Infiltration and extravasation: update on prevention and management.

Infiltration and extravasation are risks of intravenous administration therapy involving unintended leakage of solution into the surrounding tissue. Consequences range from local irritation to amputation. While immediate action using appropriate measures (ie, dilution, extraction, antidotes, and supportive treatments) can decrease the need for surgical intervention, many injuries may be prevented by following established policy and procedures. However, timely surgical intervention, when necessary, can prevent more serious adverse outcomes. Clinicians should be prepared to act promptly when an event occurs. Thorough incident documentation helps determine whether infusion care meets the standard of practice and is a keystone to medicolegal defense.

Associations of polybrominated diphenyl ethers (PBDEs) in breast milk and dietary habits and demographic factors in Taiwan.

The aim of this study was to examine levels of PBDEs in breast milk associated with seafood consumptions of Taiwanese mothers. Our participants were selected from healthy women recruited between December 2000 and November 2001 from a medical center in central Taiwan. The congeners of PBDEs in 20 milk samples were analyzed by a gas chromatograph with a high resolution mass detector. The mean level of BDE47 in breast milk from mothers with pre-pregnant BMI <22.0kg/m2 had a significantly higher magnitude compared to those with pre-pregnant BMI > or = 22.0kg/m2 (1.59 vs. 0.995ng/g lipid, p=0.041). We did not find significant correlations between PBDEs exposure levels and women's age, parity, blood pressure, annual household income, and education level. Women who ate more fish and meat did not show significantly higher PBDE levels than those who ate less, but a significant difference in PBDE levels was demonstrated between the higher (2.15ng/g lipid) and lower (3.98ng/g lipid) shellfish consuming subjects (p=0.002) after an adjustment for the confounders. The ratios of PCB153/BDE47, PCB153/BDE153, and PCB153/PBDEs were significantly correlated with frequent consumption of fish and shellfish. The PCB153/BDE153 ratio was not associated with the other dietary habits (i.e. meat). The ratios of PCB153/PBDEs may therefore be a new indicator for exposure as a result of seafood consumption.

Level of polychlorinated dibenzo-p-dioxins, dibenzofurans and biphenyls (PCDD/Fs, PCBs) in human milk and the input to infant body burden.

This study determined PCDD/F and PCB levels in human milk, examined factors associated with levels of contamination, and assessed the infant body burden from breast-feeding. The congeners of PCDD/Fs, dioxin-like PCBs, and indicator PCBs were analyzed by HRGC/HRMS for 36 human milk samples from healthy women, aged 20-35 years, from December 2000 to November 2001 in central Taiwan. Mean levels of WHO-TEQs in human milk were 10.5 (95% CI=8.8-12.2) and 14.5 (95% CI=12.5-16.5) pg-TEQ/g lipid for those <29 and > or =29 years old, respectively. PCB 138 concentration significantly predicted total WHO-TEQs with r2=0.84 (p <0.001). Milk level of dioxin-TEQ was 9.63 pg-TEQ/g lipid (95% CI=7.0-13.2) in those with a yearly income $29,000 compared to 6.3 pg-TEQ/g lipid (95% CI=5.2-7.6) for those whose yearly income was $18,000 per year. Women who reported being Buddhist (64.3 ng/glipid) had significantly higher indicator PCB concentrations than did those who reported being Taoist (35.3 ng/g lipid). The monthly dioxin intake of exclusively breastfed infants decreased with increasing duration of lactation. The cumulative dose of exclusively breastfed infants (76.5 ng TEQ, 95% CI=69.7-83.3) was significantly greater compared to that of formula-fed infants (CI=16.4-17.0) at one year and to that of infants at birth (3.90 ng TEQ, 95% CI=3.6-4.2). Our findings suggest that breast-feeding should be strongly encouraged for infants in Taiwan.