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1.
Presse Med ; 49(1): 104014, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32234381

RESUMO

IgG4-related disease (IgG4-RD) has been accepted as a distinct entity in various fields. It is being increasingly diagnosed and treated in routine practice. However, difficulties are still associated with the diagnostic process. Serum IgG4 elevations and imaging studies are useful, but not entirely diagnostic for this condition. Therefore, a pathological examination still plays an important role. Three characteristic microscopic changes are dense lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis. IgG4 immunostaining reveals many IgG4-positive plasma cells and an IgG4/IgG-positive cell ratio of more than 40%. In addition to the number and ratio of IgG4-positive plasma cells, the diffuse distribution of positive plasma cells needs to be confirmed because IgG4-positive plasma cells may focally aggregate in many other conditions. In small biopsy samples, it is important to recognize not only characteristic findings, but also microscopic changes that are unlikely to occur in IgG4-RD because the identification of the latter findings leads to the exclusion of this condition. Another challenging field regards the diagnosis of long-standing disease. Along with disease progression, inflammatory infiltrate decreases, while storiform fibrosis and obliterative phlebitis are suspected to persistently exist. Therefore, the recognition of the latter two findings will be a diagnostic clue. Given the general suspicion that IgG4-RD has recently been over-diagnosed, precise tissue examinations based on the proposed standards and close clinicopathological correlations are crucial.


Assuntos
Doença Relacionada a Imunoglobulina G4/patologia , Imunoglobulina G/análise , Plasmócitos/patologia , Linfócitos B/patologia , Biópsia , Hiperplasia do Linfonodo Gigante/diagnóstico , Hiperplasia do Linfonodo Gigante/patologia , Diagnóstico Diferencial , Fibrose/diagnóstico , Fibrose/patologia , Histiocitose Sinusal/diagnóstico , Histiocitose Sinusal/patologia , Humanos , Imunoglobulina G/sangue , Doença Relacionada a Imunoglobulina G4/diagnóstico , Imuno-Histoquímica , Flebite/diagnóstico , Flebite/patologia , Plasmócitos/imunologia , Linfócitos T/patologia
2.
Int J Antimicrob Agents ; 55(3): 105875, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31926285

RESUMO

Use of peripheral venous catheters (PVCs) is very common in hospitals. According to the literature, after a visit to the emergency department >75% of hospitalised patients carry a PVC, among which almost 50% are useless. In this study, the presence and complications of PVCs in an infectious diseases (ID) unit of a French tertiary-care university hospital were monitored. A total of 614 patients were prospectively included over a 6-month period. Among the 614 patients, 509 (82.9%) arrived in the ID unit with a PVC, of which 260 (51.1%) were judged unnecessary and were removed as soon as the patients were examined by the ID team. More than one-half of PVCs were removed within 24 h in the unit (308/509; 60.5%). PVCs were complicated for 65 (12.8%) of the 509 patients, with complications including extravasation, cutaneous necrosis, lymphangitis, phlebitis, tearing off the patient, superficial venous thrombosis and arthritis. We must therefore continue to search for unjustified PVC insertion. Alternatives to the intravenous administration route must be proposed, such as subcutaneous infusion or oral antibiotic therapy.


Assuntos
Cateterismo Periférico/efeitos adversos , Infecções Relacionadas a Cateter/etiologia , Vias de Administração de Medicamentos , Serviço Hospitalar de Emergência , Humanos , Flebite/etiologia
3.
PLoS One ; 15(1): e0226251, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31905205

RESUMO

BACKGROUND: Peripheral venous catheters (PVCs) require adequate maintenance based on heparin or saline locks in order to prevent complications. Heparin has proven effective in central venous catheters, although its use in PVCs remains controversial. Our hypothesis was that saline locks are as effective as heparin locks in preventing problems with PVCs. The objective of the present study was to compare phlebitis and catheter tip colonization rates between PVCs locked with saline and those locked with heparin in patients admitted to an internal medicine department (IMD). METHODS: We performed a 19-month prospective, controlled, open-label, randomized clinical study of patients with at least 1 PVC admitted to the IMD of our hospital. The patients were randomized to receive saline solution (PosiFlush®, group A) or heparin (Fibrilin®, group B) for daily maintenance of the PVC. Clinical and microbiological data were monitored to investigate the frequency of phlebitis, catheter tip colonization, and catheter-related bloodstream infection (C-RBSI), as well as crude mortality, days of hospital stay, and days of antimicrobial treatment. RESULTS: We assessed 339 PVCs (241 patients), of which 192 (56.6%) were locked with saline (group A) and 147 (43.4%) with heparin (group B). The main demographic characteristics of the patients were distributed equally between the 2 study groups. The median (IQR) catheter days was 5 (3-8) for both groups (p = 0.64). The frequency of phlebitis was 17.7% for group A and 13.3% for group B (p = 0.30). The frequency of colonization of PVC tips was 14.6% and 12.2% in groups A and B, respectively (p = 0.63). Only 2 episodes of C-RBSI were detected (1 patient in group A). Saline lock was not an independent factor for phlebitis or catheter colonization. CONCLUSIONS: Our study revealed no statistically significant differences in the frequency of phlebitis and catheter tip colonization between PVCs locked with saline and PVCs locked with heparin. We suggest that PVC can be maintained with saline solution, as it is safer and cheaper than heparin.


Assuntos
Anticoagulantes/administração & dosagem , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Periférico/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Heparina/administração & dosagem , Flebite/prevenção & controle , Solução Salina/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Infecções Relacionadas a Cateter/microbiologia , Feminino , Humanos , Medicina Interna , Masculino , Pessoa de Meia-Idade , Flebite/etiologia , Prognóstico , Estudos Prospectivos
4.
Br J Nurs ; 29(2): S18-S23, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31972104

RESUMO

BACKGROUND: Intravenous therapy is an integral part of professional nursing practice. Nurses have a responsibility to recognise risk factors for phlebitis. AIMS: To investigate nurses' perceptions of risk factors for phlebitis in a tertiary teaching hospital in north-east Peninsular Malaysia. METHODS: A cross-sectional study of 199 randomly selected nurses were surveyed for their perceptions of risk factors for phlebitis using a self-administered questionnaire. FINDINGS: More than half of the nurses (56.8%) had a good perception levels of risk factors for phlebitis. There was a significant association between the clinical area and nurses' perceptions of risk factors for phlebitis (p=0.04). Nurses working in medical, orthopaedic, and surgical areas had slightly better perceptions than nurses working in multidisciplinary and oncology areas. CONCLUSION: These findings suggest that nurses need to continually improve their knowledge about risk factors for phlebitis to ensure safer nursing practice.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Recursos Humanos de Enfermagem no Hospital/psicologia , Flebite/enfermagem , Adulto , Estudos Transversais , Feminino , Hospitais de Ensino , Humanos , Malásia , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários , Centros de Atenção Terciária , Adulto Jovem
6.
J Vasc Surg Venous Lymphat Disord ; 8(2): 211-215, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31864932

RESUMO

OBJECTIVE: to prospectively compare the surgical outcome of using endovenous laser ablation (EVLA) and mechanochemical ablation (MOCA) in management of patients with primary varicose veins (VV). METHODS: The present study prospectively recruited 100 patients with primary VV. They were randomly and equally allocated to one of two treatment group: the EVLA group (n = 50) or the MOCA group (n = 50). Before intervention, all patients underwent to clinical and ultrasound assessment of the vascular system. The Venous Clinical Severity Score was used to assess clinical severity. In addition, patients completed the Chronic Venous Insufficiency Questionnaire. The primary study outcome was treatment success. After intervention, patients were followed up at 1 week, 1 months, 6 months, and 12 months. RESULTS: Operative success was achieved in all patients. The MOCA group had a significantly shorter operative time when compared with EVLA group. The Venous Clinical Severity Score significantly improved in both groups over the follow-up period and showed significantly lower levels in the MOCA group. Perceived pain was significantly improved in both groups postoperatively with no significant differences. The Chronic Venous Insufficiency Questionnaire was significantly improved after 12 months of operation without significant differences between groups. MOCA patients had significantly lower rate of postoperative phlebitis and significantly shorter time to return to work. CONCLUSIONS: MOCA for primary VV is a feasible, effective, and safe procedure with better clinical outcome and lower rate of postoperative phlebitis when compared with EVLA.


Assuntos
Procedimentos Endovasculares , Terapia a Laser , Veia Safena/cirurgia , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Egito , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Flebite/etiologia , Estudos Prospectivos , Retorno ao Trabalho , Veia Safena/diagnóstico por imagem , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Varizes/diagnóstico por imagem , Insuficiência Venosa/diagnóstico por imagem , Adulto Jovem
7.
Radiology ; 294(1): 234-237, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31846410

RESUMO

HistoryA 55-year-old man with a history of chronic pancreatitis secondary to chronic alcohol abuse presented to the hospital with acute abdominal pain, generalized weakness, weight loss, and pyrexia. A clinical examination revealed he was tender to touch in the upper abdomen. Laboratory tests revealed a serum alkaline phosphatase level of 370 U/L (6.1 µkat/L) (normal range, 30-130 U/L [0.5-2.2 µkat/L]), a lipase level of 172 U/L (2.9 µkat/L) (normal range, 0-60 U/L [0-1.0 µkat/L]), a C-reactive protein level of 159 mg/L (1514 nmol/L) (normal value, <8.0 mg/L [76.2 nmol/L]), and a white cell count of 7 × 109/L (normal range, [4-11] × 109/L). During the present admission, the patient underwent urgent CT for his acute symptoms. His relevant medical history included a hospital admission 2 months earlier for abdominal discomfort. Given his history of chronic pancreatitis, baseline abdominal MRI was performed to determine the cause of his symptoms and to assess the pancreas.


Assuntos
Fístula do Sistema Digestório/diagnóstico por imagem , Fístula do Sistema Digestório/etiologia , Ductos Pancreáticos/diagnóstico por imagem , Pancreatite Crônica/complicações , Flebite/diagnóstico por imagem , Flebite/etiologia , Veia Porta/diagnóstico por imagem , Fístula do Sistema Digestório/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Stents , Tomografia Computadorizada por Raios X
8.
Med Sante Trop ; 29(4): 424-430, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31884999

RESUMO

Patients must receive high-quality and safe health care. Peripheral venous catheterization (PVC) exposes patients to complications, mostly phlebitis. This study investigated the incidence of phlebitis and its PVC-related risk factors among patients in the medical and surgical emergency departments of the Souro Sanou University Hospital Center (CHUSS) in Bobo Dioulasso, Burkina Faso. This prospective cross-sectional study took place from July 4 to August 3, 2018. The incidence of PVC-related phlebitis was calculated and its risk factors were identified by logistic regression, with SPSS software version 20 (entry option), with significance set at 5%. The 511 patients included in the study had a mean age of 44.7 (95% CI 43.1-46.3) years. The mean duration of PVC was 3.1 days. Of these patients, 149 developed phlebitis, for an incidence of 29.2% (95% CI 25.0%-33.0%). There was no statistically significant difference between the two emergency (medical and surgical) departments. Second-degree phlebitis accounted for slightly more than half the cases (53%). Risk factors associated with the occurrence of PVC-related phlebitis were female gender, catheterization duration more than 3 days, small size of the catheter, and the healthcare worker's failure to use friction in washing with a hydroalcoholic hand solution. Preventive measures are essential.


Assuntos
Cateterismo Periférico/efeitos adversos , Flebite/epidemiologia , Flebite/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Burkina Faso , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Hospitais de Ensino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
9.
Acta Cir Bras ; 34(8): e201900804, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618404

RESUMO

PURPOSE: To develop a rabbit model of a short peripheral catheter (SPC) and to observe the effects of different flushing methods on blood vessels. METHODS: Thirty rabbits were randomly divided into three groups (A, B, and C), with ten rabbits per group. In group A, we used pulsed flush; in group B, we used uniform flush; and no treatment was used in group C. RESULTS: We observed that a uniform flush reduced blockage, phlebitis, and exudation compared to a pulsed flush by visual observation. The histopathological examination found that the morphological changes in group A were more severe than in group B and C related to loss of venous endothelial cells, inflammatory cell infiltration, edema, epidermal and chondrocyte degeneration, except for the thrombosis on group B that was more serious than in group A, especially in the distal side of puncture points. The distal region of groups A and B had more inflammatory cell infiltration than the proximal region. Thrombosis was more severe in the distal region than in the proximal region in group B. CONCLUSIONS: The uniform flush produced less damage to the vascular endothelium and surrounding tissues and was superior to the pulsed flush. However, the uniform flush is prone to thrombosis.


Assuntos
Vasos Sanguíneos/patologia , Cateterismo Periférico/métodos , Animais , Cateterismo Periférico/efeitos adversos , Modelos Animais de Doenças , Orelha/irrigação sanguínea , Células Endoteliais , Endotélio Vascular/patologia , Endotélio Vascular/ultraestrutura , Masculino , Flebite/etiologia , Coelhos , Distribuição Aleatória , Fluxo Sanguíneo Regional
10.
Artigo em Inglês | MEDLINE | ID: mdl-31540024

RESUMO

Phlebitis leads to increased discomfort for patients, longer hospital stays, and higher healthcare costs. This study aimed to identify predictive factors of peripheral phlebitis related to intravenous injection among orthopedic inpatients, develop a prediction model, and evaluate the goodness-of-fit of the prediction model. This study included 270 orthopedic patients who were hospitalized in the orthopedic ward of a general hospital. A peripheral intravenous injection-related questionnaire based on previous studies and the modified Infusion Nurses Society scale were used to collect data. Phlebitis risk factors were identified, and a prediction model was developed using the Bayesian regression model. Vein quality, contrast medium use, hygiene duration, and period of nursing clinical experience were significant based on their 95% confidence intervals. The prediction model exhibited good discrimination. The prediction model developed in this study can be used for screening high-risk patients for peripheral intravenous catheter-related phlebitis and for providing basic data for developing interventions for the prevention and management of peripheral intravenous catheter-related phlebitis.


Assuntos
Cateterismo Periférico/efeitos adversos , Infusões Intravenosas/efeitos adversos , Modelos Teóricos , Procedimentos Ortopédicos , Flebite/etiologia , Teorema de Bayes , Feminino , Hospitais Gerais , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Fatores de Risco
11.
Vet Radiol Ultrasound ; 60(6): 745-752, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31515890

RESUMO

Peripheral vein phlebitis (inflammation) is a relatively frequent complication in dogs, however, published information on the ultrasonographic characteristics is currently lacking. This prospective, observational study describes the ultrasound (US) characteristics of normal canine cephalic veins, and veins with clinical phlebitis. Correlations among US findings and between US findings versus time that the intravenous catheter was in place were investigated. Safety of the US procedure was evaluated. Fifty patients were prospectively recruited for the study and 18 met the final inclusion criteria. Each patient underwent daily US examinations and was assessed for multiple criteria (vascular wall appearance, compressibility, spontaneity of flow, color fill, and presence/absence of filling defects, flow contour, direction, non-pulsatility). Characteristics of normal canine cephalic veins were as follows: smooth and thin wall, complete compressibility, no flow disturbances, no filling defects, smooth flow contours, and unidirectional, non-pulsatile flow with no turbulence. Characteristics of cephalic veins with clinical phlebitis were as follows: wall thickening (83%), decreased compressibility (55%), filling defects consistent with intraluminal thrombus (55%), vessel wall hyperechogenicity (44%), and abnormal color Doppler flow (39%). Significant correlations were found between Doppler filling defects and compressibility, Doppler filling defects and presumed thrombosis, and compressibility and presumed thrombosis (P = .001, P = .001, P = .000, respectively). No correlation was found between the US findings and time the intravenous catheter was in place. Findings indicated that duplex and compressibility US are feasible and safe methods for characterizing and monitoring cephalic veins in dogs with clinical phlebitis.


Assuntos
Doenças do Cão/diagnóstico por imagem , Flebite/veterinária , Animais , Velocidade do Fluxo Sanguíneo , Doenças do Cão/fisiopatologia , Cães , Feminino , Masculino , Flebite/diagnóstico por imagem , Estudos Prospectivos , Fluxo Pulsátil , Ultrassonografia Doppler em Cores/veterinária
12.
Asian Nurs Res (Korean Soc Nurs Sci) ; 13(4): 236-241, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31562930

RESUMO

PURPOSE: The study aimed to examine the efficacy of the I.V. House UltraDressing for protecting peripheral intravenous catheters (PIVCs) in pediatric patients. METHODS: This randomized controlled trial comprised 60 pediatric patients (aged 2-24 months): 30 in the experimental group and 30 in the control group. The PIVC dwell time and phlebitis scores were also reported for both groups. The degree of phlebitis was determined using the Visual Infusion Phlebitis Scale (VIPS) and was recorded every 8 hours from the start of antibiotic therapy until catheter removal. RESULTS: The mean catheter dwell time in the experimental group (2.10 ± 1.55 days) was significantly longer than that in the control group (1.27 ± 0.45 days) (p < .01). However, there were no significant differences between the scores and signs of phlebitis in both groups (p > .05). CONCLUSION: The I.V. House UltraDressing is a useful device that can be used to increase catheter dwell time and protect and stabilize PIVCs in pediatric patients.


Assuntos
Bandagens , Cateteres de Demora , Flebite/prevenção & controle , Equipamentos de Proteção , Administração Intravenosa , Antibacterianos/administração & dosagem , Cateterismo Periférico , Pré-Escolar , Remoção de Dispositivo , Feminino , Humanos , Lactente , Masculino , Segurança do Paciente , Fatores de Tempo , Resultado do Tratamento
14.
BMC Infect Dis ; 19(1): 558, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242860

RESUMO

BACKGROUND: Amphotericin-induced phlebitis is a common infusion-related reaction in patients managed for cryptococcal meningitis. High-quality nursing care is critical component to successful cryptococcosis treatment. We highlight the magnitude and main approaches in the management of amphotericin-induced phlebitis and the challenges faced in resource-limited settings. METHODS: We prospectively determined the incidence of amphotericin-induced phlebitis during clinical trials in Kampala, Uganda from 2013 to 2018. We relate practical strategies and challenges faced in clinical management of phlebitis. RESULTS: Overall, 696 participants were diagnosed with HIV-related cryptococcal meningitis. Participants received 7-14 doses of intravenous (IV) amphotericin B deoxycholate 0.7-1.0 mg/kg/day for induction therapy through peripheral IV lines at a concentration of 0.1 mg/mL in 5% dextrose. Overall, 18% (125/696) developed amphotericin-induced phlebitis. We used four strategies to minimize/prevent the occurrence of phlebitis. First, after every dose of amphotericin, we gave one liter of intravenous normal saline. Second, we rotated IV catheters every three days. Third, we infused IV amphotericin over 4 h. Finally, early ambulation was encouraged to minimize phlebitis. To alleviate phlebitis symptoms, warm compresses were used. In severe cases, treatment included topical diclofenac gel and oral anti-inflammatory medicines. Antibiotics were used only when definite signs of infection developed. Patient/caregivers' education was vital in implementing these management strategies. Major challenges included implementing these interventions in participants with altered mental status and limited access to topical and oral anti-inflammatory medicines in resource-limited settings. CONCLUSIONS: Amphotericin-induced phlebitis is common with amphotericin, yet phlebitis is a preventable complication even in resource-limited settings. TRIAL REGISTRATION: The ASTRO-CM trial was registered prospectively. ClincalTrials.gov : NCT01802385 ; Registration date: March 1, 2013; Last verified: February 14, 2018.


Assuntos
Anfotericina B/efeitos adversos , Infecções por HIV/tratamento farmacológico , Meningite Criptocócica/tratamento farmacológico , Flebite/induzido quimicamente , Flebite/terapia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Ácido Desoxicólico/administração & dosagem , Ácido Desoxicólico/efeitos adversos , Combinação de Medicamentos , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Recursos em Saúde/economia , Humanos , Incidência , Infusões Intravenosas , Masculino , Meningite Criptocócica/complicações , Meningite Criptocócica/epidemiologia , Flebite/epidemiologia , Áreas de Pobreza , Uganda/epidemiologia
15.
Eur J Cancer Care (Engl) ; 28(5): e13114, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31148328

RESUMO

OBJECTIVE: To establish whether using alternating arms for peripheral intravenous epirubicin administration affects the severity or duration of epirubicin-induced phlebitis. METHODS: An observational study of women with breast cancer (n = 237) in a UK Cancer Centre. Data were analysed after receiving three treatment cycles according to the arm used for epirubicin administration: same, alternating or mixed arm (two consecutive cycles in one arm and one in the alternate arm). Phlebitis severity was graded by clinical staff after each treatment; participants also self-reported symptoms during treatment and for up to 6 months after. RESULTS: The alternating arm group experienced significantly less severe symptoms than the other arm use groups, 6% (4 of 64) compared with 34% (p < 0.001, odds ratio: 0.13 (95% CI: 0.043-0.38) alternating arm compared with same arm group). The alternating arm group reported less pain (p = 0.013), lower overall impact (p = 0.009), lower effect on function (p = 0.032) and shorter duration of symptoms (p = 0.001) than the other arm use groups. CONCLUSION: Using alternating arms for peripheral administration of epirubicin significantly reduces the severity and duration of chemical phlebitis and is recommended to improve patient experience and reduce the need for central venous access devices.


Assuntos
Administração Intravenosa/métodos , Antibióticos Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Epirubicina/administração & dosagem , Reação no Local da Injeção/prevenção & controle , Flebite/prevenção & controle , Adulto , Idoso , Antibióticos Antineoplásicos/efeitos adversos , Ciclofosfamida/administração & dosagem , Docetaxel/administração & dosagem , Epirubicina/efeitos adversos , Feminino , Fluoruracila/administração & dosagem , Humanos , Reação no Local da Injeção/etiologia , Pessoa de Meia-Idade , Flebite/induzido quimicamente , Estudos Prospectivos
16.
Rev Gaucha Enferm ; 40(spe): e20180317, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31038602

RESUMO

OBJECTIVE: Analyze incident notifications related to the patient's safety. METHOD: Cross-sectional study with quantitative approach, based on data from the risk Management of a hospital complex, located in northwest São Paulo, from August 2015 to July 2016. RESULTS: 4,691 notifications were analyzed. Nurses were the professionals who notified the most (71%), followed by physicians (8%). The most frequent period in which the notifications occurred was the daytime. There was significant difference in the proportion of notifications between the days of the week. The notifications were classified by reason and the most prevalent were those related to medication (17%), followed by skin lesions (15%), and phlebitis (14%). The highest frequency of notifications occurred in the hospitalization units. In relation to severity, 344 events caused damage to the patient, most of which were of mild intensity (65%). CONCLUSION: Spontaneous notifications are an important source of information, and highlight the magnitude of the problem related to health incidents.


Assuntos
Segurança do Paciente , Gestão de Riscos , Acidentes por Quedas/estatística & dados numéricos , Brasil , Estudos Transversais , Unidades Hospitalares , Humanos , Erros de Medicação/estatística & dados numéricos , Recursos Humanos em Hospital/estatística & dados numéricos , Flebite/epidemiologia , Melhoria de Qualidade , Estudos Retrospectivos , Gestão de Riscos/métodos , Gestão de Riscos/organização & administração , Gestão de Riscos/estatística & dados numéricos , Dermatopatias/epidemiologia , Fatores de Tempo
17.
Cardiovasc Pathol ; 40: 68-71, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30928813

RESUMO

Enterocolic lymphocytic phlebitis (ELP) is a rare enteropathy characterized by lymphocytic phlebitis of the mesenteric veins without arteritis. Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is a rare disease similar to ELP, characterized by myointimal hyperplasia that constricts the lumen of veins, causing mucosal injury. A 62-year-old man with chief complaint of abdominal pain was treated by partial resection of the ileum after 3 months of conservative therapy. The pathologic diagnosis was ELP with prominent myointimal hyperplasia. Histologically, the lesion consisted of lymphocytic infiltration into the vein accompanied by prominent myointimal hyperplasia and perivenous concentric fibrosis, which are characteristics shared by ELP and IMHMV. The observations in this case suggest that some of ELP and IMHMV may belong to the same disease spectrum. Furthermore, perivascular concentric fibrosis was a remarkable observation that may contribute to differential diagnosis between ELP and "true" IMHMV.


Assuntos
Linfócitos T CD4-Positivos/patologia , Enteropatias/patologia , Veias Mesentéricas/patologia , Flebite/patologia , Túnica Íntima/patologia , Biópsia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Fibrose , Humanos , Hiperplasia , Imuno-Histoquímica , Enteropatias/diagnóstico por imagem , Enteropatias/cirurgia , Masculino , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade , Flebite/diagnóstico por imagem , Flebite/cirurgia , Flebografia/métodos , Valor Preditivo dos Testes , Resultado do Tratamento , Túnica Íntima/diagnóstico por imagem , Túnica Íntima/cirurgia
18.
BMJ Case Rep ; 12(4)2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30992283

RESUMO

Portal pyaemia or pylephlebitis is a form of septic (often suppurative) thrombophlebitis of the portal venous system. It may develop as a complication of intra-abdominal sepsis, such as diverticulitis or appendicitis. Patients typically present with a high fever that is sometimes accompanied by jaundice. We report a case of portal pyaemia associated with multiple liver abscesses and discuss the medical and surgical management of this condition.


Assuntos
Doenças do Colo/complicações , Perfuração Intestinal/complicações , Abscesso Hepático/etiologia , Flebite/etiologia , Sepse/etiologia , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/cirurgia , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Masculino , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Flebite/tratamento farmacológico , Sepse/tratamento farmacológico , Tomografia Computadorizada por Raios X
19.
J Infus Nurs ; 42(3): 143-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30985563

RESUMO

Short peripheral catheters (SPCs) are the most frequently used medical devices in hospital settings. Many hospital policies state that SPCs be replaced at 96 hours, which can be unnecessary and costly. A pre-post quality improvement initiative was implemented following complications surrounding removal of timed SPC catheters compared with those removed by clinical indication, using the Visual Infusion Phlebitis (VIP) scale. Data collected included patient demographics, SPC characteristics, nursing time, and product use. SPCs replaced based on clinical indication remained intact longer and had fewer complications than those in the group with routinely replaced SPCs. Decreasing SPC replacements by use of clinical indication resulted in cost savings of $7263.60/unit/month.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Periférico/métodos , Cateteres de Demora , Prática Clínica Baseada em Evidências/normas , Idoso , Remoção de Dispositivo , Feminino , Humanos , Infusões Intravenosas , Masculino , Flebite , Melhoria de Qualidade , Fatores de Tempo
20.
Infect Dis Health ; 24(3): 152-168, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31005606

RESUMO

BACKGROUND: Evidence-based bundles have reduced central line bloodstream infection rates in adult intensive care units. To tackle peripheral intravenous catheter (PIVC) bloodstream infection, many hospitals have implemented PIVC insertion and maintenance bundles. However, the efficacy of PIVC bundles in preventing PIVC complications and infection in hospital patients is uncertain. The aim of this paper is to synthesize evidence on the effectiveness of PIVC insertion and maintenance bundles on preventing adverse events. METHODS: In this systematic review, we searched multiple electronic databases, trial registries, and grey literature for eligible studies published in English (January 2000-December 2018) to identify intervention studies evaluating PIVC insertion or maintenance bundles with two or more components. Search terms: peripheral intravenous catheter/cannula, insertion, maintenance, bundle, infection, infiltration, extravasation, dislodgement, thrombosis, occlusion, and phlebitis. Two reviewers independently conducted data extraction and quality assessments using the Downs and Black checklist. RESULTS: Of 14,456 records screened, 13 studies (6 interrupted time-series, 7 before-and-after) were included. Insertion and maintenance bundles included multiple components (2-7 items per bundle). Despite testing different bundles, 12 studies reported reductions in phlebitis and bloodstream infection, and one study reported no change in bloodstream infection and an increase in phlebitis rate. Methodological quality of all studies ranked between 'low' and 'fair'. CONCLUSIONS: The effect of PIVC bundles on PIVC complications and bloodstream infection rates remains uncertain. Standardisation of bundle components and more rigorous studies are needed. PROSPERO registration number: CRD42017075142.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Periférico/efeitos adversos , Bacteriemia/etiologia , Cateterismo Periférico/métodos , Prática Clínica Baseada em Evidências , Hospitalização , Humanos , Flebite/etiologia , Flebite/prevenção & controle
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