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1.
Res Nurs Health ; 42(3): 198-204, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30912181

RESUMEN

The type of central vascular access device providers chosen for providing parenteral supportive treatments has evolved over the past years, going from routinely used centrally inserted catheters to a more recent trend of peripherally-inserted central catheters (PICCs) when expected treatment duration is less than 6 months. This multicenter retrospective study aimed to provide a comprehensive assessment of the safety of PICCs in administering parenteral supportive treatments. All adult inpatients and outpatients who had a PICC inserted for the administration of parenteral supportive treatments (i.e., parenteral nutrition, intravenous fluids, blood products, or antibiotics) between September 2007 and December 2014 in four public Italian hospitals were included. The primary outcome was PICC removal because of an adverse event (AE, defined as occlusion, exit-site infection, or symptomatic thrombosis). Among the 1,250 included patients, 178 PICC-related removals because of AEs (14.2%; 1.62 AEs per 1,000 PICC days) were reported. Rates of PICC removal because of occlusion, exit-site infection, and symptomatic thrombosis were 1.08, 0.32, and 0.23 per 1,000 PICC days, respectively. The median dwell-time between PICC insertion and its removal because of an AE was 67 days (interquartile range 28-180 days). Risk of PICC removal due to AE was higher with open-system PICCs [hazard ratio = 2.75, 95% confidence interval 1.52-4.96]. In this study, we found preliminary evidence that PICCs can be safely used to administer parenteral supportive treatments lasting up to 6 months. PICCs may be a relevant alternative to centrally inserted catheters for medium-term parenteral supportive treatments.


Asunto(s)
Cateterismo Venoso Central/estadística & datos numéricos , Nutrición Parenteral Total/estadística & datos numéricos , Seguridad del Paciente/estadística & datos numéricos , Adulto , Anciano , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Venoso Central/efectos adversos , Cateterismo Periférico/estadística & datos numéricos , Enfermedad Crítica/terapia , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Nutrición Parenteral Total/efectos adversos , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Tromboembolia Venosa/etiología
2.
Oncologist ; 24(9): e953-e959, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30755503

RESUMEN

BACKGROUND: Peripherally inserted central catheters (PICCs) are central venous catheters (CVCs) that are commonly used in onco-hematologic settings for chemotherapy administration. As there is insufficient evidence to recommend a specific CVC for chemotherapy administration, we aimed to ascertain PICC-related adverse events (AEs) and identify independent predictors of PICC removal in patients with cancer receiving chemotherapy. MATERIALS AND METHODS: Information on adult patients with cancer with a PICC inserted for chemotherapy administration between September 2007 and December 2014 was extracted from six hospital databases. The primary outcome was PICC removal due to PICC-related AEs (occlusion, infection, or symptomatic thrombosis). Independent predictors of PICC removal were identified using a multivariate Cox regression model. RESULTS: Among the 2,477 included patients, 419 PICC-related AEs (16.9%; 1.09 AEs per 1,000 PICC-days) were reported. AEs increased when PICC was inserted at the brachial site (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.02-1.84) and with open systems (HR, 1.89; 95% CI, 1.24-2.88) and decreased in older men (HR, 0.63; 95% CI, 0.49-0.81). CONCLUSION: Use of PICC for chemotherapy administration was associated with a low all-AEs rate. The basilic vein was the safer site, and valved systems had fewer AEs than open systems. More research is needed to explore the interaction between AEs, sex, and age. IMPLICATIONS FOR PRACTICE: These findings provide clinicians with evidence that peripherally inserted central catheters (PICCs) are safe for chemotherapy administration. They also suggest that clinicians should limit the use of open systems when long chemotherapy regimens are scheduled. Moreover, alternatives to PICCs should be considered when administering chemotherapy to young men.

3.
J Vasc Access ; 18(4): 325-327, 2017 Jul 14.
Artículo en Inglés | MEDLINE | ID: mdl-28665463

RESUMEN

INTRODUCTION: Patients with cancer need stable venous access using central vascular devices like central venous ports and peripherally inserted central catheters that can be used for a wide range of indications. Numerous flushing protocols exist including different frequencies for catheter locking to maintain catheter patency. The aim of this retrospective study was to evaluate the incidence of lumen occlusion of central venous ports in a group of adult cancer patients, adopting a policy of locking with normal saline every three months. METHODS: This is a single-center retrospective observational study. During follow-up, we analyzed adult cancer patients who had undergone port insertion from January 1st, 2007 to August 31st, 2014. Flushing and locking were performed every three months with a syringe containing normal saline. RESULTS: We collected data from 381 patients with ports inserted in subclavian vein (379 patients) and in the right jugular vein (2 patients). Locking was performed during 3-monthly follow-up visits. Median follow-up was 810 days (90-2700 days). Among 381 ports, 59 were removed; the reasons for removal were: end of use (45 cases), catheter rupture (9 cases), dislocation (3 cases) and catheter-related bloodstream infection (2 cases). We had no reports of lumen occlusion. CONCLUSIONS: Our data suggest that locking ports with normal saline every three months is not associated with an increased risk of lumen occlusion.


Asunto(s)
Antineoplásicos/administración & dosificación , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/instrumentación , Catéteres de Permanencia , Catéteres Venosos Centrales , Descontaminación/métodos , Oncología Médica/métodos , Cloruro de Sodio , Administración Intravenosa , Infecciones Relacionadas con Catéteres/microbiología , Cateterismo Venoso Central/efectos adversos , Catéteres de Permanencia/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Remoción de Dispositivos , Diseño de Equipo , Falla de Equipo , Humanos , Italia , Datos Preliminares , Estudios Retrospectivos , Cloruro de Sodio/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
4.
J Vasc Access ; 17(6): 453-464, 2016 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-27516141

RESUMEN

BACKGROUND: The most appropriate lock solution for central venous access devices is still to be defined. GAVeCeLT - the Italian group for venous access devices - has developed a consensus on the evidence-based criteria for the choice and the clinical use of the most appropriate lock solution for central venous catheters (excluding dialysis catheters). METHOD: After the constitution of a panel of experts, a systematic collection and review of the literature has been performed, focusing on clinical studies dealing with lock solutions used for prevention of occlusion (heparin, citrate, urokinase, recombinant tissue plasminogen activator [r-TPA], normal saline) or for prevention of infection (citrate, ethanol, taurolidine, ethylene-diamine-tetra-acetic acid [EDTA], vancomycin, linezolid and other antibiotics), in both adults and in pediatric patients. Studies on central lines used for dialysis or pheresis, on peripheral venous lines and on arterial lines were excluded from this analysis. Studies on lock solutions used for treatment of obstruction or infection were not considered. The consensus has been carried out according to the Delphi method. RESULTS: The panel has concluded that: (a) there is no evidence supporting the heparin lock; (b) the prevention of occlusion is based on the proper flushing and locking technique with normal saline; (c) the most appropriate lock solution for infection prevention should include citrate and/or taurolidine, which have both anti-bacterial and anti-biofilm activity, with negligible undesired effects if compared to antibiotics; (d) the patient populations most likely to benefit from citrate/taurolidine lock are yet to be defined. CONCLUSIONS: The actual value of heparinization for non-dialysis catheters should be reconsidered. Also, the use of lock with substances with anti-bacterial and anti-biofilm activity (such as citrate or taurolidine) should be taken into consideration in selected populations of patients.


Asunto(s)
Antibacterianos/administración & dosificación , Anticoagulantes/administración & dosificación , Cateterismo Venoso Central/instrumentación , Catéteres de Permanencia , Catéteres Venosos Centrales , Infecciones Relacionadas con Prótesis/prevención & control , Cloruro de Sodio/administración & dosificación , Irrigación Terapéutica/métodos , Antibacterianos/efectos adversos , Anticoagulantes/efectos adversos , Biopelículas/efectos de los fármacos , Biopelículas/crecimiento & desarrollo , Obstrucción del Catéter/etiología , Cateterismo Venoso Central/efectos adversos , Consenso , Técnica Delfos , Medicina Basada en la Evidencia , Humanos , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Factores de Riesgo , Cloruro de Sodio/efectos adversos , Irrigación Terapéutica/efectos adversos , Resultado del Tratamiento
5.
Rev. Soc. Bras. Med. Trop ; 41(6): 648-653, Nov.-Dec. 2008. ilus, tab
Artículo en Portugués | LILACS | ID: lil-502048

RESUMEN

A estrongiloidíase afeta 30 milhões de pessoas em 70 países. Usualmente, o diagnóstico dessa enteroparasitose é realizado por testes parasitológicos baseados no hidro termotropismo das larvas eliminadas nas fezes, porém esses têm se mostrado pouco sensíveis. Neste trabalho, extratos antigênicos foram testados pelas técnicas de ELISA, Immunoblotting e IFI, utilizando larvas filarióides de Strongyloides venezuelensis, parasita de roedores, que mostram reação cruzada com epítopos de Strongyloides stercoralis. Sensibilidade de 89, 85, 57 por cento para a reação de ELISA e de 100, 100 e 96 por cento, para o Immunoblotting com os antígenos SAL, ZWIP e ZW, e especificidade de 90, 60 e 81 por cento para o ELISA e 96, 92 e 91 por cento para o Immunoblotting para os mesmos antígenos, foram encontradas nestes ensaios.


Strongyloidiasis affects 30 million people in 70 countries. This enteral parasitosis is usually diagnosed using parasitological tests based on hydrotropism or thermotropism of larvae eliminated in feces, but these tests have been shown to have low sensitivity. In this study, antigenic extracts were tested by means of ELISA, immunoblotting and IFI, using filariform larvae of Strongyloides venezuelensis, a parasite of rodents that shows cross-reactions with Strongyloides stercoralis epitopes. Sensitivity of 89, 85 and 57 percent for the ELISA reaction and 100, 100 and 96 percent for immunoblotting with the SAL, ZWIP and ZW antigens, and specificity of 90, 60 and 81 percent for ELISA and 96, 92 and 91 percent for immunoblotting with the same antigens, were found in these assays.


Asunto(s)
Animales , Humanos , Antígenos Helmínticos , Strongyloides/inmunología , Estrongiloidiasis/inmunología , Antígenos Helmínticos/inmunología , Electroforesis en Gel de Poliacrilamida , Ensayo de Inmunoadsorción Enzimática , Técnica del Anticuerpo Fluorescente Indirecta , Heces/parasitología , Immunoblotting , Larva/inmunología , Sensibilidad y Especificidad , Strongyloides/clasificación , Strongyloides/aislamiento & purificación , Estrongiloidiasis/diagnóstico
6.
Rev Soc Bras Med Trop ; 41(6): 648-53, 2008.
Artículo en Portugués | MEDLINE | ID: mdl-19142446

RESUMEN

Strongyloidiasis affects 30 million people in 70 countries. This enteral parasitosis is usually diagnosed using parasitological tests based on hydrotropism or thermotropism of larvae eliminated in feces, but these tests have been shown to have low sensitivity. In this study, antigenic extracts were tested by means of ELISA, immunoblotting and IFI, using filariform larvae of Strongyloides venezuelensis, a parasite of rodents that shows cross-reactions with Strongyloides stercoralis epitopes. Sensitivity of 89, 85 and 57% for the ELISA reaction and 100, 100 and 96% for immunoblotting with the SAL, ZWIP and ZW antigens, and specificity of 90, 60 and 81% for ELISA and 96, 92 and 91% for immunoblotting with the same antigens, were found in these assays.


Asunto(s)
Antígenos Helmínticos , Strongyloides/inmunología , Estrongiloidiasis/inmunología , Animales , Antígenos Helmínticos/inmunología , Electroforesis en Gel de Poliacrilamida , Ensayo de Inmunoadsorción Enzimática , Heces/parasitología , Técnica del Anticuerpo Fluorescente Indirecta , Humanos , Immunoblotting , Larva/inmunología , Sensibilidad y Especificidad , Strongyloides/clasificación , Strongyloides/aislamiento & purificación , Estrongiloidiasis/diagnóstico
7.
Rev Soc Bras Med Trop ; 35(3): 209-14, 2002.
Artículo en Portugués | MEDLINE | ID: mdl-12045812

RESUMEN

Due to the importance of Cryptosporidium parvum, Cyclospora cayetanensis and Isospora belli as opportunistic parasites, it is essential for laboratories to morphologically differentiate these coccidia. Among the recommended methods for diagnosis of C. parvum and I. belli is the Modified Ziehl-Neelsen stain (MZN) and recently a new technique, the Acid-Fast-Trichrome (AFT) was proposed. The purpose of this study was to compare the AFT and MZN techniques regarding the detection of C. parvum and I. belli oocysts in stool samples of HIV-positive patients. According to the presence (n=60) or absence of diarrhea (n=60), two groups were selected for inclusion in this study. The stool samples were collected in 10% formalin solution and the pellets, obtained without and after centrifugation-concentration (500xg; 10 min), were submitted to both stain techniques. Considering the positivity of the techniques (AFT and MZN), we observed the superiority of MZN stain (n=19; 100% positive cases) over AFT (n=8; 42.1%). The identification of the 101 truly-negative cases was possible with both techniques, but when the AFT stain was used, the oocysts showed a variable inner stain degree, which resulted in false-negatives. Enteric coccidiosis was more frequent among the patients who presented diarrhea (26.6%) compared to asymptomatic individuals (5%); C. cayetanensis was not detected in these groups. We were interested in evaluating the employment of AFT for the Cyclospora oocyst stain. Based on the sensitivity and specificity obtained in this study (100%), we concluded that the MZN technique is still the most indicated for routine use in clinical analysis laboratories, for the diagnosis of cryptosporidiosis and isosporosis, especially when it was used together with the centrifugation procedure (500xg; 10 min). Our results showed that with some improvements, AFT would be a simple and inexpensive technique appropriate for use in the diagnosis of intestinal coccidia (C. parvum, C. cayetanensis and I. belli). It can also be extended to the detection of microsporidia.


Asunto(s)
Cryptosporidium parvum/aislamiento & purificación , Cyclospora/aislamiento & purificación , Heces/parasitología , Isospora/aislamiento & purificación , Parasitología/métodos , Animales , Humanos , Recuento de Huevos de Parásitos
8.
Rev. Soc. Bras. Med. Trop ; 35(3): 209-214, maio-jun. 2002.
Artículo en Portugués | LILACS | ID: lil-331770

RESUMEN

Due to the importance of Cryptosporidium parvum, Cyclospora cayetanensis and Isospora belli as opportunistic parasites, it is essential for laboratories to morphologically differentiate these coccidia. Among the recommended methods for diagnosis of C. parvum and I. belli is the Modified Ziehl-Neelsen stain (MZN) and recently a new technique, the Acid-Fast-Trichrome (AFT) was proposed. The purpose of this study was to compare the AFT and MZN techniques regarding the detection of C. parvum and I. belli oocysts in stool samples of HIV-positive patients. According to the presence (n=60) or absence of diarrhea (n=60), two groups were selected for inclusion in this study. The stool samples were collected in 10 formalin solution and the pellets, obtained without and after centrifugation-concentration (500xg; 10 min), were submitted to both stain techniques. Considering the positivity of the techniques (AFT and MZN), we observed the superiority of MZN stain (n=19; 100 positive cases) over AFT (n=8; 42.1). The identification of the 101 truly-negative cases was possible with both techniques, but when the AFT stain was used, the oocysts showed a variable inner stain degree, which resulted in false-negatives. Enteric coccidiosis was more frequent among the patients who presented diarrhea (26.6) compared to asymptomatic individuals (5); C. cayetanensis was not detected in these groups. We were interested in evaluating the employment of AFT for the Cyclospora oocyst stain. Based on the sensitivity and specificity obtained in this study (100), we concluded that the MZN technique is still the most indicated for routine use in clinical analysis laboratories, for the diagnosis of cryptosporidiosis and isosporosis, especially when it was used together with the centrifugation procedure (500xg; 10 min). Our results showed that with some improvements, AFT would be a simple and inexpensive technique appropriate for use in the diagnosis of intestinal coccidia (C. parvum, C. cayetanensis and I. belli). It can also be extended to the detection of microsporidia.


Asunto(s)
Humanos , Animales , Cryptosporidium parvum , Cyclospora , Heces , Isospora , Parasitología , Recuento de Huevos de Parásitos
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