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1.
J Int Med Res ; 49(5): 3000605211012379, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33947257

RESUMEN

OBJECTIVES: To investigate the pathogens and potential risk factors for urinary tract infection (UTI) in patients with retained double-J catheters (DJCs). METHODS: In total, 107 infants and young children with DJCs were included in this retrospective analysis. Patients were included in the infection group (n = 30) or non-infection group (n = 77), according to UTI presence or absence. The species and characteristics of pathogens were investigated, and the clinical features of the patients were recorded for further analysis. RESULTS: Gram-negative bacilli were the most common causative pathogens (69.2%), among which Escherichia coli was most frequent (38.5%). The second most common causative pathogens were Gram-positive cocci (28.2%), among which Enterococcus faecalis was most frequent (10.3%). UTIs among patients in this study were associated with the following factors: catheter retention (long-term) (odds ratio [OR] = 2.514, 95% confidence interval [CI] = 1.176-5.373), sex (male) (OR = 2.966, 95% CI = 1.032-8.529), DJC retention (long-term) (OR = 1.869, 95% CI = 1.194-2.926), and DJC number (unilateral) (OR = 0.309, 95% CI = 0.103-0.922). CONCLUSIONS: Infants and young children with DJCs were likely to experience UTIs, mainly caused by Gram-negative bacilli. Long-term catheter retention or DJC retention, male sex, and bilateral DJC retention were risk factors for UTI.


Asunto(s)
Antibacterianos , Infecciones Urinarias , Antibacterianos/uso terapéutico , Catéteres , Niño , Preescolar , Humanos , Lactante , Masculino , Estudios Retrospectivos , Factores de Riesgo , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología
2.
Soins ; 66(854): 10-15, 2021 Apr.
Artículo en Francés | MEDLINE | ID: mdl-33962724

RESUMEN

Alcoholic chlorhexidine 2 % is recommended for the prevention of catheter infections. A retrospective study was conducted in a nutritional assistance unit in a cohort of patients with a long-term central venous route. The tolerance (number of skin reactions) and efficacy (number of infections/days of catheters) of this antiseptic used in repeated care in these patients were described.


Asunto(s)
Antiinfecciosos Locales , Infecciones Relacionadas con Catéteres , Cateterismo Venoso Central , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/efectos adversos , Catéteres , Clorhexidina , Humanos , Estudios Retrospectivos
3.
J Int Med Res ; 49(4): 3000605211004517, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33840246

RESUMEN

OBJECTIVE: To compare the value of the subcutaneous tunneling technique versus the normal technique in improving the outcomes of patients undergoing chemotherapy with peripherally inserted central catheters (PICCs). METHODS: One hundred thirty patients were randomly divided into an experimental group (subcutaneous tunneling technique) and control group (normal technique) according to the PICC placement technique, and clinical data were compared between the groups. RESULTS: In total, 129 PICCs were successfully inserted. Compared with the control group, the experimental group had a lower occurrence of complications after placement (especially catheter dislodgement: 3.1% vs. 15.4%, venous thrombosis: 3.1% vs. 15.4%, and wound oozing: 14.1% vs. 27.7%), lower occurrence of unscheduled PICC removal (3.1% vs. 13.8%), greater comfort during placement (14.16 ± 2.21 vs. 15.09 ± 2.49 on a scale ranging from 6 to 30 points, with higher scores indicating lower degrees of comfort), and lower costs of PICC maintenance (median (interquartile range) per-day maintenance cost: 13.90 (10.99-32.83) vs. 15.69 (10.51-57.46) Yuan). The occurrence of complications and amount of bleeding during placement were not significantly different between the two groups. CONCLUSIONS: The subcutaneous tunneling technique can improve PICC placement by reducing complications and costs of maintenance with better patient comfort during placement.


Asunto(s)
Cateterismo Venoso Central , Cateterismo Periférico , Trombosis de la Vena , Cateterismo Venoso Central/efectos adversos , Cateterismo Periférico/efectos adversos , Catéteres , Catéteres de Permanencia , Humanos , Estudios Retrospectivos , Factores de Riesgo
5.
BMJ Case Rep ; 14(4)2021 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-33858900

RESUMEN

Remimazolam besylate is an ultra-short-acting benzodiazepine derivative recently approved in Japan for general anaesthesia. However, less attention has been paid to the compatibility of remimazolam with infusion solutions, and the mechanism underlying the incompatibility remains unknown. The patient was a 65-year-old man who underwent a high tibial osteotomy. After the induction of general anaesthesia using remimazolam solution (5 mg/mL), we noticed precipitate completely blocking the lumen of the intravenous tube connected to a Ringer's acetate Physio140 drip. The mixture of remimazolam solution (5 mg/mL) with Physio140 solution immediately resulted in the formation of substantial precipitate. Nuclear magnetic resonance analysis revealed that the precipitate was remimazolam. Ultraviolet spectrophotometry revealed that the mixture of remimazolam solution with higher ratios of Physio140 resulted in significantly lower solubility, concomitant with an increase in pH. It would be important to consider the remimazolam concentration and infusion solution pH to avoid the production of precipitates.


Asunto(s)
Benzodiazepinas , Hipnóticos y Sedantes , Anciano , Catéteres , Humanos , Infusiones Intravenosas , Soluciones Isotónicas , Japón , Masculino
6.
BMJ Case Rep ; 14(4)2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33795276

RESUMEN

We report the case of a 48-year-old man with spina bifida and history of previous ventriculoperitoneal (VP) shunt placement for hydrocephalus. On attempted removal of the shunt 2 years prior to presentation at a neurosurgical unit, the peritoneal component was left in situ due to difficulties with removal. He presented acutely to our general surgical department with an enterocutaneous fistula precipitated by the retained fragment discharging to the right upper abdominal quadrant that required urgent surgical intervention. Although abdominal complications of VP shunts are documented, there is minimal literature as to the risks of remnant catheters being left in situ. This case demonstrates the possible risks with retained VP shunt catheters and the necessity to remove any redundant foreign bodies to prevent significant delayed complications.


Asunto(s)
Hidrocefalia , Fístula Intestinal , Disrafia Espinal , Catéteres , Humanos , Hidrocefalia/etiología , Hidrocefalia/cirugía , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Masculino , Persona de Mediana Edad , Disrafia Espinal/complicaciones , Derivación Ventriculoperitoneal/efectos adversos
7.
Medicina (Kaunas) ; 57(4)2021 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-33808168

RESUMEN

Background and Objectives: This study was conducted to investigate the influence of an ultrasound-guided technique using a catheter-over-needle when an intravascular injection occurs in patients undergoing a caudal block. Material and Methods: We retrospectively investigated 41 cases of an ultrasound-guided technique using an angiocatheter for caudal block. These had been performed between November 2019 through August 2020 to manage pain of lumbosacral origin. Under ultrasound guidance, after advancing the introducer needle through the sacrococcygeal ligament and then slowly withdrawing it, the outer catheter was continuously advanced into the sacral hiatus. We confirmed proper needle placement under fluoroscopic imaging, using 5 mL of contrast media. We assessed the contrast spread pattern with fluoroscopic imaging and checked it for the presence of intravascular injection. Results: In all recruited cases, the catheter-over-needle was guided successfully to the sacral hiatus and into the caudal epidural space. There was 100% accuracy under ultrasound guidance, without intravascular uptake, as confirmed by contrast media fluoroscopy. The incidence of ventral spread was 84.2% above the S1 with 5 mL of contrast. Conclusions: The technique of using a catheter-over-needle under ultrasound induced successful block without intravascular injection. Thus, this technique is a reliable option for conventional caudal block.


Asunto(s)
Catéteres , Ultrasonografía Intervencional , Catéteres/efectos adversos , Humanos , Incidencia , Estudios Retrospectivos , Ultrasonografía
8.
BMJ Case Rep ; 14(4)2021 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-33827881

RESUMEN

Serratia marcescens, time and again, has demonstrated its ability to easily adhere and infect vascular access catheters, making them a bona fide source of hospital outbreaks and contributing to adverse patient outcomes. We present a unique case of a severe recurrent Serratia infection, leading to persistent bacteria in the blood, haematogenous dissemination and subsequent development of abscesses, to a degree not reported in the literature before. These infections are exceedingly challenging to eradicate, owing to multiple virulence mechanisms and the deep seeding ability of this microorganism. Serratia infections require a multifaceted approach with intricacies in identification, therapeutics and surveillance, all of which are sparsely reported in the literature and reviewed in this report.


Asunto(s)
Infección Hospitalaria , Infecciones por Serratia , Catéteres , Brotes de Enfermedades , Humanos , Infecciones por Serratia/diagnóstico , Infecciones por Serratia/tratamiento farmacológico , Serratia marcescens
9.
Angiol Sosud Khir ; 27(1): 91-95, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33825734

RESUMEN

Demonstrated in the article are the results of catheter-directed thrombolysis in a male patient presenting with bilateral acute iliofemoral venous thrombosis on the background of aplasia of the inferior vena cava. The incidence rate of this pathology is specified, with an emphasis on no recommendations on choosing optimal therapeutic strategy in this cohort of patients. The main causes and complications of the disease are described. The realized policy of revascularization demonstrated its safety and efficacy. The chosen method of correction resulted in a successful outcome of treatment, preventing phlegmasia cerulea dolens. This policy can be recommended as most preferred for patients with acute iliofemoral venous thrombosis on the background of aplasia of the inferior venal cava.


Asunto(s)
Vena Cava Inferior , Trombosis de la Vena , Catéteres , Humanos , Vena Ilíaca/diagnóstico por imagen , Masculino , Terapia Trombolítica , Resultado del Tratamiento , Vena Cava Inferior/diagnóstico por imagen , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/tratamiento farmacológico
10.
Medicina (B Aires) ; 81(2): 159-165, 2021.
Artículo en Español | MEDLINE | ID: mdl-33906133

RESUMEN

A retrospective-observational analytical study was carried out to evaluate the epidemiology of catheter-related bloodstream infections (CRBSI) in 773 adult patients hospitalized in the intensive care unit (ICU) of the Hospital Alemán of Buenos Aires, Argentina, between 1 December 2018 and 30 June 2020. During the study period, the incidence of CRBSI was 8.7 cases per 1000 catheter days. The occurrence of CRBSI was found associated with a poor clinical evolution, as evidenced by a stay in the ICU significantly longer than the stay of patients without CRBSI (median: 21.5 days vs. 4 days, p < 0.001). CRBSI-associated mortality was not statistically higher (24% vs. 20%, OR 1.26 [0.61-2.63]). Gram-positive bacteria were the most frequently identified microorganisms (73%), being Staphylococcus epidermidis the most frequent (40%). Of the 47 isolates of microorganisms surveyed, 8 (17%) were multi-resistant germs. The permanence time of the catheter was identified as a risk factor for developing CRBSI (OR 1.10 [1.05 - 1.15], p < 0.001) in a multivariate analysis. In this analysis, the risk of infection was not influenced by the anatomical site of insertion of the catheter, the ward where the procedure was performed (ICU vs. operating room/external ward), the skill of the medical practitioner, or the use of ultrasound to guide vascular accesses. We conclude that CRBSIs are a frequent complication in our department with relevant clinical consequences. Knowing the epidemiology and the problems of each service allows programming interventions aimed to correct specific public health problems.


Asunto(s)
Bacteriemia , Infecciones Relacionadas con Catéteres , Adulto , Argentina/epidemiología , Bacteriemia/epidemiología , Bacteriemia/etiología , Infecciones Relacionadas con Catéteres/epidemiología , Catéteres , Cuidados Críticos , Humanos , Unidades de Cuidados Intensivos , Estudios Retrospectivos
11.
West Afr J Med ; 38(4): 374-379, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33903091

RESUMEN

Background: Localization of epidural space has no clear-cut end point like during subarachnoid block, making it an enigma to the anaesthetist. Confirmation of correct placement of the catheter is desirable in order to prevent failure, high or total spinal when large amount of local anaesthetic agent is inadvertently injected in the intrathecal space, subdural block and lastly local anaesthesia systemic toxicity. This study evaluated the use of meniscus sign to confirm correct placement of epidural catheter. Materials and method: A total of 80 patient's scheduled for epidural anaesthesia were recruited into this prospective observational study. The epidural space was located using the loss of resistance to air (LORA) technique. An epidural catheter was inserted gradually through the Tuohy needle, with its removal, 4cm of catheter left in the space and a test dose of 2% lidocaine with adrenaline was instilled. The presence of meniscus sign on the catheter was used to confirm correct placement. The number of correctly placed epidural catheters, intravascular or peri-dura placements were all noted. Result: Of the 80 patients, meniscus sign confirmed correct epidural catheter placement in 74 of them"(92.5% success)". The study showed 100% success for both sensitivity and specificity when the meniscus sign was used for locating epidural placement. Conclusion: The meniscus sign is a reliable indicator of correct epidural catheter placement, with high sensitivity and specificity.


Asunto(s)
Anestesia Epidural , Menisco , Anestesia Epidural/efectos adversos , Cateterismo , Catéteres/efectos adversos , Espacio Epidural , Humanos
12.
Harefuah ; 160(4): 250-255, 2021 Apr.
Artículo en Hebreo | MEDLINE | ID: mdl-33899376

RESUMEN

INTRODUCTION: Hypertension is a significant risk factor for cardiovascular morbidity and mortality. Despite a large variety of pharmacological treatment options, many patients remain uncontrolled. Medical inertia and patients' non-adherence to medications are the main reasons for lack of control. Experimental evidence shows that increased renal sympathetic nerve activity increases blood pressure and surgical denervation lowers blood pressure. In studies published between the years 2010-2013, radiofrequency endovascular ablation of renal sympathetic nerves (RDN) seemed to produce antihypertensive effects. However, a randomized sham-control study failed to prove active treatment-specific benefit. One of the main reasons for failure was the small number of ablations in each procedure. In recent years, technological progress has been made with the possibility to quadruple the number of ablation sites and extend them to the branches of the main renal arteries. Small sham-controlled studies were conducted in patients with grade 1-2 hypertension, either untreated or treated with up to three drugs. At three to six months follow-up, modest yet significant decrease of blood pressure was found, both in office and ambulatory measurements. Data from the Global SYMPLICITY Registry, which collects data from consecutive patients undergoing RDN with Medtronic radiofrequency ablation catheters, most of them with resistant hypertension, also showed significant improvement in blood pressure. However, in the absence of a control group, these real-life results should be interpreted with caution. Selection criteria of patients more likely to benefit from RDN have not been defined and will be discussed in the current review. In summary, RDN is a promising new treatment for hypertension. Randomized sham-controlled studies with a longer follow-up are still needed to confirm long-lasting treatment-specific effects and to show cardiovascular protection and safety.


Asunto(s)
Ablación por Catéter , Hipertensión , Antihipertensivos/uso terapéutico , Presión Sanguínea , Catéteres , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/cirugía , Ensayos Clínicos Controlados Aleatorios como Asunto , Simpatectomía , Resultado del Tratamiento
13.
An. Fac. Cienc. Méd. (Asunción) ; 54(1): 77-82, 20210000.
Artículo en Español | LILACS | ID: biblio-1178631

RESUMEN

El empiema es una colección de líquido purulento en el espacio pleural. La causa más común es la neumonía. Las opciones de tratamiento incluyen toracocentesis terapéutica, colocación de catéter de drenaje, terapia fibrinolítica, pleurodesis y cirugía, como la decorticación pleural. El drenaje pleural es eficaz en la etapa I y la cirugía está reservada para casos complicados (estadios II y III). En estos casos, es necesaria la decorticación pulmonar. Actualmente, el enfoque más favorecido para la decorticación es mediante una toracotomía abierta. Este es un estudio observacional, descriptivo, de corte transversal, retrospectivo, con un muestreo no probabilístico de casos consecutivos que tuvo como población accesible a pacientes con el diagnostico de empiema en quienes se realizó una decorticación pleural en el Hospital de Clínicas por el Departamento de Cirugía de Tórax durante el periodo de marzo 2016 a febrero 2019. Un total de 24 pacientes con el diagnóstico de empiema fueron sometidos a una decorticación pleural. La etiología de empiema más frecuente (75%) fue el derrame paraneumónico. Las complicaciones post quirúrgicas estuvieron presentes en 9 (37,5%) pacientes, de estos, 4 (17%) presentaron fuga aérea durante los primeros días postoperatorios. Se constató la resolución completa del cuadro en 21 (87,5%) pacientes y 3 (12,5%) pacientes presentaron colección residual pleural. Se constató recurrencia en 1 (4%) paciente, requiriendo un re intervención quirúrgica. En conclusión, la casuística de nuestro departamento de tórax coincide en cuanto a valores internacionales de complicaciones, resolución y mortalidad.


Empyema is a collection of purulent fluid in the pleural space. The most common cause is pneumonia. Treatment options include therapeutic thoracentesis, drainage catheter placement, fibrinolytic therapy, pleurodesis, and surgery, such as pleural decortication. Pleural drainage is effective in stage I and surgery is reserved for complicated cases (stages II and III). In these cases, pulmonary decortication is necessary. Currently, the most favored approach to decortication is by open thoracotomy. This is an observational, descriptive, cross-sectional, retrospective study, with a non-probabilistic sampling of consecutive cases that had as the accessible population, patients with the diagnosis of empyema in whom pleural decortication was performed at the Clinica´s Hospital of San Lorenzo, by the Department of Thoracic Surgery during the period from March 2016 to February 2019. A total of 24 patients with the diagnosis of empyema underwent pleural decortication. The most frequent aetiology of empyema (75%) was parapneumonic effusion. Post-surgical complications were present in 9 (37.5%) patients, of these, 4 (17%) presented air leakage during the first postoperative days. Complete resolution of the condition was verified in 21 (87.5%) patients and 3 (12.5%) patients presented residual pleural collection. Recurrence was found in 1 (4%) patient, requiring reoperation. In conclusion, the casuistry of our thoracic department coincides in terms of international values of complications, resolution and mortality.


Asunto(s)
Neumonía , Cirugía Torácica , Toracotomía , Drenaje , Pleurodesia , Toracocentesis , Cirugía General , Tórax , Terapia Trombolítica , Estudios Retrospectivos , Catéteres
14.
Rev. ecuat. pediatr ; 22(1): 1-7, Abril 30, 2021.
Artículo en Inglés | LILACS | ID: biblio-1222350

RESUMEN

Introduction: Advances in the management and survival of severe pediatric disease have led to an increase in thromboembolic phenomena, given the frequent need for central venous catheters (CVC). The present study describes the conditions in which venous thrombosis oc-curs in pediatric patients with CVC in a public referral center in Guayaquil. Methods: This is an observational, cross-sectional study with the objective of identifying fac-tors that are associated with the development of venous thrombosis in patients with CVC ad-mitted to the Intensive Care Unit. Information was collected in a pre-designed chart of all patients with CVC for more than 7 days. A venous Doppler ultrasound was performed to de-termine the presence or absence of thrombi. Descriptive statistics were used for univariate analysis and Odds Ratio was used for the bivariate analysis. Results: 35 patients were included in the study, 14/35 (40%) young infants, 24/35 males (69%), 19 cases (54%) with malnutrition, 10 cases (29%) with congenital heart disease, and 18 cases (51%) admitted for infections. The puncture site was femoral in 11 cases (31%), the procedure was performed by the fellow in 20 cases (57%), on a scheduled basis in 27 cases (77%), and performed in a single attempt in 28 cases (80%). The tip of the catheter was located in the superior vena cava in 23 cases (66%). The prevalence of thrombosis was 14% (95% CI 12.33-16.25). Bivariate analysis showed that none of the variables were associated with the presence of CVC thrombosis. Conclusions: 14% of patients with CVC use for more than 7 days develop secondary venous thrombosis. The factors associated with CVC including nutritional status and related proce-dures could not be determined.


Asunto(s)
Niño , Infecciones Relacionadas con Catéteres , Catéteres , Obstrucción del Catéter
16.
Ann Palliat Med ; 10(3): 2971-2978, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33752422

RESUMEN

BACKGROUND: Although the peripherally inserted central catheter (PICC) has been widely utilized, there is still a lack of large sample size-based relevant risk factor investigation for the children with blood diseases in a single center of China. METHODS: We performed a retrospective cohort study through including a total of 2,974 cases aged 0-18 years with blood diseases and PICC insertion. Success rates of different PICC operation techniques were compared. Targeting the common PICC-related complications, we performed the univariate and multivariate logistic regression analyses. Then, based on the screened risk factors, the prediction modeling analysis of binary logistic regression was conducted. RESULTS: The "B-ultrasound plus Seldinger technology" showed a higher success rate of PICC placement than the "non-assistive blind insertion". The catheter type was closely linked to the occurrence of catheter occlusion. The age, insertion site, and catheter type might be the risk factors of phlebitis, while the insertion site, operation season, and catheter type might be associated with catheter fracture. Furthermore, based on these risk factors, we established the nomogram prediction models of phlebitis, rash occurrence, and catheter fracture, respectively, which shows a good predictive ability and a moderate level of predictive accuracy. CONCLUSIONS: Our findings first shed new light on the preoperative estimation of the risk factors of PICCrelated complications for the children with blood diseases in China.


Asunto(s)
Cateterismo Venoso Central , Cateterismo Periférico , Enfermedades Hematológicas , Adolescente , Cateterismo Venoso Central/efectos adversos , Cateterismo Periférico/efectos adversos , Catéteres , Niño , Preescolar , China , Humanos , Lactante , Recién Nacido , Estudios Retrospectivos , Factores de Riesgo
17.
Ann Palliat Med ; 10(3): 3135-3141, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33752431

RESUMEN

BACKGROUND: Intravenous (IV) catheter insertion may cause adverse reactions. It is necessary to investigate optimal methods for reducing blood return and extending the usage time of IV catheter by existing technologies. We investigated the efficacy of the PosiFlow regulator with an infusion clip for preventing IV catheter plugging due to venous blood return. METHODS: From January 2017 to August 2017, 960 patients requiring IV catheterization were recruited and by using the block randomization method randomly allocated to 4 groups (n=240 in each group): a control group receiving IV catheter with infusion clip; experimental group A receiving IV catheter without infusion clip; experimental group B receiving an IV catheter with the PosiFlow regulator; and experimental group C receiving an IV catheter with a PosiFlow regulator and infusion clip. The rates of catheter plugging and blood return were compared among groups. RESULTS: In different reasons for needle pulling, The rates of catheter plugging and blood return in experimental group C (Received IV catheterization with an infusion clip and PosiFlow regulato) were the lowest among all groups (P<0.05). In different puncture sites, forearm puncture further reduced IV catheter plugging in all groups compared to other puncture sites. CONCLUSIONS: Catheter plugging and blood return can be significantly reduced by combining the PosiFlow regulator and an infusion clip, resulting in reduced medical costs and patient distress from catheter reinsertion.


Asunto(s)
Catéteres , Humanos , Infusiones Intravenosas
18.
Zhongguo Dang Dai Er Ke Za Zhi ; 23(3): 201-212, 2021 Mar.
Artículo en Chino | MEDLINE | ID: mdl-33691911

RESUMEN

Peripherally inserted central catheter (PICC) has been widely used in the neonatal intensive care unit (NICU) in recent years, but there are potential risks for complications related to PICC. Based on the current evidence in China and overseas, the operation and management guidelines for PICC in neonates were developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) in order to help the NICU staff to regulate the operation and management of PICC.


Asunto(s)
Cateterismo Venoso Central , Cateterismo Periférico , Cateterismo Venoso Central/efectos adversos , Cateterismo Periférico/efectos adversos , Catéteres , China , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal
19.
Nephrol Nurs J ; 48(1): 57-63, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33683844

RESUMEN

Peritoneal dialysis catheter complications that require nonsurgical or noninvasive correction by peritoneal dialysis (PD) nurses or practitioner are reviewed. Topics reviewed include compromised PD fluid flow, pericatheter fluid leakage, mechanical integrity disruption, catheter extrusion, and exit site/tunnel complications.


Asunto(s)
Catéteres , Diálisis Peritoneal , Catéteres/efectos adversos , Humanos , Diálisis Peritoneal/efectos adversos , Diálisis Peritoneal/enfermería
20.
Curr Opin Crit Care ; 27(2): 95-102, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33560016

RESUMEN

PURPOSE OF REVIEW: Each year in the United States there are over 2.5 million visits to emergency departments for traumatic brain injury (TBI), 300,000 hospitalizations, and 50,000 deaths. TBI initiates a complex cascade of events which can lead to significant secondary brain damage. Great interest exists in directly measuring cerebral oxygen delivery and demand after TBI to prevent this secondary injury. Several invasive, catheter-based devices are now available which directly monitor the partial pressure of oxygen in brain tissue (PbtO2), yet significant equipoise exists regarding their clinical use in severe TBI. RECENT FINDINGS: There are currently three ongoing multicenter randomized controlled trials studying the use of PbtO2 monitoring in severe TBI: BOOST-3, OXY-TC, and BONANZA. All three have similar inclusion/exclusion criteria, treatment protocols, and outcome measures. Despite mixed existing evidence, use of PbtO2 is already making its way into new TBI guidelines such as the recent Seattle International Brain Injury Consensus Conference. Analysis of high-fidelity data from multimodal monitoring, however, suggests that PbtO2 may only be one piece of the puzzle in severe TBI. SUMMARY: While current evidence regarding the use of PbtO2 remains mixed, three ongoing clinical trials are expected to definitively answer the question of what role PbtO2 monitoring plays in severe TBI.


Asunto(s)
Lesiones Traumáticas del Encéfalo , Lesiones Encefálicas , Encéfalo , Lesiones Encefálicas/terapia , Lesiones Traumáticas del Encéfalo/terapia , Catéteres , Humanos , Estudios Multicéntricos como Asunto , Oxígeno
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