Percepção da criança hospitalizada acerca do brinquedo terapêutico instrucional na terapia intravenosa / Percepción del niño hospitalizado acerca del juguete terapéutico instructivo en la terapia intravenosa / Perception of the hospitalized child about the instructional therapeutic play in intravenous therapy

Resumo Objetivo analisar a percepção da criança hospitalizada quanto ao uso do brinquedo terapêutico instrucional no preparo para a terapia intravenosa. Método estudo descritivo, com abordagem qualitativa, realizado em um hospital pediátrico público no município de Juazeiro do Norte - Ceará, entre os meses de julho a setembro de 2019. Participaram do estudo 31 crianças em idade pré-escolar e escolar. Os dados foram coletados por meio de uma entrevista semiestruturada e, posteriormente, analisados por meio do software IRAMUTEQ. Resultados diante da percepção das crianças acerca da terapia intravenosa, foi averiguado que elas compreenderam a técnica a partir da utilização do brinquedo terapêutico instrucional. Quando a criança tem a oportunidade de brincar e dramatizar a terapia intravenosa, por meio do brinquedo terapêutico instrucional, a ansiedade, a dor, a angústia, a solidão, o medo e o choro são atenuados. Conclusões e implicações para a prática orientar as crianças quanto à realização da terapia intravenosa favorece sua compreensão quanto aos reais benefícios desta técnica para a sua saúde, possibilitando, ainda, a compreensão do enfermeiro quanto às condições que representam riscos para a criança e intervenha em tempo hábil por meio da utilização de estratégias que favoreçam a recuperação da saúde e a minimização de traumas subsequentes advindos da hospitalização.

Resumen Objetivo Analizar la percepción del niño hospitalizado cuanto al uso del juguete terapéutico instructivo en la preparación para la terapia intravenosa. Método Estudio descriptivo, con enfoque cualitativo, realizado en un hospital pediátrico público de la ciudad de Juazeiro do Norte - Ceará, entre julio y septiembre de 2019. Participaron 31 niños en edad preescolar y escolar. Los datos se recogieron mediante entrevista semiestructurada, posteriormente analizados con el software IRAMUTEQ. Resultados En vista de la percepción de los niños acerca de la terapia intravenosa, se encontró que ellos comprendieron la técnica a partir del uso del juguete terapéutico instructivo. Cuando tienen la oportunidad de jugar y dramatizar la terapia intravenosa, a través del juguete terapéutico instructivo, la ansiedad, el dolor, la angustia, la soledad, el miedo y el llanto son mitigados. Conclusiones e implicaciones para la práctica Orientar a los niños sobre la realización de la terapia intravenosa favorece su comprensión sobre los beneficios reales de esta técnica para su salud, permitiendo además que la enfermera comprenda las condiciones que suponen riesgos para el niño e intervenga de forma oportuna, mediante el uso de estrategias que favorezcan la recuperación de la salud y la minimización de traumas posteriores a la hospitalización.

Abstract Objective to analyze the perception of the hospitalized child regarding the use of the instructional therapeutic play in preparation for intravenous therapy. Method descriptive study, with a qualitative approach, performed in a public pediatric hospital in the city of Juazeiro do Norte - Ceará, between the months of July and September 2019. A total of 31 pre-school and school children participated in the study. The data were collected through a semi-structured interview, and later analyzed through IRAMUTEQ software. Results in view of the children's perception of intravenous therapy, it was found that they understood the technique, from the use of the instructional therapeutic play. When the child has the opportunity to play and dramatize intravenous therapy, through the instructional therapeutic play, the anxiety, the pain, the anguish, the loneliness, the fear and the crying are mitigated. Conclusion and implications for practice Orienting children in the performance of intravenous therapy favors their understanding of the real benefits of this technique for their health, allowing the nurse to understand the conditions that pose risks to the child, and intervene in a timely manner, through the use of strategies that favor the recovery of health and the minimization of subsequent trauma from hospitalization.

Indicadores de calidad en la terapia intravenosa / Analysis of quality indicators in intravenous therapy

RESUMEN Introducción: Los eventos adversos son comunes durante el uso de la terapia intravenosa, pueden causar daño al paciente y contribuir a agravar el estado de salud y la estancia hospitalaria prolongada. Además, al proporcionar acceso directo a la corriente sanguínea, los eventos adversos relacionados con la terapia intravenosa pueden tener repercusiones más graves y perjudiciales. Objetivo: Analizar indicadores de calidad relacionados con la atención de salud en la terapia intravenosa en un hospital público y de enseñanza. Métodos: Estudio descriptivo-exploratorio, transversal realizado en un hospital público, de enseñanza. Para recopilar datos se utilizó una forma adaptada compuesta por 03 indicadores: identificación de acceso venoso periférico, la identificación de goteo intravenoso para botellas de infusión y la identificación de suero y control de la velocidad de infusión de las soluciones. La muestra, intencional, consistió en 94 participantes. Resultados: Se realizaron 1 355 observaciones. De éstas, 439 fueron el acceso venoso periférico, 463 de los catéteres para la infusión intravenosa de 453 botellas de suero y medicamentos. La validez de un acceso venoso periférico, basado solo en accesos identificados correctamente, fue el único cuyo resultado de calidad de la atención (QA) era deseable (100 por ciento) y segura (83,3 por ciento); todos los demás mostraron QA mal (< 70 por ciento). Conclusión: Los resultados encontrados en este estudio están por debajo del deseado para que una asistencia de calidad en terapia intravenosa sea garantizada. La calidad de la atención en la terapia intravenosa es mucho menor que la recomendada(AU)

ABSTRACT Introduction: Adverse events are common during use of intravenous therapy can cause damage to the patient, and contribute to worsening health status and prolonged hospital stay. In addition, by providing direct access to the bloodstream, adverse events related to intravenous therapy may be more serious and harmful repercussions. Objective: To analyze the quality indicators related to health care in intravenous therapy in an extension public research teaching hospital. Methods: Descriptive and exploratory, cross-sectional study in a public hospital, teaching. For data collection, it was used an adapted form composed of 03 following indicators: identification of peripheral venous access, equipment used for intravenous infusion, serum bottles, and speed control of infusion solutions. The intentional sample was consisted of 94 participants. Results: 1355 observations were done.In these observations, 439 were of peripheral venous access, 463 of equipment used for intravenous infusion, 453 of serum bottles and medicine. Based only on properly identified access, the validity of peripheral venous access was the only one whose result of quality of care (QA) was desirable (100 percent) and safe (83,3 percent), all the others showed QA poorly (< 70 percent). Conclusions: The results found in this study are below desired for quality care in intravenous therapy is ensured. The quality of care in intravenous therapy is very lower than recommended(AU)

Hepatitis C and b virus in schistosomiasis patients on oral or parenteral treatment

Egypt leads the world in hepatitis C infection cases. Schistosomiasis and hepatitis C virus [HCV] co-infection is common in Egypt. Hepatitis B [HBsAg] is also encountered. Potassium antimony tartarate was used for Schistosomiasis in endemic areas all over the world for more than 50 years, intravenously and was prohibited since late of the last century when the oral drugs were developed. Some authors postulated that Schistosomiasis might contribute to persistence of HCV via biological factors. This study compared the prevalence of HCV and HBV among Schistosomiasis patients in endemic areas given parenteral or oral route anti-schistosomiasis. A total of 102 manual workers patients were selected from different areas in Cairo and Gharbia Governorates. They were 82 males and 20 females; their age was ranged between 16-60 years [40 +/- 12]. Sheets were filled out on each patient including name, age, sex, history of haematurea or bloody diarrhea, parasitic infection, intravenous injections, blood transfusion, dental care, shaving, previous treatment, and anti-schistosomiasis. They were divided into GI: 50 patients treated IV since 20-30 years ago with ages [49.4 +/- 7.4] and GIL 52 patients treated orally up to 8 years ago with ages [2.2 +/- 7.7]. They were subjected to IHAT anti-schistosomal antibodies, circulating schistosome antigens in urine, HBsAg and HCVAb, the latter was confirmed by PCR for positivity, and Alanin transeferese [ALT]. In GI, 42/50 [84%] had HCV compared to 4/52[7.7%] in Gil, with statistical significant. HBsAg was detected in a patient. HCV patients showed function. 3/52 received oral treatment showed elevation of liver function [5.8%]. 10% [10/50] of GI and 34.6% [18/52] of Gil were schistosomal antigen in urine positive

Efficacy of esmolol administration at different time intervals in attenuating hemodynamic response to tracheal intubation.

Background: Laryngoscopy and endotracheal intubation are known to cause increase in both arterial blood pressure and heart rate. Several strategies have been evolved to blunt the haemodynamic response to tracheal intubation but each method has its own advantages and disadvantages. Esmolol, a cardio selective Beta -1 blocking drug, can alleviate some of these problems. Esmolol, when administered parenterally, exhibits rapid onset and a short duration of action due to its rapid clearance by red blood cell esterases. Hence we conducted the present study to evaluate the efficacy and optimum time of single bolus esmolol administration in attenuating hypertensive- tachycardiac response to laryngoscopy and tracheal intubation. Materials and Methods: The randomized double blind prospective study was conducted in 60 patients, in the age group of 20-40 years, of both sexes, belonging to American Society of Anaesthesiologists (ASA) physical status class I or II and scheduled for elective surgery requiring endotracheal intubation and general anaesthesia. The efficacy and optimum time of single bolus esmolol administration in attenuating hypertensive - tachycardiac response to laryngoscopy and tracheal intubation was evaluated. Patients in group I (n=20) received bolus administration of injection esmolol 1.5 mg/kg intravenously (iv) 90 seconds before intubation; in group II (n=20) three minutes before intubation and in group III (n=20) six minutes before intubation. Results: There was no clinical and statistically significant variation in heart rate in group I and II at different time intervals of the study period but in group III heart rate increased significantly one minute after tracheal intubation. (P<0.05) One minute after intubation, the increase in systolic, diastolic and mean blood pressure and rate pressure product was statistically significant in group I (P<0.01) and group III. (P<0.05) However, in group II increase in systolic blood pressure and rate pressure product was statistically not significant. (P>0.05) Conclusion: To conclude, single intravenous bolus dose of esmolol (1.5 mg/kg) is safe and more effective in attenuating haemodynamic response to laryngoscopy and tracheal intubation when administered three minutes prior to intubation.

Dimethyl sulfoxide effects on the febrile response to lipopolysaccharide injection in rabbits / Efeitos do dimetil sulfóxido sobre a resposta febril induzida pela injeção de lipopolissacarídeo em coelhos

The present study was designed to determine whether DMSO causes an inhibition on the development of fever in rabbits. The intravenous administration of LPS (1.5µg.kg-1 body weight) caused fever in both saline+LPS and DMSO+LPS group, but the onset and magnitude of the induced fever were significantly different. The saline+LPS group presented a prototypic biphasic fever whereas the DMSO+LPS group presented an attenuated febrile response, but it was not abolished. These results suggest that DMSO may provide a protective mechanism against pyrogen LPS, probably through the modulation of NF-kB mediated events, such as fever.

Estudaram-se os efeitos do DMSO na resposta febril induzida pela administração intravenosa de LPS em coelhos. A administração intravenosa de LPS (1,5µg.kg-1 peso vivo) causou febre mesmo na presença do DMSO. No entanto, o início e a magnitude da febre induzida foram significativamente menores no grupo tratado com DMSO enquanto o LPS isolado induziu resposta febril bifásica. Estes resultados sugerem que o DMSO pode exercer um mecanismo protetor contra a ação pirogênica do LPS, provavelmente por meio da modulação dos eventos mediados pelo NF-kB, entre eles, a febre.

Acesso venoso pela via intra-óssea em urgências médicas: [revisão] / Venous access by intraosseous access in medical urgencies: [review]

JUSTIFICATIVA E OBJETIVOS: Inicialmente introduzida em 1922, a técnica de acesso intra-ósseo foi extensamente utilizada até os anos de 1940 e revisada nos anos 1980. Considerando sua recomendação em diretrizes de reanimação cardiopulmonar, o objetivo deste estudo foi apresentar uma revisão histórica e principais aspectos clínicos sobre acessos intra-ósseos ao sistema venoso. CONTEÚDO: Foi realizada uma busca por artigos originais através da palavra-chave "acesso intra-ósseo" na base de artigos MedLine (1950 a janeiro de 2008). Adicionalmente, referências destes artigos, capítulos de livros e artigos históricos foram avaliados para esta revisão. Portais na internet de fabricantes de equipamentos para punção intra-óssea também foram consultados. Foram identificados e revisados 231 artigos, e o presente estudo condensou os principais resultados descritos. Foram considerados ensaios clínicos na língua inglesa, estudos retrospectivos e artigos de revisão. CONCLUSÕES: O acesso intra-ósseo é usado principalmente para garantir rapidamente um acesso venoso quando há algum retardo ou dificuldade para acesso venoso periférico. Consiste em técnica de simples aprendizado e suas complicações são inferiores a 1 por cento. A maior parte dos fármacos utilizados em emergências pode ser administrada por esta via em suas doses rotineiras. O acesso intra-ósseo pode ser usado com segurança em diferentes locais de punção, tanto em adultos quanto crianças. Este acesso pode ser satisfatoriamente utilizado para coleta sanguínea objetivando análise de gases e bioquímica sanguínea, infusão de sangue e hemoderivados, solução fisiológica para reposição volêmica em estados de choque, parada cardiorrespiratória e outras emergências, quando o acesso venoso convencional não pode ser rapidamente efetivado.

BACKGROUND AND OBJECTIVES: First introduced in 1922, the intraosseous access technique was extensively used in the 1940's and revised in the 1980's. Since this technique is recommended in actual cardiopulmonary resuscitation guidelines, the authors present an historical and clinical review of intraosseous access to the venous system. CONTENTS: The MedLine (1950 to January 2008) database was searched for pertinent abstracts, using the key term intraosseous access. Additional references and historical papers were obtained from the bibliographies of the articles reviewed. Manufacturer Web sites were used to obtain information about intraosseous venous (IO) insertion devices. Were identified and reviewed 231 articles, and this present article condensed the mainly the principal findings described. All available English-language clinical trials, retrospective studies and review articles describing IO drug administration were reviewed. CONCLUSIONS: The intraosseous access is used mainly to gain rapid access to the intravenous system when there is delay in obtaining the latter one. The technique is simple to learn. The complications rate is less than 1 percent. Most emergency drugs can be administered in the same doses used by intravenous routes. Bone access can be used in children and adults of any age in several sites. This access can be used satisfactorily to draw blood for cross-matching, blood gases and blood chemistries and emergency infusion of blood and its derivatives, saline solutions for volume replacement in shock, cardiac arrest and emergencies when an intravenous access cannot be made readily available.

Corpus of biochemical changes after death by potassium intoxication in rabbits / 法医学杂志

OBJECTIVE@#To explore the objective evidence of the corpus biochemical changes in rabbits for postmortem diagnosis of potassium intoxication.@*METHODS@#Rabbits were sacrificed by Infusion of 0.3% KCl at full speed push or 1% KCl at 100 drip/min, respectively, with normal rabbits used as control. Cardiac blood and urine samples were collected before and after potassium infusion to examine the concentrations of various electrolytes (K+, Na+, Ca2+, Mg2+, Cl-, and HCO3-) and to observe the antemortem and postmortem biochemical changes.@*RESULTS@#The mean lethal infusion time in the 0.3%KCl group was longer than that in the 1% KCl group (P = 0.006). The serum concentration of K+ increased while the serum concentrations of Na+, Ca2+, Cl-, and HCO3- decreased after the infusion. There were no statistically significant differences in the whole blood concentration of K+ as well as the serum concentration of Mg2+ between the two groups (P = 0.062). There were statistically significant differences in the concentrations of whole blood K+, as well as serum Na+, Mg2+, and Cl-, but not in the serum K+, Ca2+, and HCO3-. There were no statistically significant differences seen in the urine volumes and the concentrations of all the urine electrolytes between the groups.@*CONCLUSION@#Examination of the concentrations of K+ both in the whole blood and serum, as well as Mg2+ in the serum may be helpful for postmortem diagnosis of potassium intoxication.

Morphological changes in rabbits died of potassium intoxication / 法医学杂志

OBJECTIVE@#Morphologic features of the corpse of rabbits died of potassium intoxication were studied in order to elucidate an objective evidence for forensic determination of death caused by potassium intoxication.@*METHODS@#Macroscopic, microscopic, and ultrastructural (by transmission electron microscopy) changes were observed in the heart, brain, and kidney of rabbits killed by intravenous push or continuous infusion at 100 drips per minute with 0.3% and 1% KCl, respectively. Normal rabbits without any treatment killed by bleeding were used as controls.@*RESULTS@#Macroscopically, cardiac dilatation and congestion/stasis as well as ischemic and hypoxic changes in various organs were observed in rabbits died of potassium injection. Microscopically and ultrastructurally, there were destruction of the cardiac fibers with thickening, concentrating, or disappearing of the Z-line, constriction of the glomerular capillaries, enlargement of the Bowman capsule, thinning and fusion of foot processes, as well as apoptosis with phagocytosis in brain observed, particularly in the group infused with 1% KCl.@*CONCLUSION@#The morphologic changes observed in the heart and kidney appear to be characteristic, supporting death caused by potassium intoxication.

High dose intravenous immunoglobulin therapy in neonatal immune hemolytic jaundice

Isoimmune hemolytic jaundice due to blood group [ABO] and Rhesus [Rh] incompatibility is an important problem in the neonatal period. A controlled study was conducted to assess the role of high dose intravenous immunoglobulin [HDIVIG] therapy in neonatal immune hemolytic jaundice. Newborn patients with ABO and/or Rh incompatibilities proved by significant hyperbilirubinemia [>15mg/dl], positive direct Coombs' test and high reticulocytic count [>6%] were randomly assigned to receive either conventional treatment measures alone, including phototherapy and exchange transfusion if needed [control group, n=10 newborns] or phototherapy with high dose i.v. immunoglobulin [1gm/kg] over 4 hours [study group, n=30 newborns] as soon as the diagnosis was established. One of the 30 patients in the HDIVIG group required exchange transfusion, while this became necessary in 3 of 10 patients in the control group [p<0.001]. The duration of phototherapy and hospitalization, in terms of hours were significantly shorter in the HDIVIG group [p<0.001]. No adverse effects of HDIVIG therapy were observed. The use of HDIVIG therapy in newborns with ABO and/or Rh hemolytic disease reduces hemolysis, serum bilirubin levels, the need for blood exchange transfusion and the duration of hospitalization

Factores que influyen para el buen cuidado de enfermería a pacientes con venoclisis

Estudio descriptivo cuantitativo de los factores que influyen para el buen cuidado de las enfermeras en el tratamiento intravenoso en los pacientes internados en el Servicio de Semiología Médica del Hospital de Clínicas. Describe el procedimiento y los conocimientos del personal de enfermería encargado, además de los problemas de infraestructura con que cuenta

Controlador programável para a administraçäo intravenosa de líquidos / Programmed control for liquid intravenous administration

O controlador do fluxo de líquido atua em uma pinça, ativada através de um motor de passo, que comprime um tubo de descarga a fim de manter a freqüência do gotejamento constante. Ele se baseia em um transdutor infravermelho que transforma o período de gotejamento em pulsos elétricos, que intercepetam o feixe infravermelho de um transdutor fixado no equipo. Os sinais são comparados aos previamente fixados como referências e a tensão elétrica resultante é aplicada no motor de passo que regula a abertura da pinça. Os teste indicam um desvio de 0,2 por cento, erro de 0,87 por cento e histerése de 0.6 por cento além de excelente precisão devido a circuitos especiais adicionados ao aparelho

Abstract - The liquid flow controller acts on a pincer activated by a step-motor. that constrains a discharge tube in order to maintain the drip frequency constant. lt is based on an infrared transducer, that transforms the dripping period in electric pulses when intercepts the infrared beam of the transducer. Submitted to digital treatment, these signals are compared to those previously set as a reference and the resulting electric tension applied onto the step-motor to regulate the pincer overture. Tests shown a very low drift (0.2%), error (0.87%) and histeresys (0.6%), exhibiting an excellent accuracy dueto special circuits added to the device framework

Use of magnesium sulfate in severe bronchial asthma

Four patients were treated with intravenous magnesium sulfate. Magnesium sulfate was used in addition to other drug therapy for bronchial asthma. All 4 patients responded to intravenous magnesium sulfate and tolerated the drug without any side effects. This study illustrated the usef lness and the safety of the drug

Pharmacokinetic parameters of morphine after ocular instillation versus intravenous administration

The route of administration of morphine, other than parenteral administration may be promising in increasing the compliance in patients that continuously need morphine for its analgesic effect. Morphine systemic penetration was investigated after ocular instillation. Its pharmacokinetic parameters and its bioavailability after ocular instillation compared to its intravenous administration were determined in healthy New Zealand albino rabbits. A cross over design was performed with an eight days wash-out period between the ocular and intravenous administrations. After ocular instillation, morphine was rapidly absorbed and attained serum levels compatible with effective concentration for its analgesic effect. Ocular bioavailability of morphine was high [66%]. Ocular administration of morphine could provide prolonged high serum levels and prolonged systemic pharmacologic effect. Ocular administration of morphine should be considered for its systemic pharmacologic effect

Intravenous adriamycin and external radiation therapy for treatment of hepatocellular carcinoma

Twenty four patients with primary malignant hepatocellular carcinoma [PHC], treated with either external radiation therapy alone [group I], or external radiotherapy with Adriamycin [group II], were evaluated. The median survival was 8 months for group I and 6 months for group II. The partial response rate was 46% for group I and 45% for group II. Acute and subacute toxicities developed in group II patients. It was found that external radiation therapy alone can palliate primary hepatocellular carcinoma for a reasonable duration and single agent Adriamycin chemotherapy does not add any further improvement

Pulsoterapia venosa retrógrada em úlcera de estase infectada / Venous retrograde pulsetherapy in infected stasis ulcer

Foram tratados 25 pacientes portadores de úlceras de estase infectadas, através da técnica da pulsoterapia venosa retrógrada (PVR), com gentamicina e buflomedil. O total de úlceras tratadas foi de 53, sendo realizados cultura e teste de sensibilidade a antibióticos do exsudato em todas elas e obtidos 36 isolados bacterianos, dos quais 10 eram resistentes à gentamicina in vitro. A infecção do fundo foi controlada em 45,8 por cento das úlceras com apenas uma sessão de PVR. O máximo de sessões diárias necessárias para controle da infecção foi de seis. Adicionalmente, o tamanho das úlceras - tanto em seu diâmetro longitudinal quanto no transverso - mostrou nítida redução entre o pré-tratamento e a última aplicação de PVR, com diferença estatisticamente significativa (p<0,001). Conclui-se que o combate à infecção é importante para a cicatrização da úlcera de estase, que a melhor maneira de combater esta infecção é a utilização de altas concentrações de antibiótico no local da infecção e que mesmo as bactérias resistentes à gentamicina in vitro respondem a esta medicação quando em altas doses. O melhor método de atingir esta alta concentração local, sem comprometimento do organismo como um todo, é através da PVR, cuja utilização diminui os tempos de uso do antibiótico e de tratamento, sendo uma terapêutica eficaz, bem tolerada e segura nesta patologia.