Cyclosporine level: difference between blood samples collected through peripheral and central venous access.

AIMS AND OBJECTIVES: To identify differences in cyclosporine levels between blood samples collected from a peripheral venous access, catheter line used for drug infusion and catheter line not used for drug infusion in adult patients receiving allogeneic haematopoietic stem cell transplantation. Background. Cyclosporine is an immunosuppressant that prevents graft-versus-host disease, has a narrow therapeutic window and causes nephrotoxicity. For cyclosporine infusion, a tunnelled central venous access device is used; however, because of the lipophilic properties of the drug, it can adsorb to the catheter surface and falsely raise cyclosporine concentrations in blood specimens. DESIGN: Prospective observational study. METHODS: The study collected 135 blood samples from 16 patients. In 13 subjects, samples were obtained from the three lines at three time points (1, 7 and 14 days after the start of cyclosporine infusion), and for three subjects, samples were only obtained at 1 and 7 days after the start of infusion. The 5-ml blood discard method was used for samples collected from the catheter. Using this procedure, the catheter line was washed with saline solution, 5 ml of blood and saline solution were aspirated from the catheter line and discarded, and then sample blood used for the test was collected. The paired t-test with the Bonferroni correction was used to analyse the differences in cyclosporine serum levels. RESULTS: Significant differences were observed when the drug serum levels obtained in the line used for drug infusion were compared with the levels obtained in the line not used for infusion or the peripheral venous line. No differences in drug levels were identified in blood collected from the peripheral venous line and the line not used for drug infusion. CONCLUSION: Drug adsorption occurs in the line used for infusion. Therefore, the blood sample collected from the line not used for cyclosporine infusion can be considered reliable for drug concentration determination. RELEVANCE TO CLINICAL PRACTICE: Nurses should standardise one line of the tunnelled central venous access device for cyclosporine infusion, which avoids the need for evasive procedures and provides patients with more comfort.

First experience of percutaneous radio-frequency ablation for atrial flutter and atrial fibrillation in a patient with HeartMate II left ventricular assist device.

We report the first case of percutaneous radio-frequency (RF) ablation procedure in a patient implanted with a HeartMate II left ventricular assist device for refractory heart failure. This procedure was performed for poorly tolerated recurrent atrial arrhythmias. No harmful consequence happened during or after the procedure despite the potential electromagnetic interferences existing between the RF delivery and the functioning of the device.

A contribuição dos membros da equipe de enfermagem para o processo de enfermagem na visão dos enfermeiros / The contribution of members of the nursing team to the nursing process according to nurses / La contribución de los miembros del equipo de enfermería al proceso de enfermería según los enfermeros

Há controvérsias quanto à participação de auxiliares e técnicos de enfermagem na realização do processo de enfermagem no Brasil. Neste estudo teve-se como objetivo identificar a opinião de 18 enfermeiros das cidades de Brasília-DF e Ribeirão Preto-SP sobre a participação de auxiliares e técnicos de enfermagem nessa metodologia, no que diz respeito a: etapas das quais poderiam participar e medidas necessárias para tal inclusão; atribuições para as quais cada membro da equipe de enfermagem tem competência legal e técnica para desenvolver; e atribuições que poderiam ser desenvolvidas caso tivessem competência legal. Embora a maioria concorde com a participação desses profissionais, restrições foram identificadas: os enfermeiros consideraram os auxiliares e técnicos competentes e habilitados legalmente para executar, prioritariamente, a coleta de dados e a implementação da assistência, contudo, há divergência entre o julgamento realizado pelos sujeitos e o que é previsto na legislação.

There is controversy as to the participation of nursing auxiliaries and technicians in the nursing process in Brazil. This study had the objective of hearing the opinion of 18 nurses from Brasília, capital of Brazil, and Ribeirão Preto, State of São Paulo, on the participation of nursing auxiliaries and technicians in this methodology with respect to: what stages they could participate in and measures necessary for this inclusion; attributions for which each member of the nursing team has legal and technical competency; attributions that could be developed if they had legal competency. Although most participants agree with the participation of these workers, restrictions were stated: the nurses consider that auxiliaries and technicians were competent and legally authorized to collect data and provide care; however, there is disagreement about he judgment and what is laid out in the legislation.

En Brasil, la participación de auxiliares y técnicos de enfermería en la realización del proceso de enfermería es controvertida. La finalidad del presente estudio ha sido identificar la opinión de 18 enfermeros de Brasília-DF y de Ribeirão Preto-SP, sobre la participación de auxiliares y técnicos de enfermería en dicha metodología respecto a: etapas de las cuales podrían participar y medidas necesarias para tal inclusión; atribuciones para cuyo desarrollo cada miembro del equipo de enfermería tiene competencia legal y técnica y atribuciones que podrían ser desarrolladas si tuvieran competencia legal. Aunque la mayoría esté de acuerdo con la participación de tales profesionales igual se identificaron algunas restricciones: los enfermeros consideraron que los auxiliares y técnicos son competentes y están habilitados legalmente para ejecutar, prioritariamente, la recogida de datos y la implementación de la atención pero, sin embargo, hay divergencias entre el juicio de los sujetos y lo que está previsto en la legislación.

Heart rate variability before ventricular arrhythmias in patients with coronary artery disease and an implantable cardioverter defibrillator.

BACKGROUND: Changes in autonomic regulation of the heart may be responsible for the occurrence of arrhythmias. Although a decrease in 24-hour heart rate variability is a strong predictor of subsequent arrhythmias in patients with heart disease, many questions remain unanswered concerning changes in heart rate and heart rate variability in the minutes or hours preceding an arrhythmia. The aim of our study was to analyze changes in heart rate and heart rate variability occurring during the 90 minutes preceding an arrhythmia, in patients with coronary heart disease and an implantable defibrillator. MATERIALS AND METHODS: Thirty-eight patients, with a total of 93 episodes of ventricular arrhythmia, were included in the study. Heart rate and heart rate variability were measured in three 30-minute and five 2-minute periods preceding the arrhythmia. Heart rate variability was assessed using measurements of Poincaré plots. RESULTS: The results show a gradual increase in heart rate before the arrhythmia, from 73+/-13/min, to 75+/-14/min, and finally 78+/-15/min in the 90 minutes preceding the arrhythmia (P<0.05). CONCLUSION: Measurements of Poincaré plots showed a significant increase in their length and no significant change in their width. These results suggest that sympathetic activation is the predominant change in autonomic nervous system before a ventricular arrhythmia in patients with coronary heart disease. This change may occur as early as one hour and a half before the arrhythmia.