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1.
Klin Lab Diagn ; 64(8): 503-506, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31479608

RESUMO

The results of the bacteriological catheter investigation on the analyzer with the technology of laser light scattering and using D. Maki culture technique coincided in 91.8% of cases. Catheter-associated infections are proven in 8 cases. The following obtained from blood and intravascular catheter in 5 patients: Staphylococcus epidermidis (n=1), Staphylococcus haemolyticus (n=1), Escherichia coli (n=1), Staphylococcus aureus (n=2); Staphylococcus epidermidis (n=1) was detected in 1 child from ventricular shunt and cerebrospinal fluid and Escherichia coli lactose-negative + Staphylococcus haemolyticus were detected in 1 child from ventricular shunt, whily only Escherichia coli lactose-negative was detected from cerebrospinal fluid; Pseudomonas aeruginosa (n=1) was foud out in 1 patient from the urinary catheter and urine. Clinical significance of the isolated microorganisms from the catheter must be assessed in each particular case taking into account its quantity and type of the isolated microorganism.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Relacionadas a Cateter/diagnóstico , Lasers , Criança , Escherichia coli , Humanos , Pseudomonas aeruginosa , Staphylococcus aureus , Staphylococcus epidermidis , Staphylococcus haemolyticus
2.
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
3.
J Infus Nurs ; 42(4): 193-196, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283661

RESUMO

Central line-associated bloodstream infections (CLABSIs) account for one-third of all hospital-acquired infections and can cost the health care system between $21,000 and $100,000 per infection. A dedicated vascular access team (VAT) can help develop, implement, and standardize policies and procedures for central line usage that address insertion, maintenance, and removal as well as educate nursing staff and physicians. This article presents how 1 hospital developed a VAT and implemented evidence-based guidelines. Central line utilization decreased by 45.2%, and CLABSI incidence decreased by 90%. The results of the study demonstrated that a reduced utilization of central lines minimized the risk of patients developing a CLABSI.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/normas , Controle de Infecções/métodos , Equipe de Assistência ao Paciente/normas , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/métodos , Fidelidade a Diretrizes , Humanos , Estudos Retrospectivos
4.
Nat Commun ; 10(1): 2763, 2019 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-31235751

RESUMO

Multidrug resistant (MDR) Acinetobacter baumannii poses a growing threat to global health. Research on Acinetobacter pathogenesis has primarily focused on pneumonia and bloodstream infections, even though one in five A. baumannii strains are isolated from urinary sites. In this study, we highlight the role of A. baumannii as a uropathogen. We develop the first A. baumannii catheter-associated urinary tract infection (CAUTI) murine model using UPAB1, a recent MDR urinary isolate. UPAB1 carries the plasmid pAB5, a member of the family of large conjugative plasmids that represses the type VI secretion system (T6SS) in multiple Acinetobacter strains. pAB5 confers niche specificity, as its carriage improves UPAB1 survival in a CAUTI model and decreases virulence in a pneumonia model. Comparative proteomic and transcriptomic analyses show that pAB5 regulates the expression of multiple chromosomally-encoded virulence factors besides T6SS. Our results demonstrate that plasmids can impact bacterial infections by controlling the expression of chromosomal genes.


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/patogenicidade , Infecções Relacionadas a Cateter/microbiologia , Plasmídeos/genética , Pneumonia Bacteriana/microbiologia , Infecções Urinárias/microbiologia , Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/genética , Acinetobacter baumannii/isolamento & purificação , Animais , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Infecções Relacionadas a Cateter/epidemiologia , Modelos Animais de Doenças , Farmacorresistência Bacteriana Múltipla/genética , Perfilação da Expressão Gênica , Regulação Bacteriana da Expressão Gênica , Humanos , Camundongos , Pneumonia Bacteriana/epidemiologia , Proteômica , Estudos Retrospectivos , Sistemas de Secreção Tipo VI/genética , Sistemas de Secreção Tipo VI/metabolismo , Cateteres Urinários/efeitos adversos , Cateteres Urinários/microbiologia , Sistema Urinário/microbiologia , Infecções Urinárias/epidemiologia , Virulência/genética , Fatores de Virulência/genética , Fatores de Virulência/metabolismo
5.
Cochrane Database Syst Rev ; 5: CD004680, 2019 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-31149735

RESUMO

BACKGROUND: Peritonitis is one of the limiting factors for the growth of peritoneal dialysis (PD) worldwide and is a major cause of technique failure. Several studies have examined the effectiveness of various catheter-related interventions for lowering the risk of PD-related peritonitis. This is an update of a review first published in 2004. OBJECTIVES: To evaluate the role of different catheter implantation techniques and catheter types in lowering the risk of PD-related peritonitis in PD patients. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 15 January 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: Studies comparing different catheter insertion techniques, catheter types, use of immobilisation techniques and different break-in periods were included. Studies of different PD sets were excluded. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study quality and extracted data. Statistical analyses were performed using a random effects model and the results expressed as risk ratio (RR) with 95% confidence intervals (CI). MAIN RESULTS: Forty-two studies (3144 participants) were included: 18 evaluated techniques of catheter implantation, 22 examined catheter types, one assessed an immobiliser device, and one examined break-in period. In general, study quality was variable and almost all aspects of study design did not fulfil CONSORT standards for reporting.Catheter insertion by laparoscopy compared with laparotomy probably makes little or no difference to the risks of peritonitis (RR 0.90, 95% CI 0.59 to 1.35; moderate certainty evidence), exit-site/tunnel infection (RR 1.00, 95% CI 0.43 to 2.31; low certainty evidence), catheter removal/replacement (RR 1.20, 95% CI 0.77 to 1.86; low certainty evidence), technique failure (RR 0.71, 95% CI 0.47 to 1.08; low certainty evidence), and death (all causes) (RR 1.26, 95% CI 0.72 to 2.20; moderate certainty evidence). It is uncertain whether subcutaneous burying of catheter increases peritonitis (RR 1.16, 95% CI 0.37 to 3.60; very low certainty evidence). Midline insertion compared to lateral insertion probably makes little or no difference to the risks of peritonitis (RR 0.65, 95% CI 0.32 to 1.33; moderate certainty evidence) and may make little or no difference to exit-site/tunnel infection (RR 0.56, 95% CI 0.12 to 2.58; low certainty evidence). Percutaneous insertion compared with open surgery probably makes little or no difference to the exit-site/tunnel infection (RR 0.16, 95% CI 0.02 to 1.30; moderate certainty evidence).Straight catheters probably make little or no difference to the risk of peritonitis (RR 1.04, 95% CI 0.82 to 1.31; moderate certainty evidence), peritonitis rate (RR 0.91, 95% CI 0.68 to 1.21; moderate certainty evidence), risk of exit-site infection (RR 1.12, 95% CI 0.94 to 1.34; moderate certainty evidence), and exit-site infection rate (RR 1.05, 95% CI 0.77 to 1.43; moderate certainty evidence) compared to coiled catheter. It is uncertain whether straight catheters prevent catheter removal or replacement (RR 1.11, 95% CI 0.73 to 1.66; very low certainty evidence) but straight catheters probably make little or no difference to technique failure (RR 0.82, 95% CI 0.51 to 1.31; moderate certainty evidence) and death (all causes) (RR 0.95, 95% CI 0.62 to 1.46; low certainty evidence) compared to coiled catheter. Tenckhoff catheter with artificial curve at subcutaneous tract compared with swan-neck catheter may make little or no difference to peritonitis (RR 1.29, 95% CI 0.85 to 1.96; low certainty evidence) and incidence of exit-site/tunnel infection (RR 0.96, 95% CI 0.77 to 1.21; low certainty evidence) but may slightly improve exit-site infection rate (RR 0.67, 95% CI 0.50 to 0.90; low certainty evidence). AUTHORS' CONCLUSIONS: There is no strong evidence that any catheter-related intervention, including the use of different catheter types or different insertion techniques, reduces the risks of PD peritonitis or other PD-related infections, technique failure or death (all causes). However, the numbers and sizes of studies were generally small and the methodological quality of available studies was suboptimal, such that the possibility that a particular catheter-related intervention might have a beneficial effect cannot be completely ruled out with confidence.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo/métodos , Diálise Peritoneal , Peritonite/prevenção & controle , Cateteres de Demora , Humanos , Diálise Peritoneal/instrumentação , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
BMC Infect Dis ; 19(1): 429, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096918

RESUMO

BACKGROUND: Several randomized controlled trials (RCTs) evaluated the role of Chlorhexidine-impregnated dressing for prophylaxis of central venous catheter (CVC) related complications, but the results remained inconsistent, updated meta-analyses on this issue are warranted. METHODS: A meta-analysis on the RCTs comparing Chlorhexidine-impregnated dressing versus other dressing or no dressing for prophylaxis of central venous catheter-related complications was performed. A comprehensive search of major databases was undertaken up to 30 Dec 2018 to identify related studies. Pooled odd ratio (OR) and mean differences (MDs) with 95% confidence intervals (CI) were calculated using either a fixed-effects or random-effects model. Subgroup analysis was performed to identify the source of heterogeneity, and funnel plot and Egger test was used to identify the publication bias. RESULTS: A total of 12 RCTs with 6028 patients were included. The Chlorhexidine-impregnated dressings provided significant benefits in reducing the risk of catheter colonization (OR = 0.46, 95% CI: 0.36 to 0.58), decreasing the incidence of catheter-related bloodstream infection (CRBSI) (OR = 0.60, 95% CI: 0.42 to 0.85). Subgroup analysis indicated that the Chlorhexidine-impregnated dressings were conducive to reduce the risk of catheter colonization and CRBSI within the included RCTs with sample size more than 200, but the differences weren't observed for those with sample less than 200. No publication bias was observed in the Egger test for the risk of CRBSI. CONCLUSIONS: Chlorhexidine-impregnated dressing is beneficial to prevent CVC-related complications. Future studies are warranted to assess the role and cost-effectiveness of Chlorhexidine-impregnated dressings.


Assuntos
Anti-Infecciosos Locais/farmacologia , Bandagens , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Clorexidina/farmacologia , Bandagens/microbiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais , Clorexidina/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
Mo Med ; 116(2): 129-133, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31040499

RESUMO

The term "intestinal failure" signifies the inability of the body to meet the digestive, absorptive and nutritive needs of the body. In children, intestinal failure is most often due to short bowel syndrome, often a result of necrotizing enterocolitis, a severe GI ischemic pathology that is generally associated with prematurity. With advances in neonatal care, more preterm infants are surviving, and subsequently we care for more children with SBS than ever before. These children require parenteral nutrition (PN) for survival. Neurodevelopmental outcomes are tied to nutrition in early years; thus these children are the most vulnerable to the sequelae of intestinal failure. As such, the development of multi-disciplinary intestinal rehabilitation programs have emerged as the state of the art in the care of children with intestinal failure.


Assuntos
Enterocolite Necrosante/complicações , Nutrição Parenteral/métodos , Equipe de Assistência ao Paciente , Síndrome do Intestino Curto/etiologia , Infecções Relacionadas a Cateter/prevenção & controle , Criança , Enterocolite Necrosante/diagnóstico , Enterocolite Necrosante/epidemiologia , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Missouri , Síndrome do Intestino Curto/terapia
9.
Int J Infect Dis ; 84: 22-29, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31005622

RESUMO

A panel of experts was convened by the International Society for Infectious Diseases (ISID) to overview recommendations on managing and preventing vascular catheter infections, specifically for the prevention and management of central line-associated bloodstream infections. These recommendations are intended to provide insight for healthcare professionals regarding the prevention of infection in the placement and maintenance of the catheter and diagnosis as well as treatment of catheter infection. Aspects of this area in pediatrics and in limited-resource situations and a discussion regarding the selection of empiric or targeted antimicrobial therapy are particular strengths of this position paper.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Adulto , Anti-Infecciosos/uso terapêutico , Infecções Relacionadas a Cateter/tratamento farmacológico , Cateterismo Venoso Central/métodos , Criança , Humanos
10.
J Nurses Prof Dev ; 35(4): 193-195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31022091

RESUMO

After a survey revealed practice gaps in central venous catheter care, one organization was challenged to identify a novel approach to educate nurses. Through a search for evidence, a project workgroup discovered an existing but beneficial teaching method, using a mobile cart to deliver meaningful education at the point of care. Successful outcomes and sustained practice change were realized.


Assuntos
Cateterismo Venoso Central/enfermagem , Competência Clínica , Capacitação em Serviço/métodos , Recursos Humanos de Enfermagem no Hospital/educação , Materiais de Ensino , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/instrumentação , Humanos
12.
Medicine (Baltimore) ; 98(14): e14940, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946317

RESUMO

PURPOSE: The purpose of our study is to carry out a Bayesian network meta-analysis comparing the efficacy of different antimicrobial dressings for prevention of catheter-related blood infections (CRBSI) and rank these antimicrobial dressings for practical consideration. METHODS: We searched the PubMed, Cochrane library, Embase, earlier relevant meta-analysis and reference lists of included studies for randomized controlled trials (RCTs) that compared dressings for prevention of CRBSI. Two authors independently extracted data from each included RCT according to a predesigned Excel spreadsheet and assessed the methodological quality of included RCTs using the Cochrane risk of bias tool. Data was analyzed using the WinBUGS (V.1.4.3) and the Stata (V.15.0). RESULTS: Finally, 35 RCTs involving 8494 patients and evaluating 13 dressings were included. Network meta-analysis showed that transparent dressing may be the best way to prevent CRBSI. Suture and bordered polyurethane dressing might have the lowest risk of CRBSI rate per 1000 catheter-days, and sutureless securement device might lead to the lowest incidence of catheter failure. CONCLUSIONS: This network meta-analysis indicated that transparent dressings may be selected for the prevention of CRBSI in patients with central venous catheters, which is of importance in future research. Although evidence is scant, more attention should be paid to head-to-head comparisons of the most commonly used dressings in this field.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres Venosos Centrais/microbiologia , Adulto , Idoso , Bacteriemia/epidemiologia , Bandagens/normas , Infecções Relacionadas a Cateter/tratamento farmacológico , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Poliuretanos , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Ren Fail ; 41(1): 303-313, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30991864

RESUMO

INTRODUCTION: Staphylococcal infections can cause significant morbidity in patients undergoing dialysis. This study evaluated the effects of HIV infection on nasal carriage of Staphylococcus aureus, staphylococcal peritonitis, and catheter infection rates in patients with end-stage renal failure managed with continuous ambulatory peritoneal dialysis (CAPD). METHODS: Sixty HIV-positive and 59 HIV-negative CAPD patients were enrolled and followed up for up to 18 months. S. aureus nasal carriage (detected by nasal swab culture), Staphylococcal peritonitis (diagnosed by clinical presentation, and CAPD effluent Staphylococcal culture and white blood cell count ≥100 cells/µL), and catheter infections (including exit site and tunnel infections) were assessed monthly. RESULTS: At 18 months, S. aureus nasal carriage rates were 43.3% and 30.5% (p = 0.147) and the methicillin-resistant S. aureus (MRSA) nasal carriage rates were 31.7% and 13.6% (p = 0.018) for the HIV-positive and HIV-negative cohorts, respectively. The HIV-positive cohort was associated with increased hazards for staphylococcal peritonitis, (adjusted hazard ratio [AHR] 2.85, 95% confidence interval [CI] 1.19-6.84, p = 0.019) due to increased coagulase-negative staphylococcal (CNS) peritonitis rate in the HIV-positive cohort compared with the HIV-negative cohort (0.435 vs. 0.089 episodes/person-years; AHR 7.64, CI 2.18-26.82, p = 0.001). On multivariable analysis, CD4+ cell count <200 cells/µL, diabetes, and S. aureus nasal carriage were found to be independent predictors of S. aureus peritonitis. CONCLUSIONS: These findings suggest that HIV infection may be a risk factor for MRSA nasal colonization and may increase the risks of CNS peritonitis, while a CD4+ cell count <200 cells/µL and S. aureus nasal carriage may be important predictors of S. aureus peritonitis.


Assuntos
Portador Sadio/epidemiologia , Infecções por HIV/imunologia , Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Adulto , Portador Sadio/imunologia , Portador Sadio/microbiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/imunologia , Infecções Relacionadas a Cateter/microbiologia , Cateteres de Demora/efeitos adversos , Cateteres de Demora/microbiologia , Feminino , Seguimentos , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Nariz/microbiologia , Diálise Peritoneal Ambulatorial Contínua/instrumentação , Peritonite/epidemiologia , Peritonite/imunologia , Peritonite/microbiologia , Estudos Prospectivos , Fatores de Risco , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/imunologia , Infecções Estafilocócicas/microbiologia
14.
Klin Padiatr ; 231(4): 177-182, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-30974467

RESUMO

BACKGROUND: In May 2018, the commission on infection prevention and control in Germany (KRINKO) of the RKI published a guidance document providing recommendations on the prevention of catheter-associated infections in premature children and newborns. AIM: Summarized presentation, explanation and discussion of the KRINKO recommendations. METHODS: The recommendations of the KRINKO were summarized and discussed with reference to the original sources. RESULTS: In particular, statements were formulated for the insertion and maintenance of vascular catheters and for the preparation of infusions. Overall, however, the evidence of the recommendations is low. About 26% (19 out of 74) are classified under category IA or IB. However, 40% of the recommendations are category II only and therefore based on indicative clinical or epidemiological studies or comprehensible theoretical justifications. Accordingly, there is a lack of urgently needed clinical trials. DISCUSSION: Prevention strategies were discussed in detail and practical issues were addressed. The high number of recommendations, sometimes with low evidence levels, suggests a shared assessment of the infection control team and clinicians to ensure a successful implementation in practice and a focus on key content adapted to the local situation.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Controle de Doenças Transmissíveis , Equipamentos e Provisões , Higiene/normas , Equipamentos e Provisões/microbiologia , Alemanha , Humanos , Recém-Nascido , Recém-Nascido Prematuro
15.
J Vasc Access ; 20(1_suppl): 60-64, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31032729

RESUMO

INTRODUCTION: Long-term use of peritoneal dialysis catheter is associated with complications such as infection and malfunction, necessitating removal of catheter with subsequent reinsertion or permanent transfer to haemodialysis. This study aims to investigate the outcome in patients who underwent reinsertion. METHODS AND MATERIALS: A single-centre retrospective study was performed in Singapore General Hospital for all adult incident peritoneal dialysis patients between January 2011 and January 2016. Study data were retrieved from patient electronic medical records up till 1 January 2017. RESULTS: A total of 470 patients had peritoneal dialysis catheter insertion with median follow-up period of 29.2 (interquartile range = 16.7-49.7) months. A total of 92 patients required catheter removal. Thirty-six (39%) patients underwent catheter reinsertion. The overall technique survival at 3 and 12 months were 83% and 67%. Median time to technique failure of the second catheter was 6.74 (interquartile range = 0-50.2) months. The mean survival for patients who converted to haemodialysis and re-attempted peritoneal dialysis was comparable (54.9 ± 5.5 vs 57.3 ± 3.6 months; p = 0.75). Twelve (13%) patients had contraindication for peritoneal dialysis and were excluded from analysis. Of 11 patients who required catheter removal due to malfunction, 7 (64%) underwent catheter reinsertion and 6 (86%) patients ultimately converted to haemodialysis during study period. Of the 69 patients who had catheter removal due to infection, 29 (42%) underwent catheter reinsertion and 8 (28%) patients eventually converted to haemodialysis during the study period. CONCLUSION: Patient survival was comparable between patients who re-attempted peritoneal dialysis and patients who transferred to haemodialysis. Patients who had previous catheter removal due to infections had favourable technique survival than those due to catheter malfunction.


Assuntos
Infecções Relacionadas a Cateter/terapia , Cateteres de Demora , Remoção de Dispositivo , Nefropatias/terapia , Diálise Peritoneal/instrumentação , Diálise Renal , Adulto , Idoso , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/etiologia , Remoção de Dispositivo/efeitos adversos , Registros Eletrônicos de Saúde , Falha de Equipamento , Feminino , Humanos , Nefropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Singapura , Fatores de Tempo , Resultado do Tratamento
16.
J Infus Nurs ; 42(3): 125-131, 2019 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30985560

RESUMO

Patients are increasingly receiving therapy at home via central vascular access devices (CVADs). Limited data exist regarding patients' experiences with outpatient CVADs. This study characterized outpatient CVAD care via 14-day patient diaries. Information included location, frequency, and purpose of CVAD access episodes and who performed CVAD care. Across all patients, 77% of care was provided in the patient's home compared with other sites. Home care was provided via self-care (48%), by a family member/caregiver (25%), or by a nurse (27%). Flushing the device was the most frequent reason for device access (52%). An occlusion rate of 9.57 per 1000 device days was also noted. Further examination of CVAD maintenance and patient/care provider education is warranted.


Assuntos
Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais , Serviços de Assistência Domiciliar , Pacientes Ambulatoriais/estatística & dados numéricos , Dispositivos de Acesso Vascular , Idoso , Infecções Relacionadas a Cateter/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Autocuidado
17.
J Infus Nurs ; 42(3): 132-136, 2019 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30985561

RESUMO

To maximize safety and the patient experience, caregivers require intensive training to administer home parenteral nutrition (HPN) before initial hospital discharge. This article provides the rationale, best practices, and a template for caregiver predischarge HPN education provided by nurses. The standardized HPN discharge curriculum is outlined over 5 didactic and hands-on sessions.


Assuntos
Cuidadores/educação , Currículo , Nutrição Parenteral no Domicílio/métodos , Alta do Paciente , Infecções Relacionadas a Cateter/prevenção & controle , Criança , Humanos , Nutrição Parenteral no Domicílio/efeitos adversos , Educação de Pacientes como Assunto/métodos , Dispositivos de Acesso Vascular
18.
J Infus Nurs ; 42(3): 137-142, 2019 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30985562

RESUMO

Central line-associated bloodstream infection (CLABSI) can result in increased length of hospital stay and increased costs for both patients and organizations. This article illustrates how a multidisciplinary collaboration and the use of scientific evaluation and implementation tools can facilitate a decrease in CLABSIs and have a positive effect on staff satisfaction when caring for central lines.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central , Cateteres Venosos Centrais , Prática Clínica Baseada em Evidências , Unidades de Terapia Intensiva Pediátrica , Equipe de Assistência ao Paciente/normas , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/normas , Cateterismo Venoso Central/estatística & dados numéricos , Criança , Infecção Hospitalar/prevenção & controle , Humanos , Controle de Infecções/métodos , Dispositivos de Acesso Vascular
19.
J Infus Nurs ; 42(3): 143-148, 2019 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30985563

RESUMO

Short peripheral catheters (SPCs) are the most frequently used medical devices in hospital settings. Many hospital policies state that SPCs be replaced at 96 hours, which can be unnecessary and costly. A pre-post quality improvement initiative was implemented following complications surrounding removal of timed SPC catheters compared with those removed by clinical indication, using the Visual Infusion Phlebitis (VIP) scale. Data collected included patient demographics, SPC characteristics, nursing time, and product use. SPCs replaced based on clinical indication remained intact longer and had fewer complications than those in the group with routinely replaced SPCs. Decreasing SPC replacements by use of clinical indication resulted in cost savings of $7263.60/unit/month.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Periférico/métodos , Cateteres de Demora , Prática Clínica Baseada em Evidências/normas , Idoso , Remoção de Dispositivo , Feminino , Humanos , Infusões Intravenosas , Masculino , Flebite , Melhoria de Qualidade , Fatores de Tempo
20.
J Infus Nurs ; 42(3): 149-150, 2019 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30985564

RESUMO

EDITOR'S NOTE: Still considered a "hot topic" 4 years later, JIN is pleased to reprint this classic article from May/June 2015, Issue 3. Since publication, "Accepted but Unacceptable: Peripheral IV Catheter Failure" has been downloaded nearly 400 times and cited dozens of times in other related research. Based on these data, we asked the lead author to update readers on the status of catheter failure and what has been improved since 2015.


Assuntos
Infecções Relacionadas a Cateter/complicações , Cateterismo Periférico/efeitos adversos , Dispositivos de Acesso Vascular/efeitos adversos , Cateterismo Periférico/métodos , Cateteres de Demora/efeitos adversos , Humanos
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