Reducing central vein catheterization complications with a focused educational program: a retrospective cohort study.

Central venous catheters (CVCs) are frequently used, but the rate of complications is high. This study evaluates the effects of a short training program for CVC insertion in a university-based teaching hospital. A sample of adults with CVCs inserted outside the intensive care unit was selected from two academic years: 2015, year without structured training, and 2016, year with structured training. Clinical and laboratory information, as well as the procedure's characteristics and complications (mechanical and infectious) were collected. The incidence of complications before and after the training was compared. A total of 1502 punctures were evaluated. Comparing the pre- and post-training period, there was an increase in the choice for jugular veins and the use of ultrasound. A numerical reduction in the rate of complications was identified (RR 0.732; 95% CI 0.48-1.12; P = 0.166). This difference was driven by a statistically significant lower rate of catheter-related infections (RR 0.78; 95% CI 0.64-0.95; P = 0.047). In the multivariate analysis, aspects regarding technique (ultrasound use, multiple punctures) and year of training were associated with outcomes. Structured training reduces the rate of complications related to CVC insertion, especially regarding infections.

Bromatological and mycotoxin analysis on soybean meal before and after the industrial process of micronization / Análise bromatológica e micotoxicológica do farelo de soja antes e após processo industrial de micronização

Aflatoxins, fumonisins and zearalenone take part of the most studied mycotoxin groups due to their toxic effects on animal and human health. This research evaluated samples of soybeans meal used in animal food industry. A hundred and twenty one soybean meal samples were analyzed, so that 66 were analyzed before the industrial processing of micronization and 55 after it. The bromatological average of samples before micronization showed the following answers: 12.4% moisture; 46.4% protein; 79.5% protein solubility; 5.9% ash content; 2.2% fat; 4.3% fiber and 0.02 (ΔpH) of urease activity. The samples of micronization soybean meal showed 7.0% average values for moisture and 48.6% for crude protein. The mycotoxin levels were low in natura soybean meal; therefore, average values were 0.5μg kg-1, 29.6μg kg-1 and 56.8μg kg-1 for aflatoxin, zearelenone and fumonisin, respectively. After micronization, the average values for the studied samples were 1.3μg kg-1, 67.5μg kg-1 and 89.1μg kg-1, respectively for the same mycotoxins. The results for bromatological and mycotoxin analyses indicate similarity with the established patterns according to the Brazilian Compendium for Animal feed and reference literature. However, at least one of the three studied mycotoxin was detected in all of the analyzed samples and there was greater contamination of soybeans meal after the micronization process.

Aflatoxinas, fumonisinas e zearalenona pertencem aos grupos de micotoxinas mais estudados, devido aos efeitos tóxicos provocados na saúde animal e humana. O presente estudo avaliou amostras de farelo de soja utilizado em uma indústria de nutrição animal. Foram analisadas 121 amostras de farelo de soja, sendo 66 antes do processo industrial de micronização e 55 após o processamento. A composição bromatológica média das amostras antes da micronização apresentou 12,4% de umidade; 46,4% de proteína; 79,5% de solubilidade proteica; 5,9% de cinzas; 2,2% de gordura; 4,3% de fibra e 0,02 (ΔpH) de atividade ureásica. As amostras de farelo de soja micronizado apresentaram valores médios de 7.0% para umidade e 48,6% para proteína bruta. Os resultados apresentaram baixos níveis de micotoxinas no farelo de soja "in natura", detectando valores médios para aflatoxina, zearalenona e fumonisina de 0,5μg kg-1, 29,6μg kg-1e 56,8μg kg-1, respectivamente. Após a micronização, as amostras apresentaram valores médios de 1,3μg kg-1, 67,5μg kg-1 e 89,1μg kg-1, respectivamente, para as mesmas micotoxinas. Os resultados das análises bromatológicas e de micotoxinas evidenciaram conformidade com os padrões estabelecidos pelo Compêndio Brasileiro de Alimentação Animal e literatura de referência. Entretanto, detectou-se a presença de, no mínimo, uma das três micotoxinas pesquisadas em todas as amostras analisadas e uma maior contaminação no farelo de soja após o processo de micronização.