mud, and the starch along with bridging materials to establish the mud cake on the formation and minimize leak off of the drilling fluid into the formation. Cleaning mud cake is essential for all gravel pack and open hole completion wells, it is important for stimulation operations. Cleaning mud cake maximizes the production, and injection rate by minimizing the formation damage caused by the drilling fluid filtration and deposition across the reservoir rocks while drilling operations. Extensive laboratory studies were conducted to determine the extent of formation damage that occurs while drilling the pay zone section. This paper defines novel methodology involving thermal - gravimetric analysis, to quantify the internal, external filter cake clean up efficiency. The novel lab test can quantify the cleaning efficiency of any breaker; it has several advantages over the conventional methods. This paper demonstrates the benefits and the drawbacks of some breakers (including polymer specific enzymes), aiming to select the best breaker for each well condition and reduce induced damage caused by the drill-in fluid.
Novel Technique to Determine Cement Contamination
Authors: Fakhreldin Y. , Al-Sharji H. , Aghbari S. , Rashdi S.
Published: October 2011

In a well integrity, repair for well AB, 9 5/8″ casing perforated to fix gas breakthrough problem behind 13 3/8″ casing, right after the casings perforation, contaminated cement circulated to surface from the annulus between 9 5/8″ and 13 3/8″ casing. Oil extracted from contaminated cement sample using two solvents, hexane and dichloromethane. The extracts analyzed using gas chromatography. Hexane and dichloromethane extracts, showed that the cement has hydrocarbons in the carbon number region from C8 to C30. Hard cementitious material milled and circulated out of hole from 900 meter downward to S formation at 1440 meter. Having contaminated cement in the top part of the cement column and hard cementitious material downward to the oil reservoir at 1440 meter, then outstanding cement downward to the section TD at 2530 meter, indicates that cement above this reservoir did not hydrate at all. Cement contaminated as a result of the losses encountered right after displacing the cement, the entire cement column form S formation upward to the top of cement contaminated with S formation oil, contaminated cement settled and compacted because of the hydrostatic head above it. Compacted solids prevent further influx to take place. This case history along with the detailed demonstration including the novel lab work will present in this paper.
Underbalanced Drilling Technology for Unconventional Gas Reservoirs
Authors: Qutob Hani , Khlaifat Abdelaziz , Barakat Naiem
Published: October 2011

The increased demand for more sources of clean energy such as natural gas from unconventional reservoirs has forced the industry to explore the more challenging tight gas reservoirs. Tight gas reservoirs constitute a significant proportion of the world's natural gas resource and offer great potential for future reserve growth and production. However, to meet future global energy demand, access to tight gas reservoirs requires innovative and cost effective technical solutions.

Yet, tight gas reservoirs are often characterized by complex geological and petrophysical systems as well as heterogeneities at all scales. Exploring and developing tight gas accumulations are both technically and commercially challenging due to the large subsurface uncertainty and low expected ultimate recovery per well. Appraisal of deep tight gas reservoirs offers many challenges, including production rate predictions when wells are drilled overbalanced. Overbalance leads to near wellbore damage to the rock matrix and fractures. Damage to natural fractures intersecting the well can prevent their detection leading to missed productive intervals.

In addition, the operating environment is very challenging and that affects the decisions for data acquisition. The use of salt-saturated mud systems creates a contrast and uncertainty in the data. Hence, the quality of data acquired is compromised.

In the 80's hydraulic fracturing of deviated wells was the method of choice for developing tight gas reservoirs worldwide. Although sound in principle, in practice problems were experienced and caused either by poor cleanup due to fluid incompatibility, erosion of surface facilities or early water breakthrough due to fracturing into the water leg.

In the 90's horizontal drilling became common practice as new drilling technologies developed and proved to be very successful in many tight gas fields. However, conventional drilling operations introduced foreign fluids and solids into the reservoir which lead to several different formations damage mechanisms that prevented the identification of the gas production potential from these wells.

In the late 90's underbalanced drilling (UBD) was introduced, mainly to avoid the frequent drilling problems associated with total losses into these tight gas reservoirs. However, significant productivity gains were also observed and this became a key driver to apply the same UBD technology in tight gas fields.

This paper provides a technical overview of the state-of-the-art UBD technology used to develop unconventional tight gas reservoirs. Two real case histories from eastern Jordan and South West Algeria will be presented and discussed.
Full Scale Testing of Fast Swell Packer for Shallow Aquifer Applications
Authors: Pervez T. , Qamar S. Z. , Al-Abri O. S. , de Velden M. V. , Al-Houqani S. A. , Van Eijden J.
Published: October 2011

A full scale experimental setup was designed and commissioned for testing of swelling elastomer seals against a casing (cased hole) and formation (open hole). Actual replicate of wellbore was designed with varying inside diameters and roughness to reproduce the effect of actual formation. The Dynaset packer mounted on 7" tubular was allowed to swell against a 9-5/8" casing, while the fast swell packer mounted on 9-5/8" tubular was allowed to swell against the 12-1/4" replicated well bore. The fast swell elastomer will bridge the annulus between casing and OH to prevent total losses and to allow cement to surface. Recent drilling condition required the development and testing of fast swell packers to isolate shallow aquifers. Under actual shallow-aquifer field conditions (50°C and 0.5% salinity) 70% swelling was expected in 24 hours. However, under fresh water the swelling was achieved in more than 24 hours. It took approximately ten days for the elastomers to completely fill the irregular cavities in the replicated well bore. The test demonstrated the way the elastomers fill the asperities and was worth of observation for field engineers. The Dynaset packer at low salinity took 4 weeks to completely seal the gaps. Under high salinity it takes approximately 3 weeks for complete sealing. The measured-cum-calculated results showed that the swelled elastomers have developed an internal pressure of 50‒70 bars against the leakage. Dismantling of the test setup showed that the elastomer has swelled to brain like surface structure, which was a startling observation and needs further work. Isolation of shallow aquifers and fractured formations has been a major challenge for many years in Oman. The requirement for zonal isolation of the shallow aquifers is often compromised by the total losses. The simplicity of solution using swellables will avoid a cocktail of chemicals and will open new applications to materialize low cost wells.
A Review of Casing Drilling Advantages to Reduce Lost Circulation, Improve Wellbore Stability, Augment Wellbore Strengthening, and Mitigate Drilling-Induced Formation Damage
Authors: Karimi Moji , Petrie Scott , Moellendick Eric , Holt Calvin
Published: October 2011

Casing Drilling is a process in which a well is drilled and cased simultaneously. This innovative technology has been successfully practiced for the past decade. The original purpose of developing Casing Drilling was to eliminate Non Productive Time (NPT) associated with tripping drill pipe and running casing. However, during early implementation of the technology, other benefits were observed while drilling with large diameter casing. This paper reviews four of these advantages which are lost circulation reduction, wellbore strengthening, improved wellbore stability, and drilling-induced formation damage mitigation.

Casing Drilling reduces mud lost to the formation in two ways; the Plastering Effect seals off the wellbore and prevents fluid transfer between the borehole and the formation; secondly, in the worst cases where the losses can't be cured, drilling will be continued with minimized losses until the casing reaches the total depth. Reduced mud loss to the reservoir section can be directly correlated to reduced skin due to drilling induced formation damage. This leads to improved productivity of the wells drilled with casing in the reservoir section.

As the Plastering creates an impermeable mud cake on the wellbore wall the pressure containment of the borehole is augmented. This process increases the fracture gradient of the formation in near wellbore area which results in a wider operational mud weight window (Wellbore Strengthening). Wells with stability problems are among the best candidates for Casing Drilling and could be drilled trouble free. The wellbore stability benefits of Casing Drilling are due to no tripping, less mud formation exposure, gauged well, superior hydraulics and borehole cleaning, etc.

With all the mentioned benefits Casing Drilling is heralding the way to the future of the drilling industry. There have been a lot of drilling practices developed to gain every one of the discussed benefits; however, Casing Drilling offers the whole package with one unified solution.
Stacked Horizontal Drilling in Challenging Conditions
Authors: Nasrumminallah Muhammad , Baig Farooq , Hariri Nour , Bugni Michael , Akhmetov Rustam
Published: October 2011

In southern and central Oman, a field development campaign involves a major steam injection pattern across stacked horizontal producers for enhanced oil recovery. With a yearly goal of more than 350 wells drilled with 5 automated drilling rigs comprising injectors and stacked horizontal laterals targeting 3 different reservoirs on top of each other, efficient drilling and the reduction of time-based costs with no collision incidents have been the main concern. Because of the fast drilling pace, numerous drilling challenges were presented by the field, including losses in the top section, unconsolidated washable formations, trajectory control, shocks and vibrations, and bit walk tendencies in abrasive loose sand reservoirs causing equipment damage.

The typical horizontal producer well design planned for a 16-in. vertical and a 12½-in. section kicking off from vertical to 90° inclination, followed by an 8½-in. lateral section.

Several collaborative drilling practices were implemented in the 12½-in. buildup section to optimize drilling while building from vertical to almost 90° inclination using the steerable motor assembly delivering a dogleg severity (DLS) of 5°/100ft in unconsolidated formations. Drilling performance and hole cleaning were optimized in the 8½-in. lateral section by pumping up to 600 gal/min using a fully rotating rotary steerable point-the-bit system with PDC bit standardization to counteract the bit walk tendency at a penetration rates of 500 to 600 ft/hr. An added feature of the point-the-bit rotary steerable system is the inclination at the bit, which facilitates drilling through a 3-ft total vertical depth (TVD) tolerance window and promotes proactive decision making to avoid collision with the reservoirs above or below, with a TVD separation of up to 30 ft.

This field experience lead to a total saving of 3 drilling days in the AFE for each well. Using a point-the-bit rotary steerable system in the lateral, with added savings from eliminating openhole sidetracks, avoided a trip cost of 0.5 days. The high quality of the wellbore saved 0.5 days by avoiding a wiper trip and stuck incidents. The lateral is drilled in the narrow target using continuous inclination at the bit, which improved well outflow capabilities. Casing was run without any hang-up problems, eradicating any remedial cost.

This paper explains the methodology followed to improve the performance of drilling horizontal wells and attain 100% well delivery with a smooth borehole. It was also a step change in drilling horizontal wells using the fit-for-purpose approach (i.e., optimized trajectory, proven bit, and recommended drilling parameters derived from simulations compared to actual) to deliver wells in a cost-effective manner.
Application of Laser Technology for Oil and Gas Wells Perforation
Authors: Bakhtbidar Mahdi , Ghorbankhani Mohsen , Asfeh Mohammad Reza , Alimohammadi Mehdi , Rezaei Pegah
Published: October 2011

In gas and oil well completion, perforation channels must be made through the steel casing wall and cement and into the rock formation in the production zone to allow formation fluid to enter the well. This paper will present study results on using a pulsed CO2 laser to drill the perforation channels through reservoir rocks. With fiber optic cable delivery capability, a CO2 laser beam has the potential to be delivered to deep oil production zones. Effects of laser pulse parameters, beam properties, and assistant gas purging on the perforating efficiency and rock permeability will be reported. Unlike the conventional explosive charge perforation that often causes great reduction of rock permeability, laser perforation would enhance the rock permeability, therefore increasing the oil or gas production rate of the well.

Laser on time, laser relaxation time between laser bursts and sample rotary speed also affect the perforation. A laser burst is the sum of the multiple pulses over the period of laser on time. Pulsed CO2 laser with fiber optic cable delivery is a strong candidate for laser perforation application for oil and natural gas wells. Preliminary test shows that CO2 laser can perforate the rock as efficiently as the other types of high power lasers and the permeability of the rock lased by pulsed CO2 laser beam increases up to 566% compared to non-lased rocks due to clay dehydration and microfractures induced by the high temperature gradient and phase transformation volume expansion generated in the rock while lasing.
Development of a Liner Drilling System Incorporating a Retrievable Bottom Hole Assembly
Authors: Eriksen E. , Herrera D. , Moffitt M. , Jordan G. Rodriguez , Mazzaferro G
Published: October 2011

This paper chronicles the surface and field trials of a liner drilling system in which a liner is releasably attached to a drill string used to both convey the liner and bottom hole assembly into the well bore and apply drilling force to the bottom hole assembly. The purposes behind the development of this system are the mechanical strengthening of the wellbore provided by rotating a casing string against the open hole while circulating cuttings up the annulus during the drilling process, and to drill and case the hole the same operation, both protecting the hole as it is being drilled and allowing a passageway back to surface for the BHA if hole issues are encountered.

Both 7" × 9-5/8" and 9-5/8" × 13-3/8" liner drilling systems have been designed, built and drill tested to provide the above advantages. The purpose of this paper is to highlight the reasoning behind the development of the systems and the testing of the 9 5/8" liner drilling system. This particular liner drilling system was drill tested twice in Cameron, Texas. The first drilling test demonstrated the liner was set and reset successfully through three separate cycles over separate intervals. The second test was an attempt to reproduce the success of the first test over longer intervals deeper in the wellbore. In this test the liner hanger set only one out of three attempts, leading to the conclusion that a minor design change was required to increase the system's resistance to cuttings ingress into the interface of the hanger and setting tool.
Optimal Positioning of Occupational Therapy
Authors: Letts Lori J.
Published: October 2011

Background. Occupation is central to occupational therapy. Although occupation is a universal experience, occupational therapists need to consider the risks and opportunities of exploring new roles and maintaining existing services.

Purpose. I propose three questions to guide the optimal positioning of occupational therapy services. First, how proximal is occupation in the role? Second, how strong is the evidence to support occupational therapy in the role? Third, is the timing right for change? These questions are applied to the role of occupational therapy in primary health care.

Key Issues. Occupation is proximal and the evidence is emerging to support an occupational therapy role in primary health care. Reforms make timing ideal.

Implications. If we focus on the underlying principles of primary health care reform, the potential for an emerging role in primary health care is optimal. The same three questions can be used to transform and optimally position occupational therapy.
Analyse Critique D'instruments de Mesure Des AVQ en Pédiatrie: Déficits Exécutifs et Indépendance
Authors: Clavel Virginie , Bottari Carolina
Published: October 2011

Description. Bien que l'évaluation des activités de la vie quotidienne (AVQ) par analyse de tâches soit au cœur du rôle de l'ergothérapeute œuvrant auprès d'enfants ayant un traumatisme craniocérébral (TCC), aucune étude visant l'analyse des instruments utilisés à cet effet selon leur potentiel de mettre en évidence des déficits liés aux fonctions exécutives (ex: formuler un but, planifier) n'a été recensée.

But. Déterminer s'il existe des outils de mesure des AVQ qui considèrent les fonctions exécutives, validés auprès d'enfants de 10 à 15 ans ayant un TCC.

Méthodologie. Quatre outils, le «Assessment of Motor and Process Skills», le «Children's Kitchen Task Assessment», la «tâche du gâteau au chocolat» et le «Profil des AVQ» ont été analysés selon des critères tels que: 1) complexité des tâches, 2) approche d'évaluation non-structurée, et 3) qualités psychométriques adéquates pour la clientèle cible.

Résultats. Ces outils ne sont que partiellement conformes aux critères recherchés.

Conclusion. La poursuite des études sur ces outils serait primordiale pour mieux répondre aux besoins de cette clientèle.
Brain Injury from a First Nations' Perspective: Teachings from Elders and Traditional Healers
Authors: Keightley Michelle L. , King Grace E. , Jang Shu-Hyun , White Randy J. , Colantonio Angela , Minore J. Bruce , Katt Mae V. , Cameron D. Anita , Bellavance Alice M. , Longboat-White Claudine H.
Published: October 2011

Background. There is a lack of knowledge about how cultural ideas affect First Nations peoples' perception of rehabilitation needs and the ability to access services.

Purpose. The study explored the perceptions of treating and healing brain injury from First Nations elders and traditional healers in the communities served by Wassay-Gezhig-Na-Nahn-Dah-We-Igamig (Kenora Area Health Access Centre).

Methods. A participatory action approach was used, leading to a focus group with elders and traditional healers. Findings, established through a framework analysis method, were member checked prior to dissemination.

Findings. Four themes arose from the data: pervasiveness of spirituality, “fixing” illness or injury versus living with wellness, working together in treating brain injury, and financial support needed for traditional healing.

Implications. Funding is required for traditional healing services to provide culturally safe and responsive occupational therapy services to First Nations individuals with brain injury.
A Phenomenological Inquiry into the Embodied Nature of Occupation at End of Life
Authors: Lala Anna Park , Kinsella Elizabeth Anne
Published: October 2011

Background. Occupational therapists propose that occupation is a basic human need across the lifespan. However, there is limited understanding of how occupation contributes to the end-of-life experience.

Purpose. The purpose of this study was to examine the embodied nature of occupation at end of life from the perspectives of Canadians 60 years of age or older who are diagnosed with a terminal illness.

Methods. The study adopted a phenomenological methodological approach to conduct semi-structured interviews with eight participants.

Findings. Six themes were identified. Participants described orientations toward occupations that involved: living with death, reworking everyday life, being guided by the will of the body, giving priority to relationships, attending to the small things, and engaging existential orientations.

Implications. This study contributes to knowledge about occupation at end of life and offers a starting point to guide practice that is attentive to the lived dimensions of occupation at end of life.
Introducing the Leadership in Enabling Occupation (LEO) Model
Authors: Townsend Elizabeth A. , Polatajko Helene J. , Craik Janet M. , von Zweck Claudia M.
Published: October 2011

Background. Occupational therapy is a broad profession yet access to services remains restricted and uneven across Canada. Access to the potential breadth of occupational therapy is severely restrained by complex supply, retention, and funding challenges. To improve access to occupational therapy, widespread leadership is needed by all practitioners.

Purpose. This brief report introduces the Leadership in Enabling Occupation (LEO) Model, which displays the inter-relationship of four elements of everyday leadership as described in “Positioning Occupational Therapy for Leadership,” Section IV, of Enabling Occupation II: Advancing a Vision of Health, Well-being and Justice through Occupation (Townsend & Polatajko, 2007).

Key Issues. All occupational therapists have the power to develop leadership capacity within and beyond designated leadership positions.

Implications. LEO is a leadership tool to extend all occupational therapists' strategic use of scholarship, new accountability approaches, existing and new funding, and workforce planning to improve access to occupational therapy.
Incidence, risk factors and outcome of nosocomial pneumonia in patients with central nervous system infections
Authors: Gajovic Olgica , Todorovic Zoran , Mijailovic Zeljko , Canovic Predrag , Nesic Ljiljana , Djordjevic Zorana , Stanojevic Marijana , Lazic Zorica
Published: October 2011

Introduction. Pneumonia is the most frequent nosocomial infection in
intensive care units. The reported frequency varies with definition, the type
of hospital or intensive care units and the population of patients. The
incidence ranges from 6.8-27%. Objective. The objective of this study was to
determine the frequency, risk factors and mortality of nosocomial pneumonia
in intensive care patients. Methods. We analyzed retrospectively and
prospectively the collected data of 180 patients with central nervous system
infections who needed to stay in the intensive care unit for more than 48
hours. This study was conducted from 2003 to 2009 at the Clinical Centre of
Kragujevac. Results. During the study period, 54 (30%) patients developed
nosocomial pneumonia. The time to develop pneumonia was 10?6 days. We found
that the following risk factors for the development of nosocomial pneumonia
were statistically significant: age, Glasgow Coma Scale (GCS) score <9,
mechanical ventilation, duration of mechanical ventilation, tracheostomy,
presence of nasogastric tube and enteral feeding. The most commonly isolated
pathogens were Klebsiella-Enterobacter spp. (33.3%), Pseudomonas aeruginosa
(24.1%), Acinetobacter spp. (16.6%) and Staphylococcus aureus (25.9%).
Conclusion. Nosocomial pneumonia is the major cause of morbidity and
mortality of patients with central nervous system infections. Patients on
mechanical ventilation are particularly at a high risk. The mortality rate of
patients with nosocomial pneumonia was 54.4% and it was five times higher
than in patients without pneumonia.
Results of the modification of antireflux subserosal and submucosal implantation of the ureter into the rectosigmoid urinary reservoir after total cystectomy
Authors: Stojkovic Ivica , Ignjatovic Ivan , Basic Dragoslav
Published: October 2011

Introduction. Uretero-intestinal anastomisis has a large influence on
derivation quality. Objective. The aim of the study was to present the
modified serous lined extramural Abol-Enein method of implantation of low
quality ureter into the sigma-rectum pouch and comparison of the results with
Le Duc implantation. Methods. From 1995 to 2009, 62 dilated ureter units were
implanted in the detubularized rectosigmoid urinary reservoir. In 28 units Le
Duc, and in 34 Abol-Enein method was done. Urinary fistula and ileus were
considered as early complications, while late complications included stenosis
and reflux pyelonephritis. Frequency of urination was considered as a
parameter of functionality. Results. Transitory urine fistulae occurred only
in the ureters implanted according to Le Duc technique in 4/28 (14.2%); the
difference between the examined groups was close but still below the level of
statistical significance (p=0.07). Ileus occurred with nearly equal frequency
in both groups. Stenosis on the ureteral implantation place was significantly
more frequent (p=0.04) in the Le Duc group 5/28 (21.7%) than in the
Abol-Enein group 0/34 (0%). Refluxive pyelonephritis occurred in 3/34 (8.8%)
of the Abol-Enein group, and in 5/28 (21.7%) of patients in the Le Duc group.
Concerning the daily frequency, there was no difference between the examined
groups. Conclusion. Uretero-intestinal anastomisis of dilated ureters through
a serous-lined extramural tunnel decreases the risk of reflux in a
considerable number of patients, with an acceptable level of complications.
There are several advantages in comparison with Le Duc method.
Successful intestinal ischemia treatment by percutaneus transluminal angioplasty of visceral arteries in a patient with abdominal angina
Authors: Nenezic Dragoslav , Popov Petar , Tanaskovic Slobodan , Gajin Predrag , Matic Predrag , Kovacevic Vladimir , Petrovic Branko , Ilijevski Nenad
Published: October 2011

Introduction. Abdominal angina, also known as chronic mesenteric ischemia or
intestinal angina, is a rare disease caused by intestinal flow reduction due
to stenosis or occlusion of mesenteric arteries. A case of successful
treatment of a patient with abdominal angina by percutaneous transuliminal
angioplasty of high-grade superior mesenteric artery and coeliac trunk
stenosis was presented. Case Outline. A 77-year-old male patient was admitted
at our Clinic for severe postprandial abdominal pains followed by frequent
diarrhoeas. Extensive gastrointestinal investigations were performed and all
results were normal. Multislice computerized (MSCT) arteriography was
indicated which revealed ostial celiac trunk and superior mesenteric artery
subocclusion. Percutaneous transluminal angioplasty of the superior
mesenteric artery and coeliac trunk was done with two stents implantation.
Just a few hours following the intervention, after food ingestion, there were
no abdominal pains. Six months later, the patient described a significant
feeling of relief after food ingestion and no arduousness at all. Conclusion.
High-grade visceral arteries stenoses in patients with intestinal ischemia
symptoms can be treated by either surgical procedures or percutaneus
transluminal angioplasty. In cases when a low operative risk is anticipated,
surgical treatment is recommended due to a better anatomical outcome, while
percutaneus angioplasty is advised to elderly patients in whom increased
operative risks can be expected.
Transfusion management of patients with alloanti-Gerbich antibodies: Case report
Authors: Jovanovic Radmila , Bujandric Nevenka , Lisulov Slobodanka , Bogdanovic Sanja
Published: October 2011

Introduction. Transfusion management of patients who are alloimmunized
against high-prevalence erythrocyte antigens is often problematic. Strategy
management depends, not only on the specific clinical circumstances of the
patient, but also on the acceptable time frame. In patients without
clinically significant antibody incompatible transfusion it may be less
harmful than delaying medical intervention. Case Outline. We report a
57-year-old female from Libya, blood group O, RhD-positive, who was treated
at the Institute of Cardiovascular Diseases of Vojvodina. At the Blood
Transfusion Institute of Vojvodina, during pretransfusion testing an IgG
alloantibody of unknown specificity was determined. A total of 200 blood
units (O, RhD-positive) were crossmatched, but positive reactions indicating
that the donor units were incompatible for that specific patient. By testing
the patient?s family members in Tripoli, six compatible blood units were
found and applied during and after surgery. Due to the deterioration of the
patient?s condition a rapid transfusion was required; however cross-match
compatible blood was not available. After a biological crossmatch to predict
the clinical significance of this antibody, 12 units of erythrocytes with the
lowest positive cross-match reactions, were transfused to the patient without
any adverse effects. Good tolerance of the units suggested that the present
antibodies were not clinically significant. Later on, a rare alloantibody
directed to the high frequency Gerbich blood group antigens was identified by
the Foundation Central Laboratory, Blood Transfusion Service in Bern,
Switzerland. Conclusion. In cases of emergency patients with alloantibodies
against high frequency Gerbich, when autologous or compatible alogenous
transfusion is unavailable, blood with the lowest positive cross-match
reaction could be transfused if the biological cross-match is negative.
Formation of a national register of donors with rare blood groups and their
connection with international registers is of crucial significance in the
management of patients requiring antigen negative blood otherwise unavailable
from routine blood banks.
Primary Burkitt’s lymphoma of the stomach
Authors: Colovic Natasa , Radovanovic Nebojsa , Vidovic Ana , Colovic Milica
Published: October 2011

Introduction. Burkitt?s lymphoma belongs to the group of non-Hodgkin?s
lymphomas with B immunophenotypic features of lymphoma cells. It has tendency
for extranodal localization primarily in the gastrointestinal tract and
retroperitoneum. Primary Burkitt?s lymphoma of the stomach is very rare.
Stomach is most frequently involved secondarily, growing from intrabdominal
tumorous mass into the stomach. Case Outline. The authors present a
30-year-old male in whom after 6 months duration of temporarily melaenas the
diagnosis of Burkitt?s lymphoma was established by endoscopic examination and
biopsy of ulceroinfiltrative lesion on the antral part of the stomach. The
patient was in clinical stage IIE. After one cycle of chemotherapy according
to protocol R-HyperCVAD, a subtotal distal gastrectomy and additional three
cycles of the same chemotherapeutic protocol a complete remission was
achieved. Conclusion. Burkitt?s lymphoma is a highly aggressive non-Hodgkin?s
lymphoma often present in extranodal sites. It should be treated with
systemic intensive chemotherapy and surgical removal of tumorous mass when
possible. Long-term survival using the combination therapy is possible to
achieve in 40-80% of patients.
Silicotuberculosis and silicosis as occupational diseases: Report of two cases
Authors: Milovanovic Aleksandar , Nowak Dennis , Milovanovic Andjela , Hering Kurt , Kline Joel , Kovalevskiy Evgeny , Kundiev Ilich , Perunicic Bogoljub , Popevic Martin , Sustran Branka , Nenadovic Milutin
Published: October 2011

Introduction. Silicosis, the most prevalent of the pneumoconioses, is caused
by inhalation of crystalline silica particles. Silica-exposed workers are at
increased risk for tuberculosis and other mycobacterium-related diseases. The
risk of a patient with silicosis developing tuberculosis is higher (2.8 to 39
fold higher, depending on the severity of silicosis) than that found in
healthy controls. Outline of Cases. The first patient was a 52-year-old male
who was admitted in 2002 for the second time with dyspnoea, wheezing and
fatigue over the last 11 years. He had worked in an iron smelting factory and
was exposed to silica dust for 20 years. First hospitalization chest
radiography showed bilateral pleural adhesions, diffuse lung fibrosis with
signs of a specific lung process. Second hospitalization chest radiography
showed bilateral massive irregular, non-homogenous calcified changes in the
upper and middle parts of lungs. The patient died due to respiratory failure
and chronic pulmonary heart in 2007. The main causes of his death were
silicotuberculosis and chronic obstructive pulmonary disease. The second
patient was a 50-year-old male who was admitted in 2005 for the second time
with chest tightness, dyspnoea, wheezing and fatigue over the last 10 years.
He had worked in an iron smelting factory and was exposed to silica dust for
30 years. First hospitalization chest radiography showed diffuse lung
fibrosis and small nodular opacities. The patient was diagnosed with
silicosis, small opacities sized level p/q, and profusion level 2/3. Second
hospitalization chest radiography and CT showed diffuse lung fibrosis and
small nodular opacities predominantly in the upper lobes. The patient was
recognized as having an occupational disease, and received early retirement
due to disability. Conclusion. In low-income countries, new cases of
silicosis and associated lung cancer, chronic obstructive pulmonary disease
and tuberculosis are likely to be seen for decades because necessary
reduction of silica use will take time to be achieved.
Evidence-based Practice: Improving Outcomes for Patients with a Central Venous Access Device
Authors: Mathers Dorothy
Published: October 2011

Purpose: To apply evidence-based practice when flushing central venous access devices (CVADs).

Background/Introduction: There is a lack of standardized flushing protocols for CVADs among health care institutions. Identifying best practice and assuring skillful implementation of evidence-based practice protocols is essential to maintaining catheter patency.

Review of Relevant Literature: Evidence supports the use of nonheparinized saline flush, positive-pressure valve caps, and proper flushing technique to maintain CVAD patency (Bowers, Speroni, Jones, & Atherton, 2008; Hadaway, 2006; & Jasinsky & Wurster, 2009). Reinforcement of proper flushing techniques has demonstrated improved patency rates of CVADs (Feehery, Allen, & Bey, 2003).

Methods: Corporate and individual in-services were conducted to improve nurses' skill and knowledge of evidence-based practice related to flushing CVADs. Outcomes were measured by comparing baseline data with data collected in the same manner post-education. Data was obtained by means of a questionnaire and direct observation of nurses' flushing technique.

Outcomes: The evidence-based practice project demonstrated a significant improvement (p <0.05) in both the nurses' knowledge and skill in flushing CVADs.

Conclusion: Continuing education and reinforcement of proper flushing technique is an appropriate strategy to increase knowledge of and compliance with evidence-based practice protocols.

Implications for practice: Providing continuing education and periodic reinforcement of nursing skills can lead to improved patient outcomes. These strategies, along with changing flushing protocols to non-heparinized saline, can also reduce health care costs. Future studies are needed to determine the appropriate frequency of in-service education.
The Ideal Use of the Power Injectable Peripherally Inserted Central Catheter in the Pediatric Population
Authors: Klee Stephanie Juanita
Published: October 2011

Introduction: The peripherally inserted central catheter (PICC) is being used more frequently in pediatric populations in both hospital and home care settings in order to provide secure vascular access. In 2007, the Power PICC was introduced to pediatric populations. In contrast to traditional PICCs, the power injectable PICC withstands higher flow rates and can deliver contrast injections. Although effectiveness studies of power injectable PICCs have been performed in adults, only limited published research is available regarding pediatric populations.

Purpose: This study aimed to develop criteria for identifying the ideal pediatric candidate for the power injectable PICC. A secondary aim was to identify contraindications and barriers to power injectable catheter use in pediatric populations.

Methods: Retrospective and prospective chart reviews were used to analyze complication rates for 97 power injectable PICCs placed in patients aged 4 months to 17 years.

Results: A low incidence of catheter complications was identified during and post- insertion. Our documented infection rate of 1.30 per 1000 catheter days was similar to the infection rate of 1.27 per 1000 catheter days found in the Abedin & Kapoor (2008) study.

Discussion: The introduction into a pediatric hospital of power injectable PICCs for power injection scans for contrast injection was safe and effective in patients with many disease processes.

Conclusion: In properly selected pediatric patients, the power injectable PICC is not associated with an increased risk to thrombosis or infection and can improve patient outcome.
Clinical Evaluation of the Sorbaview SHIELD Securement Device Used on Peripheral Intravenous Catheters in the Acute Care Setting
Authors: Flippo Polly L. , Lee Jayne
Published: October 2011

Peripheral intravenous therapy (PIV) is probably the most common acute care invasive procedure, estimated at 90 percent for all inpatients. Current standards of practice recommend the use of a manufactured catheter stabilization device to secure PIVs. At FirstHealth Moore Regional Hospital (MRH), the PIV policy requires the use of a stabilization device to achieve a 96 hour dwell time for the PIV. The hospital does not utilize an intravenous therapy team; all nurses can insert PIVs and apply the dressing. In 2009, as a cost reduction measure, MRH changed securement devices from a two piece dressing and securement device to the Sorbaview SHIELD (SHIELD). A clinical evaluation of the SHIELD was conducted in January 2010, with 109 medical-surgical patients with PIVs, to demonstrate the expected cost savings associated with the SHIELD by maintaining the PIV for 96 hours and meeting patient and staff expectations. In 91.5% of the patients, the PIV stayed in for their length of stay (if less than 96 hours) or for 96 hours, only eight patients had unscheduled restarts. Eighty-six percent of nurses surveyed rated the device as excellent to good. Ninety-one percent of patients reported no discomfort of their PIV site. Changing to this device in 2009 has resulted in an average annual cost savings of $120,000 over the two piece device and has improved compliance by nursing.
Managing Peripherally Inserted Central Catheter Thrombosis Risk: A Guide for Clinical Best Practice
Authors: Meyer Britt M.
Published: October 2011

Purpose: The purpose of this study was to evaluate the effectiveness of clinical practice changes in an effort to reduce peripherally inserted central catheter thrombosis risk.

Patients and Method: A retrospective analysis of adult patients in the acute care setting.

Results: A total number of 1307 charts of patients who received PICCs were reviewed encompassing the months of January 2008, October 2008 and August 2010. During the period from January 2008 to October 2008, clinical practice changes were made to include the use of ultrasound guidance. Ensuring catheter tip termination in the superior vena cava with the addition of ultrasound technology as an insertion practice combined to decrease symptomatic PICC related deep vein thrombosis rates from 4.8 % to 2.9%. During the period from October 2008 to August 2010, an additional practice was introduced that involved measurement and documentation of vein diameters(without the use of a tourniquet) prior to all PICC insertion procedures. Deep vein thrombosis (DVT) rates dropped further from 2.9 % to 1.4 % during this period.

Conclusion: Obtaining central tip location and using ultrasound guidance for PICC placement are effective in reducing PICC related DVT. Additionally, routine measurement of vein diameters in their native state and use of that information to ensure that the vessel diameter is at least twice the outer diameter of the catheter is an effective practice to reduce DVT rates and reduce thrombosis risk.
Lower Volume Peripheral Blood Sample Collection: Key Considerations for Nurses - Roundtable Discussion
Authors: Bowe-Geddes Leigh Ann
Published: October 2011

A group of seven nurses from a range of laboratory and hospital settings across the United States were invited to present opinions and clinical case study examples that reflect the key considerations in peripheral blood sample collection involving lower volume samples and patients affected by difficult venous access (DVA). Panelists were asked to review and compare prevailing standard operating procedures (SOPs) in sample collection and challenges in efforts to expand the use of lower volume sample collection and processing. The discussion identified achievable goals to improve standard of care in lower volume blood sample collection and the treatment of DVA patients.