RESUMEN
Objective of the present study was to investigate the effects of peripherally inserted central catheter (PICC) parenteral nutrition support on immune function and nutritional support in patients undergoing radical gastrectomy for gastric cancer. 140 patients who underwent radical gastrectomy for gastric cancer were selected as participants and were divided into study group and the control group by random number table, with 70 cases in each group. Patients in the two groups underwent standard gastrectomy under general anesthesia by the same group of doctors. The study group received postoperative PICC catheter parenteral nutrition, and the control group received central venous catheter (CVC) nutrition support. Comparative study was done using t test and Chi-square test. The serum levels of ALB, TFN, PA, Hb, CD4+, CD8+, CD4+/CD8+, IgA, IgG, IgM and CD3+ in the two groups were observed before and after treatment, and the postoperative complications of the two groups were compared. After treatment, the levels of ALB, TFN, PA and Hb in the two groups were significantly increased (P<0.05). Levels of CD3+, CD4+, CD4+/CD8+, IgA, IgG and IgM also amplified significantly after treatment in both the groups, while CD8+ decreased significantly (P<0.05). What's more, the improvement degree of the study group was significantly greater than that of the control group (P<0.05). The time of drawing drainage tube, recovering intestinal function, getting off bed and the length of hospital stay in the study group were significantly shorter than those in the control group (P<0.05). The incidence of postoperative complications in the study group and control group were 8.6% (6/70 cases) and 11.4% (8/70 cases) respectively, and there was no significant difference (P>0.05). PICC catheter parenteral nutrition support and improve the nutritional status of patients, it was proved a safe and effective nutritional support which improve the cellular immune function and accelerated the recovery of gastrointestinal function.
Asunto(s)
Nutrición Parenteral/métodos , Complicaciones Posoperatorias/prevención & control , Neoplasias Gástricas/cirugía , Dispositivos de Acceso Vascular , Anciano , Antígenos de Diferenciación de Linfocitos T/sangre , Catéteres Venosos Centrales , Femenino , Gastrectomía , Humanos , Isotipos de Inmunoglobulinas/sangre , Masculino , Persona de Mediana Edad , Nutrición Parenteral/instrumentación , Complicaciones Posoperatorias/dietoterapia , Complicaciones Posoperatorias/inmunología , Resultado del TratamientoRESUMEN
BACKGROUND: Parenteral nutrition for intestinal failure (IF) often requires a tunneled central venous catheter (CVC). The purpose of this study was to characterize complications after CVC placement and contributors to line loss in pediatric IF patients. METHODS: An institutional review board-approved retrospective review of pediatric (<18 y) IF patients who had a silicone tunneled CVC newly inserted or exchanged from 2012 to 2016 in an IF center was conducted. Patient demographics, procedure service (surgery versus interventional radiology), procedure type (new versus exchange), vessel, and complications related to CVCs were evaluated. Complications included dislodgement, infection, break, occlusion/malfunction, and others. An ethanol-lock protocol for silicone CVCs in IF patients was instituted in January 2012. RESULTS: Twenty-nine IF patients with tunneled CVCs were identified with 182 lines and 18,534 line d. Median age at line insertion was 17.1 mo (interquartile range [IQR] 7.6-31.5) with a median of five catheters (IQR 2-8) per patient. There were 19.2 complications per 1000 line d. Occlusions/malfunctions were the most common complication (6.0/1000 line d) followed by breaks (5.6/1000 line d). Median life of catheters was 51.5 d (IQR 21-129). On regression, adjusting for age, insertion service, and procedure type, shorter line life was associated with younger age (P = 0.04) and placement by interventional radiology (P < 0.01). Dislodgement was associated with newly placed lines relative risk 6.5 (95% CI 2.2-28.8). CONCLUSIONS: CVCs in pediatric IF patients have frequent complications and short line lifetimes. Dislodgement of CVC was an unexpectedly common complication with loss of access in newly placed lines. There may be modifiable processes to mitigate CVC complications.
Asunto(s)
Infecciones Relacionadas con Catéteres/etiología , Catéteres Venosos Centrales , Falla de Equipo/estadística & datos numéricos , Enfermedades Intestinales/terapia , Nutrición Parenteral/instrumentación , Adolescente , Infecciones Relacionadas con Catéteres/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Nutrición Parenteral/efectos adversos , Nutrición Parenteral/métodos , Análisis de Regresión , Estudios Retrospectivos , Factores de RiesgoAsunto(s)
Cateterismo Venoso Central , Cateterismo Periférico , Nutrición Enteral , Gastrostomía , Yeyunostomía , Nutrición Parenteral , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/instrumentación , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/instrumentación , Catéteres de Permanencia , Catéteres Venosos Centrales , Nutrición Enteral/efectos adversos , Nutrición Enteral/instrumentación , Gastrostomía/efectos adversos , Gastrostomía/instrumentación , Humanos , Yeyunostomía/efectos adversos , Yeyunostomía/instrumentación , Nutrición Parenteral/efectos adversos , Nutrición Parenteral/instrumentación , Factores de Tiempo , Resultado del TratamientoRESUMEN
CLINICAL QUESTION: Is parenteral nutrition via peripherally inserted central catheters (PICCs) associated with better delivery of nutrition and growth and fewer adverse events compared with short peripheral cannulas in neonates? BOTTOM LINE: Compared with short peripheral cannulas, parenteral nutrition via PICCs is associated with better nutrient delivery and lower rates of subsequent catheters or cannulas placed and is not associated with increased rates of invasive infection.
Asunto(s)
Cateterismo Venoso Central/instrumentación , Cateterismo Periférico/instrumentación , Recién Nacido , Nutrición Parenteral/instrumentación , HumanosRESUMEN
BACKGROUND: Small studies suggest differences in efficacy and safety exist between olive oil-based (OLIVE) and soybean oil-based (SOYBEAN) parenteral nutrition regimens in hospitalized adult patients. This large, prospective, randomized (1:1), open-label, multi-center, noninferiority study compared the delivery, efficacy, and safety of OLIVE (N = 226) with SOYBEAN (N = 232) in Chinese adults (≥18 years) admitted to a surgical service for whom parenteral nutrition was required. METHODS: Treatments were administered for a minimum of 5 days up to 14 days (to achieve approximately 25 kcal/kg/day, 0.9 g/kg/day amino acids, 0.8 g/kg/day lipid). Impact of treatment on anabolic/catabolic and serum inflammatory, chemistry, and hematological markers, safety, and ease of use were assessed. The primary efficacy variable was serum prealbumin level at Day 5. RESULTS: OLIVE (n = 219) was not inferior to SOYBEAN (n = 224) based on the prealbumin least square geometric mean [LSGM] ratio [95% CI] 1.12 [1.06, 1.19]; P = 0.002), improved the anabolic/catabolic status of patients enrolled in the study, and was well tolerated compared with SOYBEAN. Improved anabolic status was supported by significantly higher levels of prealbumin at Day 5, albumin at Day 5 and IGF-1 at Day 14 in the OLIVE group, while catabolism was similar between groups. C-reactive protein, intercellular adhesion molecule-1, procalcitonin, and oxidation were similar in each group, but infections were significantly lower with OLIVE (3.6% versus 10.4%; P < 0.01). CONCLUSIONS: OLIVE provided effective nutrition, was well tolerated, was associated with fewer infections, and conferred greater ease-of-use than SOYBEAN. TRIAL REGISTRATION: NTC 01579097.
Asunto(s)
Emulsiones Grasas Intravenosas/uso terapéutico , Aceite de Oliva/uso terapéutico , Nutrición Parenteral/instrumentación , Nutrición Parenteral/métodos , China , Emulsiones Grasas Intravenosas/administración & dosificación , Emulsiones Grasas Intravenosas/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aceite de Oliva/administración & dosificación , Aceite de Oliva/efectos adversos , Estudios Prospectivos , Aceite de Soja/efectos adversos , Aceite de Soja/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: Neonatal parenteral nutrition may be delivered via peripheral cannulas or central venous catheters (umbilical or percutaneous). As the result of complications associated with umbilical catheters, many neonatal units prefer to use percutaneous catheters after initial stabilisation. Although they can be difficult to place, these catheters may be more stable than peripheral cannulae and require less frequent replacement. These delivery methods may be associated with different risks of adverse events, including acquired invasive infection and extravasation injury. OBJECTIVES: To determine the effects of infusion of parenteral nutrition via percutaneous central venous catheters versus peripheral cannulae on nutrient input, growth and development and complications among hospitalised neonates receiving parenteral nutrition in terms of adverse consequences such as bacteraemia or invasive fungal infection, cardiac tamponade or other extravasation injuries. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 5), MEDLINE (1966 to June 2015) and EMBASE (1980 to June 2015), as well as conference proceedings and previous reviews. SELECTION CRITERIA: Randomised controlled trials that compared delivery of intravenous fluids (primarily parenteral nutrition) via percutaneous central venous catheters versus peripheral cannulae in hospitalised neonates. DATA COLLECTION AND ANALYSIS: We extracted data using standard methods of the Cochrane Neonatal Group, with separate evaluation of trial quality and data extraction by two review authors. MAIN RESULTS: We found six trials recruiting a total of 549 infants. One trial showed that use of a percutaneous central venous catheter was associated with a smaller deficit between prescribed and actual nutrient intake during the trial period (mean difference (MD) -7.1%, 95% confidence interval (CI) -11.02 to -3.2). Infants in the percutaneous central venous catheter group needed significantly fewer catheters/cannulae (MD -4.3, 95% CI -5.24, -3.43). Meta-analysis of data from all trials revealed no evidence of an effect on the incidence of invasive infection (typical risk ratio (RR) 0.95, 95% CI 0.72 to 1.25; typical risk difference (RD) -0.01, 95% CI -0.08 to 0.06). AUTHORS' CONCLUSIONS: Data from one small trial suggest that use of percutaneous central venous catheters to deliver parenteral nutrition increases nutrient input. The significance of this in relation to long-term growth and developmental outcomes is unclear. Three trials suggest that use of percutaneous central venous catheters decreases the number of catheters/cannulae needed to deliver nutrition. No evidence suggests that percutaneous central venous catheter use increases risks of adverse events, particularly invasive infection, although none of the included trials was large enough to rule out an effect on uncommon severe adverse events such as pericardial effusion.
Asunto(s)
Cateterismo Venoso Central/instrumentación , Cateterismo Periférico/instrumentación , Recién Nacido , Nutrición Parenteral/instrumentación , Cateterismo Venoso Central/efectos adversos , Cateterismo Periférico/efectos adversos , Extravasación de Materiales Terapéuticos y Diagnósticos/etiología , Humanos , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Nutrición Parenteral/efectos adversos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Nutrition science continues to flourish, building on recent advances in genetics, bioengineering, and technological Sciences. The article presents the main directions of modern nutrition and the prospects for its development in the multidisciplinary hospital.
Asunto(s)
Catéteres , Materiales Biocompatibles Revestidos , Nutrición Enteral , Nutrición Parenteral , Nutrición Enteral/instrumentación , Nutrición Enteral/métodos , Femenino , Humanos , Enfermedades Intestinales/terapia , Masculino , Nutrición Parenteral/instrumentación , Nutrición Parenteral/métodosRESUMEN
The article deals with results of the first Russian national observational study of nutritional support in children in the ICU. We assessed a frequency of use of enteral and parenteral nutrition and analyzed preparations for enteral and parenteral nutrition. The article discusses methods of the calculation of malnutrition in children in critical states.
Asunto(s)
Nutrición Enteral/métodos , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Nutrición Parenteral/métodos , Adolescente , Niño , Preescolar , Ingestión de Energía/fisiología , Metabolismo Energético/fisiología , Nutrición Enteral/instrumentación , Nutrición Enteral/estadística & datos numéricos , Humanos , Lactante , Nutrición Parenteral/instrumentación , Nutrición Parenteral/estadística & datos numéricos , Federación de RusiaRESUMEN
BACKGROUND: The tubing (administration set) attached to both venous and arterial catheters may contribute to bacteraemia and other infections. The rate of infection may be increased or decreased by routine replacement of administration sets. This review was originally published in 2005 and was updated in 2012. OBJECTIVES: The objective of this review was to identify any relationship between the frequency with which administration sets are replaced and rates of microbial colonization, infection and death. SEARCH METHODS: We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 6), MEDLINE (1950 to June 2012), CINAHL (1982 to June 2012), EMBASE (1980 to June 2012), reference lists of identified trials and bibliographies of published reviews. The original search was performed in February 2004. We also contacted researchers in the field. We applied no language restriction. SELECTION CRITERIA: We included all randomized or controlled clinical trials on the frequency of venous or arterial catheter administration set replacement in hospitalized participants. DATA COLLECTION AND ANALYSIS: Two review authors assessed all potentially relevant studies. We resolved disagreements between the two review authors by discussion with a third review author. We collected data for seven outcomes: catheter-related infection; infusate-related infection; infusate microbial colonization; catheter microbial colonization; all-cause bloodstream infection; mortality; and cost. We pooled results from studies that compared different frequencies of administration set replacement, for instance, we pooled studies that compared replacement ≥ every 96 hours versus every 72 hours with studies that compared replacement ≥ every 48 hours versus every 24 hours. MAIN RESULTS: We identified 26 studies for this updated review, 10 of which we excluded; six did not fulfil the inclusion criteria and four did not report usable data. We extracted data from the remaining 18 references (16 studies) with 5001 participants: study designs included neonate and adult populations, arterial and venous administration sets, parenteral nutrition, lipid emulsions and crystalloid infusions. Most studies were at moderate to high risk of bias or did not adequately describe the methods that they used to minimize bias. All included trials were unable to blind personnel because of the nature of the intervention.No evidence was found for differences in catheter-related or infusate-related bacteraemia or fungaemia with more frequent administration set replacement overall or at any time interval comparison (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.67 to 1.69; RR 0.67, 95% CI 0.27 to 1.70). Infrequent administration set replacement reduced the rate of bloodstream infection (RR 0.73, 95% CI 0.54 to 0.98). No evidence revealed differences in catheter colonization or infusate colonization with more frequent administration set replacement (RR 1.08, 95% CI 0.94 to 1.24; RR 1.15, 95% CI 0.70 to 1.86, respectively). Borderline evidence suggested that infrequent administration set replacement increased the mortality rate only within the neonatal population (RR 1.84, 95% CI 1.00 to 3.36). No evidence revealed interactions between the (lack of) effects of frequency of administration set replacement and the subgroups analysed: parenteral nutrition and/or fat emulsions versus infusates not involving parenteral nutrition or fat emulsions; adult versus neonatal participants; and arterial versus venous catheters. AUTHORS' CONCLUSIONS: Some evidence indicates that administration sets that do not contain lipids, blood or blood products may be left in place for intervals of up to 96 hours without increasing the risk of infection. Other evidence suggests that mortality increased within the neonatal population with infrequent administration set replacement. However, much the evidence obtained was derived from studies of low to moderate quality.
Asunto(s)
Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Catéteres de Permanencia/estadística & datos numéricos , Remoción de Dispositivos/estadística & datos numéricos , Infusiones Intravenosas/instrumentación , Nutrición Parenteral/instrumentación , Adulto , Sangre , Infecciones Relacionadas con Catéteres/mortalidad , Cateterismo Venoso Central/instrumentación , Remoción de Dispositivos/normas , Humanos , Recién Nacido , Lípidos , Factores de TiempoRESUMEN
AIM: To evaluate the feeding behaviour and performance of preterm neonates receiving feeds by paladai (a small beaked receptacle). METHODS: We enrolled stable neonates - 10 each in 28-30 weeks [group I] and 31-32 weeks gestation [group II], and offered them paladai feeds. We recorded the feeding sessions on alternate days until they were on full enteral feeds. The outcome variables were (1) feeding behaviour, as assessed by changes in states of wakefulness, oromotor functions and coordination between breathing and swallowing; (2) feeding performance, as assessed by proficiency and efficiency. RESULTS: A total of 47 and 27 sessions were studied in groups I and II, respectively. The median postconceptional age (PCA) at start of paladai feeding was 30 (range, 29-32) and 32 (31-32) weeks in the two groups. The infants accepted paladai feedings in all behavioural states. Incoordination between feeding and breathing was observed in about 25% of the sessions in both the groups. We observed a rapid improvement in feeding performance with experience - the median proficiency improved from 5.5 to 10.1 mL/min and 6.2-11.5 mL/min in groups I and II, respectively. The proficiency of group I infants at a median PCA of 30.9 weeks was higher than that of group II infants at median PCA 31.7 weeks. CONCLUSION: Stable preterm neonates can be fed with paladai from 30 weeks PCA. The oropharyngeal ability is possibly influenced more by the postnatal experience than by maturity at birth.
Asunto(s)
Nutrición Enteral/instrumentación , Conducta Alimentaria/fisiología , Recien Nacido Prematuro/fisiología , Nutrición Enteral/métodos , Humanos , India , Recién Nacido , Intubación Gastrointestinal/métodos , Evaluación de Resultado en la Atención de Salud , Nutrición Parenteral/instrumentación , Nutrición Parenteral/métodos , Estudios ProspectivosRESUMEN
PURPOSE: Anastomotic leakage is a serious complication after gastric cancer surgery. Despite the superiority of enteral nutrition (EN), total parenteral nutrition (PN) remains the standard therapy for anastomotic leakage. After introduction of EN via a nasointestinal tube for patients with anastomotic leakage in our institution in 2006, standard nutritional therapy was shifted gradually from PN to EN. The present preliminary study evaluates the safety and feasibility of EN via a nasointestinal tube for anastomotic leakage after gastric cancer surgery. METHODS: Retrospective review of all gastric cancer surgeries from 2005 to 2009 (n = 2,588) revealed 53 patients (2.0%) who developed anastomotic leakage and were treated conservatively. EN was performed via a nasointestinal tube inserted using a guidewire under X-ray fluoroscopy. Clinical outcomes and complications following EN were compared with those in patients treated with PN (historical control group). The severity of complications was evaluated according to the Clavien-Dindo classification. RESULTS: Fifty patients were included in the final analysis (three patients died): 29 patients managed by EN and 21 managed by PN. There were no significant differences in clinical outcomes and the frequency of total complications between the two groups; however, there were fewer tube/catheter-related complications in the EN compared with the PN group (1 vs. 7, respectively; P < 0.01). There was one epistaxis (3.4%; grade I) in the EN group and seven catheter infections (33.3%; grade II) in the PN group. The risk of grade II or higher complications was greater in the PN than the EN group (11 vs. 4, respectively; P < 0.01), with the greatest difference seen in the incidence of catheter infections. On days 7, 10, and 15 after diagnosis of leakage, the white blood cell count and C-reactive protein levels were higher in the PN than in the EN group. The PN group required prolonged intravenous antibiotic infusion (P < 0.01). CONCLUSIONS: Nasointestinal tube insertion with EN can be performed safely for patients with anastomotic leakage. A major advantage of EN is fewer infectious complications. Because EN was not inferior to PN in terms of clinical outcome, we recommended that it is used in patients with anastomotic leakage after gastric cancer surgery.
Asunto(s)
Fuga Anastomótica/terapia , Nutrición Enteral/métodos , Gastrectomía/métodos , Intubación Gastrointestinal/instrumentación , Administración de la Seguridad/métodos , Neoplasias Gástricas/cirugía , Anciano , Fuga Anastomótica/diagnóstico , Antibacterianos/uso terapéutico , Estudios de Cohortes , Nutrición Enteral/instrumentación , Estudios de Factibilidad , Estudios de Seguimiento , Gastrectomía/efectos adversos , Gastrectomía/mortalidad , Humanos , Intubación Gastrointestinal/métodos , Masculino , Persona de Mediana Edad , Nutrición Parenteral/instrumentación , Nutrición Parenteral/métodos , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Medición de Riesgo , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/patología , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
The VINCat Program is an institutional surveillance program for hospital-acquired infections developed in the healthcare institutions of Catalonia, Spain. The program includes the monitoring of various components of hospital-acquired infection, among which is catheter-related bloodstream infection (CRBSI). The aim of this study was to describe the frequency of CRBSI in hospitals participating in the VINCat Program over a period of 4 years (2007-2010). The monitoring of the CRBSI component is carried out continuously in all inpatient units by performing a daily assessment of all blood culture results issued by the Microbiology Laboratories. Precise definitions are used for CRBSI, and adjusted rates are expressed per 1,000 days of hospitalization, hospital size and type of catheter. The rates of CRBSI in catheters used for parenteral nutrition are adjusted and expressed per 1,000 days of device use. The aggregate data of the total period are shown in percentiles (10%, 25%, 50% or median, 75%, and 90%). From 2007 to 2010, a total of 2977 episodes of CRBSI were reported in 40 hospitals participating in the VINCat Program. The cumulative incidence of CRBSI has been 0.26 episodes per 1,000 days of hospitalization (CI95% 0.2 to 0.3). The overall incidence varied depending on hospital size: 0.36 for hospitals in Group I (>500 beds), 0.17 for Group II (200-500 beds), and 0.09 for Group III (<200 beds). 76% of the episodes were associated with central venous catheters (CVC), 19% of the episodes with peripheral venous catheters (PVC), and the remaining 5% with peripherally inserted CVCs (PICC). The most common organisms causing CRBSI were staphylococci, the group Klebsiella, Serratia and Enterobacter, Candida spp., and Pseudomonas aeruginosa. There are important differences in the etiology of CRBSI in relation to these variables. During the reporting period, a significant reduction (38.1%, CI95%, 29.0-46.0%) of CRBSI rates have been observed in Group I hospitals. CRBSI surveillance is an important element of the VINCat Program, offering to us the possibility of establishing standard values for this component and implementing intervention strategies for its reduction.
Asunto(s)
Bacteriemia/epidemiología , Infecciones Relacionadas con Catéteres/epidemiología , Infección Hospitalaria/epidemiología , Hospitales Públicos/estadística & datos numéricos , Laboratorios de Hospital/estadística & datos numéricos , Vigilancia de la Población/métodos , Bacteriemia/microbiología , Infecciones Relacionadas con Catéteres/microbiología , Cateterismo Periférico/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Infección Hospitalaria/microbiología , Fungemia/epidemiología , Fungemia/microbiología , Capacidad de Camas en Hospitales/estadística & datos numéricos , Hospitales Públicos/clasificación , Hospitales Especializados/estadística & datos numéricos , Humanos , Incidencia , Tiempo de Internación/estadística & datos numéricos , Nutrición Parenteral/instrumentación , España/epidemiologíaRESUMEN
INTRODUCTION: The preparation of parenteral nutrition mixture (PNM) in an open chamber requires the use of intermediate containers sterile and non-pyrogenic. A sterilization of containers by moist heat in large autoclaves is the suitable method. However, sterilization by moist heat is not a depyrogenation method. In our study, we report the validation of a sterilization and depyrogenation method for containers by dry heat using a convection oven. MATERIALS AND METHODS: Sterilization and depyrogenation of material by dry heat have been audited by the reduction of at least three logarithms of original endotoxin rate. The containers were initially artificially contaminated with a suspension of endotoxin for 16 hours. Contaminated containers were placed in an oven with revolving heat at 250 °C for 1 hour. After treatment with dry heat, the residual endotoxin levels in the containers were determined by a kinetic chromogenic method. RESULTS: After treatment with dry heat, the average log reductions of endotoxin levels were respectively, for glass and steel containers, 4.78 ± 0.07 and 4.87 ± 0.03. DISCUSSION AND CONCLUSION: The present validation study confirms the effectiveness of treatment with dry heat for sterilization and depyrogenation of glass and steel containers. This method of sterilization and depyrogenation meets the microbiological quality requirements for the preparation of MNP.
Asunto(s)
Embalaje de Medicamentos , Alimentos Formulados/normas , Nutrición Parenteral/instrumentación , Pirógenos/química , Composición de Medicamentos , Endotoxinas/química , Vidrio , Inosina/análogos & derivados , Reproducibilidad de los Resultados , EsterilizaciónRESUMEN
John Tingle discusses an NCEPOD report which reveals serious failings in the care of hospital patients receiving parenteral nutrition.
Asunto(s)
Nutrición Parenteral , Calidad de la Atención de Salud/organización & administración , Adulto , Benchmarking/organización & administración , Auditoría Clínica , Documentación , Humanos , Recién Nacido , Evaluación de Procesos y Resultados en Atención de Salud , Nutrición Parenteral/efectos adversos , Nutrición Parenteral/instrumentación , Nutrición Parenteral/estadística & datos numéricos , Selección de Paciente , Medicina Estatal/organización & administración , Reino UnidoRESUMEN
INTRODUCTION: The parenteral nutrition admixture (PNA) manufacturing in hospital pharmacy is realized by aseptic transfer (AT) or sterilizing filtration (SF). The development of filling systems for PNA manufacturing requires, without standard, an evaluation comparing to traditional methods of SF. MATERIALS AND METHODS: The filling accuracy of automated AT and SF was evaluated by mass and physical-chemistry tests in repeatability conditions (identical composition of PNA; n=five bags) and reproducibility conditions (different composition of PNA; n=57 bags). For each manufacturing method, the filling precision and the average time for PNA bags manufacturing were evaluated starting from an identical composition and volume PNA (n=five trials). RESULTS: Both manufacturing methods did not show significant difference of accuracy. Precision of both methods was lower than limits generally admitted for acceptability of mass and physical-chemistry tests. However, the manufacturing time for SF was superior (five different binary admixtures in five bags) or inferior (one identical binary admixture in five bags) to time recorded for automated AT. DISCUSSION AND CONCLUSIONS: We show that serial manufacturing of PNA bags by SF with identical composition is faster than automated AT. Nevertheless, automated AT is faster than SF in variable composition of PNA. The manufacturing method choice will be motivate by the nature (i. e., variable composition or not) of the manufactured bags.
Asunto(s)
Nutrición Parenteral/instrumentación , Nutrición Parenteral/normas , Automatización , Embalaje de Medicamentos , Alimentos Formulados , Humanos , Servicio de Farmacia en Hospital , Esterilización , UltrafiltraciónRESUMEN
Epicutaneo-caval catheters have been widely used in neonatal intensive care units since Shaw has described them in 1973. These central venous access devices are usually placed at bedside and they have the purpose of delivering parenteral nutrition and/or drugs that are not compatible with the peripheral route. Even though in the last decade there was a fast advancement in the world of vascular access devices, such changes have only marginally affected the field of neonatal venous access. The aim of this editorial is to give 10 recommendations that correspond to 10 novelties in the field of epicutaneo-caval catheter: some are already evidence-based and should be introduced in our daily practice now, while others are particularly interesting and deserve further clinical studies.
Asunto(s)
Cateterismo Venoso Central/instrumentación , Cateterismo Periférico/instrumentación , Catéteres de Permanencia , Catéteres Venosos Centrales , Cuidado Intensivo Neonatal , Administración Intravenosa/instrumentación , Cateterismo Venoso Central/efectos adversos , Cateterismo Periférico/efectos adversos , Diseño de Equipo , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Nutrición Parenteral/instrumentación , Preparaciones Farmacéuticas/administración & dosificación , Factores de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND & AIMS: A retrospective evaluation was undertaken in intestinal failure (IF) patients with long term CVCs to evaluate differential time to positivity (DTP) against paired quantitative blood cultures (PP) for the diagnosis of CRBSI. METHODS: A list of patients with a diagnosis of CRBSI was obtained from the intestinal failure unit database for a five year period, 2013 to 2017. Microbiology records were reviewed to obtain further information about blood culture and pour plate examinations. Organisms and times of collection, loading and positivity were recorded. Patients with a contemporaneous set of central and peripheral PP and blood cultures were included in an analysis of the sensitivity of DTP compared to PP. RESULTS: There were 61 (45.5%) episodes in 56 patients where complete sets of central and peripheral blood cultures and PP were received. All 61 episodes had positive central blood cultures, 59 (96.7%) had positive central line PP and 17 (27.9%) had positive peripheral PP. Using PP as the gold standard, DTP sensitivity was 96.0% for 50 episodes where PP were consistent with CRBSI. Sensitivity increased to 100% for 17 episodes where there were no delays in either collection or loading of blood cultures. CONCLUSIONS: This is the first evaluation to support the use of DTP as a sensitive test in diagnosing CRBSI in patients with IF and provides confidence to IF centers where pour plate cultures are not available.
Asunto(s)
Bacteriemia/diagnóstico , Cultivo de Sangre/estadística & datos numéricos , Infecciones Relacionadas con Catéteres/diagnóstico , Recuento de Colonia Microbiana/estadística & datos numéricos , Enfermedades Intestinales/sangre , Factores de Tiempo , Bacteriemia/microbiología , Cultivo de Sangre/métodos , Infecciones Relacionadas con Catéteres/microbiología , Cateterismo Venoso Central/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Enfermedad Crónica , Recuento de Colonia Microbiana/métodos , Bases de Datos Factuales , Humanos , Enfermedades Intestinales/microbiología , Enfermedades Intestinales/terapia , Nutrición Parenteral/instrumentación , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: Manual feeding by parents using a syringe, a widespread practice in Sweden since the 1980s, favors parents' involvement in childcare tasks. This approach is used in our neonatal unity since 2007. OBJECTIVE: To study the behavioral changes of preterm children during nasogastric tube feeding: manual milk administration by parents (MAP) versus electric syringe administration (ESA) over a 30-minute period. METHOD: This is a randomized, crossover study conducted in the neonatology unit of Toulouse. Preterm children under 33 weeks of age and over 7 days of life were included. A video recording was performed to assess the children's behavioral response, using the Dsilna score. The reviewer was blinded. RESULTS: 15 preterm children with a median gestational age of 30.1 weeks and a median birth weight of 1.210 g were included from March to October 2012. The facility, environment, and state of alertness of children were similar in both groups. Signs of well-being were significantly more prevalent in the MAP group versus the ESA group (36.2 (±8.0) versus 30.7 (±9.5)), (p = 0.04), particularly "hand-to-mouth, mouth gestures, seeking suction and sucking". Although not significant, motor withdrawal signs were more apparent and fluctuating in the ESA group. Qualitative analysis of NIDCAP observations confirms this data. CONCLUSION: There are behavior changes of preterm children during nasogastric tube feeding. This pilot study showed previously undescribed results: MAP is associated with more common well-being signs and could be more widely used in neonatal units.