Reliability of blood test results in samples obtained using a 2-mL discard volume from the proximal lumen of a triple-lumen central venous catheter in the critically ill patient.

BACKGROUND: Intensive care patients require a high frequency of blood testing, which results in a significant amount of blood loss. When blood is obtained from a central venous catheter (CVC), a large volume is usually discarded to obtain an unaltered sample for testing. AIM: To determine the reliability of complete blood test results in blood samples obtained from the proximal lumen of a triple-lumen CVC using a 2-mL discard volume DESIGN: Observational study with the prospective collection of data METHODS: The subjects enrolled were all patients with a subclavian triple-lumen CVC, older than 17 years and consecutively admitted to intensive care over a 2-year period. In each of the 54 participants, one blood sample was drawn from the proximal lumen of the catheter, discarding 1·61 mL of blood plus 0·39 mL of catheter deadspace (2 mL) and without interrupting infusion in the middle and distal lumens. A second sample was then obtained by direct venous puncture. The reliability of blood test results was determined by comparing sets of variables recorded for the two sampling methods through intraclass correlation coefficients in the Bland-Altman method. RESULTS: Inter-method reliability for the variables examined was excellent, >0·75; range (0·868-0·998). Mean differences between the two sample types for the variables most often determined in critically ill patients were leukocytes: 0·200 × 103 /µL, 95% confidence interval (CI) (0·025 to 0·375); erythrocytes: 0·045 × 106 /uL, 95% CI (-0·003 to 0·094); sodium: 0·074 mEq/L, 95% CI (-0·369 to 0·517); potassium: -0·002mEq/L, 95% CI (-0·065 to 0·061) and glucose: 2·426 mg/dL, 95% CI (0·498-4·354). CONCLUSIONS: The sampling method proposed minimizes blood loss while offering reliable blood test results. RELEVANCE TO CLINICAL PRACTICE: The main benefit of the method proposed is reduced blood loss, improving the care of a critically ill patient.

[THERAPEUTIC GUIDE IN VENOUS ULCERS]. / Guía terapéutica en úlceras venosas.

The treatment of venous ulcers and wounds in general, is a complex and important public health problem, with personal effects, family and health, without addressing the economic impact includes assistance, care of patients with ulcerative lesions. The increase in life expectancy, driven by improved socio-sanitary conditions that this aging population, facilitates the emergence of chronic diseases may be complicated by the presence of skin ulcers. There is no doubt that the best way to treat a skin ulcer is avoiding to occur, hence the importance of early diagnosis and risk factors act alone them. In relation to venous ulcers is crucial, provide local treatment, act on the cause, because if not, relapse is the norm in this type of injury. Currently, the moist wound healing, is an important step in solving earlier of these chronic wounds. This has meant that the pharmaceutical industry has been involved in researching and creating different types of dressings, having specific activity at different stages of venous ulcer healing, ie inflammatory phase, proliferative and remodeling. The proliferation of these products has been increasing over the years, not surprisingly, are described therapeutic 12 families that are applied in the management, care of these injuries. The fact of existing therapeutic options highlights the ineffectiveness of these products individually. Therefore, the nurse will not forget that the optimal treatment of venous ulcers, necessarily involves choosing the right product for every type and stage of the lesion. In this decision process, strongly influenced by the specific characteristics of each patient and injury, the nurse will take into account a lot of factors when choosing the product, not forgetting that an ulcer is not cured with a single therapeutic element, several products being used throughout the process to evolutionary venous ulcer until complete resolution.

Guía terapéutica en úlceras venosas / Therapeutic guide in venous ulcers

El tratamiento de las úlceras venosas y de las heridas crónicas en general constituye un complejo e importante problema de salud pública, con repercusiones personales, familiares y sociales, sin olvidar el impacto económico que supone la asistencia y cuidado de los pacientes con lesiones ulcerosas. El aumento de la esperanza de vida, propiciado por las mejores condiciones sociosanitarias, condiciona que este envejecimiento de la población facilite la aparición de las enfermedades crónicas, que pueden complicarse con la presencia de úlceras cutáneas. No cabe duda de que la mejor forma de tratar una úlcera cutánea es evitando que se produzca, de ahí la importancia de establecer un diagnóstico precoz de los factores de riesgo y actuar sobre los mismos. En relación con las úlceras venosas es esencial, además del tratamiento local, actuar sobre la causa, ya que, en caso contrario, la recidiva será la norma habitual en este tipo de lesiones. Actualmente, la cura en ambiente húmedo supone un avance importante en la resolución más precoz de estas heridas crónicas. Este hecho ha propiciado que la industria farmacéutica se haya implicado en investigar y crear diferentes tipos de apósitos, que tengan actividad específica en las diferentes fases del proceso de curación de la úlcera venosa, es decir: fase inflamatoria, proliferativa y de remodelación. La proliferación de estos productos se ha ido incrementando con el paso de los años. No en vano, hay descritas más de 12 familias terapéuticas que se emplean en el manejo y cuidado de estas lesiones. El hecho de que existan tantas opciones terapéuticas pone de manifiesto la ineficacia individualizada de estos productos. Por ello, el profesional de enfermería no olvidará que el tratamiento óptimo de las úlceras venosas pasa necesariamente por la elección del producto más adecuado para cada tipo y estadio de lesión. En este proceso de decisión, muy condicionado por las características específicas de cada paciente y lesión, la enfermera tendrá en cuenta una gran cantidad de factores a la hora de elegir el producto, sin olvidar que una úlcera no se cura con un solo elemento terapéutico, pues son varios los productos que deberá utilizar a lo largo del proceso evolutivo de la úlcera venosa, hasta su completa resolución (AU)

The treatment of venous ulcers and wounds in general, is a complex and important public health problem, with personal effects, family and health, without addressing the economic impact includes assistance, care of patients with ulcerative lesions. The increase in life expectancy, driven by improved socio-sanitary conditions that this aging population, facilitates the emergence of chronic diseases may be complicated by the presence of skin ulcers. There is no doubt that the best way to treat a skin ulcer is avoiding to occur, hence the importance of early diagnosis and risk factors act alone them. In relation to venous ulcers is crucial, provide local treatment, act on the cause, because if not, relapse is the norm in this type of injury. Currently, the moist wound healing, is an important step in solving earlier of these chronic wounds. This has meant that the pharmaceutical industry has been involved in researching and creating different types of dressings, having specific activity at different stages of venous ulcer healing, ie inflammatory phase, proliferative and remodeling. The proliferation of these products has been increasing over the years, not surprisingly, are described therapeutic 12 families that are applied in the management, care of these injuries. The fact of existing therapeutic options highlights the ineffectiveness of these products individually. Therefore, the nurse will not forget that the optimal treatment of venous ulcers, necessarily involves choosing the right product for every type and stage of the lesion. In this decision process, strongly influenced by the specific characteristics of each patient and injury, the nurse will take into account a lot of factors when choosing the product, not forgetting that an ulcer is not cured with a single therapeutic element, several products being used throughout the process to evolutionary venous ulcer until complete resolution (AU)