Audit of phlebotomy turnaround time in a private hospital setting.

An audit on the turnaround time (TAT) of a hospital phlebotomy service was undertaken to assess whether or not the existing service standards can satisfy the needs and expectations of both the external and internal customers. A job request survey form was designed and implemented in June 2005 to be used by the day shift to record the number of phlebotomy cases and the corresponding TAT. The success rate and complaints related to phlebotomy were also recorded. Phlebotomists provided the data for this study on an honor system basis. Out of 2,118 test requests received by the laboratory, 1,867 (88.1 percent) were phlebotomy requests. Approximately 62 phlebotomy requests were recorded, on average, per day shift. The average time, expressed in mean +/- standard deviation (SD) needed for response, arrival, and job completion was 7.4 +/- 1.5 minutes, 5.6 +/- 1.6 minutes, and 10.4 +/- 2.4 minutes respectively, with an average overall TAT of 23.4 +/- 4.1 minutes per phlebotomy request. The success rate at first phlebotomy attempt was 97 percent, and only one complaint was received during the audit period. This study may help hospital management identify possible bottlenecks that delay phlebotomy TAT, thus improving service standards in this area.

A three-day course of dexamethasone therapy to prevent chronic lung disease in ventilated neonates: a randomized trial.

BACKGROUND: Although several trials of early dexamethasone therapy have been completed to determine if such therapy would reduce mortality and chronic lung disease (CLD) in infants with respiratory distress, optimal duration and side effects of such therapy remain unknown. PURPOSE: The purpose of this study was: 1) to determine if a 3-day course of early dexamethasone therapy would reduce CLD and increase survival without CLD in neonates who received surfactant therapy for respiratory distress syndrome and 2) to determine adverse effects associated with such therapy. DESIGN: This was a prospective multicenter randomized trial comparing a 3-day course of dexamethasone therapy beginning at 24 to 48 hours of life to placebo therapy. Two hundred forty-one neonates (dexamethasone n = 118, placebo n = 123), who weighed between 500 g and 1500 g, received surfactant therapy, and were at significant risk for CLD or death using a model to predict CLD or death at 24 hours of life, were enrolled in the trial. Infants randomized to receive early dexamethasone were given 6 doses of dexamethasone at 12-hour intervals beginning at 24 to 48 hours of life. The primary outcomes compared were survival without CLD and CLD. CLD was defined by the need for supplemental oxygen at the gestational age of 36 weeks. Complication rates and adverse effects of study drug therapy were also compared. RESULTS: Neonates randomized to early dexamethasone treatment were more likely to survive without CLD (RR: 1.3; 95% CI: 1.03, 1.7) and were less likely to develop CLD (RR: 0.6; CI: 0.3, 0. 98). Mortality rates were not significantly different. Subsequent dexamethasone therapy use was less in early dexamethasone-treated neonates (RR: 0.8; CI: 0.7, 0.96). Very early (

Clinical utility of a bedside blood analyzer for measuring blood chemistry values in neonates.

OBJECTIVE: The purpose of this study was to determine whether blood chemistry measurements obtained by a bedside blood analyzer through an umbilical artery catheter agreed with those obtained with use of conventional laboratory analyzers. STUDY DESIGN: Forty-two neonates (1910 +/- 1000 gm) being treated in a level III neonatal intensive care unit had 88 blood samples drawn through an umbilical artery catheter. Serum sodium, potassium, glucose, and hematocrit concentrations were measured (n = 352) with use of a laboratory analyzer (0.7 ml of blood) and a bedside blood analyzer (0.06 ml of blood). RESULTS: Only 5.7% of all measurement differences (20/352) were outside the predetermined clinically acceptable difference range, and just 1.4% (5/352) might have affected clinical decision making. Correlations between laboratory analyzer measurements and bedside blood analyzer measurements were excellent: serum potassium, r = 0.97, p = 0.0001; serum glucose, r = 0.93, p = 0.0001; and blood hematocrit, r = 0.93, p = 0.0001. Serum sodium measurement correlation was significant (p = 0.0001) but weaker (r = 0.86). CONCLUSION: The bedside blood analyzer evaluated in this report is clinically useful for neonatal patients and could limit phlebotomy loss if used routinely.

Association between tracheal pepsin, a reliable marker of gastric aspiration, and head of bed elevation among ventilated neonates.

OBJECTIVES: To determine the frequency of tracheal pepsin in ventilated neonates and whether the angle of head elevation was associated with tracheal pepsin. STUDY DESIGN: Serial trachael samples (at 3, 7, 14, 21 and 28 days of ventilation) were obtained from intubated, ventilated very low birth weight infants. Presence of tracheal pepsin was determined by Western blot analysis using a specific anti-human pepsin antibody. RESULTS: Tracheal pepsin was detected in 35/66 (53%) of the ventilated neonates (birthweight: 798 ± 268 grams [mean ± standard deviation]). Neonates whose head elevation was in the upper quartile (≥14 degrees) during the first sampling time (day 3) were less likely (4/16 vs 9/10, P = 0.0013) to have tracheal pepsin when compared to neonates whose head elevation was in the lowest quartile (≤8 degrees). CONCLUSIONS: Pepsin, a marker for gastric secretion aspiration, was detected in 53% of ventilated low birth weight neonates; early elevation of the head of the bed was associated with a lower rate of tracheal pepsin.

Avaliação da cavidade orofaríngea da tartaruga da Amazônia, Podocnemis expansa (Schweigger, 1812) / Evaluation of the oropharyngeal cavity of Giant South American turtle Podocnemis expansa (Schweigger, 1812)

Os quelônios são importantes como fonte alimentar e econômica para as comunidades da região amazônica. Sendo assim, a caça, a pesca e a procura por ovos destes animais tem ocorrido frequentemente. Podocnemis expansa (Tartaruga da Amazônia) é o maior quelônio de água doce da América do Sul. É uma espécie largamente distribuída, porém, nota-se que aspectos anatômicos da espécie são insuficientemente descritos. O objetivo desse estudo foi descrever a cavidade orofaríngea desses quelônios. Foram utilizadas 12 cabeças de P. expansa adultas, de ambos os sexos, com idade entre 3 a 8 anos, com peso corpóreo de 5 a 22kg (média de 7,5kg). P. expansa conta com a presença de rafontecas afiadas e bem desenvolvidas que, associadas à musculatura potente da mandíbula e à língua volumosa e bem distribuída no assoalho da orofaringe, atuam na apreensão e deglutição do alimento, garantindo uma maior adaptação em diversos ambientes...

Turtles are important as food and economic resources for the Amazon communities and there is a large demand on its meat and eggs. Podocnemis expansa (Giant South American turtle) is the largest freshwater chelonian of South America. This turtle is a widely distributed specie, however its anatomical features are poorly described. The objective of this study was to describe the oropharyngeal cavity of the turtle. Twelve heads of 3 to 8-year-old female and male P. expansa turtles with an average body weight of 7.5kg were used. P. expansa has a sharp and well developed rhamphotheca, which together with a powerful jaw muscles and a large tongue uniformly distributed on the oropharynx floor works for the apprehension and swallowing of food, what ensures good adaptation in different environments...

Pilot trial to compare tolerance of chlorhexidine gluconate to povidone-iodine antisepsis for central venous catheter placement in neonates.

OBJECTIVE: The purpose of this pilot trial was to determine whether rates of contact dermatitis following cutaneous antisepsis for central catheter placement were similar among neonates treated with chlorhexidine gluconate and povidone-iodine. Chlorhexidine gluconate absorption was also evaluated. STUDY DESIGN: Infants weighing > or =1500 g and > or =7 days of age were randomized to a 10% povidone-iodine or 2% chlorhexidine gluconate site scrub before catheter placement. Primary outcomes evaluated included dermatitis, catheter colonization and chlorhexidine gluconate absorption. RESULT: A total of 48 neonates were enrolled. Colonization rates were similar among treatment groups (P<0.6). Dermatitis did not occur at chlorhexidine gluconate (central catheters, n=24; peripheral catheters, n=29) sites. Seven neonates had measurable chlorhexidine gluconate concentrations (range 13 to 100 ng ml(-1)) during catheterization. CONCLUSION: In this small trial chlorhexidine gluconate antisepsis was tolerated by study neonates. Chlorhexidine gluconate was cutaneously absorbed. Larger trials are needed to determine efficacy and tolerance of chlorhexidine gluconate in neonates.

A randomized trial comparing povidone-iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates.

UNLABELLED: Neonates who require a central venous catheter (CVC) for prolonged vascular access experience high rates of catheter-related bloodstream infection (CRBSI). PURPOSE: A multicenter randomized clinical trial was undertaken to ascertain the efficacy of a novel chlorhexidine-impregnated dressing (Biopatch Antimicrobial Dressing) on the CVC sites of neonates for the prevention of catheter tip colonization, CRBSI, and bloodstream infection (BSI) without a source. Setting. Six level III neonatal intensive care units. Patients Studied. Neonates admitted to study units who would require a CVC for at least 48 hours. METHODS: Eligible infants were randomized before catheter placement to 1 of the 2 catheter site antisepsis regimens: 1) 10% povidone-iodine (PI) skin scrub, or 2) a 70% alcohol scrub followed by placement of a chlorhexidine-impregnated disk over the catheter insertion site. A transparent polyurethane dressing (Bioclusive Transparent Dressing) was used to cover the insertion site in both study groups. Primary study outcomes evaluated were catheter tip colonization, CRBSI, and BSI without an identified source. RESULTS: Seven hundred five neonates were enrolled in the trial, 335 randomized to receive the chlorhexidine dressing and 370 to skin disinfection with PI (controls). Neonates randomized to the antimicrobial dressing group were less likely to have colonized CVC tips than control neonates (15.0% vs 24.0%, relative risk [RR]: 0.6 95% confidence interval [CI]: 0.5-0.9). Rates of CRBSI (3.8% vs 3.2%, RR: 1.2, CI: 0.5-2.7) and BSI without a source (15.2% vs 14.3%, RR: 1.1, CI: 0.8-1.5) did not differ between the 2 groups. Localized contact dermatitis from the antimicrobial dressing, requiring crossover into the PI treatment group, occurred in 15 (15.3%) of 98 exposed neonates weighing