In vitro use of standard fluid infusion central venous catheter for slow continuous ultrafiltration feasibility assessment.

BACKGROUND: Slow continuous ultrafiltration (SCUF) by central venous catheter (CVC) for hemodialysis is a simple extracorporeal ultrafiltration that can reduce and control fluid overload in patients with chronic or acute chronic heart failure unresponsive to medical therapy. In order to avoid complications and risks related to the catheterization with a standard CVC for hemodialysis to provide the SCUF, considering that hospitalized patients affected by congestive heart failure commonly undergo CVC placement for medications delivering, we tested an in vitro model to use a standard CVC for infusion to perform SCUF. METHODS: We performed an in vitro SCUF experimental model through two different lumens of a triple (8Fr × 20 cm Tri-lumen catheter Kit-Envans Extra) and a quad-lumen CVC (8.5Fr × 20 cm Quad-lumen catheter kit-Benefis Medical Devices) commonly used in our Intensive Care Unit for fluids and medications infusions. We used Prismaflex with the HF-20 set (Baxter, IL, USA) to perform the SCUF treatment. RESULTS: Our in vitro data confirm the technical feasibility of the use of standard CVC for fluid infusion to perform a SCUF treatment with a theoretical weight loss of up to 200 ml/h by a blood flow ranging from 30 to 45 ml/min. CONCLUSIONS: The use of standard infusion CVC could be utilized in the intensive care unit to perform SCUF not exposing patients to the risks and complications related to the placement and permanence of CVC for hemodialysis.

Intravenous ferric carboxymaltose for iron deficiency anemia in dialysis patients: Effect of a new protocol adopted for a hemodialysis limited assistance center.

Iron and erythropoietin deficiencies are determinants of anemia in chronic kidney disease. In hemodialysis (HD) patients, intravenous (IV) iron is associated with a greater hemoglobin (Hb) production and better erythropoietin response but may be associated to hypersensitivity reaction. After the 2013 European Medicines Agency report regarding early detection/management of iron allergic reactions, IV iron administration dramatically reduced in Italian Hemodialysis-Limited-Assistance-Centre (HD-CAL) where a physician is present only once a week. Objective of the study was providing an effective and secure IV iron administration protocol for HD-CAL patients. IV ferric carboxymaltose (FCM) administration was more effective and better tolerated than sodium ferric gluconate for iron deficiency correction and resolution of anemia in 24 patients undergoing HD in our HD-CAL. Six months of FCM IV treatment once a week increased ferritin and Hb compared to sodium ferric gluconate once a week leading to decreased erythropoietin consumption from 24 000 to 15 000 U/patient/week with an erythropoietin annual expense reduction. No blood transfusions, gastrointestinal intolerance or other adverse effects were reported. The FCM IV administration protocol for our HD-CAL patients was safe and no adverse events were reported, resulting in significantly increased ferritin, transferrin saturation, and Hb levels, reduction of erythropoietin requirements, and consequently reduction of erythropoietin expenses.

Participatory approaches to reaching the Sustainable Development Goals: San Marino: promoting healthy lifestyles through schools and family

In San Marino, the intersectoral approach to improving population health is a long-standing tradition. Several intersectoral projects have been under way for some time with a focus on the achievement of the Sustainable Development Goals (SDGs). In 2013, the Health and school working group was established to promote a systematic approach to health education. The aim is to create a school system in which everyone involved works together to provide students with a safe and healthy environment and positive experiences, and to promote a more sustainable and fairer lifestyle. Such an environment, involving both families and communities, is needed in tackling the burden of noncommunicable and chronic diseases and their risk factors. The adoption of the 2030 Agenda in 2015 gave San Marino the impetus to create the Intersectoral working group on implementation of the SDGs. Comprising representatives of all government departments, this working group is tasked with preparing the voluntary national review for submission to the High Level Political Forum in 2019. San Marino has also set up a strategic platform entitled “Produce health and development” to promote intersectoral policies and multi-partner cooperation, and provide leadership of the World Health Organization (WHO) Small Countries Initiative in conjunction with the WHO European Centre for Investment for Health and Development of the WHO Regional Office for Europe. The action reported in this briefing is directly linked to SDG 3 (good health and well-being), targets 3.4 and 3.5, and SDG 4 (quality education), target 4.7, and the strategic directions of the WHO European “Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well-being”.