Intravascular catheter migration: A cross-sectional and health-economic comparison of adhesive and subcutaneous engineered stabilisation devices for intravascular device securement.

The Infusional Services Team at a large cancer centre in Belfast, Northern Ireland, performed a cross-sectional analysis of two catheter securement technologies to address an area of frequent, but underestimated concern - peripherally inserted central catheter migration and dislodgement. Healthcare practitioner and patient feedback, along with economic impact, were assessed. The costs associated with catheter replacement during the adhesive device group study period were calculated using an average cost per insertion, based on material costs required for the procedure. Other factors were the replacement cost of the adhesive engineered securement device with each dressing change. In the subcutaneous securement group, the material costs were adjusted for use of the subcutaneous device as it remained in situ for the duration of the catheters' dwell time. This review found that subcutaneous securement offers both patient and facilities a safe, effective and economical alternative for device securement with patients who are unable to tolerate or have successful securement with adhesive securement devices. The use of subcutaneous devices provided for reduced risks for peripherally inserted central catheters in terms of dislodgement, migration or malposition, alleviating the potential risks to develop catheter-related thrombosis and device-related infection.

i-STAT hand-held point-of-care analyzer for dialysis units.

The i-STAT hand-held analyzer assays ten tests including electrolytes, gases, urea, glucose, ionized calcium, and hematocrit. Eight different cartridges assay one to eight tests. We have previously confirmed or demonstrated that accuracy and precision for blood assays are comparable to accepted laboratory methods. We now report similar results for hemodialysis dialysate and peritoneal dialysis effluent. The i-STAT analyzer is simple to use, and dialysis nurses produced accurate results with 20 min training. The results are viewed digitally on the analyzer and automatically on a small attachable printer. i-STAT blood analysis is most valuable when results are desired immediately, anywhere, including before, during and after dialysis in hemodialysis units. Hemodialysate analysis using i-STAT can be most valuable for rapidly checking dialysis machine function such as dialysate mixing and conductivity and ramping results and dialysate concentrations prepared in the unit. Peritoneal effluent analysis is useful for rapid evaluation of membrane function.

Pharmacoeconomic comparison of cyclosporine oral solution and capsules after kidney transplantation.

We studied 20 kidney transplant recipients who had received Sandimmune cyclosporine A (CSA) capsules for an average of 7.9 months at a mean dose of 312 mg/day. They were switched to CSA liquid in the same dosage for an average of 15.5 months. There was no significant difference between the means for the monthly values of either serum creatinine or whole blood CSA when the periods on capsules and liquid were compared. Fourteen bottles from 4 batches with volume stated as 50 ml CSA actually contained an average of 53.7 ml. Comparison of the amount of capsules and liquid CSA prescribed and the amount dispensed by the pharmacy showed that the amount neglected (prescribed > dispensed) was similar for patients on liquid and capsules. Wastage (prescribed < dispensed) was about 5% greater when on liquid, and as our cost for liquid was 18% less than for capsules, we saved about 13% by use of the liquid.

In search of sterile, endotoxin-free dialysate.

Sterile dialysate, free of endotoxin (ET) and other cytokine inducing factors, will probably become a future standard. High-flux dialysis with bicarbonate and reuse has the membrane, the pressures, and bacteriologic potential for ET fragments to pass from dialysate to the blood side of the membrane with activation of monocytes and production of cytokines. Ultrafiltration through polysulfone filters has been shown to remove bacteria, ET, and its fragments and other cytotoxic inducing factors. The authors found that in spite of sterile, ET-free, reverse osmosis (RO) water, ET was usually present at the dialyzer inlet and arose from the RO storage tank water with bacteria < 30 CFU/ml, in spite of repeated disinfection. The authors now remove bacteria, ET, and fragments from RO tank water with a 5 mu cellulose filter followed by ultrafiltration with a Fresenius F-80 polysulfone dialyzer inserted between the wall RO delivery port and each delivery system. At the dialyzer inlet, monthly bacterial counts were < 30 cfu/ml, and ET values (n = 38) were not detectable in 89% and < 0.5 EU/ml in 11%. The F-80 filters were used for 180+ dialyses along with the 5 mu filters, which replaced the frequently endotoxin contaminated 10 mu filters in the Monitral-S delivery systems. The costs did not increase.

Assessment of specific gravity determined by Ames N-Multistix-SG.

Specific gravity (SG) was determined in 204 urines by N-Multistix-SG solid phase test strip. Seventy-seven of the urines were from patients with known renal disease or were positive for protein or glucose, or had pH greater than 6.4 (Group I) and were assayed for osmolality, SG by urinometer and refractometer, and several other parameters, intercorrelations were calculated. Osmolality was used as the gold standard. In Group I, correlation of osmolality with N-Multistix SG (r = 0.66) was not significantly different (p greater than 0.1) from that found with SG determined by refractometer (r = 0.72), or urinometer (r = 0.60). The correlation coefficient for 45 N-Multistix-SG values determined by two staff members was 0.91. For the 127 Group II normal urines, the correlation coefficient between Multistix-SG and SG by refractometer was 0.85. Multistix-SG avoids the errors related to large molecules such as glucose and radiographic contrast media seen with SG determined by urinometer and refractometer (uncorrected for glucose) and was found to have comparable accuracy to these two methods when compared with osmolality, in patients with known renal disease or abnormal urinalysis.