Uso clínico de lidocaína intravenosa para manejo de dolor neuropático no oncológico en adultos / Clinical Use of Intravenous Lidocaine for Management of non-Oncologic Neuropathic Pain in Adults

El dolor neuropático es común en la práctica clínica. Se estima que afecta entre el 2 y 3 % de la población a nivel global. Una cantidad considerable de pacientes presentan dolor refractario a tratamientos existentes, volviéndolo un reto diagnóstico y terapéutico. El objetivo de este estudio es describir el uso clínico de lidocaína intravenosa para manejo de dolor neuropático no oncológico en adultos. La búsqueda de información se realizó consultando las bases de datos HINARI, SciELO y PubMed. Se seleccionaron artículos en inglés y español de 2017 a 2021. Se utilizaron artículos originales, ensayos clínicos, revisiones bibliográficas y metaanálisis. Las causas de dolor neuropático en las que ha sido utilizada la lidocaína son la neuralgia posherpética, neuropatía diabética y neuralgia del trigémino. El uso de lidocaína intravenosa demostró que disminuye la intensidad del dolor; sin embargo, al compararlo con otros fármacos de primera línea no hay diferencias a largo plazo. La mayoría de efectos secundarios se presentan en el sistema nervioso, gastrointestinal y cardiovascular. La lidocaína intravenosa como monoterapia para manejo de dolor neuropático no oncológico, si bien fue eficaz a corto plazo con dosis de 3-5 mg/Kg, no tuvo un efecto persistente y duradero

Neuropathic pain is common in clinical practice; it is estimated that 2 to 3 % of the global population is affected; a considerable number of patients present pain refractory to existing treatments, making it a diagnostic and therapeutic challenge. The objective of this study is to describe the clinical use of intravenous lidocaine for the management of non-cancer neuropathic pain in adults. The information search was performed by consulting the HINARI, SciELO and PubMed databases. Articles with an obsolescence of no more than five years, both in English and Spanish, were selected. Original articles, clinical trials, bibliographic reviews and meta-analyses were used. The causes of neuropathic pain in which lidocaine has been used were postherpetic neuralgia, diabetic neuropathy, and trigeminal neuralgia. The use of intravenous lidocaine has been shown to decrease pain intensity; however, when compared with other first line drugs, there are no long-term differences. Most side effects occur in the nervous, gastrointestinal, and cardiovascular systems. Intravenous lidocaine as monotherapy for the management of non-cancer neuropathic pain, although effective in the short term with doses of 3-5 mg/Kg, does not have a persistent and long-lasting effect

Hypertriglyceridaemia Induced Pancreatitis Management: A Case Report.

Acute pancreatitis results in high morbidity and mortality. Gallstones and alcoholism are considered leading causes of acute pancreatitis. However, increasing prevalence of obesity, diabetes and lifestyle choices has resulted in Hypertriglyceridaemia induced pancreatitis (HTAP) becoming more common. HTAP is said to be more severe than other causes. The treatment options available vary including intravenous (IV) insulin, heparin, plasma exchange, fibrates, niacin, omega three fatty acids and dietary restrictions. This is a case report of a patient presenting with HTAP and the dilemma treating physicians faced in trying to balance the need for urgent treatment with invasiveness of procedure and paucity of evidence.

Retrospective analysis of the feasibility and safety of external jugular vein cannulation in surgical patients.

BACKGROUND: Establishing intravenous (IV) access is an essential procedure in surgical patients. External jugular vein (EJV) cannulation can be a good alternative for patients forwhom it is difficult to establish peripheral IV access. We aimed to investigate the feasibilityand safety of EJV cannulation in surgical patients. METHODS: We performed a retrospective review of EJV cannulation in patients who underwent anesthesia for surgery at a tertiary hospital between 2010 and 2021. We collectedclinical characteristics, including EJV cannulation-related variables, from the anesthetic records. We also investigated the EJV cannulation-related complications, which included anyEJV cannulation-related complications (insertion site swelling, infection, thrombophlebitis,pneumothorax, and arterial cannulation) within 7 days after surgery, from the electronicmedical records during the hospitalization period for surgery. RESULTS: We analyzed 9,482 cases of 9,062 patients for whom EJV cannulation was performed during anesthesia. The most commonly performed surgery was general surgery(49.6%), followed by urologic surgery (17.5%) and obstetric and gynecologic surgery (15.7%).Unplanned EJV cannulation was performed emergently during surgery for 878 (9.3%) cases.The only EJV cannulation-related complication was swelling at the EJV-cannula insertion site(65 cases, 0.7%). There was only one case of unplanned intensive care unit admission dueto swelling related to EJV cannulation. CONCLUSIONS: Our study showed the feasibility and safety of EJV cannulation for surgical patients with difficult IV access or those who need additional large-bore IV access during surgery. EJV cannulation can provide safe and reliable IV access with a low risk of major complications in a surgical patient.

Fatores associados ao insucesso da cateterização intravenosa periférica em crianças com câncer / Factores asociados al fracaso del cateterismo intravenoso periférico en niños con cáncer / Factors associated with peripheral intravenous catheterization failure in children with cancer

Resumo Objetivo Estimar a prevalência de insucesso na inserção de cateteres intravenosos periféricos em crianças com câncer e sua associação com características demográficas, clínicas, da cateterização e terapia intravenosa utilizada previamente. Métodos Estudo de corte transversal e exploratório realizado na unidade de clínica oncológica pediátrica de um hospital público. Foram utilizados dados provenientes da observação de 130 cateterizações intravenosas periféricas e prontuários das crianças. Analisadas as características demográficas, clínicas, da cateterização intravenosa periférica e terapia intravenosa utilizada e sua relação com o insucesso da cateterização. Utilizou-se regressão de Poisson com variância robusta para determinar os fatores associados ao desfecho estudado, considerando p<0,05. Resultados A prevalência do insucesso foi de 38,5% e esteve estatisticamente associada ao tempo de hospitalização (RP=1,6; IC95% 1,05-2,56), uso de terapia intravenosa prévia prolongada (RP=2,1; IC95% 1,32-3,20), antecedente de extravasamento (RP=1,99; IC95% 1,15-3,28) e agitação da criança (RP=1,41; IC95% 1,02-1,94). Conclusão Observou-se elevada prevalência de insucesso da cateterização intravenosa periférica em crianças com câncer, associada ao tempo de hospitalização maior ou igual a oito dias, uso de TIV prévia prolongada, antecedente de extravasamento e agitação da criança durante a inserção do cateter.

Resumen Objetivo Estimar la prevalencia de fracaso en la inserción de catéteres intravenosos periféricos en niños con cáncer y su relación con características demográficas, clínicas, del cateterismo y de terapia intravenosa previamente utilizada. Métodos Estudio de corte transversal y exploratorio realizado en la unidad de clínica oncológica pediátrica de un hospital público. Se utilizaron datos provenientes de la observación de 130 cateterismos intravenosos periféricos y las historias clínicas de los niños. Se analizaron las características demográficas, clínicas, del cateterismo intravenoso periférico y terapia intravenosa utilizada y su relación con el fracaso del cateterismo. Se utilizó regresión de Poisson con varianza robusta para determinar los factores asociados al evento estudiado, considerando p<0,05. Resultados La prevalencia del fracaso fue del 38,5 % y estuvo estadísticamente relacionada con el tiempo de internación (RP=1,6; IC95% 1,05-2,56), el uso de terapia intravenosa previa prolongada (RP=2,1; IC95% 1,32-3,20), antecedentes de extravasación (RP=1,99; IC95% 1,15-3,28) y la agitación del niño (RP=1,41; IC95% 1,02-1,94). Conclusión Se observó una elevada prevalencia de fracaso del cateterismo intravenoso periférico en niños con cáncer, relacionada con el tiempo de internación mayor o igual a ocho días, el uso de TIV previa prolongada, antecedentes de extravasación y agitación del niño durante la inserción del catéter.

Abstract Objective To estimate the prevalence of peripheral intravenous catheter insertion failure in children with cancer and its association with demographic, clinical, catheterization and previously used intravenous therapy characteristics. Methods This is a cross-sectional and exploratory study conducted at the pediatric oncology clinic of a public hospital. Data from the observation of 130 peripheral intravenous catheterizations and medical records of children were used. We analyzed the demographic and clinical characteristics of peripheral intravenous catheterization and intravenous therapy used and its relationship with catheterization failure. Poisson regression with robust variance was used to determine the factors associated with the outcome studied, considering p<0.05. Results The prevalence of failure was 38.5% and was statistically associated with length of stay (PR=1.6; 95%CI 1.05-2.56), previous prolonged intravenous therapy use (PR=2.1; 95%CI % 1.32-3.20), history of extravasation (PR=1.99; 95%CI 1.15-3.28) and child agitation (PR=1.41; 95%CI 1.02-1.94). Conclusion There was a high prevalence of peripheral intravenous catheterization failure in children with cancer, associated with length of hospitalization greater than or equal to eight days, previous prolonged IVT use, history of extravasation and child agitation during catheter insertion.

Construction and application of a decision-making flowchart for difficult peripheral intravenous puncture in children / Construcción y aplicación de un diagrama de flujo de toma de decisiones para la punción intravenosa periférica difícil en niños / Construção e aplicação de fluxograma decisório para punção intravenosa periférica difícil de crianças

ABSTRACT Objectives: to construct and verify the clinical applicability of a flowchart for assessing children and adolescents who will undergo peripheral intravenous catheterization, according to risk factors for procedure failure. Method: this is a methodological and observational study, which followed the AGREEII instrument guidelines and steps for the construction of a decision-making flowchart for difficult peripheral intravenous puncture. Afterwards, clinical applicability with children and adolescents was verified after approval of ethical merit, with the main outcome being the success rate in the first puncture attempt. It was verified, through statistical analysis, the association of the outcome with the risk factors raised. Results: in the first stage of the study, a literature review was carried out to survey the risk factors for difficult puncture, and prematurity, less than three years, more pigmented skin, obesity, chronic diseases, dehydration, vein difficult to see and/or not palpable, history of multiple punctures and complications of intravenous therapy were found. After applying the flowchart, it was found that 96.3% of the children and adolescents assessed were at risk of being punctured more than once and that 43.9% underwent more than one procedure for success. Those who were unsuccessful on the first attempt were younger than three years old, had chronic disease, vein difficult to see, not palpable vein and a history of multiple punctures. Conclusion: flowchart construction was based on the risk factors for difficult puncture identified in the literature. Clinical applicability showed that it can be a useful tool to identify children and adolescents at risk for puncture failure.

RESUMEN Objetivos: construir y verificar la aplicabilidad clínica de un diagrama de flujo para la evaluación de niños y adolescentes que serán sometidos a cateterismo intravenoso periférico según factores de riesgo de falla del procedimiento. Método: estudio metodológico y observacional, que siguió las pautas y pasos del instrumento AGREEII para la construcción del diagrama de flujo de toma de decisiones para la punción intravenosa periférica difícil. Posteriormente, se verificó la aplicabilidad clínica con niños y adolescentes, previa aprobación del mérito ético, siendo el resultado principal la tasa de éxito en el primer intento de punción. Se verificó, a través del análisis estadístico, la asociación del desenlace con los factores de riesgo planteados. Resultado: en la primera etapa del estudio se realizó una revisión bibliográfica para relevar los factores de riesgo de la punción difícil, encontrándose prematuridad, menos de tres años, piel más pigmentada, obesidad, enfermedades crónicas, deshidratación, vasos difíciles de visualizar y/o palpar, antecedentes de múltiples punciones y complicaciones de la terapia intravenosa. Después de aplicar el diagrama de flujo, se encontró que el 96,3% de los niños y adolescentes evaluados tenían riesgo de ser puncionados más de una vez, y que el 43,9% se sometió a más de un procedimiento con éxito. Los que no tuvieron éxito en el primer intento eran menores de tres años, tenían enfermedad crónica, dificultad para la visualización y palpación de los vasos y antecedentes de múltiples punciones. Conclusión: la construcción del diagrama de flujo se basó en los factores de riesgo para punción difícil identificados en la literatura. La aplicabilidad clínica demostró que puede ser una herramienta útil para identificar a niños y adolescentes con riesgo de fracaso de la punción.

RESUMO Objetivos: construir e verificar a aplicabilidade clínica de um fluxograma para avaliação de crianças e adolescentes que serão submetidos à cateterização intravenosa periférica, segundo fatores de risco para insucesso do procedimento. Método: estudo metodológico e observacional, que seguiu diretrizes e etapas do instrumento AGREEII para a construção do fluxograma decisório para punção intravenosa periférica difícil. Depois, verificou-se a aplicabilidade clínica com crianças e adolescentes, após aprovação do mérito ético, sendo o desfecho principal o índice de sucesso na primeira tentativa de punção. Verificou-se, por análise estatística, a associação do desfecho com os fatores de risco levantados. A coleta dos dados foi realizada entre os meses de novembro de 2018 e fevereiro de 2019. Resultado: na primeira etapa do estudo realizou-se revisão de literatura para levantamento dos fatores de risco para a difícil punção sendo encontrados prematuridade, menos de três anos, pele mais pigmentada, obesidade, doenças crônicas, desidratação, vasos difíceis de serem visualizados e/ou palpados, história de múltiplas punções e complicações da terapia intravenosa. Após aplicação do fluxograma, verificou-se que 96,3% das crianças e adolescentes avaliados tinham risco para serem puncionados mais de uma vez, e que 43,9% foram submetidos a mais de um procedimento para o sucesso. Os que não obtiveram sucesso na primeira tentativa tinham menos de três anos, possuíam doença crônica, difícil visualização e palpação dos vasos e histórico de múltiplas punções. Conclusão: a construção do fluxograma foi fundamentada nos fatores de risco para a difícil punção identificados na literatura. A aplicabilidade clínica mostrou que pode ser instrumento útil para identificar crianças e adolescentes com risco para insucesso da punção.

Demographic profile, training and practical experience of professionals performing peripheral intravenous catheterization in brazil / Perfil demográfico, formación y experiencia práctica de los profesionales que realizan cateterismo intravenoso periférico en brasil / Perfil demográfico, formação e experiência prática de profissionais executantes da cateterização intravenosa periférica no brasil

ABSTRACT Objective: to describe the demographic profile, training and practical experience of professionals who perform peripheral intravenous catheterization in Brazil. Method: this is a descriptive cross-sectional study, carried out in the five macroregions of Brazil with 2,584 nursing professionals who worked in direct care of patients undergoing peripheral intravenous catheterization, using a questionnaire containing professional demographic characteristics, training and experience. Data collection took place between July 2021 and May 2022. Descriptive statistics, one-way ANOVA test, Pearson's chi-square test for k independent samples and Tukey's multiple comparison test and adjusted residuals were used. Results: most nursing professionals resided in the southeast macro-region and were women. The mean age of nurses was 39.52 (±8.74) years, technicians, 39.66 (±9.22), and nursing assistants, 40.61 (±10.57). The mean training time for nurses was 11.83 (±8.18) years, for nursing technicians, 10.81 (±7.62), and for nursing assistants, 11.19 (±8.33). During the training process, most professionals received lessons in pharmacology, vascular access devices and venous catheterization. The mean number of devices inserted by nurses, in a 12-hour shift, was lower than the mean inserted by technicians and nursing assistants. Conclusion: nurses are not recognized as professionals legally responsible for the peripheral intravenous catheterization procedure, and intravenous therapy implementation is predominantly carried out by technicians and nursing assistants. The training process is incipient.

RESUMEN Objetivo: describir el perfil demográfico, la formación y la experiencia práctica de los profesionales que realizan cateterismo intravenoso periférico en Brasil. Método: estudio transversal descriptivo, realizado en las cinco macrorregiones de Brasil con 2.584 profesionales de enfermería que actuaban en el cuidado directo de pacientes sometidos a cateterismo intravenoso periférico, mediante un cuestionario que contiene las características demográficas, formación y experiencia de los profesionales. La recolección de datos se realizó entre julio de 2021 y mayo de 2022. Se utilizó estadística descriptiva, prueba ANOVA de 1 vía, Chi-Cuadrado T de Pearson para k muestras independientes y prueba de comparación múltiple de Tukey y residuos ajustados. Resultados: la mayoría de los profesionales de enfermería residían en la macrorregión Sudeste y eran mujeres. La edad media de los enfermeros fue de 39,52 (±8,74) años, de los técnicos, de 39,66 (±9,22) años, y de los auxiliares de enfermería, de 40,61 (±10,57) años. El tiempo medio de formación de los enfermeros fue de 11,83 (±8,18) años, de los técnicos de enfermería, de 10,81 (±7,62) años, y de los auxiliares de enfermería, de 11,19 (±8,33) años. Durante el proceso de formación, la mayoría de los profesionales recibieron lecciones de farmacología, dispositivos de acceso vascular y cateterismo venoso. El promedio de dispositivos insertados por enfermeros, en un turno de 12 horas, fue inferior al promedio insertado por técnicos y auxiliares de enfermería. Conclusión: los enfermeros no son reconocidos como profesionales legalmente responsables del procedimiento de cateterismo intravenoso periférico y la implementación de la terapia intravenosa es realizada predominantemente por técnicos y auxiliares de enfermería. El proceso de formación es incipiente.

RESUMO Objetivo: descrever o perfil demográfico, formação e a experiência prática de profissionais que realizam a cateterização intravenosa periférica no Brasil. Método: estudo transversal descritivo, realizado nas cinco macrorregiões do Brasil com 2.584 profissionais de enfermagem que atuavam no cuidado direto de pacientes submetidos à cateterização intravenosa periférica, utilizado um questionário contendo características demográficas, formação e experiência dos profissionais. A coleta ocorreu entre julho de 2021 e maio de 2022. Empregou-se estatística descritiva, Teste de Anova 1 Fator, Teste do Qui Quadrado de Pearson para k amostras independentes e Teste de comparações múltiplas de Tukey e resíduos ajustados. Resultados: a maior parte dos profissionais de enfermagem residiam na macrorregião sudeste, eram mulheres. A média de idade dos enfermeiros foi de 39,52 (±8,74) anos, dos técnicos de 39,66 (±9,22) anos e dos auxiliares de enfermagem de 40,61 (±10,57) anos. O tempo médio de formação dos enfermeiros foi igual a 11,83 (±8,18) anos, dos técnicos de enfermagem 10,81 (±7,62) anos e auxiliares de enfermagem 11,19 (±8,33) anos. Durante o processo formativo a maioria dos profissionais recebeu aulas de farmacologia, dispositivos de acesso vascular e cateterização venosa. O número médio de dispositivos inseridos por enfermeiros, em turno de 12 horas, foi inferior à média inserida por técnicos e auxiliares de enfermagem. Conclusão: enfermeiros não se reconhecem como profissionais legalmente responsáveis pelo procedimento de cateterização intravenosa periférica e a implementação da terapia intravenosa é predominantemente realizada pelos técnicos e auxiliares de enfermagem. O processo formativo é incipiente.

Eventos clínicos indesejáveis relacionados com a administração de aminas: Estudo transversal / Undesirable clinical events related to the administration of amines: A cross-sectional study / Eventos clínicos indeseables relacionados con la administración de aminas: Estudio transversal

Resumo Enquadramento: Identificação de eventos clínicos indesejáveis relacionados com a administração de aminas é fundamental com vista à segurança dos doentes, particularmente em contexto de cuidados intensivos. Objetivo: O estudo tem como objetivo geral investigar as práticas relacionadas com a administração de aminas vasoativas e como objetivos específicos descrever a administração de aminas e analisar os eventos clínicos indesejáveis relacionados com a administração destes fármacos em doentes críticos. Metodologia: Estudo quantitativo observacional, transversal, amostra de 97 doentes. Investigaram-se as variáveis relacionadas com a administração das aminas e com os registos de eventos clínicos indesejáveis. Realizada análise estatística descritiva e inferencial. Resultados: A noradrenalina obteve uma frequência de uso de (70,1%), seguida da dobutamina (29,9%). Cerca de 47,4% das doses foram administradas no lúmen proximal do cateter venoso central, enquanto que 12,4% foram duplamente confirmadas na prescrição. Evidenciou-se que os eventos clínicos indesejáveis foram três vezes maiores em doentes monitorizados a cada 2 horas. Conclusão: Verifica-se uma falha na monitorização dos doentes com aminas prescritas, bem como na dupla confirmação destes fármacos.

Abstract Background: Identifying undesirable clinical events related to the administration of vasoactive amines is essential for patient safety, particularly in intensive care settings. Objective: The general objective is to analyze the practices related to the administration of vasoactive amines. The specific objectives are to describe the administration of vasoactive amines and analyze the undesirable clinical events related to the administration of these drugs in critically ill patients. Methodology: Quantitative, observational, cross-sectional study with a sample of 97 patients. The variables related to the administration of vasoactive amines and the records of undesirable clinical events were analyzed. Descriptive and inferential statistical analysis was performed. Results: The frequency of use of norepinephrine was 70.1%, followed by dobutamine (29.9%). About 47.4% of amines were administered through the proximal lumen of the central venous catheter, while 12.4% were double-checked in the prescription. The undesirable clinical events were three-fold higher in patients monitored every 2 hours. Conclusion: There is a failure in the monitoring of patients with prescribed amines and in the double checking of these drugs.

Resumen Marco contextual: La identificación de eventos clínicos indeseables relacionados con la administración de aminas es fundamental para la seguridad de los pacientes, especialmente en los entornos de cuidados intensivos. Objetivo: El estudio pretende investigar las prácticas relacionadas con la administración de aminas vasoactivas y tiene como objetivos específicos describir la administración de aminas y analizar los eventos clínicos indeseables relacionados con la administración de estos fármacos en pacientes críticos. Metodología: Estudio observacional cuantitativo, transversal, muestra de 97 pacientes. Se investigaron las variables relacionadas con la administración de aminas y con el registro de eventos clínicos indeseables. Se realizó un análisis estadístico descriptivo e inferencial. Resultados: La frecuencia de uso de la noradrenalina fue del 70,1%, seguida de la dobutamina (29,9%). Alrededor del 47,4% de las dosis se administraron en el lumen proximal del catéter venoso central, mientras que el 12,4% se confirmaron doblemente en la prescripción. Se comprobó que los eventos clínicos indeseables eran tres veces mayores en los pacientes monitorizados cada 2 horas. Conclusión: Se observa una falta en la monitorización de los pacientes con aminas prescritas, así como en el doble control de estos fármacos.

Hemodynamic Effects of Ketamine Infusion in the Intensive Care Unit for Maintenance Sedation Compared With Propofol and Midazolam: A Retrospective Cohort Study.

Background: Sedation and analgesia in the intensive care unit (ICU) are major clinical challenges, and several continuous infusion medications have been used for these purposes. The use of these sedative medications has been associated with hemodynamic effects that complicate the patient's critical illness. Continuous ketamine infusion is an emerging sedative option that has been used more frequently in the ICU since 2017. The purpose of this study was to characterize the hemodynamic differences between 3 continuous sedative infusions: ketamine, propofol, and midazolam. Methods: For this single-center retrospective cohort study, we collected data for patients hospitalized between January 2015 and April 2020 at Saint Luke's Health System in Kansas City, Missouri. Adult patients in the ICU requiring a norepinephrine infusion and sedation were included. The change in norepinephrine requirement from baseline at 1 hour was the primary outcome. The change in vasopressor requirement at 3 and 30 hours after initiation of the infusion was also tabulated. Results: Sixty-eight critically ill patients with several types of shock requiring vasopressor support with norepinephrine were enrolled in our study. Patients who received ketamine had an increase in norepinephrine requirement compared to midazolam and propofol, although this difference was not statistically significant. Conclusion: In our study, continuous ketamine infusion did not reveal a statistically significant favorable hemodynamic effect compared with propofol and midazolam because of the small sample size. A trend toward an unfavorable hemodynamic effect is not expected, but large randomized trials are needed to further evaluate the hemodynamic effects of continuous ketamine infusion in the ICU.

Predictores de respuesta terapéutica del estado migrañoso en una sala de infusión / Predictors of response in status migrainosus in an outpatient infusion center

RESUMEN INTRODUCCIÓN: El estado migrañoso es una complicación de la migraña, los pacientes a menudo son hospitalizados para estudios diagnósticos o tratamiento. Una alternativa para el manejo son las salas de infusión, lo que permite minimizar los ingresos hospitalarios y la realización de exámenes innecesarios. OBJETIVO: Determinar la respuesta terapéutica y los factores asociados con esta en pacientes con estado migrañoso tratados en una sala de infusión. METODOLOGÍA: estudio de cohorte retrospectiva cuya población fueron pacientes con estado migrañoso atendidos en sala de infusión entre febrero y agosto del 2019. La información sobre variables sociodemográficas, variable clínicas y el manejo terapéutico se obtuvo a partir de la revisión de historias clínicas. Se evaluó la respuesta con escala análoga del dolor al inicio y al final del tratamiento; los pacientes con mejoría mayor al 50 % se consideraron respondedores. Se evaluaron los factores predictores de la respuesta terapéutica mediante regresión logística. RESULTADOS: Se incluyeron 124 pacientes, con promedio de edad de 36 (DE = 12) años, de los cuales el 82,3 % fueron mujeres. La duración promedio del estado migrañoso fue 8 (DE = 4) días, el 73,4 % de los casos se presentó sin aura y 97 (78,2 %) fueron respondedores. Los factores predictores de buena respuesta fueron el uso de dexametasona (OR 4,3) y no usar lidocaína (OR 6,0). CONCLUSIONES: La mayoría de los pacientes tuvo buena respuesta, lo que sugiere que las salas de infusión constituyen una buena alternativa al manejo intrahospitalario de la migraña. En nuestra experiencia, el esteroide constituye parte fundamental del manejo del estado migrañoso una vez se ha instaurado.

ABSTRACT INTRODUCTION: Status migrainosus is a complication of migraine, patients are often hospitalized for diagnostic studies and/or treatment. An alternative for the management, are the outpatient infusion center, minimizing hospital admissions and unnecessary examinations. OBJECTIVE: To determine the therapeutic response and associated factors in patients with migraine status treated in an infusion room. METHODOLOGY: Retrospective cohort study whose population was migraine patients attended in an infusion room between February and August 2019. Information on sociodemographic, clinical, and therapeutic management variables was obtained from the review of medical records. The response was evaluated with an analogous pain scale at the beginning and at the end of the treatment; Those patients with improvement greater than 50 % were considered responders. Predictive factors of therapeutic response were evaluated using logistic regression. RESULTS: 124 patients were included, with an average age of 36 (SD = 12 years), 82.3 % were women. The average duration of the migraine state was 8 (SD = 4 days), 73.4 % of the cases were without aura and 97 (78.2 %) were responders. The predictors of good response were the use of dexamethasone (OR: 4.3) and not using lidocaine (OR: 6.0). CONCLUSIONS: Most of the patients had a good response, which identified the outpatient infusion center as a good alternative to inpatient treatment of headache. In our experience, the steroid constitutes a fundamental part of the management of the status migrainosus once it has been established.

Evaluación de una vena periférica para quimioterapia intravenosa: un estudio prospectivo observacional / Evaluation of a peripheral vein for intravenous chemotherapy: a prospective observational study

Este estudio tuvo como objetivo evaluar las alteraciones en el tiempo de una vena periférica utilizada para la infusión de quimioterapia en pacientes con cáncer de mama. Es un estudio observacional prospectivo que incluyó pacientes que estaban programados para recibir infusión periférica de quimioterapia. A estos pacientes se les evaluó la primera vena periférica utilizada para la infusión en cinco momentos: antes de la venopunción, después de la extracción del dispositivo al final de la primera infusión de quimioterapia y los días 21, 42 y 63 después de la primera infusión. El resultado primario fue el calibre de la vena, medido en milímetros con un transiluminador Veinlite LEDX® y una cinta métrica. Se inscribieron en el estudio 59 mujeres que recibieron doxorrubicina y docetaxel por primera vez. El tamaño del calibre varió de 2 a 4 milímetros en la línea de base y disminuyó con el tiempo. Durante el período de seguimiento, las venas periféricas de 35 mujeres (59,3%) se midieron a 0 mm el día 63. Las 24 mujeres restantes (40,7%) tuvieron cierta recuperación, pero para 15 de ellas (62,5%) la vena se convirtió en un cordón palpable. La viabilidad de utilizar una vena periférica para realizar quimioterapia disminuyó a medida que avanzaba el tratamiento.(AU)

This study aimed to assess over time alterations of a peripheral vein used for chemotherapy infusion in patients with breast cancer. It is a prospective observational study which included patients who were scheduled to receive peripheral infusion of chemotherapy. These patients had the first peripheral vein used for infusion evaluated in five moments: before the venipuncture, after device removal at the end of the first chemotherapy infusion, and on days 21, 42, and 63 after the first infusion. The primary outcome was the caliber of the vein, measured in millimeters with a Veinlite LEDX® transilluminator and a tape measure. Fifty-nine women receiving doxorubicin and docetaxel for the first time were enrolled to the study. The caliber size varied from 2 to 4 millimeters at baseline, and decreased overtime. During the follow-up period, peripheral veins of 35 women (59.3%) were measured at 0 mm at day 63. The remaining 24 women (40.7%) had some recovery, but for 15 of them (62.5%) the vein became a palpable cord. The feasibility of using a peripheral vein to perform chemotherapy decreased as the treatment progresses.(AU)

Fatores de risco para extravasamento em cateteres periféricos em crianças com câncer / Factores de riesgo para extravasación en catéteres periféricos en niños con cáncer / Risk factors for extravasation in peripheral catheters in children with cancer

Resumo Objetivo Estimar a incidência de extravasamento relacionada a cateteres intravenosos periféricos curtos em crianças e adolescentes com câncer e sua associação com características demográficas, clínicas, da cateterização e terapia intravenosa utilizada previamente. Métodos Tratou-se de um estudo longitudinal e prospectivo, realizado com crianças/adolescentes com idade entre 29 dias a 16 anos, hospitalizados em unidade de oncologia de um hospital pediátrico, submetidos à administração de fármacos e soluções por cateter intravenoso periférico curto. A coleta de dados ocorreu mediante observação do cateterismo intravenoso periférico e prontuário do participante. Resultados Foram avaliados 299 cateteres intravenosos periféricos, realizados em 73 crianças e 23 adolescentes, com incidência de extravasamento de 8,7%. Conforme análise multivariada os fatores de risco para a ocorrência de extravasamento foram: histórico de dificuldade de punção venosa periférica, uso prévio de terapia intravenosa, ocorrência de complicações, impossibilidade de visualizar e palpar a veia. Conclusão Observou-se elevada incidência de extravasamento em crianças e adolescentes com câncer de uma cidade do Estado da Bahia, associada a uso prévio de terapia intravenosa, antecedentes de complicação, histórico de dificuldade da CIP, ausência de visibilidade e palpabilidade da veia.

Resumen Objetivo Estimar la incidencia de extravasación relacionada con catéteres intravenosos periféricos cortos en niños y adolescentes con cáncer y su relación con características demográficas, clínicas, del cateterismo y terapia intravenosa utilizada previamente. Métodos Se trató de un estudio longitudinal y prospectivo, realizado con niños/adolescentes entre 29 días y 16 años de edad, hospitalizados en unidad de oncología de un hospital pediátrico, sometidos a la administración de fármacos y soluciones por catéter intravenoso periférico corto. La recopilación de datos se realizó mediante observación del cateterismo intravenoso periférico y la historia clínica del participante. Resultados Se evaluaron 299 catéteres intravenosos periféricos, realizados en 73 niños y 23 adolescentes, con una incidencia de extravasación de 8,7 %. De acuerdo con el análisis multivariado, los factores de riesgo para la ocurrencia de extravasación fueron: historial de dificultad de venopunción periférica, uso previo de terapia intravenosa, episodios de complicaciones, imposibilidad de visualizar y palpar la vena. Conclusión Se observó una elevada incidencia de extravasación en niños y adolescentes con cáncer de una ciudad del estado de Bahia, asociada al uso previo de terapia intravenosa, antecedentes de complicaciones, historial de dificultad del CIP, ausencia de visibilidad y palpación de la vena.

Abstract Objective To estimate extravasation incidence related to short peripheral intravenous catheters in children and adolescents with cancer and its association with demographic, clinical, catheterization and previously used intravenous therapy characteristics. Methods This was a longitudinal and prospective study, carried out with children/adolescents aged between 29 days and 16 years, hospitalized in an oncology unit of a pediatric hospital, submitted to the administration of drugs and solutions through a short peripheral intravenous catheter. Data collection took place through observation of peripheral intravenous catheterization and participants' medical records. Results A total of 299 peripheral intravenous catheters were assessed, performed in 73 children and 23 adolescents, with an incidence of extravasation of 8.7%. According to multivariate analysis, risk factors for extravasation occurrence were history of difficulty in peripheral venous puncture, previous intravenous therapy use, occurrence of complications, inability to visualize and palpate the vein. Conclusion A high incidence of extravasation was observed in children and adolescents with cancer in a city in the state of Bahia, associated with previous intravenous therapy use, history of complications, history of difficulty in peripheral intravenous catheterization, lack of vein visibility and palpability.

Estabilidade do cloridrato de vancomicina empregado em soluções de selo antimicrobiano de cateteres intravenosos centrais / Stability of vancomycin hydrochloride employed in antimicrobial seal solutions of central intravenous catheters / Estabilidad del clorhidrato de vancomicina utilizado en soluciones de sellado antimicrobiano para catéteres intravenosos centrales

Resumo Objetivo: verificar a estabilidade do cloridrato de vancomicina em soluções de selo antimicrobiano sem e com associação de heparina sódica segundo a temperatura e tempo de associação. Método: estudo experimental delineado para análise de potencial hidrogeniônico e concentração por cromatografia líquida de alta eficiência de soluções de cloridrato de vancomicina (n=06) e cloridrato de vancomicina e heparina sódica (n=06). Submeteram-se as soluções estudadas à ausência de luz, 22°C e 37°C. Análises em triplicadas (n=192) ocorreram no momento inicial (T0), três (T3), oito (T8) e 24 horas (T24) após preparo. Os dados foram submetidos à análise de variância (p≤0,05). Resultados: a concentração do antimicrobiano a 22°C apresentou redução (T0-T8) e posterior elevação (T24); o potencial hidrogeniônico diminuiu significativamente ao longo do tempo. Em 37°C a concentração aumentou em até T3 e reduziu em T24, com redução de potencial hidrogeniônico até 24 horas. A concentração das soluções de cloridrato de vancomicina e heparina sódica apresentaram variação com redução a 22°C acompanhada de aumento de potencial hidrogeniônico. Observou-se formação de precipitado por inspeção visual da associação cloridrato de vancomicina e heparina sódica (T3). Conclusão: evidenciou-se estabilidade farmacológica do cloridrato de vancomicina (5 mg/mL) e incompatibilidade física com heparina sódica (100 UI/mL) após três horas de associação nas soluções de selo antimicrobiano estudadas.

Abstract Objective: to verify the stability of vancomycin hydrochloride in antimicrobial seal solutions with and without association of heparin sodium according to temperature and association time. Method: an experimental study designed for the analysis of hydrogenionic potential and concentration by means of high-efficiency liquid chromatography of vancomycin hydrochloride (n=06) and vancomycin hydrochloride and heparin sodium (n=06). The solutions studied were submitted to absence of light, as well as to 22°C and 37°C. Analyses in triplicate (n=192) were performed at the initial moment (T0) and three (T3), eight (T8) and 24 hours (T24) after preparation. The data were submitted to analysis of variance (p≤0.05). Results: concentration of the antimicrobial at 22°C presented a reduction (T0-T8) and a subsequent increase (T24); hydrogenionic potential decreased significantly over time. At 37°C, the concentration increased up to T3 and decreased at T24, with a reduction of hydrogenionic potential up to 24 hours. Concentration of the vancomycin hydrochloride and heparin sodium solutions varied with a reduction at 22°C, accompanied by increased hydrogenionic potential. Precipitate formation was observed by visual inspection of the vancomycin hydrochloride-heparin sodium association (T3). Conclusion: pharmacological stability of vancomycin hydrochloride (5 mg/mL) and physical incompatibility with heparin sodium (100 IU/mL) were evidenced after three hours of association in the antimicrobial seal solutions studied.

Resumen Objetivo: verificar la estabilidad del clorhidrato de vancomicina en soluciones de sellado antimicrobiano solo y combinado con heparina sódica según la temperatura y el tiempo de combinación. Método: estudio experimental diseñado para analizar el potencial de hidrógeno y la concentración por cromatografía líquida de alta resolución de soluciones de clorhidrato de vancomicina (n=06) y de clorhidrato de vancomicina y heparina sódica (n=06). Las soluciones estudiadas fueron sometidas a ausencia de luz, 22°C y 37°C. Se realizaron análisis por triplicado (n=192) en el momento inicial (T0), a las tres (T3), ocho (T8) y 24 horas (T24) después de la preparación. Los datos fueron sometidos a análisis de varianza (p≤0,05). Resultados: la concentración de antimicrobiano a 22°C mostró una reducción (T0-T8) y un posterior aumento (T24); el potencial de hidrógeno disminuyó significativamente con el tiempo. A 37°C, la concentración aumentó hasta T3 y disminuyó en T24, el potencial de hidrógeno disminuyó hasta las 24 horas. La concentración de las soluciones de clorhidrato de vancomicina y heparina sódica mostró variación con la reducción a 22°C acompañada de un aumento del potencial de hidrógeno. Mediante inspección visual se observó la formación de un precipitado al combinar clorhidrato de vancomicina y heparina sódica (T3). Conclusión: el clorhidrato de vancomicina (5 mg/ml) presentó evidencia de estabilidad farmacológica e incompatibilidad física con la heparina sódica (100 UI/ml) después de las tres horas de haberse realizado la combinación en las soluciones de sellado antimicrobiano estudiadas.

Effect of intravenous infusion of lidocaine on efficacy of conventional treatment for rheumatoid arthritis / 中华麻醉学杂志

Objective:To evaluate the effect of intravenous infusion of lidocaine on the efficacy of conventional treatment for rheumatoid arthritis.Methods:Forty-four patients with rheumatoid arthritis of either sex, aged 32-85 yr, weighing 40-76 kg, who were admitted to the Department of Pain and Nephrology in our hospital from September 2019 to September 2020, were divided into 2 groups ( n=22 each) according to the random number table method: control group (C group) and lidocaine group (L group). Both groups received conventional treatment.When visual analogue scale (VAS) score ≥5, glucocorticoid (GC) and non-steroidal anti-inflammatory drugs (NSAIDs) were taken orally to maintain the VAS score ≤4.In group L, 0.2% lidocaine hydrochloride injection 3 mg/kg (diluted with 0.9% sodium chloride injection 500 ml) was intravenously infused at a rate of 25 ml/h for 2 h, once a day, for 5 consecutive days, based on the conventional treatment.The VAS score, 28-joint Disease Activity Score (DAS28 score), simplified disease activity index score (SDAI score), consumption of GC and NSAIDs and adverse reactions were recorded before treatment (T 1) and at 1, 4 and 8 weeks after treatment (T 2-4). The temperature of the pain area of the affected joint was evaluated through infrared thermal imaging at T 1 and T 2. Results:Compared with the baseline at T 1, VAS score, DAS28 score and SDAI score were significantly decreased at each time point, and the temperature of the pain area of the affected joint at T 2 was decreased in the two groups ( P<0.05). There were no significant differences in VAS score, DAS28 score and SDAI score at each time point between two groups ( P>0.05). Compared with group C, the consumption of GC and NSAIDs was significantly decreased, and the temperature of the pain area of the dorsum of both hands and the dorsum of right foot at T 2 and incidence of adverse reactions were decreased in group L ( P<0.05). Conclusions:Intravenous infusion of lidocaine can optimize the efficacy of conventional treatment for rheumatoid arthritis.

A protocol for cell therapy infusion in neonates.

Cell therapies for neonatal morbidities are progressing to early phase clinical trials. However, protocols for intravenous (IV) delivery of cell therapies to infants have not been evaluated. It has been assumed the cell dose prescribed is the dose delivered. Early in our clinical trial of human amnion epithelial cells (hAECs), we observed cells settling in the syringe and IV tubing used to deliver the suspension. The effect on dose delivery was unknown. We aimed to quantify this observation and determine an optimal protocol for IV delivery of hAECs to extremely preterm infants. A standard pediatric infusion protocol was modeled in the laboratory. A syringe pump delivered the hAEC suspension over 60 minutes via a pediatric blood transfusion set (200-µm filter and 2.2 mL IV line). The infusion protocol was varied by agitation methods, IV-line volumes (0.2-2.2 mL), albumin concentrations (2% vs 4%), and syringe orientations (horizontal vs vertical) to assess whether these variables influenced the dose delivered. The influence of flow rate (3-15 mL/h) was assessed after other variables were optimized. The standard infusion protocol delivered 17.6% ± 9% of the intended hAEC dose. Increasing albumin concentration to 4%, positioning the syringe and IV line vertically, and decreasing IV-line volume to 0.6 mL delivered 99.7% ± 13% of the intended hAEC dose. Flow rate did not affect dose delivery. Cell therapy infusion protocols must be considered. We describe the refinement of a cell infusion protocol that delivers intended cell doses and could form the basis of future neonatal cell delivery protocols.

Effect of ketamine on the NeuroSENSE WAVCNS during propofol anesthesia; a randomized feasibility trial.

Dose-dependent effects of ketamine on processed electroencephalographic depth-of-hypnosis indices have been reported. Limited data are available for the NeuroSENSE WAVCNS index. Our aim was to establish the feasibility of closed-loop propofol-remifentanil anesthesia guided by the WAVCNS index in the presence of an analgesic dose of ketamine. Thirty ASA I-II adults, 18-54 years, requiring general anesthesia for anterior cruciate ligament surgery were randomized to receive: full-dose [ketamine, 0.5 mg kg-1 initial bolus, 10 mcg kg-1 min-1 infusion] (recommended dose for postoperative pain management); half-dose [ketamine, 0.25 mg kg-1 bolus, 5 mcg kg-1 min-1 infusion]; or control [no ketamine]. After the ketamine bolus, patients received 1.0 mcg kg-1 remifentanil over 30 s, then 1.5 mg kg-1 propofol over 30 s, followed by manually-adjusted propofol-remifentanil anesthesia. The WAVCNS was > 60 for 7/9 patients in the full-dose group at 7 min after starting the propofol infusion. This was inconsistent with clinical observations of depth-of-hypnosis and significantly higher than control (median difference [MD] 17.0, 95% confidence interval [CI] 11.4-26.8). WAVCNS was median [interquartile range] 49.3 [42.2-62.6] in the half-dose group, and not different to control (MD 5.1, 95% CI - 4.9 to 17.9). During maintenance of anesthesia, the WAVCNS was higher in the full-dose group compared to control (MD 14.7, 95% CI 10.2-19.2) and in the half-dose group compared to control (MD 11.4, 95% CI 4.7-20.4). The full-dose of ketamine recommended for postoperative pain management had a significant effect on the WAVCNS. This effect should be considered when using the WAVCNS to guide propofol-remifentanil dosing.Trial Registration ClinicalTrails.gov No. NCT02908945.

Training on intravenous medication administration in pediatric nursing: a before-after study / Formación en administración de fármacos intravenosos en enfermería pediátrica: un estudio antes-después / Treinamento sobre administração de medicamentos endovenosos na enfermagem pediátrica: estudo antes e depois

ABSTRACT Objective: To evaluate the effect of training on intravenous medication administration in pediatric patients on nursing staff 's learning and response. Method: This is a quasi-experimental study (pre- and post-test), with 38 nursing professionals who participated in training on administration of intravenous (IV) medication in pediatric patients with heart disease. For data collection, a questionnaire with 19 items was applied to evaluate participants' learning before (pre-test) and after (post-test) training. Data were analyzed by descriptive and analytical statistics (binomial and Friedman tests). Results: Nurses predominated (52.6%), mean age 41.2 years and 9.8 years of professional experience in pediatrics. For learning evaluation, there was an increase in the rate of hits from the pre-test to the post-test in 13 items, with a significant difference (p < 0.05) in the items: removing adornments to sanitize hands; wearing gloves when administering medication; administering medication with gloves, mask and goggles; and checking patient name by asking their companion. Conclusion: Training had positive effects on nursing professionals' learning and reaction.

RESUMEN Objetivo: Evaluar el efecto del entrenamiento sobre la administración de fármacos intravenosos en pacientes pediátricos sobre el aprendizaje y la reacción del equipo de enfermería. Método: Estudio cuasiexperimental (pre-y post-test), con 38 profesionales de enfermería que participaron en la formación sobre la administración de medicación intravenosa (IV) en pacientes pediátricos con cardiopatías. Para la recolección de datos, se aplicó un cuestionario con 19 ítems para evaluar el aprendizaje de los participantes antes (pre-test) y después (post-test) del entrenamiento. Los datos fueron analizados mediante estadística descriptiva y analítica (pruebas binomial y Friedman). Resultados: Hubo predominio de enfermeras (52,6%), edad media 41,2 años y 9,8 años de experiencia profesional en pediatría. En la evaluación de aprendizajes, hubo un aumento en la tasa de aciertos del pre-test al post-test en 13 ítems, con una diferencia significativa (p < 0.05) en los ítems: quitar los adornos para desinfectar las manos; usar guantes al administrar medicamentos; administrar medicamentos con guantes, mascarilla y anteojos; y comprobar el nombre del paciente preguntándole a su acompañante. Conclusión: La formación tuvo efectos positivos en el aprendizaje y la reacción de los profesionales de enfermería.

RESUMO Objetivo: Avaliar o efeito de um treinamento sobre administração de medicamento endovenoso em pacientes pediátricos na aprendizagem e reação da equipe de enfermagem. Método: Estudo quase experimental (pré-e pós-teste), com 38 profissionais da enfermagem que participaram de um treinamento sobre administração de medicamento endovenoso (EV) em pacientes pediátricos cardiopatas. Para coleta de dados, aplicou-se um questionário com 19 itens para avaliar a aprendizagem dos participantes antes (pré-teste) e após (pós-teste) o treinamento. Analisaram-se os dados por estatística descritiva e analítica (testes binomial e Friedman). Resultados: Predominaram enfermeiras (52,6%), média de 41,2 anos de idade e 9,8 anos de experiência profissional na pediatria. Na avaliação da aprendizagem, houve aumento no índice de acertos do pré-teste para o pós-teste em 13 itens, com diferença significativa (p < 0,05) nos quesitos: retirar adornos para higienizar as mãos; usar luva ao administrar medicamento; administrar medicamento com luva, máscara e óculos de proteção; e conferir nome do paciente perguntando a ele ou ao acompanhante. Conclusão: O treinamento apresentou efeitos positivos na aprendizagem e reação dos profissionais de enfermagem.

Dose of intravenously infused cisatracurium for maintenance of deep neuromuscular blockade during thoracic surgery / 中华麻醉学杂志

Objective:To investigate the dose of intravenously infused cisatracurium for the maintenance of deep neuromuscular blockade during thoracic surgery.Methods:Patients of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, scheduled for elective thoracic surgery under general anesthesia, were studied.The patients were connected to a muscle relaxation monitor after entering the operating room.After the completion of muscle relaxant calibration and anesthesia induction, cisatracurium was intravenously infused at a constant rate to maintain deep neuromuscular blockade (post-tetanic count [PTC]≤5 ). The infusion rate was calculated by modified Dixon up-and-down method.The first patient received cisatracurium at 0.12 mg·kg -1·h -1.If the PTC was 0 or was maintained≤5 continuously, the infusion rate was decreased 0.01 mg·kg -1·h -1 in the next patient, until PTC was >5 during operation.The mean dose for the patient was used as initial dose.Then the infusion rate was increased/decreased by 0.005 mg·kg -1·h -1.The 95% effective dose of cisatracurium (ED 95) was the median of 6 thresholds. Results:A total of 22 cases completed the study.The ED 95 of continuous intravenous infusion of cisatracurium for the maintenance of deep neuromuscular blockade was 0.108 mg·kg -1·h -1(95% confidence interval 0.105-0.125 mg·kg -1·h -1). Conclusion:The dose of intravenous infusion of cisatracurium for the maintenance of deep neuromuscular blockade during thoracic surgery is 0.108 mg·kg -1·h -1.

Ultrasound combined with X-ray-guided precise implantation of totally implantable access ports in the chest wall / 中国基层医药

Objective:To investigate the success rate, operation time and complications of ultrasound combined with X-ray-guided precise implantation of totally implantable access port (TIAP) in the chest wall.Methods:A total of 623 patients who underwent implantation of totally implantable venous access ports in the chest wall in Meizhou People's Hospital, China between January 2015 and August 2018 were included in this study. In group A ( n = 320), jugular or subclavian access ports were precisely implanted in the chest wall under the guidance of ultrasound combined with X-ray. During the surgery, color Doppler ultrasound was used to guide the puncture and a C-arm machine was used to locate the position of catheter tip. In group B ( n = 303), venous access ports were implanted using the conventional method. Subclavian vein puncture was performed using anatomic landmarks and the depth of catheterization was estimated by experience. The success rate of the first implantation, operation time, and complications (pneumothorax, hemothorax, catheter displacement, poor position of catheter tip, skin infection, and thrombosis) were compared between the two groups. Results:There were no statistical differences in baseline data between the two groups ( P > 0.05). The success rate of the first implantation in the group A was significantly higher than that in the group B [100% (320/320) vs. 93.06% (282/303), χ2 = 22.95, P < 0.01]. The operation time in the group A was significantly shorter than that in the group B [(26.48 ± 5.49) minutes vs. (35.51 ± 14.37) minutes, t = -10.25, P < 0.01]. In group A, 2 patients developed pneumothorax and healed after conservative treatment, 6 patients had thrombosis, and the incidence of complications was 2.5% (8/320). In group B, complications occurred in 67 patients, including pneumothorax in 9 patients, poor catheter tip position in 17 patients, thrombosis in 36 patients, and skin infection in 1 patient, and the incidence of complications was 22.11% (67/303). There was significant difference in the incidence of complications between the two groups ( χ2 = 56.53, P < 0.01). In group B, 6 out of 9 patients developing pneumothorax were healed after closed thoracic drainage, and 4 patients underwent a secondary surgery because of catheter displacement into the internal jugular vein. Conclusion:Precise implantation of venous access ports in the chest wall guided by ultrasound combined with X-ray has the advantages including 100% success rate of first precise implantation, few complications, short operation time, high comfort, safety and efficacy.

Towards more efficient use of intravenous lumens in multi-infusion settings: development and evaluation of a multiplex infusion scheduling algorithm.

BACKGROUND: Multi-drug intravenous (IV) therapy is one of the most common medical procedures used in intensive care units (ICUs), operating rooms, oncology wards and many other hospital departments worldwide. As drugs or their solvents are frequently chemically incompatible, many solutions must be administered through separate lumens. When the number of available lumens is too low to facilitate the safe administration of these solutions, additional (peripheral) IV catheters are often required, causing physical discomfort and increasing the risk for catheter related complications. Our objective was to develop and evaluate an algorithm designed to reduce the number of intravenous lumens required in multi-infusion settings by multiplexing the administration of various parenteral drugs and solutions. METHODS: A multiplex algorithm was developed that schedules the alternating IV administration of multiple incompatible IV solutions through a single lumen, taking compatibility-related, pharmacokinetic and pharmacodynamic constraints of the relevant drugs into account. The conventional scheduling procedure executed by ICU nurses was used for comparison. The number of lumens required by the conventional procedure (LCONV) and multiplex algorithm (LMX) were compared. RESULTS: We used data from 175,993 ICU drug combinations, with 2251 unique combinations received by 2715 consecutive ICU patients. The mean ± SD number of simultaneous IV solutions was 2.8 ± 1.6. In 27% of all drug combinations, and 61% of the unique combinations the multiplex algorithm required fewer lumens (p < 0.001). With increasing LCONV, the reduction in number of lumens by the multiplex algorithm further increased (p < 0.001). In only 1% of cases multiplexing required > 3 lm, versus 12% using the conventional procedure. CONCLUSION: The multiplex algorithm addresses a major issue that occurs in ICUs, operating rooms, oncology wards, and many other hospital departments where several incompatible drugs are infused through a restricted number of lumens. The multiplex algorithm allows for more efficient use of IV lumens compared to the conventional multi-infusion strategy.

Damage control resuscitation.

The United States Navy originally utilized the concept of damage control to describe the process of prioritizing the critical repairs needed to return a ship safely to shore during a maritime emergency. To pursue a completed repair would detract from the goal of saving the ship. This concept of damage control management in crisis is well suited to the care of the critically ill trauma patient, and has evolved into the standard of care. Damage control resuscitation is not one technique, but, rather, a group of strategies which address the lethal triad of coagulopathy, acidosis, and hypothermia. In this article, we describe this approach to trauma resuscitation and the supporting evidence base.