The aim of this study is to establish the incidence of serious morbidity and mortality associated with the placement of large-bore (18 to 20 F) percutaneous bypass cannulae for venovenous bypass (VVBP) during orthotopic liver transplantation (OLT). This technique has been reported to be rapid, simple, and safe. We reviewed the case notes of 312 patients who underwent OLT in our center using this technique. We describe 4 cases of serious morbidity (incidence, 1.28%) and 1 death (incidence, 0.32%) related directly to percutaneous placement of the bypass cannula. We conclude that percutaneous cannula placement for VVBP during OLT has the potential for lifethreatening complications, and this must be considered when electing to use this technique. When percutaneous cannulae are to be used, we recommend the use of the right internal jugular vein for return cannulation and the use of ultrasound guidance, particularly in those patients in whom cannulation is predictably difficult. S urgical approaches to adult orthotopic liver transplantation (OLT) vary among institutes and individual surgeons around the world. Approaches to maintain venous return if the inferior vena cava is clamped and divided during the conventional surgical technique vary among institutes. Some centers perform venovenous bypass (VVBP) only in high-risk patients, whereas others use VVBP whenever the conventional surgical technique is used. Methods of cannulae placement for VVBP vary among institutes, but percutaneous placement is common and has been reported to be rapid, simple, and safe. [1][2][3] We report the serious morbidity and mortality associated with a series of 312 OLTs performed using VVBP with percutaneous placement of large-bore (18 to 20 F) bypass cannulae over 8 years. MethodsIn this institute, percutaneous catheters for VVBP have been used with increasing frequency since the early 1990s. It is now our practice in those patients undergoing OLT with the use of VVBP to insert two 18 F, polyurethane, 15-cm long, wirereinforced, thin-walled cannulae (Fem-Flex II femoral arterial cannula with internal dilator; Research Medical Inc, Midvale, UT) percutaneously after induction of anesthesia. One cannula is inserted into either the internal jugular (IJV) or subclavian vein (SCV) and the other into a femoral vein using the Seldinger technique and serial dilation. The cannulae are flushed with heparin, 1 IU/mL (maximum, 50 mL), and clamped pending connection to the bypass circuit. In the operating room after mobilization of the portal vein, all cannulae are connected in circuit to the centrifugal pump (Medtronics Inc, Minneapolis, MN).We reviewed the case notes of 312 patients for whom this method of cannulation was used to establish the safety of this technique.

Summary Hospital staff are at risk from occupational exposure to blood‐borne viruses due to needle stick injuries. Occupational health departments have invested considerable resources in the prevention of these injuries, which can be very distressing to the affected individuals. We surveyed health care workers, i.e. doctors, nurses and operating department practitioners, in the operating theatre and critical care units of two UK hospitals located in the Midlands and Merseyside to compare attitudes and experiences. There were significant deficiencies in several aspects of the safe practice of universal precautions. These deficiencies were similar in the two hospitals surveyed and may reflect a national trend. We conclude that every individual, department and trust needs to reflect on their practice and address these deficiencies.

A single-centre study of

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