Técnicas e procedimentos de controle de infecções de cateteres venosos em onco-hematologia infantil: aspectos clínico-epidemiológicos e microbiológicos e prevalência de Corynebacterium spp. - Instituto Nacional de Câncer, RJ / Techniques and procedures central line infections control in childhood cancer patients: clinical and epidemiological aspects, microbiological and prevalence of Corynebacterium spp. - Instituto Nacional de Câncer, RJ

Estudo descritivo retrospectivo realizado no Instituto Nacional do Câncer José Alencar Gomes da Silva, HCI-Rio de Janeiro, Brasil, (INCA-HCI-RJ), no qual foram avaliadas infecções relacionadas aos acessos venosos para tratamento oncológico, nos setores Onco-Hematológicos pediátricos. A infecção representa uma importante complicação em pacientes oncológicos em tratamento. Devido ao tratamento oncológico que envolve: procedimentos cirúrgicos muitas vezes mutilantes, tratamento com quimioterápicos que ocasionam períodos de imunossupressão e neutropenia, e tratamento radioterápico com radiação e lise celular. O uso de dispositivos venosos associados a períodos de imunossupressão pode levar a infecção da corrente sanguínea e outras complicações (por exemplo trombose). No presente estudo foram investigados aspectos clínico-epidemiológicos das infecções e da susceptibilidade antimicrobiana em amostras clínicas obtidas de processos infecciosos associados ao uso de cateteres venosos de longa permanência no tratamento oncológico em pacientes do Hospital do Câncer José de Alencar Gomes da Silva, HCI/INCA, Rio de Janeiro Brasil. Foram avaliadas: a) prevalência das espécies diversas relacionadas aos quadros infecciosos identificados nestes pacientes oncológicos; b) prevalência de casos de complicações e outras infecções invasivas relacionadas ao uso de cateteres de longa permanência; c) perfis de susceptibilidade a antimicrobianos e ocorrência de multirresistência. O desenvolvimento deste projeto de pesquisa possibilitou a observação análise e validação da evolução dos processos envolvidos nos quadros de infecções nosocomiais em pacientes oncológicos pediátricos na prevenção de complicações que envolvem todo o sistema de saúde, além de contribuir na escolha de antimicrobianos e estratégias terapêuticas mais efetivas para o tratamento de infecções em cateteres por espécies multirresistentes de Corynebacterium.

Retrospective descriptive study conducted at the National Cancer Institute José Alencar Gomes da Silva, INCA / HCI-Rio de Janeiro, Brazil, (INCA-HCI-RJ). Infection represents an important complication in cancer patients. This group is more prone to infections due to the cancer treatment that involves: surgical procedures often mutilating, treatment with chemotherapy that cause periods of immunosuppression even with neutropenia, and radiotherapy treatment with radiation and cell lysis. The vascular devices associated with these periods can lead to bloodstream infection besides others complication as thrombosis. The number of reports of infections in hospitalized cancer patients increases morbidity and mortality rates. In the present study clinical and epidemiological aspects of infections were identified and antimicrobial susceptibility were investigated in clinical exams and samples from blood patients and venous catheter in children oncological patients at the José de Alencar Gomes da Silva, HCI / INCA, Rio de Janeiro Brazil. It was possible evaluate a) prevalence of various species infections in cancer patients; b) prevalence of cases of complications and other invasive infections related to the use of long-term catheters; c) antimicrobial susceptibility profiles and occurrence of multidrug resistance. The development of this research project in nosocomial infections in pediatric cancer patients was enabled analysis and validation of some process involved to prevent vascular complications that involve entire health system. In addition to contributing to the choice of antimicrobials and the most effective therapeutic strategies for the treatment of multi-resistant Corynebacterium sp.

Early History of Home Parenteral Nutrition: From Hospital to Home.

Technologic advances in the past century have led to the ability to safely deliver parenteral nutrition (PN) to hospitalized patients. Key breakthroughs included the development of saline and glucose infusions, infusion pumps, macronutrients (lipids, dextrose, and amino acids), and central venous catheters. In the 1960s, centrally delivered PN was performed in short-term hospitalized patients by Lincoln James Lawson (North Staffordshire Royal Infirmatory, United Kingdom) and long-term patients by Stanley Dudrick (University of Pennsylvania, United States). These early studies showed that a system was needed that would allow patients with intestinal failure to be discharged from the hospital and receive home PN (HPN). In the late 1960s and early 1970s, Belding Scribner, Maurice Shils, Khursheed Jeejeebhoy, Marvin Ament, Dudrick, and their teams discharged patients from the hospital who then self-administered HPN. Shortly after these early cases of HPN, multidisciplinary centers were established first in North America, and later in Europe, to manage these complex cases. The current article describes the patients treated by these early HPN pioneers, in addition to subsequent case series reported by them and others.

Between the lines: The 50th anniversary of long-term central venous catheters.

BACKGROUND: Tunneled central venous catheters (CVC) were developed five decades ago. Since then, several clinician-inventors have created a variety of catheters with different functions. Indeed, many catheters have been named after their inventor. Many have wondered who the inventors were of each catheter, and what specifically inspired their inventions. Many of these compelling stories have yet to be told. DATA SOURCE: A literature review of common catheters and personal communication with inventors. Only first person accounts from inventors or those close to the invention were used. CONCLUSIONS: CVCs are now essential devices that have saved countless lives. Though the inventors have earned the honor of naming their catheters, it may be reasonable to consider more consistent terminology to describe these catheters to avoid confusion.

Acesso vascular para hemodiálise: o que há de novo? / Vascular access for hemodialisys: what's new?

O aumento da expectativa de vida dos portadores de doenças crônicas, entre as quais a insuficiência renal crônica, faz com que métodos de tratamentos estejam em constante aperfeiçoamento. O uso em longo prazo da hemodiálise torna necessário confeccionar e manter acessos vasculares de utilização duradoura. Tanto as fístulas arteriovenosas - primeira opção de acesso para os pacientes hemodialíticos - como os cateteres vêm sendo objeto de estudos na literatura, na tentativa de prolongar sua vida útil. Esta revisão tem como objetivo relatar as alternativas e soluções atuais para os acessos vasculares para hemodiálise.

The increasing life expectancy of patients with chronic diseases, including chronic renal failure, means that treatment methods are constantly being updated and improved. Long term hemodialysis has created the need to provide and maintain long lasting vascular access. Arteriovenous fistula is the first-choice option for hemodialysis and research has been conducted to attempt to increase the useful life of both fistula and catheter access methods. This article reviews the vascular access options and solutions currently available for hemodialysis.

Revisión de vías venosas centrales: anatomía quirúrgica y sus complicaciones / Central venous lines: surgical anatomy and its complications

Los registros de canalización de venas centrales datande 1927, principios de siglo X, cuando se logró abordarel bulbo superior de la vena yugular interna. Actualmente, es una heramienta que se ha expandido y utilza enuna gran variedad de procedimientos terapéuticos y diagnósticos dentro de los que se destacan la monitorización de parámetros hemodinámicas. En Estados Unios se colocan anualmente 5 milones de catéteresvenosos centrales (CVC), de los cuales aproximadamente15%presenta complicaciones, lo que signifca un riesgopara la vida del paciente. La experiencia del personalmédico en la instalación y manejo de los catéteres, esfundamental en pos de disminuir la tasa de complicaciones. En el presente trabajo se realiza una revisiónbibliográfica sobre los riesgos y complicaciones de lacitada intervención, abordando las relaciones anatómicas de los sitos de punción más frecuentes y la técnicaa emplear, conocimientos que consideramos básicospara el éxito del procedimiento. Resultados: las principales complicaciones encontradas con respecto al abordajeYugular son las siguientes, la Trombosis en un 7,6 a12%, siendo la más frecuente; seguida de la Punciónarterial con un 6.3 – 9.4% y la colocación incorecta delcatéter (5%), entre otras. En la Subclavia, el riesgo principal está referido a la incorecta colocación de la vía(9%) y en menor medida la Trombosis (1,9 a 8%). Porotro lado, la realización de la vía Femoral produjo unaTrombosis del 12- 21,5% seguida de la Punción arterial(9- 15%). La Vena Femoral, presentó una mayor incidencia de bacteriemias, siendo la Vena Subclavia la queprodujo menor cantidad de casos. Hubo mayor cantidadde complicaciones en la V. Yugular Interna pero de mayorgravedad en la V. Subclavia. Conclusiones: Llevar lafrecuencia de complicaciones a cero es imposible, peroel adecuado conocimiento de la anatomía normal y latécnica de punción es una condición elemental paradisminuir al mínimo las complicaciones.

Central veins chaneling records date back to 1927,begining of 20th century, when was adresing the uperbulb of the vein, internal jugular. Curently, it is a tol thathas expanded and used in a variety of therapeuticprocedures and diagnoses within which stand monitoringhemodynamic parameters. United States 5 milon centralvenous catheters (CVCS) are placed anualy, of them15% aproximately presents complications, thusrepresenting a risk to the life of the patient. The experienceof the medical personel in the instalation andmanagement of catheters, is esential in order to reducethe rate of complications.In this paper is a literature review on the risks andcomplications of the abovementioned intervention,adresing the anatomical relations of requent puncturesites and the technique to be used, knowledge which weconsider basic to the suces of the procedure.Results: the main complications were found with respectto the aproach to jugular are as folows, thrombosis in a7.6 to 12%, being the most common; folowed by thearterial puncture with a 6.3 - 9.4% and the incorectplacement of the catheter (5%), among others. Insubclavian, the main risk is refering to the incorectplacement of the via (9%) and to a leser extentthrombosis (1.9-8%). On the other hand, the completionof the via Femoral produced a 12-21.5% folowed by arterial puncture thrombosis (9-15%).The Femoral veins, was which presented higherincidence of bacteraemia, being it subclavian vein whichdid les. There were many complications in the V. internaljugular but more serious in the V. subclavian.Conclusions: The frequency of complications zero isimposible, but the adequate knowledge of normalAnatomy and puncture technique is a basic conditon tominimize complications.

Revisión de vías venosas centrales: anatomía quirúrgica y sus complicaciones / Central venous lines: surgical anatomy and its complications

Los registros de canalización de venas centrales datande 1927, principios de siglo X, cuando se logró abordarel bulbo superior de la vena yugular interna. Actualmente, es una heramienta que se ha expandido y utilza enuna gran variedad de procedimientos terapéuticos y diagnósticos dentro de los que se destacan la monitorización de parámetros hemodinámicas. En Estados Unios se colocan anualmente 5 milones de catéteresvenosos centrales (CVC), de los cuales aproximadamente15%presenta complicaciones, lo que signifca un riesgopara la vida del paciente. La experiencia del personalmédico en la instalación y manejo de los catéteres, esfundamental en pos de disminuir la tasa de complicaciones. En el presente trabajo se realiza una revisiónbibliográfica sobre los riesgos y complicaciones de lacitada intervención, abordando las relaciones anatómicas de los sitos de punción más frecuentes y la técnicaa emplear, conocimientos que consideramos básicospara el éxito del procedimiento. Resultados: las principales complicaciones encontradas con respecto al abordajeYugular son las siguientes, la Trombosis en un 7,6 a12%, siendo la más frecuente; seguida de la Punciónarterial con un 6.3 û 9.4% y la colocación incorecta delcatéter (5%), entre otras. En la Subclavia, el riesgo principal está referido a la incorecta colocación de la vía(9%) y en menor medida la Trombosis (1,9 a 8%). Porotro lado, la realización de la vía Femoral produjo unaTrombosis del 12- 21,5% seguida de la Punción arterial(9- 15%). La Vena Femoral, presentó una mayor incidencia de bacteriemias, siendo la Vena Subclavia la queprodujo menor cantidad de casos. Hubo mayor cantidadde complicaciones en la V. Yugular Interna pero de mayorgravedad en la V. Subclavia. Conclusiones: Llevar lafrecuencia de complicaciones a cero es imposible, peroel adecuado conocimiento de la anatomía normal y latécnica de punción es una condición elemental paradisminuir al mínimo las complicaciones.(AU)

Central veins chaneling records date back to 1927,begining of 20th century, when was adresing the uperbulb of the vein, internal jugular. Curently, it is a tol thathas expanded and used in a variety of therapeuticprocedures and diagnoses within which stand monitoringhemodynamic parameters. United States 5 milon centralvenous catheters (CVCS) are placed anualy, of them15% aproximately presents complications, thusrepresenting a risk to the life of the patient. The experienceof the medical personel in the instalation andmanagement of catheters, is esential in order to reducethe rate of complications.In this paper is a literature review on the risks andcomplications of the abovementioned intervention,adresing the anatomical relations of requent puncturesites and the technique to be used, knowledge which weconsider basic to the suces of the procedure.Results: the main complications were found with respectto the aproach to jugular are as folows, thrombosis in a7.6 to 12%, being the most common; folowed by thearterial puncture with a 6.3 - 9.4% and the incorectplacement of the catheter (5%), among others. Insubclavian, the main risk is refering to the incorectplacement of the via (9%) and to a leser extentthrombosis (1.9-8%). On the other hand, the completionof the via Femoral produced a 12-21.5% folowed by arterial puncture thrombosis (9-15%).The Femoral veins, was which presented higherincidence of bacteraemia, being it subclavian vein whichdid les. There were many complications in the V. internaljugular but more serious in the V. subclavian.Conclusions: The frequency of complications zero isimposible, but the adequate knowledge of normalAnatomy and puncture technique is a basic conditon tominimize complications.(AU)