RESUMEN
Objetivo: validar a aparência do bundle para manuseio do cateter central de inserção periférica em neonatos pela equipe de enfermagem. Método: estudo metodológico, desenvolvido durante os meses de novembro de 2020 e fevereiro de 2021, em unidades neonatais de um hospital de ensino. A amostra foi composta por 43 membros da equipe de enfermagem e os dados analisados pelo índice de validade de conteúdo acima de 80%. Aplicou-se um instrumento contendo dados de identificação, o bundle e a relevância para prática clínica no Google Formulários. Resultados: todos os itens do bundle apresentaram índice de validade de conteúdo acima de 80% e foram considerados relevantes para prática clínica. Conclusão: este estudo permitiu validar a aparência do bundle junto a equipe de enfermagem e incluiu cuidados relacionados a manutenção do cateter central de inserção periférica em neonatos.
Objective: to validate the appearance of the bundle and ematos of the central insertion catheter by the nursing team. Method:methodological study, developed during the months of November 2020 and February 2021, in neonatal units of a teaching hospital. The sample consisted of 43 members of the nursing team and the data analyzed by the content validity index above 80%. An instrument containing identification data, the bundle and relevance to clinical practice on Google Forms was applied. Results:all bundle items had a content validity index above 80% and were considered relevant for clinical practice. Conclusion: this study allowed us to validate the appearance of the bundle with the nursing team and included care related to the maintenance of peripherally inserted central catheter in neonates.
Objetivo: validar el aspecto del fascículo para manipulación del catéter central de inserción periférica en neonatos por el equipo de enfermería. Método: estudio metodológico, desarrollado durante los meses de noviembre de 2020 y febrero de 2021, en unidades neonatales de un hospital de enseñanza. La muestra estuvo compuesta por 43 miembros del equipo de enfermería y los datos analizados por el índice de validez de contenido superior al 80%. Se aplicó un instrumento que contiene los datos de identificación, el paquete y la relevancia para la práctica clínica en Google Forms. Resultados: todos los ítems del paquete tuvieron un índice de validez de contenido superior al 80% y se consideraron relevantes para la práctica clínica. Conclusión: este estudio permitió validar la apariencia del paquete con el equipo de enfermería e incluyó cuidados relacionados con el mantenimiento del catéter central de inserción periférica en los recién nacidos.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Unidades de Cuidado Intensivo Neonatal/tendencias , Catéteres/tendencias , Paquetes de Atención al Paciente/enfermería , Catéteres/normasRESUMEN
Introdução: Pacientes oncológicos em quimioterapia que fazem o uso de Cateter Venoso Central de Longa Permanência (CVC-LP) apresentam riscos inerentes de complicações clínicas, dentre elas, as complicações infecciosas, as quais pode acarretar em maiores taxas de morbimortalidade. Para garantir a prevenção e controle de tais complicações, profissionais de saúde podem recorrer a implementação de outras estratégias de educação em saúde além do fornecimento de, somente, orientações padronizadas ou do cuidado usual, tais como programas de ensino-aprendizagem, direcionados a pacientes oncológicos e/ou seus respectivos cuidadores/familiares, os quais abordem técnicas de manipulação e cuidados adequados com o dispositivo. Objetivo: Avaliar a eficácia de programas de ensino-aprendizagem sobre o cuidado com o CVC-LP, direcionados a pacientes oncológicos em quimioterapia endovenosa e/ou seus respectivos cuidadores/familiares, na prevenção e controle de complicações infecciosas relacionadas a este dispositivo. Método: Revisão sistemática da literatura, relatada segundo as etapas propostas pelo PRISMA. A busca por estudos foi realizada nas bases de dados eletrônicas CINAHL, Cochrane Library, EMBASE, LILACS, MEDLINE via portal PubMed, Scopus e Web of Science. A literatura cinzenta foi consultada a partir do Google Scholar. As estratégias de busca foram formuladas e adaptadas segundo as especificidades de cada uma das fontes de informação utilizadas, contendo descritores controlados e palavras-chave. A seleção dos estudos elegíveis foi realizada, por dois revisores de maneira independente e cega, levando em consideração os critérios de elegibilidade previamente estabelecidos. Um terceiro revisor foi consultado para resolver eventuais conflitos. Ao final da seleção, realizou-se a busca manual nas listas de referências dos estudos incluídos, a fim de identificar outros estudos para a inclusão. Os estudos incluídos foram analisados criteriosamente, e submetidos ao processo de extração de dados. Em seguida, o risco de viés de cada estudo foi avaliado utilizando as ferramentas RoB 2 e ROBINS-I, disponibilizadas pela Colaboração Cochrane. Os dados obtidos foram, então, sintetizados, somente, de forma qualitativa, uma vez que, devido a significativa heterogeneidade quanto às configurações metodológicas dos estudos incluídos, não foi possível a realização da síntese quantitativa (metanálise). Resultados: Sete estudos foram considerados elegíveis para compor a presente revisão, sendo dois ensaios clínicos randomizados, dois ensaios clínicos não-randomizados, e três estudos quase-experimentais. Quatro estudos foram realizados com pacientes pediátricos e seus cuidadores/familiares, e três estudos foram realizados com pacientes adultos. Os programas de ensino-aprendizagem implementados para a educação do paciente e/ou cuidador/familiar, sobre o cuidado com o CVC-LP, foram desenvolvidas por meio de dimensões teórico-práticas, em cinco estudos, e por meio de dimensões somente teóricas, em dois estudos. Conclusões: Os programas de ensino-aprendizagem, tanto teóricos como teórico-práticos sobre o cuidado com o CVC-LP, direcionados a pacientes oncológicos em quimioterapia endovenosa e/ou seus respectivos cuidadores/familiares, são mais eficazes na prevenção e controle de complicações infecciosas relacionadas a este dispositivo, do que somente o fornecimento de orientações-padrão e/ou cuidados usuais fornecidos pela equipe de saúde
Background: Cancer patients undergoing chemotherapy who use the Long Term Central Venous Catheter (LT-CVC) present inherent risks of clinical complications, including infectious complications, which can lead to higher rates of morbidity and mortality. To ensure the prevention and control of such complications, healthcare professionals can resort to implementing other health education strategies besides the provision of only standardized guidelines or the usual care, such as teaching-learning programs, aimed to cancer patients and/or their respective caregivers/parents, that address handling techniques and proper care of the device. Objective: To evaluate the effectiveness of teaching-learning programs about LT-CVC care, aimed at cancer patients undergoing intravenous chemotherapy and/or their respective caregivers/parents, in the prevention and control of infectious complications related to this device. Method: Systematic review of the literature, reported according to the steps proposed by PRISMA. The search for studies was performed in the electronic databases CINAHL, Cochrane Library, EMBASE, LILACS, MEDLINE via PubMed portal, Scopus and Web of Science. Gray literature was consulted using Google Scholar. Search strategies was formulated and adapted according to the specificities of each information source, containing controlled descriptors and keywords. The selection of eligible studies was performed by two reviewers independently and blindly, take into account previously established eligibility criteria. A third reviewer was consulted to resolve any conflicts. At the end of the selection, a hand search was performed in the references lists of included studies, in order to identify other studies for inclusion. The included studies were carefully analyzed, and submitted to the process of data extraction. After that, the risk of bias of each study was assessed using the RoB 2 and ROBINS-I tools provided by the Cochrane Collaboration. The data obtained were then synthesized only qualitatively, since, due to significant heterogeneity regarding the methodological configurations of the included studies, it was not possible to perform a quantitative synthesis (meta-analysis). Results: Seven studies were considered eligible to compose the present review, being two randomized clinical trials, two non-randomized clinical trials, and three quasi-experimental studies. Four studies were performed with pediatric patients and their caregivers/parents, and three studies were performed with adult patients. The teaching-learning programs implemented for patient and caregivers/parents education on the LT-CVC care were developed through theoretical-practical dimensions, in five studies, and through only theoretical dimensions, in two studies. Conclusions: Teaching-learning programs, both theoretical and theoretical-practical, aimed to cancer patients undergoing intravenous chemotherapy and/or their respective caregivers/parents, are more effective in preventing and controlling infectious complications related to this device, than, only, the provision of standard-orientations and/or usual care provided by the healthcare team
Asunto(s)
Humanos , Educación del Paciente como Asunto , Infecciones Relacionadas con Catéteres/enfermería , Catéteres/normas , Oncología MédicaRESUMEN
Importance: Data regarding upper extremity midline catheter (MC)-related thrombosis (CRT) are sparse, with some evidence indicating that MCs have a high rate of CRT. Objective: To compare 2 MCs with differing antithrombogenic mechanisms for this outcome. Design, Setting, and Participants: In this parallel, 2-arm randomized clinical trial, 496 adult patients hospitalized at a tertiary care suburban academic medical center who received an MC were assessed for eligibility between January 1, 2019, and October 31, 2020, and 212 were randomized. Interventions: Inpatients were randomized to receive a 4F antithrombotic MC (MC-AT) or a 4.5F antithrombotic and antimicrobial MC (MC-AT-AM). Main Outcomes and Measures: The primary outcome was symptomatic midline CRT inclusive of deep vein thrombosis or superficial venous thrombophlebitis within 30 days after insertion. Secondary outcomes included catheter-associated bloodstream infection and catheter failure. Results: A total of 191 patients (mean [SD] age, 60.2 [16.7] years; 114 [59.7%] female) were included in the final analysis: 94 patients in the MC-AT group and 97 in the MC-AT-AM group. Symptomatic midline CRT occurred in 7 patients (7.5%) in the MC-AT group and 11 (11.3%) in the MC-AT-AM group (P = .46). Deep vein thrombosis occurred in 5 patients (5.3%) in the MC-AT group and 5 patients (5.2%) in the MC-AT-AM group (P > .99). Pulmonary embolism occurred in 1 patient in the MC-AT group. No catheter-associated bloodstream infection occurred in either group. Premature catheter failure occurred in 22 patients (23.4%) in the MC-AT group and 20 (20.6%) in the MC-AT-AM group (P = .64). In Cox proportional hazards regression analysis, no statistically significant difference was found between groups for the risk of catheter failure (hazard ratio, 1.27; 95% CI, 0.67-2.43; P = .46). Conclusions and Relevance: No difference was found in thrombosis in MCs with 2 distinct antithrombogenic mechanisms; however, the risk of CRT in both groups was high. Practitioners should strongly consider the safety risks associated with MCs when determining the appropriate vascular access device. Trial Registration: ClinicalTrials.gov Identifier: NCT03725293.
Asunto(s)
Cateterismo Venoso Central/efectos adversos , Cateterismo Periférico/efectos adversos , Catéteres/normas , Trombosis de la Vena/etiología , Adulto , Anciano , Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/estadística & datos numéricos , Cateterismo Periférico/métodos , Cateterismo Periférico/estadística & datos numéricos , Catéteres/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trombosis de la Vena/prevención & controlRESUMEN
Respiratory pressure responses to cervical magnetic stimulation are important measurements in monitoring the mechanical function of the respiratory muscles. Pressures can be measured using balloon catheters or a catheter containing integrated micro-transducers. However, no research has provided a comprehensive analysis of their pressure measurement characteristics. Accordingly, the aim of this study was to provide a comparative analysis of these characteristics in two separate experiments: (1) in vitro with a reference pressure transducer following a controlled pressurization; and (2) in vivo following cervical magnetic stimulations. In vitro the micro-transducer catheter recorded pressure amplitudes and areas which were in closer agreement to the reference pressure transducer than the balloon catheter. In vivo there was a main effect for stimulation power and catheter for esophageal (Pes ), gastric (Pga ), and transdiaphragmatic (Pdi ) pressure amplitudes (p < 0.001) with the micro-transducer catheter recording larger pressure amplitudes. There was a main effect of stimulation power (p < 0.001) and no main effect of catheter for esophageal (p = 0.481), gastric (p = 0.923), and transdiaphragmatic (p = 0.964) pressure areas. At 100% stimulator power agreement between catheters for Pdi amplitude (bias =6.9 cmH2 O and LOA -0.61 to 14.27 cmH2 O) and pressure areas (bias = -0.05 cmH2 O·s and LOA -1.22 to 1.11 cmH2 O·s) were assessed. At 100% stimulator power, and compared to the balloon catheters, the micro-transducer catheter displayed a shorter 10-90% rise time, contraction time, latency, and half-relaxation time, alongside greater maximal rates of change in pressure for esophageal, gastric, and transdiaphragmatic pressure amplitudes (p < 0.05). These results suggest that caution is warranted if comparing pressure amplitude results utilizing different catheter systems, or if micro-transducers are used in clinical settings while applying balloon catheter-derived normative values. However, pressure areas could be used as an alternative point of comparison between catheter systems.
Asunto(s)
Catéteres/efectos adversos , Transductores de Presión/efectos adversos , Adulto , Catéteres/normas , Esófago/fisiología , Femenino , Humanos , Masculino , Manometría/instrumentación , Presión , Pruebas de Función Respiratoria/instrumentación , Músculos Respiratorios/fisiología , Transductores de Presión/normasRESUMEN
INTRODUCTION: The accurate placement of the ventricular catheter (VC) is critical in reducing the incidence of proximal failure of ventriculoperitoneal shunts (VPSs). The standard freehand technique is based on validated external anatomical landmarks but remains associated with a relatively high rate of VC malposition. Already proposed alternative methods have all their specific limitations. Herein, we evaluate the accuracy of our adapted freehand technique based on an individualized radio-anatomical approach. Reproducing the preoperative imaging on the patient's head using common anatomical landmarks allows to define stereotactic VC coordinates to be followed at surgery. MATERIAL AND METHODS: Fifty-five consecutive patients treated with 56 VPS between 11/2005 and 02/2020 fulfilled the inclusion criteria of this retrospective study. Burr hole coordinates, VC trajectory, and length were determined in all cases on preoperative computed tomography (CT) scan and were accurately reported on patients' head. The primary endpoint was to evaluate VC placement accuracy. The secondary endpoint was to evaluate the rate and nature of postoperative VC-related complications. RESULTS: Our new technique was applicable in all patients and no VC-related complications were observed. Postoperative imaging showed VC optimally placed in 85.7% and sub-optimally placed in 14.3% of cases. In all procedures, all the holes on the VC tip were found in the ventricular system. CONCLUSIONS: This simple individualized technique improves the freehand VC placement in VPS surgery, making its accuracy comparable to that of more sophisticated and expensive techniques. Further randomized controlled studies are required to compare our results with those of the other available techniques.
Asunto(s)
Cateterismo/métodos , Ventrículos Cerebrales/anatomía & histología , Neuronavegación/métodos , Derivación Ventriculoperitoneal/métodos , Cateterismo/efectos adversos , Catéteres/normas , Ventrículos Cerebrales/diagnóstico por imagen , Femenino , Humanos , Hidrocefalia/cirugía , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad , Neuronavegación/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Tomografía Computarizada por Rayos X/métodos , Trepanación/efectos adversos , Trepanación/métodos , Derivación Ventriculoperitoneal/efectos adversosRESUMEN
BACKGROUND: The external ventricular drain (EVD) placement is one of the most common neurosurgical procedures. This operation is performed by freehand technique in the majority of cases; therefore, the operator's experience plays an important role in success and possible morbidity of this procedure. OBJECTIVE: To evaluate the accuracy and safety of EVD placement by junior neurosurgery residents and factors predicting accuracy of EVD placement. METHODS: This is a prospective cohort study conducted at our academic medical center, between September 2017 and August 2018. All patients 18 years or older who required EVD placement were included. The accuracy and complications of EVD placement were assessed in the first and second year resident cohorts as well as by their level of experience, using descriptive statistics. Univariate and multivariate models were used to assess predictive factors for optimal EVD. RESULTS: A total of 100 EVDs were placed in 100 patients during the study period. According to Kakarla classification, the catheter was optimally placed in 80% of cases. The first year residents had a significantly higher rate of suboptimal burr hole placement compared to the second year residents (66.7% versus 27.1%, p = 0.004). The trainees with less than 10 EVD placement experience also had a significantly higher rate of suboptimal burr hole placement (55.2% vs. 23.9%, p = 0.003), significantly longer duration of operation (43.1 min ± 14.9SD vs 34.2 min ± 9.6 p = 0.005), and significantly lower rate of optimal EVD location (85.9% versus 65.5%, p = 0.023). Optimal location of the burr hole was the only significant predictor of optimal EVD placement in multivariate analysis (OR 11.9, 95% CI 3.2-44.6, p < 0.001). CONCLUSIONS: Neurosurgery residents experience and optimal burr hole placement are the main predicators of accurate EVD placement.
Asunto(s)
Trepanación/educación , Ventriculostomía/educación , Adulto , Catéteres/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neurocirujanos/educación , Complicaciones Posoperatorias/epidemiología , Trepanación/efectos adversos , Ventriculostomía/efectos adversosRESUMEN
BACKGROUND: Emergency placement of an external ventricular drain (EVD) is one of the most frequently performed neurosurgical procedures. EVD-related infection continues to be a major challenge causing significant morbidity and costs. Bundle approaches have been shown to reduce infection rates; however, they are still not widely used, and observation periods often were rather short. METHODS: The present study evaluated the effect of a multi-item bundle approach for EVD placement and care on the occurrence of EVD-related infection. A before/after approach was used to compare groups of consecutive patients over 5-year epochs to control for bias and secondary confounding variables. RESULTS: The number of patients in the group before implementation of the bundle approach was 141 and 208 thereafter. There were no statistical differences in demographic and other variables. While 41/141 patients (29.1%) had an EVD-related infection before, this was the case in only 10/208 patients (4.8%) thereafter (p < 0.0001). The EVD-related infection rate was reduced from 13.7/1000 catheter days to 3.2/1000, and the 50% probability of an EVD-related infection in correlation to the mean duration of EVD placement was significantly lower (p < 0.0001). Routine EVD replacement was not helpful to reduce EVD-related infection. EVD-related infection rates remained low also over the next 8 years after the study was finished. CONCLUSIONS: The introduction of a multi-item bundle approach for EVD insertion and care resulted in a marked reduction of EVD-related infection. Long observation periods over 5 years and beyond confirm that short-term changes are sustained with continued use of such protocols.
Asunto(s)
Infecciones Relacionadas con Catéteres/epidemiología , Drenaje/métodos , Complicaciones Posoperatorias/epidemiología , Ventriculostomía/métodos , Adulto , Infecciones Relacionadas con Catéteres/etiología , Infecciones Relacionadas con Catéteres/prevención & control , Catéteres/normas , Drenaje/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Ventriculostomía/efectos adversosRESUMEN
OBJECTIVES: In children, intravenous therapy (IVT) is generally administered via peripheral intravenous catheters (PIVCs) (2-6 cm in length). There is evidence that PIVCs are unreliable after 2 days. Long peripheral catheters (LPCs) (6-15 cm in length) could improve the delivery of IVT. The aim of this trial was to determine if LPCs could decrease catheter failure and the number of catheters in children receiving multiday IVT. METHODS: This was an open-label randomized controlled trial conducted at Monash Children's Hospital in Melbourne, Australia. Participants were from the ages of 1 to 17 years, undergoing surgery and requiring >48 hours of postoperative IVT. Participants were randomly assigned to a 2.5-cm 22G PIVC or an 8-cm 22G LPC. RESULTS: Seventy-two children were randomly assigned, 36 received PIVCs, and 36 received LPCs. The median duration of IVT was 5.1 days and was similar between groups (P = .9). Catheter failure was higher for PIVCs than LPCs (66.7% vs 19.4%; relative risk [RR]: 3.4; P = .0001 or 187.9 vs 41.0 failures per 1000 catheter-days). Infiltration was the most common reason for PIVC failure (33.3% vs 2.8%; RR: 12.0; P = .001). LPCs exhibited superior life span (4.7 vs 3.5 days [median]; P = .01). Children with LPCs were twice as likely to complete therapy with a single catheter (80.6% vs 38.9%; RR: 2.1; P = .0006). CONCLUSIONS: LPCs reduce catheter failure and total catheters in children. They should be considered as the first-line device for peripheral access in any child receiving prolonged IVT.
Asunto(s)
Administración Intravenosa/instrumentación , Administración Intravenosa/normas , Cateterismo Periférico/instrumentación , Cateterismo Periférico/normas , Catéteres de Permanencia/normas , Administración Intravenosa/economía , Adolescente , Cateterismo Periférico/economía , Catéteres/economía , Catéteres/normas , Catéteres de Permanencia/economía , Niño , Preescolar , Remoción de Dispositivos/economía , Remoción de Dispositivos/normas , Esquema de Medicación , Femenino , Humanos , Lactante , MasculinoRESUMEN
AIM: This study aims to evaluate the intracorporeal pressures immediately after the insertion of the catheters for urodynamic testing with a water-filled urodynamic pressure transducer system to determine the relevance of the International Continence Society (ICS) zeroing principles. METHODS: Here, a retrospective analysis of a random series of urodynamic recordings is performed. The initial pressures, immediately after the insertion of the catheters, have been compared with the pressures after some milliliters of filling and flushing away of the gel, used with insertion, and/or the mucus and debris from the inserted catheters. Differences of initially recorded intravesical and intrarectal pressures from those after flushing and filling are analyzed and associated with the ICS standard practice of zeroing. RESULTS: Statistically and clinically significant differences between the initial pressures and the pressures after filling and flushing are observed, with nonphysiological initial pressures in 62% of the studies. Some filling (20 ml or more in the bladder) and flushing of the pressure channels resulted in the registration of physiological pressures and synchronous response from both lines on abdominal pressure increases. CONCLUSIONS: The pressure signal quality of a water-filled urodynamic system immediately after catheter insertion is low with inaccurately displayed pressure values, but it changes to normal after flushing the pressure channels and some filling. Rezeroing of the intracorporeal pressures immediately after catheter insertion for cystometry is the inappropriate correction procedure that misleadingly modifies the false initial pressures, resulting in ongoing unrealistic urodynamic study pressures.
Asunto(s)
Catéteres/normas , Transductores de Presión/normas , Transductores/normas , Enfermedades de la Vejiga Urinaria/cirugía , Urodinámica/fisiología , Agua/química , Femenino , Humanos , Estudios Retrospectivos , Cateterismo Urinario/métodosRESUMEN
BACKGROUND: Accurate ventricular catheter (VC) placement plays an important role in reducing the risk of ventriculoperitoneal shunt failure. Free-hand VC insertion is associated with a significant misplacement rate. Consequently, several expensive alternative methods that are unfortunately not available worldwide have been used. To overcome these limitations, we developed a simple surgical technique based on radio-anatomical landmarks aimed at reducing VC's misplacements. METHOD: We reproduce the preoperative imaging on the patient's head using common anatomical landmarks. This allows defining stereotactic VC coordinates to be followed during the surgical procedure. CONCLUSION: This simple and cost-effective method improves VC insertion accuracy.
Asunto(s)
Complicaciones Posoperatorias/prevención & control , Derivación Ventriculoperitoneal/métodos , Cateterismo/instrumentación , Cateterismo/métodos , Catéteres/efectos adversos , Catéteres/normas , Femenino , Humanos , Hidrocefalia/cirugía , Masculino , Complicaciones Posoperatorias/etiología , Técnicas Estereotáxicas/efectos adversos , Derivación Ventriculoperitoneal/efectos adversos , Derivación Ventriculoperitoneal/instrumentaciónRESUMEN
A system for sorbent-assisted peritoneal dialysis (SAPD) has been developed that continuously recirculates dialysate via a tidal mode using a single-lumen peritoneal catheter with the regeneration of spent dialysate by means of sorbents. SAPD treatment may improve plasma clearance by the maintenance of a high plasma-to-dialysate concentration gradient and by increasing the mass transfer area coefficient (MTAC) of solutes. The system is designed for daily 8-hr treatment (12 kg, nighttime system). A wearable system (2.3 kg, daytime system) may further enhance the clearance of phosphate and organic waste solutes during the day. Uremic pigs (n = 3) were treated with the day- (n = 3) and nighttime system (n = 15) for 4-8 hr per treatment. Plasma clearance (Cl), MTAC, and total mass transport (MT) of urea, creatinine, phosphate, and potassium were compared with a static dwell (n = 28). Cl, MTAC, and MT of urea, creatinine, phosphate, and potassium were low in the pig as compared to humans due to the pig's low peritoneal transport status and could be enhanced only to a limited extent by SAPD treatment compared with a static dwell (nighttime system: Cl urea: ×1.5 (p = .029), Cl creatinine: ×1.7 (p = .054), Cl phosphate: ×1.5 (p = .158), Cl potassium: ×1.6 (p = .011); daytime system: Cl creatinine: ×2.7 (p = .040), Cl phosphate: ×2.2 (p = .039)). Sorbent-assisted peritoneal dialysis treatment in a uremic pig model is safe and enhances small solute clearance as compared to a static dwell. Future studies in humans or animal species with higher peritoneal transport should elucidate whether our SAPD system enhances clearance to a clinically relevant extent as compared to conventional PD.
Asunto(s)
Diálisis Peritoneal/métodos , Uremia/terapia , Animales , Resinas de Intercambio Aniónico/química , Resinas de Intercambio Aniónico/normas , Catéteres/normas , Cloruros/sangre , Cloruros/orina , Creatinina/orina , Femenino , Diálisis Peritoneal/instrumentación , Fosfatos/sangre , Fosfatos/orina , Potasio/sangre , Potasio/orina , Porcinos , Urea/sangre , Urea/orinaRESUMEN
We performed the midpoint transverse process to pleura (MTP) block in a patient with a recurrent pleural effusion requiring medical thoracoscopy, drainage of pleural effusion, talc poudrage, and placement of tunneled pleural catheter under sedation while in the left lateral decubitus position. Forty milliliters of a combination of bupivacaine hydrochloride and lidocaine, with dexamethasone and clonidine as adjuvants, was injected at the T6 level under ultrasound guidance with satisfactory intra- and postoperative analgesia.
Asunto(s)
Neoplasias de la Mama/secundario , Pleura/inervación , Derrame Pleural/cirugía , Toracoscopía/métodos , Neoplasias de la Mama/complicaciones , Catéteres/normas , Drenaje/métodos , Femenino , Humanos , Persona de Mediana Edad , Bloqueo Nervioso/instrumentación , Pleura/efectos de los fármacos , Pleura/patología , Derrame Pleural/etiología , Talco/administración & dosificación , Resultado del Tratamiento , Ultrasonografía Intervencional/métodosAsunto(s)
Fístula Bronquial/patología , Fístula Bronquial/cirugía , Broncoscopía/instrumentación , Enfermedades Pleurales/patología , Enfermedades Pleurales/cirugía , Adulto , Cuidados Posteriores , Anciano , Anciano de 80 o más Años , Fístula Bronquial/diagnóstico por imagen , Broncoscopía/métodos , Catéteres/normas , Femenino , Fluoroscopía/métodos , Fragilidad , Humanos , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Enfermedades Pleurales/diagnóstico por imagen , Neumonectomía/efectos adversos , Dispositivo Oclusor Septal , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Collection of HPC by apheresis requires adequate venous access for inflow and for outflow. The use of midline has never been reported in this setting. We prospectively analyzed the use of midline for performing apheresis on 3 healthy donors and 3 adults patients requiring autologous transplantation. A total of 8 polyurethane midlines, with an external diameter of 5 French, was inserted (2 midlines in both arms in 2 healthy donors) by our PICC team the day before apheresis and removed at the end of target collection. Mean flow rate was 35 ml/min. Target cellular dose was reached in all patients / donors with a maximum of 2 procedures without any complications. Midline is effective and safe for HPC collection either in donors or patients avoiding the placement of a central venous catheter.
Asunto(s)
Eliminación de Componentes Sanguíneos/métodos , Catéteres/normas , Trasplante de Células Madre Hematopoyéticas/métodos , Acondicionamiento Pretrasplante/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Donantes de TejidosRESUMEN
The study goals were to determine if intraosseous (IO) catheters can be placed with greater success into the humerus, femur, or tibia of cadaver rabbits, and to evaluate the accuracy of perceived success (PS) and objective clinical success (OCS) criteria against true intramedullary catheterization confirmed by fluoroscopy. This was a prospective study utilizing 12 rabbit cadavers. Twenty-two participants attempted IO catheter placement at 3 sites. Perceived success, OCS, and fluoroscopic true success (FTS) were recorded. A Fisher's exact test was used to compare PS, OCS, and FTS, and FTS rates between sites (P < 0.05). A Wilcoxon test was used to compare speed of placement (P < 0.05). Overall, of 66 attempts, PS was reported in 86.4%, OCS was documented in 62.1%, FTS was confirmed in 43.9%. Perceived success and OCS overestimated FTS (P ≤ 0.01 and P = 0.027, respectively). Confirmation of FTS occurred in 10/22 (45.5%) humeral, 5/22 (22.7%) femoral, and 14/22 (63.6%) tibial (P = 0.03) attempts. Median time until placement for the humerus was 37.5 seconds (range: 15 to 125 seconds); the femur 135 seconds (range: 91 to 148 seconds); the tibia 49 seconds (range: 19 to 150 seconds). The humerus and tibia were faster to catheterize than the femur (P = 0.01 and 0.03, respectively). Participant PS and OCS criteria overestimated FTS. The humerus or tibia may be more successful and are faster to catheterize.
Les objectifs de la présente étude étaient de déterminer si des cathéters intra-osseux (IO) peuvent être placés avec plus de succès dans l'humérus, le fémur ou le tibia de cadavres de lapins, et d'évaluer la précision des critères du succès perçu (PS) et du succès clinique objectif (OCS) versus le cathétérisme intramédullaire réel confirmé par fluoroscopie. Il s'agissait d'une étude prospective utilisant 12 cadavres de lapin. Vingt-deux participants ont tenté le placement des cathéters IO aux trois sites. Le PS, l'OCS et le succès réel par fluoroscopie (FTS) furent notés. Un test exact de Fisher fut utilisé pour comparer PS, OCS, et FTS, et les taux de FTS entre les sites (P < 0,05). Un test de Wilcoxon a été utilisé pour comparer la vitesse de placement (P < 0,05). Globalement, des 66 essais, PS a été rapporté dans 86,4 % des cas, OCS a été documenté dans 62,1 % des cas, et FTS a été confirmé dans 43,9 % des cas. Le PS et l'OCS surestimaient le FTS (P ≤ 0,01 et P = 0,027, respectivement). La confirmation de FTS s'est produite dans 10/22 (45,5 %) des essais sur l'humérus, 5/22 (22,7 %) des essais sur le fémur, et 14/22 (63,6 %) des essais sur le tibia (P = 0,03).Le temps médian du placement pour l'humérus était de 37,5 secondes (écart : 15 à 125 secondes); pour le fémur de 135 secondes (écart : 91 à 148 secondes); et pour le tibia de 49 secondes (écart : 19 à 150 secondes). Le cathétérisme de l'humérus et du tibia étaient plus rapides que celui du fémur (P = 0,01 et 0,03, respectivement). Les critères pour le PS et l'OCS des participants surestimaient le FTS. L'humérus et le tibia sont plus rapides à cathétériser et le taux de succès est meilleur.(Traduit par Docteur Serge Messier).
Asunto(s)
Catéteres/veterinaria , Fémur/cirugía , Húmero/cirugía , Conejos/cirugía , Tibia/cirugía , Animales , Cadáver , Catéteres/clasificación , Catéteres/normas , Fémur/diagnóstico por imagen , Húmero/diagnóstico por imagen , Infusiones Intraóseas/veterinaria , Tibia/diagnóstico por imagen , Factores de Tiempo , Dispositivos de Acceso Vascular/veterinariaRESUMEN
OBJECTIVE: To introduce a rapid and simple technique to engage and localize through left common carotid (LCCA) artery during selective carotid angiography using the same type of catheter (6F Medtronic™/launcher Judkins Right Guide Catheter, 4.0 Tip,2 Side holes, U.S.A.). METHODS: Patients were divided into two groups as new method and conventional method group including 295 and 292 prior to carotid angiography, respectively. The primary endpoints of this study included an analysis of total procedure time, time required for cannulation of left common carotid artery, fluoroscopy time and selective imaging success for left common carotid artery, feasibility, safety, amount of radio opaque agent and radiation exposure. RESULTS: Our novel method applied using a single catheter shortened total procedure time (5.41 ± 1.56 min. vs. 7.52 ± 2.48 min., respectively, p<0.001), fluoroscopy time (98 ± 9 sec. vs. 210 ± 19 sec., respectively, p<0.001), duration of left carotid artery cannulation (15 ± 1.2 sec vs. 42 ± 1.9 sec, respectively, p< 0.001). Use of our method reduced radiation exposure (120 ± 17 mGy vs. 217 ± 11 mGy, respectively, p<0.001), amount of contrast agent (44.99 ± 12.84 ml vs. 59.89 ± 18.93 ml, respectively, p<0.001). Aortic arch angiography was not needed in the first group compared with the conventional method group (0% vs. 29%, respectively, p<0.001). Also a higher success was achieved in cannulation of left common carotid artery using an identical catheter compared with application of conventional methods requiring use of different types of catheter (100% vs. 60%, respectively, p<0.001). No major complication and mortality was found due to use of both methods. However, a statistically insignificant elevation in minor complication was encountered in the patient group who underwent coronary angiography by the conventional method (3% vs. 7%, respectively, p<0.064). CONCLUSIONS: This new method is more easily applicable with a shorter duration for cannulation and localization of LCCA, safer for the patients with use of a limited amount of radio-opaque agent and finally cost-effective by requiring only one type of catheter and a limited.
Asunto(s)
Cateterismo Cardíaco/métodos , Arterias Carótidas/diagnóstico por imagen , Catéteres/normas , Medios de Contraste/normas , Angiografía Coronaria/métodos , Fluoroscopía/métodos , Arteria Radial/diagnóstico por imagen , Anciano , Cateterismo , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: The use of peripheral venous catheters (PVCs) is hampered by short dwell time, and central venous catheters (CVCs) are often preferred for medium- to long-time intravenous treatment. Ultrasound techniques allow for easy catheter insertion into the major veins of the upper arm. A new generation of midline catheters, PowerGlide Pro, utilises a one-hand Seldinger technique and can be inserted by one single operator without assistance. This study aimed to evaluate the clinical performance of the PowerGlide Pro midline catheter. METHODS: Consecutively inserted midline catheters were followed in a prospective, observational quality control study. Endpoints were dwell time, the incidence of premature catheter removal, causes of catheter removal and the dwell time and incidence rates of predefined subgroups representing potential effect modifiers. RESULTS: Hundred midline catheters, of which 98 were accessible to follow-up, were inserted in 70 patients. Median dwell time was 8 days and 60 catheters were removed before the indication for intravenous therapy had ceased. The overall incidence for premature catheter removal was 71.8/1000 days and no significant effects of subgroups (sex, body mass index, catheter reinsertions, significant comorbidity, anticoagulant therapy, irritant infusions) were identified for either dwell time or the incidence rate for premature midline catheter removal. The most frequent reasons for premature catheter removal were pain during infusion, clotted catheter or signs of infection. CONCLUSION: The median dwell time of the midline catheters was 8 days with substantial variation, whereas the incidence for premature catheter removal was 71.8/1000 catheter days. The majority of midline catheters were removed prematurely.
Asunto(s)
Cateterismo/instrumentación , Catéteres/normas , Dinamarca , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , TiempoRESUMEN
BACKGROUND: Endovascular thrombectomy is currently the standard of care for acute ischemic stroke (AIS). Although earlier trials on endovascular thrombectomy were performed using stent retrievers, recently completed the contact aspiration vs stent retriever for successful revascularization (ASTER) and a comparison of direct aspiration versus stent retriever as a first approach (COMPASS) trials have shown the noninferiority of direct aspiration. OBJECTIVE: To report the largest experience with ADAPT thrombectomy and compare the impact of advancement in reperfusion catheter technologies on outcomes. METHODS: We reviewed a retrospective database of AIS patients who underwent ADAPT thrombectomy between January 2013 and November 2017 at the Medical University of South Carolina. Demographics and baseline characteristics, technical variables, and radiological and clinical outcomes were reviewed. RESULTS: Among 510 patients (mean age: 67.7, 50.6% females), successful recanalization at first pass was achieved in 61.8%, and with aspiration only in 77.5%. Mean procedure time was 27.4 min, and the rate of good outcomes (mRS 0-2) at 90 d was 42.9%. The rate of recanalization with aspiration only was significantly higher, and procedure time was significantly lower in patients treated with larger catheters (ACE 064 and ACE 068) compared to smaller catheters (5 MAX and ACE, P < .05). There were no differences in complication rates or postoperative parenchymal hemorrhage across groups (P > .05); however, use of ACE 068 was an independent predictor of good outcomes at 90 d on multivariate regression analysis (odds ratio = 1.6, P < .05). CONCLUSION: Refinement of ADAPT thrombectomy by incorporating reperfusion catheters with higher inner diameters and thus higher aspiration forces is associated with better outcomes, shorter procedure times, and lower likelihood of using additional devices without impacting complication rates.
Asunto(s)
Isquemia Encefálica/cirugía , Catéteres , Paracentesis/métodos , Stents , Accidente Cerebrovascular/cirugía , Trombectomía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico por imagen , Catéteres/normas , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Paracentesis/instrumentación , Paracentesis/normas , Estudios Prospectivos , Estudios Retrospectivos , Stents/normas , Accidente Cerebrovascular/diagnóstico por imagen , Trombectomía/instrumentación , Trombectomía/normas , Resultado del Tratamiento , Adulto JovenRESUMEN
Abdominal compartment syndrome is an emergent condition caused by increased pressure within the abdominal compartment. It can be caused by a number of etiologies, which are associated with decreased abdominal wall compliance, increased intraluminal or intraperitoneal contents, or edema from capillary leak or fluid resuscitation. The history and physical examination are of limited utility, and the criterion standard for diagnosis is intra-abdominal pressure measurement, which is typically performed via an intravesical catheter. Management includes increasing abdominal wall compliance, evacuating gastrointestinal or intraperitoneal contents, avoiding excessive fluid resuscitation, and decompressive laparotomy in select cases.
Asunto(s)
Síndromes Compartimentales/epidemiología , Síndromes Compartimentales/terapia , Fluidoterapia/efectos adversos , Hipertensión Intraabdominal/complicaciones , Pared Abdominal/fisiopatología , Administración Intravesical , Catéteres/normas , Niño , Síndromes Compartimentales/mortalidad , Síndromes Compartimentales/fisiopatología , Descompresión Quirúrgica/efectos adversos , Drenaje/métodos , Humanos , Incidencia , Hipertensión Intraabdominal/diagnóstico , Laparotomía/métodos , Mortalidad/tendencias , Pediatras/estadística & datos numéricos , Factores de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: Antibiotic-impregnated external ventricular drains (AI-EVDs) have a debated efficacy in clinical studies. OBJECTIVES: Our aim was to assess the durability of antimicrobial activity of AI-EVDs used in clinical settings. METHODS: From April 2017 to January 2018, all consecutive AI-EVDs (Bactiseal™) inserted in adult patients were prospectively included. After removal, each AI-EVD was cultured and assessed for antimicrobial activity on both internal and external sides of AI-EVDs. Catheters were each challenged with a single Staphylococcus strain [MSSA, MRSA or methicillin-resistant Staphylococcus epidermidis (MRSE)]. MS was used to measure residual concentrations of rifampicin and clindamycin. RESULTS: Sixty-five AI-EVDs were included (56 patients). Among these, 21 were challenged with MSSA, 23 with MRSA and 21 with MRSE. Five ventriculostomy-related colonizations (9%) and two ventriculostomy-related infections (4%) occurred. Staphylococcus was the main bacterium responsible for colonization (4/5). AI-EVD inhibition decreased significantly against MRSA and MRSE according to duration of catheterization (for external and internal sides, Pâ<â0.02) and overall volume of CSF drained (Pâ<â0.005 for both sides against MRSE, Pâ<â0.005 for external side against MRSA), but not against MSSA. Clindamycin concentration was not correlated with duration of catheterization or CSF volume drained, but <20% of initial concentration was recovered even after 5 days of AI-EVD dwelling. Conversely, rifampicin concentration showed a rapid and significant decline correlated to duration and CSF volume (Pâ<â0.001 and Pâ=â0.03, respectively). CONCLUSIONS: Antimicrobial activity of AI-EVDs dropped quickly in vivo. Antimicrobial impregnation did not prevent AI-EVD colonization by susceptible strains in 9% of the cases.