Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 266
Filtrar
1.
Am J Trop Med Hyg ; 103(1): 508-514, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32314689

RESUMO

Intensive care unit-acquired bloodstream infections (ICU-BSI) are frequent and are associated with high morbidity and mortality rates. We conducted this study to describe the epidemiology and the prognosis of ICU-BSI in our ICU and to search for factors associated with mortality at 28 days. For this, we retrospectively studied ICU-BSI in the ICU of the Cayenne General Hospital, from January 2013 to June 2019. Intensive care unit-acquired bloodstream infections were diagnosed in 9.5% of admissions (10.3 ICU-BSI/1,000 days). The median delay to the first ICU-BSI was 9 days. The ICU-BSI was primitive in 44% of cases and secondary to ventilator-acquired pneumonia in 25% of cases. The main isolated microorganisms were Enterobacteriaceae in 67.7% of patients. They were extended-spectrum beta-lactamase (ESBL) producers in 27.6% of cases. Initial antibiotic therapy was appropriate in 65.1% of cases. Factors independently associated with ESBL-producing Enterobacteriaceae (ESBL-PE) as the causative microorganism of ICU-BSI were ESBL-PE carriage before ICU-BSI (odds ratio [OR]: 7.273; 95% CI: 2.876-18.392; P < 0.000) and prior exposure to fluoroquinolones (OR: 4.327; 95% CI: 1.120-16.728; P = 0.034). The sensitivity of ESBL-PE carriage to predict ESBL-PE as the causative microorganism of ICU-BSI was 64.9% and specificity was 81.2%. Mortality at 28 days was 20.6% in the general population. Factors independently associated with mortality at day 28 from the occurrence of ICU-BSI were traumatic category of admission (OR: 0.346; 95% CI: 0.134-0.894; P = 0.028) and septic shock on the day of ICU-BSI (OR: 3.317; 95% CI: 1.561-7.050; P = 0.002). Mortality rate was independent of the causative organism.


Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Bacteriemia/terapia , Candidemia/epidemiologia , Candidemia/mortalidade , Candidemia/terapia , Portador Sadio/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/mortalidade , Infecções Relacionadas a Cateter/terapia , Cateterismo Venoso Central/estatística & dados numéricos , Cateterismo Periférico/estatística & dados numéricos , Coma/epidemiologia , Comorbidade , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Infecção Hospitalar/terapia , Infecções por Enterobacteriaceae/epidemiologia , Feminino , Guiana Francesa/epidemiologia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/terapia , Prognóstico , Terapia de Substituição Renal/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Insuficiência Respiratória/epidemiologia , Estudos Retrospectivos , Choque/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Infecções Estafilocócicas/terapia , Ferimentos e Lesões/epidemiologia
2.
Lancet Infect Dis ; 20(7): 864-872, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32151333

RESUMO

BACKGROUND: Catheter-associated bloodstream infections and urinary tract infections are frequently encountered health care-associated infections. We aimed to reduce inappropriate use of catheters to reduce health care-associated infections. METHODS: In this multicentre, interrupted time-series and before and after study, we introduced a de-implementation strategy with multifaceted interventions in seven hospitals in the Netherlands. Adult patients admitted to internal medicine, gastroenterology, geriatic, oncology, or pulmonology wards, and non-surgical acute admission units, and who had a (central or peripheral) venous or urinary catheter were eligible for inclusion. One of the interventions was that nurses in the participating wards attended educational meetings on appropriate catheter use. Data on catheter use were collected every 2 weeks by the primary research physician during the baseline period (7 months) and intervention period (7 months), which were separated by a 5 month transition period. The primary outcomes were percentages of short peripheral intravenous catheters and urinary catheters used inappropriately on the days of data collection. Indications for catheter use were based on international guidelines. This study is registered with Netherlands Trial Register, NL5438. FINDINGS: Between Sept 1, 2016, and April 1, 2018, we screened 6157 patients for inclusion, of whom 5696 were enrolled: 2650 patients in the baseline group, and 3046 in the intervention group. Inappropriate use of peripheral intravenous catheters occurred in 366 (22·0%, 95% CI 20·0 to 24·0) of 1665 patients in the baseline group and in 275 (14·4%, 12·8 to 16·0) of 1912 patients in the intervention group (incidence rate ratio [IRR] 0·65, 95% CI 0·56 to 0·77, p<0·0001). Time-series analyses showed an absolute reduction in inappropriate use of peripheral intravenous catheters from baseline to intervention periods of 6·65% (95% CI 2·47 to 10·82, p=0·011). Inappropriate use of urinary catheters occurred in 105 (32·4%, 95% CI 27·3 to 37·8) of 324 patients in the baseline group compared with 96 (24·1%, 20·0 to 28·6) of 398 patients in the intervention group (IRR 0·74, 95% CI 0·56 to 0·98, p=0·013). Time-series analyses showed an absolute reduction in inappropriate use of urinary catheters of 6·34% (95% CI -12·46 to 25·13, p=0·524). INTERPRETATION: Our de-implementation strategy reduced inappropriate use of short peripheral intravenous catheters in patients who were not in the intensive care unit. The reduction of inappropriate use of urinary catheters was substantial, yet not statistically significant in time-series analysis due to a small sample size. The strategy appears well suited for broad-scale implementation to reduce health care-associated infections. FUNDING: Netherlands Organisation for Health Research and Development.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Periférico , Fidelidade a Diretrizes/normas , Procedimentos Desnecessários , Cateteres Urinários , Administração Intravenosa , Adulto , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Prospectivos , Cateteres Urinários/efeitos adversos , Cateteres Urinários/estatística & dados numéricos , Infecções Urinárias/prevenção & controle
3.
Medicine (Baltimore) ; 98(32): e15837, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393341

RESUMO

Peripherally inserted central catheters (PICCs) can provide nutritional and medical support for very low birth weight or critically ill newborns. The aim of this study was to retrospectively analyze the use of PICCs in our clinic for critically ill newborns to evaluate the relationship between catheter related factors and the occurrence of complications.Retrospective analysis was conducted for all newborns consecutively admitted at the Neonatal Intensive Care Unit (NICU), Chongqing Health Center for Women and Children, who underwent PICC insertion between May 2011 and March 2018. Data collected included total puncture success rate, one puncture success rate, infection rate, complication rate, unplanned catheter withdrawal rate, device days, and catheter indwelling time.Five-hundred eighty-eight infants (304 males and 284 females) aged 3.4 ±â€Š3.9 days, mean gestational age of 30.9 ±â€Š2.7 weeks and a mean body mass of 1.38 ±â€Š0.47 kg at insertion were included. Total puncture success rate was 99.65%, one puncture success rate was 77.77%. The mean catheter retention was 13.6 ±â€Š6.7 days: more than 30 days in 15 (2.61%) cases, 20 to 30 days in 60 (10.43%) cases, 10 to 19 days in 372 (64.70%) cases, and 62 days in 1 case. Complications occurred in 63 (10.71%) cases: with PICC insertion within 24 hours after birth in 29 (15.43%), within 48 hours in 13 (6.63%), and after 48 hours in 21 (10.99%) cases. Catheter tip culture was positive in 3 cases and there was 1 case of catheter-related bloodstream infection.Nursing measures of the maintenance of body temperature and the evaluation of blood vessels were important conditions for improving the success rate of one puncture in critically ill neonates. PICC catheterization as early as 48 hours will not increase the difficulty of PICC puncture. Nor did it increase the incidence of PICC complications.


Assuntos
Cateterismo Periférico/estatística & dados numéricos , Cateteres de Demora/estatística & dados numéricos , Estado Terminal , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres de Demora/efeitos adversos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Masculino , Estudos Retrospectivos
4.
Res Nurs Health ; 42(3): 198-204, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30912181

RESUMO

The type of central vascular access device providers chosen for providing parenteral supportive treatments has evolved over the past years, going from routinely used centrally inserted catheters to a more recent trend of peripherally-inserted central catheters (PICCs) when expected treatment duration is less than 6 months. This multicenter retrospective study aimed to provide a comprehensive assessment of the safety of PICCs in administering parenteral supportive treatments. All adult inpatients and outpatients who had a PICC inserted for the administration of parenteral supportive treatments (i.e., parenteral nutrition, intravenous fluids, blood products, or antibiotics) between September 2007 and December 2014 in four public Italian hospitals were included. The primary outcome was PICC removal because of an adverse event (AE, defined as occlusion, exit-site infection, or symptomatic thrombosis). Among the 1,250 included patients, 178 PICC-related removals because of AEs (14.2%; 1.62 AEs per 1,000 PICC days) were reported. Rates of PICC removal because of occlusion, exit-site infection, and symptomatic thrombosis were 1.08, 0.32, and 0.23 per 1,000 PICC days, respectively. The median dwell-time between PICC insertion and its removal because of an AE was 67 days (interquartile range 28-180 days). Risk of PICC removal due to AE was higher with open-system PICCs [hazard ratio = 2.75, 95% confidence interval 1.52-4.96]. In this study, we found preliminary evidence that PICCs can be safely used to administer parenteral supportive treatments lasting up to 6 months. PICCs may be a relevant alternative to centrally inserted catheters for medium-term parenteral supportive treatments.


Assuntos
Cateterismo Venoso Central/estatística & dados numéricos , Nutrição Parenteral Total/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Adulto , Idoso , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/estatística & dados numéricos , Estado Terminal/terapia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral Total/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tromboembolia Venosa/etiologia
5.
J Pediatr Surg ; 54(7): 1481-1486, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30898402

RESUMO

BACKGROUND: Survival of newborns with gastroschisis is significantly higher in high-income versus low and middle-income countries. We reviewed treatment and outcomes of gastroschisis in a middle-income country setting with increasing protocolized management. METHODS: All newborns with gastroschisis treated during the period 1989-2013 at a single Brazilian academic surgical service were studied retrospectively. Protocolized diagnosis, delivery, nutrition, medical interventions, and surgical interventions were introduced in 2002. Outcomes before and after protocol introduction were studied using univariate and multivariate analysis. RESULTS: One hundred fifty-six newborns were treated for gastroschisis: 35 (22.4%) and 121 (77.6%) before and after 2002, respectively. When compared to the earlier cohort, patients treated after 2002 had higher rates of prenatal diagnosis (90.9% vs. 60.0%, p < 0.001), delivery at a tertiary center (90.9% vs. 62.9%, p < 0.001), early closure (65.3% vs. 33.3%, p = 0.001), primary repair (55.4% vs. 31.4%, p = 0.013), monitoring of bladder pressure (62.0% vs. 2.9%, p = 0.001), PICC placement (71.1% vs. 25.7%, p < 0.001), early initiation of enteral feeding (54.5% vs. 20.0%, p < 0.001), and lower rates of electrolyte disturbances (53.7% vs. 85.7%, p = 0.001). Mortality decreased from 34.3% before 2002 to 24.8% (p = .27) after 2002 despite an increase in the complex gastroschisis rate from 11.4% to 15.7% during the same period. CONCLUSIONS: Gastroschisis outcomes in a middle-income country can be gradually improved through targeted interventions and management protocols. TYPE OF STUDY: Therapeutic. LEVEL OF EVIDENCE: III.


Assuntos
Gastrosquise/diagnóstico , Gastrosquise/cirurgia , Adolescente , Adulto , Brasil , Cateterismo Periférico/estatística & dados numéricos , Protocolos Clínicos , Parto Obstétrico/estatística & dados numéricos , Nutrição Enteral/estatística & dados numéricos , Feminino , Gastrosquise/complicações , Gastrosquise/terapia , Humanos , Recém-Nascido , Análise de Séries Temporais Interrompida , Masculino , Gravidez , Diagnóstico Pré-Natal/estatística & dados numéricos , Estudos Retrospectivos , Taxa de Sobrevida , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento , Desequilíbrio Hidroeletrolítico/etiologia , Adulto Jovem
6.
Mil Med ; 184(Suppl 1): 133-137, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30901391

RESUMO

OBJECTIVE: Care provided to a casualty in the prehospital combat setting can influence subsequent medical interactions and impact patient outcomes; therefore, we aimed to describe the incidence of specific prehospital interventions (lifesaving interventions (LSIs)) performed during the resuscitation and transport of combat casualties. METHODS: We performed a prospective observational, IRB approved study between November 2009 and March 2014. Casualties were enrolled as they were cared for at nine U.S. military medical facilities in Afghanistan. Data were collected using a standardized collection form. Determination if a prehospital intervention was performed correctly, performed incorrectly, or was necessary but was not performed (missed LSIs) was made by the receiving facility's medical provider. RESULTS: Two thousand one hundred and six patients met inclusion criteria. The mean age was 25 years and 98% were male. The most common mechanism of injury was explosion 57%. There were 236 airway interventions attempted, 183 chest procedures, 1,673 hemorrhage control, 1,698 vascular access, and 1,066 hypothermia preventions implemented. There were 142 incorrectly performed interventions and 360 were missed. CONCLUSIONS: In our study, the most commonly performed prehospital LSI in a combat setting were for vascular access and hemorrhage control. The most common incorrectly performed and missed interventions were airway interventions and chest procedures respectively.


Assuntos
Serviços Médicos de Emergência/métodos , Adolescente , Adulto , Campanha Afegã de 2001- , Afeganistão , Manuseio das Vias Aéreas/métodos , Manuseio das Vias Aéreas/estatística & dados numéricos , Cateterismo Periférico/métodos , Cateterismo Periférico/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Humanos , Hipotermia/terapia , Masculino , Medicina Militar/métodos , Medicina Militar/estatística & dados numéricos , Estudos Prospectivos
7.
Ann Emerg Med ; 74(3): 381-390, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30926188

RESUMO

STUDY OBJECTIVE: We compare the use and survivorship rate of peripheral intravenous catheters placed in the emergency department (ED) by insertion method. METHODS: We analyzed a prospective cohort of ED patients who received a peripheral intravenous catheter in the ED by ultrasonographically guided or landmark insertion. Research assistants recorded the uses of the ED-inserted catheters during the ED visit and hospitalization. Among subjects admitted, research assistants tracked catheter survivorship for 72 hours or hospital discharge, whichever came first. Research assistants documented reason for catheter removal and whether it was replaced during hospitalization. Premature removal was defined as catheters that were replaced because of mechanical failure, complication, or discomfort. We used multivariate binomial regression to estimate the relative risk of insertion method on premature removal and a Kaplan-Meier curve to compare survivorship duration by insertion method. RESULTS: A cohort of 1,174 patients with a mean age of 45 years and 63% female predominance was analyzed. Catheter use was 73% and 78% in the ED and hospital for the administration of fluids, medications, or contrast agents (and 96% if blood drawn for testing was included). Peripheral intravenous use did not differ significantly in the ED or hospital by insertion method. For 330 patients who were admitted, 132 of 182 patients (73%) in the ultrasonographically guided group and 117 of 148 (79%) in the landmark group had 72-hour catheter survival. Premature removal was not significantly more likely to occur if the catheter was inserted by the ultrasonographically guided method compared with the landmark one (relative risk 1.26; 95% confidence interval 0.88 to 1.80). CONCLUSION: ED-inserted peripheral intravenous catheters were frequently used in the ED and hospital. Peripheral intravenous use and hospital survivorship of ED-inserted peripheral intravenous catheters were similar by insertion method.


Assuntos
Cateterismo Periférico/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Ultrassonografia de Intervenção/estatística & dados numéricos , Estudos de Casos e Controles , Cateterismo Periférico/estatística & dados numéricos , Cateteres de Demora/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
8.
Rev Bras Enferm ; 72(1): 88-94, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30916272

RESUMO

OBJECTIVE: To measure the average direct cost of peripherally inserted central catheterization performed by nurses in a pediatric and neonatal intensive care unit. METHOD: A quantitative, exploratory-descriptive, single-case study, whose sample consisted of the non-participant observation of 101 peripherally inserted central catheter procedures. The cost was calculated by multiplying the execution time (timed using a chronometer) spent by nursing professionals, participants in the procedure, by the unit cost of direct labor, added to the cost of materials, drugs, and solutions. RESULTS: The average direct cost of the procedure was US$ 326.95 (standard deviation = US$ 84.47), ranging from US$ 99.03 to US$ 530.71, with a median of US$ 326.17. It was impacted by material costs and the direct labor of the nurses. CONCLUSION: The measurement of the average direct cost of the peripherally inserted central catheter procedure shed light on the financials of consumed resources, indicating possibilities of intervention aiming to increase efficiency in allocating these resources.


Assuntos
Cateterismo Periférico/economia , Cateteres/economia , Enfermeiras e Enfermeiros/economia , Cateterismo Periférico/estatística & dados numéricos , Cateteres/estatística & dados numéricos , Criança , Pré-Escolar , Custos e Análise de Custo , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Enfermeiras e Enfermeiros/estatística & dados numéricos
9.
J Clin Nurs ; 28(11-12): 2206-2213, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30786094

RESUMO

AIMS AND OBJECTIVES: To determine the factors affecting the first-attempt success of peripheral intravenous catheter (PIVC) placement in older emergency department patients. BACKGROUND: In older patients who require intravenous treatment, establishing a PIVC as fast as possible is clinically important. DESIGN: This is a prospective, observational, descriptive study. METHODS: Using a data collection form, researchers questioned both the patient and the nurse performing the procedure in terms of patient- and operator-related factors. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (See Supporting Information Appendix S1). RESULTS: A total of 472 patients were included in the final analyses. According to the logistic regression analysis, independent factors which affected first-attempt failure were found to be: choosing a nonupper extremity site for PIVC (OR: 4.72, 95% CI: 1.35-16.45, p-value: 0.015), history of difficult intravenous access (OR: 3.02, 95% CI: 1.72-5.29, p-value: <0.001), nurse having less than 2 years of professional experience (OR: 3.45, 95% CI: 2.00-5.97, p-value: <0.001), nonpalpable veins observed after the application of tourniquet (OR: 2.21, 95% CI: 1.10-4.41, p-value: 0.025), a moderate degree of difficulty anticipated by the nurse prior to the procedure (OR: 4.32, 95% CI: 2.31-8.08, p-value: <0.001) and a high degree of difficulty anticipated by the nurse prior to the procedure (OR: 8.41, 95% CI: 4.10-17.24, p-value: <0.001). CONCLUSION: Factors affecting first-attempt success rates in peripheral intravenous catheter placement in older emergency department patients may be listed as follows: the anticipated difficulty of the procedure rated by the nurse, previous history of a difficult intravenous cannulation, choosing a nonupper extremity site for cannulation, the level of experience of the nurse and the palpability of the vein. RELEVANCE TO CLINICAL PRACTICE: Healthcare providers should consider alternative methods in the presence of factors affecting first-attempt success in older emergency department patients.


Assuntos
Cateterismo Periférico/enfermagem , Recursos Humanos de Enfermagem no Hospital/psicologia , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/psicologia , Cateterismo Periférico/estatística & dados numéricos , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Estudos Prospectivos , Falha de Tratamento
10.
J Invasive Cardiol ; 31(5): 141-145, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30765619

RESUMO

BACKGROUND: Traditional approaches to pediatric cardiac catheterization have relied on femoral venous access. Upper- extremity venous access may enable cardiac catheterization procedures to be performed safely for diagnostic and interventional catheterizations. The objective of this multicenter study was to demonstrate the feasibility and safety of upper-extremity venous access in a pediatric cardiac catheterization laboratory. METHODS: A retrospective chart review of all patients who underwent cardiac catheterization via upper-extremity vascular access was performed. RESULTS: Eighty-two cardiac catheterizations were attempted via upper-extremity vein on 72 patients. Successful access was obtained in 75 catheterizations (91%) in 67 patients. Median age at catheterization was 18.79 years (interquartile range [IQR], 13.02-32.75 years; n = 75) with a median weight of 59.4 kg (IQR, 43.3-76.5 kg; n = 75). The youngest patient was 4.1 months old, weighing 4.3 kg. Local anesthesia or light sedation was utilized in 46 procedures (61%). Diagnostic right heart catheterization was the most common procedure (n = 65; 87%), with intervention performed via the upper extremity in 8 cases (11%). Median fluoroscopy time was 10.02 min (IQR, 2.87-36.26 min; n = 75), with dose area product/kg of 3.765 µGy•m²/kg (IQR, 0.74-34.12 µGy•m²/kg; n = 64). Median sheath duration time was 48 min (IQR, 19.5-147 min; n = 57) and median total procedure time was 116 min (IQR, 80.5-299 min; n = 65). Median length of stay for outpatient procedures was 5.37 hr (IQR, 4.25-6.92 hr; n = 27). There were no procedural complications. CONCLUSION: Upper-extremity venous access is a useful, feasible, and safe modality for cardiac catheterization in the pediatric cardiac catheterization laboratory.


Assuntos
Cateterismo Cardíaco , Cateterismo Periférico , Extremidade Superior/irrigação sanguínea , Adolescente , Adulto , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/estatística & dados numéricos , Cateterismo Periférico/métodos , Cateterismo Periférico/estatística & dados numéricos , Criança , Estudos de Viabilidade , Feminino , Fluoroscopia/métodos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Doses de Radiação
11.
J Feline Med Surg ; 21(2): 173-177, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29772964

RESUMO

OBJECTIVES: The aim of this study was to investigate the incidence of complications associated with arterial catheterization in cats in a veterinary hospital, and to document which factors may increase the incidence of complications. METHODS: Medical records at a referral veterinary hospital were retrospectively reviewed to identify cats that had an arterial catheter placed between January 2010 and October 2014. RESULTS: Thirty-five cats having 38 arterial catheters were included in the study. There was a relatively high incidence of minor complications (23.7%), with the most common being catheter occlusion. The incidence of major arterial catheter complications was low (2.63%). Duration of catheter use was positively correlated to the incidence of complications. There was also a significant correlation between catheters used for intensive care unit monitoring and incidence of complications. All cats with catheter complications survived to discharge. CONCLUSIONS AND RELEVANCE: The low incidence of major arterial catheter complications in this population of cats illustrates that arterial catheterization is a safe monitoring and diagnostic tool. The duration of catheter placement is significantly associated with the incidence of catheter complications.


Assuntos
Doenças do Gato , Cateterismo Periférico , Cateteres de Demora , Complicações Pós-Operatórias , Animais , Doenças do Gato/epidemiologia , Doenças do Gato/terapia , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/estatística & dados numéricos , Cateterismo Periférico/veterinária , Cateteres de Demora/efeitos adversos , Cateteres de Demora/veterinária , Gatos , Incidência , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/veterinária , Estudos Retrospectivos
12.
Diagn Interv Radiol ; 24(5): 276-282, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30211681

RESUMO

PURPOSE: We aimed to report approach, safety, technical success, and clinical outcomes of prone trans- radial access (PTRA) and demonstrate feasibility for procedures requiring simultaneous arterial intervention and prone percutaneous access. METHODS: Fifteen patients underwent PTRA, seven females (47%) and eight males (53%), mean age of 55 years (range, 19-78 years). All patients underwent PTRA for combined transarterial and posterior-approach percutaneous interventions. Variables included sheath size (French, F), type of anesthesia, arterial intervention technical success, posterior-approach percutaneous intervention technical success, estimated blood loss (mL), fluoroscopy and procedure time, complications, and follow-up. RESULTS: Mean sheath size was 4 F (range, 4-6 F; SD = 0.5). Arterial interventions included transarterial embolization of renal (n=6), hepatic (n=2), and pelvic vessels (n=2), diagnostic arteriography (n=4), and embolization of an arteriovenous malformation (n=1). Posterior-approach intervention technical success was 100% (15/15). PTRA technical success was 100% (15/15). Posterior-approach percutaneous interventions included retroperitoneal (n=5) and pelvic (n=1) mass biopsies, nephrostomy tube placement (n=2), cryoablation of pelvic (n=2) and renal (n=1) masses, sclerotherapy of arteriovenous malformations (n=2), foreign body removal from the renal collecting system (n=2), ablation of a renal tumor (n=1), intracavitary injection of pulmonary mycetoma (n=1), and ablation and cementoplasty of a vertebral body tumor (n=1). The biopsies were diagnostic (6/6). There were no minor or major access-site complications. CONCLUSION: PTRA is a safe and feasible method for performing combined arterial and posterior approach percutaneous interventions without the need for repositioning.


Assuntos
Cateterismo Periférico/instrumentação , Procedimentos Endovasculares/instrumentação , Artéria Radial/cirurgia , Adulto , Idoso , Angiografia/instrumentação , Angiografia/métodos , Malformações Arteriovenosas/cirurgia , Perda Sanguínea Cirúrgica , Cateterismo Periférico/métodos , Cateterismo Periférico/estatística & dados numéricos , Criocirurgia/métodos , Embolização Terapêutica/instrumentação , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/métodos , Estudos Retrospectivos , Escleroterapia/métodos , Resultado do Tratamento
13.
J Healthc Qual ; 40(5): 274-282, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30169441

RESUMO

Peripheral intravenous catheters (PIVCs) are common devices used across many healthcare settings. This quality improvement project aims to proactively remove PIVCs as soon as possible by empowering nurses and providers to clinically evaluate the necessity of every PIVC on a daily basis on a general hospital medical unit. Specific criteria were established to assess PIVC necessity. Cases of PIVCs not meeting established criteria are escalated to providers for a decision point. The PIVC removal times documented within the electronic medical record were analyzed to compare precriteria PIVC dwell times to postcriteria dwell times. The time between removal of a patient's last PIVC and patient discharge was analyzed to determine if more PIVCs are being removed sooner after becoming clinically unnecessary. Significantly fewer PIVCs (decrease of 14.4%) are being removed on the day of discharge in the postintervention time frame, whereas more PIVCs are being removed one (increase of 5.5%) or two (increase of 4.0%) days before the day of discharge. A strategic project to critically evaluate PIVCs on a daily basis and remove PIVCs not meeting criteria for use was successful in proactively removing PIVCs. Hospitals should evaluate PIVC practice, monitor daily usage, and strategically intervene to remove unneeded PIVCs.


Assuntos
Cateterismo Periférico/estatística & dados numéricos , Cateterismo Periférico/normas , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Gerais , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade/estatística & dados numéricos , Fatores de Tempo , Estados Unidos
14.
Pediatr Crit Care Med ; 19(12): 1097-1105, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30142121

RESUMO

OBJECTIVES: The purpose of our study is to compare the rate of central line-associated blood stream infections and venous thromboembolism in central venous catheters versus peripherally inserted central catheters in hospitalized children. There is a growing body of literature in adults describing an increased rate of venous thromboembolisms and similar rates of central line-associated blood stream infection associated with peripherally inserted central catheters versus central venous catheters. It is not known if the rate of central line-associated blood stream infection and venous thromboembolism differs between peripherally inserted central catheters and central venous catheters in children. Based on current adult literature, we hypothesize that central line-associated blood stream infection rates for peripherally inserted central catheters and central venous catheters will be similar, and the rate of venous thromboembolism will be higher for peripherally inserted central catheters versus central venous catheters. DESIGN: This is a cohort study using retrospective review of medical records and prospectively collected hospital quality improvement databases. SETTING: Quaternary-care pediatric hospital from October 2012 to March 2016. PATIENTS: All patients age 1 day to 18 years old with central venous catheters and peripherally inserted central catheters placed during hospital admission over the study dates were included. Central venous catheters that were present upon hospital admission were excluded. The primary outcomes were rate of central line-associated blood stream infection and rate of venous thromboembolism. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 2,709 catheters included in the study, 1,126 were peripherally inserted central catheters and 1,583 were central venous catheters. Peripherally inserted central catheters demonstrated a higher rate of both infection and venous thromboembolism than central venous catheters in all reported measures. In multivariable analysis, peripherally inserted central catheters had increased association with central line-associated blood stream infection (odds ratio of 3.15; 95% CI, 1.74-5.71; p = 0.0002) and increased association with venous thromboembolism (odds ratio of 2.71; 95% CI, 1.65-4.45; p < 0.0001) compared with central venous catheters. CONCLUSIONS: Rates of central line-associated blood stream infection and venous thromboembolism were higher in hospitalized pediatric patients with peripherally inserted central catheters as compared to central venous catheters. Our study confirms the need for further investigation into the safety of central access devices to assist in proper catheter selection.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Tromboembolia Venosa/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/estatística & dados numéricos , Cateterismo Periférico/estatística & dados numéricos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Tromboembolia Venosa/etiologia
15.
J Pak Med Assoc ; 68(5): 787-789, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29885184

RESUMO

The aim of study was to evaluate whether adequate initial management and safe transfer of paediatric burn patients was carried out in our setup. Patients transferred from other hospitals/ cities to Paediatric Surgery Department, Mayo Hospital were evaluated in this prospective study. Data was entered in a proforma. Around 90.4% patients on presentation had discrepancy in their burn percentage calculation. No intravenous fluids were administered to 75.4% patients and 71.1% patients did not have any intravenous access. Foley's catheter was inserted in 2 patients only though 72.8% needed it. No fasciotomy was performed in 10.5% patients needing it. Two patients needed endotracheal intubation but it was not passed, 49.1% patients were transferred by ambulance and 28.9% patients presented with sepsis. The mortality rate was 38.2%. Initial fluid resuscitation was compared with survival and found significant (p=0.000). This shows that initial burn management, transfer system and referral system is full of errors.


Assuntos
Queimaduras/terapia , Hidratação/estatística & dados numéricos , Assistência ao Paciente/normas , Transferência da Responsabilidade pelo Paciente/normas , Transferência de Pacientes/normas , Superfície Corporal , Unidades de Queimados , Cateterismo Periférico/estatística & dados numéricos , Criança , Pré-Escolar , Fasciotomia/estatística & dados numéricos , Feminino , Humanos , Lactente , Intubação Intratraqueal/estatística & dados numéricos , Masculino , Estudos Prospectivos , Taxa de Sobrevida , Cateterismo Urinário/estatística & dados numéricos
17.
Neth J Med ; 76(4): 176-183, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29845940

RESUMO

INTRODUCTION: Literature in Europe regarding implementation of nurse practitioners or physician assistants in the intensive care unit (ICU) is lacking, while some available studies indicate that this concept can improve the quality of care and overcome physician shortages on ICUs. The aim of this study is to provide insight on how a Dutch ICU implemented non-physician providers (NPP), besides residents, and what this staffing model adds to the care on the ICU. METHODS: This paper defines the training course and job description of NPPs on a Dutch ICU. It describes the number and quality of invasive interventions performed by NPPs, residents, and intensivists during the years 2015 and 2016. Salary scales of NPPs and residents are provided to describe potential cost-effectiveness. RESULTS: The tasks of NPPs on the ICU are equal to those of the residents. Analysis of the invasive interventions performed by NPPs showed an incidence of central venous catheter insertion for NPPs of 20 per fulltime equivalent (FTE) and for residents 4.3 per FTE in one year. For arterial catheters the NPP inserted 61.7 per FTE and the residents inserted 11.8 per FTE. The complication rate of both groups was in line with recent literature. Regarding their salary: after five years in service an NPP earns more than a starting resident. CONCLUSION: This is the first European study which describes the role of NPPs on the ICU and shows that practical interventions normally performed by physicians can be performed with equal safety and quality by NPPs.


Assuntos
Unidades de Terapia Intensiva/organização & administração , Profissionais de Enfermagem/organização & administração , Admissão e Escalonamento de Pessoal , Assistentes Médicos/organização & administração , Qualidade da Assistência à Saúde , Idoso , Artérias , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/estatística & dados numéricos , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/estatística & dados numéricos , Análise Custo-Benefício , Humanos , Unidades de Terapia Intensiva/economia , Internato e Residência , Pessoa de Meia-Idade , Modelos Organizacionais , Profissionais de Enfermagem/economia , Profissionais de Enfermagem/educação , Assistentes Médicos/economia , Assistentes Médicos/educação , Papel Profissional , Salários e Benefícios
18.
Mil Med ; 183(11-12): e730-e734, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29800299

RESUMO

Introduction: This study was completed to determine if guidewire catheters improve first-pass success and time of placement for peripheral intravenous access. In the military, 21% of casualties from the battlefield arrive to a medical facility in hemorrhagic shock. The importance of successful and timely intravenous placement is crucial in the initial steps of preventing this condition. Multiple studies and reviews have shown that initial first-pass success rates for pre-hospital intravenous placement have been as low as 40%, and an average success rate of 81% when completed by paramedics or similarly skilled personnel. In an attempt to replicate or improve these rates, we proposed to study placement success rates by active duty military combat medics. We hypothesized that there would be no difference in first-pass success rates when using either a standard or guidewire catheter. Materials and Methods: This study was a prospective, randomized, controlled trial with a crossover study design comparing the Accucath 18-gauge guidewire catheter to the standard 18-gauge peripheral intravenous catheter. The study included 93 1st Cavalry Division Army Combat Medics. Participants were voluntarily enrolled and consented on an individual basis. Each participant paired with a partner of their choice and acted as their own control. All supplies were laid out for the participants with the catheters randomly selected for either arm of the patient. The subjects were allowed to choose which catheter they would be tested on first. Times were recorded for only successful attempts. Results: The guidewire catheter was not proven to have a higher cannulation rate, achieving only a 44% success rate versus 66% in the standard catheter group, as well as averaging 42 seconds longer to obtain successful cannulation versus the standard catheter. Interestingly, it was observed that the greater the time in service, there was an increased success rate with the guidewire catheter that was not noted with the standard catheter. Conclusions: There was not a statistically significant improvement in the first-pass success rate of intravenous placement with the use of the guidewire catheter when compared with the standard-issue catheter. With these results, we cannot recommend the guidewire catheter to be used in leu of the standard catheter. Further studies might show improvement if subjects are allotted increased practice and familiarity with the new guidewire device.


Assuntos
Cateterismo Periférico/instrumentação , Cateterismo Periférico/normas , Auxiliares de Emergência/normas , Adulto , Cateterismo Periférico/estatística & dados numéricos , Estudos Cross-Over , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/estatística & dados numéricos , Auxiliares de Emergência/estatística & dados numéricos , Desenho de Equipamento/normas , Feminino , Humanos , Masculino , Estudos Prospectivos
19.
J Pediatr Orthop ; 38(6): e354-e359, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29727410

RESUMO

BACKGROUND: Our institution created a multidisciplinary guideline for treatment of acute hematogenous osteomyelitis (AHO) and septic arthritis (SA) in response to updates in evidence-based literature in the field and existing provider variability in treatment. This guideline aims to improve the care of these patients by standardizing diagnosis and treatment and incorporating up to date evidence-based research into practice. The primary objective of this study is to compare cases before versus after the implementation of the guideline to determine concrete effects the guideline has had in the care of patients with AHO and SA. METHODS: This is an Institutional Review Board-approved retrospective study of pediatric patients age 6 months to 18 years hospitalized between January 2009 and July 2016 with a diagnosis of AHO or SA qualifying for the guideline. Cohorts were categorized: preguideline and postguideline. Exclusion criteria consisted of: symptoms >14 days, multifocal involvement, hemodynamic instability, sepsis, or history of immune deficiency or chronic systemic disease. Cohorts were compared for outcomes that described clinical course. RESULTS: Data were included for 117 cases that qualified for the guideline: 54 preguideline and 63 postguideline. Following the successful implementation of the guideline, we found significant decrease in the length of intravenous antibiotic treatment (P<0.001), decrease in peripherally inserted central catheter use (P<0.001), and an increase in bacterial identification (P=0.040). Bacterial identification allowed for targeted antibiotic therapy. There was no change in length of hospital stay or readmission rate after the implementation of the guideline. CONCLUSION: Utilizing an evidence-based treatment guideline for pediatric acute hematogenous bone and joint infections can lead to improved bacterial diagnosis and decreased burden of treatment through early oral antibiotic use. LEVEL OF EVIDENCE: Level III- retrospective comparative study.


Assuntos
Antibacterianos/administração & dosagem , Artrite Infecciosa/terapia , Drenagem/métodos , Infecções por Neisseriaceae/terapia , Osteomielite/terapia , Infecções Estafilocócicas/terapia , Doença Aguda , Administração Intravenosa , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/microbiologia , Cateterismo Periférico/estatística & dados numéricos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Kingella kingae , Tempo de Internação , Masculino , Infecções por Neisseriaceae/diagnóstico , Osteomielite/diagnóstico , Osteomielite/microbiologia , Readmissão do Paciente , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus , Ferida Cirúrgica
20.
Eur J Cardiothorac Surg ; 54(2): 341-347, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29528384

RESUMO

OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) has become the standard of cardiopulmonary support during a sequential double lung transplant for pulmonary hypertension. Whether central or peripheral cannulation is the best strategy for these patients remains unknown. Our goal was to determine which is the best strategy by comparing 2 populations of patients. METHODS: We performed a single-centre retrospective study based on an institutional prospective lung transplant database. RESULTS: Between January 2011 and November 2016, 103 patients underwent double lung transplant for pulmonary hypertension. We compared 54 patients who had central ECMO (cECMO group) to 49 patients who had peripheral ECMO (pECMO group). The pECMO group had significantly more bridged patients who received emergency transplants (31% vs 6%, P = 0.001). The incidence of Grade 3 primary graft dysfunction requiring ECMO (14% vs 11%, P = not significant) and of in-hospital mortality (11% vs 14%, P = not significant) was similar between the groups. Groin infections (16% vs 4%, P = 0.031), deep vein thrombosis (27% vs 11%, P = 0.044) and lower limb ischaemia (12% vs 2%, P = 0.031) occurred significantly more often in the pECMO group. The number of chest reopenings for bleeding or infection was similar between the groups. The 3-month, 1-year and 5-year survival rates did not differ between the groups (P = 0.94). CONCLUSIONS: Central or peripheral ECMO produced similar results during double lung transplant for pulmonary hypertension in terms of in-hospital deaths and long-term survival rates. Central ECMO provided satisfactory results without major bleeding provided the patient was weaned from ECMO at the end of the procedure. Despite the rate of groin and lower limb complications, peripheral cannulation remained the preferred solution to bridge the patient to transplant or for postoperative support.


Assuntos
Cateterismo Periférico , Oxigenação por Membrana Extracorpórea , Hipertensão Pulmonar/cirurgia , Transplante de Pulmão , Adulto , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/métodos , Cateterismo Periférico/mortalidade , Cateterismo Periférico/estatística & dados numéricos , Bases de Dados Factuais , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/mortalidade , Oxigenação por Membrana Extracorpórea/estatística & dados numéricos , Feminino , Humanos , Transplante de Pulmão/efeitos adversos , Transplante de Pulmão/métodos , Transplante de Pulmão/mortalidade , Transplante de Pulmão/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA