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PLoS One ; 17(10): e0275783, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36215232


BACKGROUND: Subcutaneous (SC) hydration is a valuable method for treating dehydration in the very old patients. Data are absent on the absorption rate, and the availability of SC infused fluid in the circulation in this group of patients where SC hydration is particularly relevant. METHODS: We performed an explorative study on ill very old (range 78-84 years old) geriatric patients with comorbidities who received an SC infusion of 235 ml isotonic saline containing a technetium-99m pertechnetate tracer. The activity over the infusion site was measured using a gamma detector to assess the absorption rate from the SC space. The activity was measured initially every 5 minutes, with intervals extended gradually to 15 minutes. Activity in blood samples and the thyroid gland was measured to determine the rate of availability in the circulation. RESULTS: Six patients were included. The mean age was 81 years (SD 2.1), the number of comorbidities was 4.6 (SD 1.3), and the Tilburg frailty indicator was 3.8 (SD 2.4). When the infusion was completed after 60 minutes, 53% (95% CI 50-56%) of the infused fluid was absorbed from the SC space, with 88% (95% CI 86-90%) absorbed one hour later. The absorption rate from the SC space right after the completion of the infusion was 127 ml/h (95% CI 90-164 ml/h). The appearance of the fluid into the blood and the thyroid gland verified the transfer from SC to circulation. CONCLUSION: This first explorative study of absorption of SC infused fluid in the very old found an acceptable amount of fluid absorbed from the SC space into the circulation one hour after infusion had ended. Results are uniform but should be interpreted cautiously due to the low sample size. TRIAL REGISTRATION: Identifier: NCT04536324.

Pertecnetato Tc 99m de Sódio , Tecnécio , Idoso , Idoso de 80 Anos ou mais , Humanos , Hipodermóclise , Infusões Parenterais
Rev Lat Am Enfermagem ; 30: e3623, 2022.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-35976356


OBJECTIVE: to identify the occurrences related to peripheral venipuncture and hypodermoclysis among patients hospitalized in a general hospital and in an exclusive hospital institution for the care of patients in palliative cancer care. METHOD: an observational, descriptive and multicenter study. The consecutive and non-probabilistic sample consisted of 160 cancer patients hospitalized in Palliative Care. The outcome variable corresponded to the occurrences and complications related to each type of puncture. A questionnaire containing the sociodemographic and clinical variables and a structured script for monitoring and daily evaluation of the puncture were used. Descriptive statistics were employed for data analysis. RESULTS: the occurrences related to venipuncture at a general hospital were blood soiling at catheter insertion (17.4%) and expired use period (15.8%), while at a specific service for the care of patients under palliative care they were expired use period (32%) followed by infiltration (18.9%). As for hypodermoclysis, there were two subcutaneous punctures with phlogistic signs (1.0%) at the general hospital and a hematoma at the catheter insertion site (0.5%). At the specific service for the care of patients under palliative care there were three subcutaneous punctures with phlogistic signs (5.7%). CONCLUSION: the number of occurrences related to peripheral venipuncture was higher than those related to hypodermoclysis.

Hipodermóclise , Neoplasias , Humanos , Hipodermóclise/efeitos adversos , Neoplasias/terapia , Cuidados Paliativos , Flebotomia/efeitos adversos , Punções
Int J Palliat Nurs ; 28(7): 308-312, 2022 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-35861446


BACKGROUND: Hypodermoclysis is a method of subcutaneous fluid administration. It has been used to treat palliative patients safely and effectively. However, the use of subcutaneous hydration is often overlooked. AIM: This study aimed to compare the feasibility, pain experience and acceptability between subcutaneous and intravenous hydration in a hospital setting. METHODS: A prospective, randomised clinical trial was conducted. Patients requiring fluid administration were randomly allocated an intravenous or subcutaneous route. Patients' pain score, satisfaction and acceptance levels were collected. The difficulty score of the needle insertion and acceptance scores from nurses were recorded. FINDINGS: A total of 26 patients were enrolled. The difficulty scores and patients' pain scores were significantly lower in the subcutaneous group. The satisfaction and acceptance levels of the patients and nurses were similar in both groups. No systemic side-effects were found in either group. CONCLUSION: Hypodermoclysis was acceptable and satisfying to patients and nurses. It was less painful than the intravenous route.

Hipodermóclise , Cuidados Paliativos , Estudos de Viabilidade , Hidratação/métodos , Humanos , Dor , Cuidados Paliativos/métodos , Estudos Prospectivos , Tailândia
Palliat Med ; 36(5): 830-840, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35531661


BACKGROUND: Palliative populations are at risk for dehydration which can cause discomfort, distress and cognitive symptoms. Subcutaneous hydration ('hypodermoclysis') has been used as an alternative administration route to the more invasive intravenous route, but research is lacking on its net clinical effects (harms and benefits) for palliative populations, particularly in real world settings. AIM: To quantify prospectively the net clinical effects of hypodermoclysis in palliative patients with advanced disease who required supplementary fluids. DESIGN: Multisite, multinational consecutive cohort study. SETTING/PARTICIPANTS: Patients receiving hypodermoclysis in an inpatient palliative care setting. RESULTS: Twenty sites contributed data for 99 patients, of which 88 had complete benefits and harms data. The most common primary target symptom for infusion was generalised weakness (18.2%), and the most common non-symptom indication was supplemental hydration (31.8%). Benefits were experienced in 33% of patients in their primary target symptom, and in any symptom in 56.8%. Harms were experienced in 38.7% of patients (42% at Grade 1). Benefits increased with higher performance status, while harms were more frequent in patients with lower performance status (Australia-modified Karnofsky performance status ⩽40). Patients in the terminal phase of their illness experienced the least benefit (15.4% in any indication only) and had more frequent harms (38%). CONCLUSIONS: Hypodermoclysis may improve certain symptoms in patients in palliative care but frequency of harms and benefits may differ at certain timepoints in the illness trajectory. Further research is needed to better delineate which patients will derive the most net clinical benefit from hypodermoclysis.

Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Hipodermóclise , Estudos de Coortes , Humanos , Hipodermóclise/psicologia , Cuidados Paliativos/psicologia
Rev Rene (Online) ; 23: e77955, 2022. graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1376109


RESUMO Objetivo mapear as evidências sobre hipodermóclise na assistência à saúde da criança. Métodos trata-se de uma revisão de escopo, com busca nas bases Medical Literature Analysis and Retrieval System Online , Literatura Latino-Americana e do Caribe em Ciências da Saúde, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature , Scopus Elsevier, Web of Science e Embase. Incluíram-se estudos publicados em português, inglês e espanhol, sem recorte temporal. Resultados foram analisados 11 estudos com predomínio de revisões de literatura. Os principais temas foram: uso da hialuronidase humana recombinante como facilitadora da absorção subcutânea; comparação entre a reidratação subcutânea e intravenosa; vantagens da hipodermóclise; dor do paciente e as tentativas de punção. Conclusão este estudo permitiu mapear as evidências científicas sobre hipodermóclise, revelando ser uma alternativa viável e válida para administrar medicamentos em crianças. Contribuições para a prática o uso da técnica pode trazer benefícios e fornece evidências para indicá-la e aplicá-la na assistência à criança.

ABSTRACT Objective to mapping the evidence on hypodermoclysis in child health care. Methods this is a scope review, with a search in Medical Literature Analysis and Retrieval System Online, Latin American and Caribbean Health Sciences Literature, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Scopus Elsevier, Web of Science and Embase. Studies published in Portuguese, English and Spanish were included, with no time cut. Results a total of 11 studies were analyzed, with a predominance of literature reviews. The main themes were: use of recombinant human hyaluronidase as a facilitator of subcutaneous absorption; comparison between subcutaneous and intravenous rehydration; advantages of hypodermoclysis; patient pain and puncture attempts. Conclusion this study allowed mapping the scientific evidence on hypodermoclysis, revealing it to be a viable and valid alternative for administering medications in children. Contributions to practice the use of the technique can bring benefits and provides evidence to indicate and apply it in child care.

Humanos , Saúde da Criança , Hipodermóclise , Infusões Intravenosas , Desidratação/enfermagem
Rev. méd. Minas Gerais ; 32: 32107, 2022.
Artigo em Português | LILACS | ID: biblio-1390852


Introdução: A hipodermóclise consiste na inserção de um cateter via subcutânea para reposição de fluidos e administração de fármacos. Há poucos estudos clínicos que comprovem sua eficácia e segurança para administração de fármacos. Objetivos: Caracterizar o uso da hipodermóclise em pacientes internados em um hospital pediátrico em Belo Horizonte. Métodos: Estudo descritivo, observacional, de coorte transversal e com abordagem quantitativa, utilizando dados de prontuário eletrônico e realizado em uma instituição hospitalar da rede pública de saúde no estado de Minas Gerais no período de 2017 a 2018. Resultados: 27 pacientes fizeram uso da hipodermóclise n=17 (56%) tinham idade inferior a cinco anos, a indicação do cateter foi mais usual na unidade de cuidados paliativos n=12(43%). A região subclavicular foi o sítio mais puncionado n=31 (51,7%), tempo de permanência do cateter entre 1 e 5 dias n=31 (51,7%) e os principais motivos para a retirada foram: sinais flogísticos n=12 (20%) e exteriorização acidental do dispositivo n=10 (16,7%). Foram prescritos 12 fármacos diferentes por esta via sendo a morfina a mais utilizada n=15 (28,9%) e as principal indicação foi para o conforto e controle da dor n=22 (42%). Conclusão: A hipodermóclise é um método seguro e de baixo custo. Novas pesquisas na população geral e pediátrica são fundamentais para produzir evidências da segurança e efetividade desta via.

Introduction: Hypodermoclysis consists of inserting a subcutaneous catheter to replace fluids and administer drugs. There are few clinical studies that prove its efficacy and safety for drug administration. Purpose: To characterize the use of hypodermoclysis in patients admitted to a pediatric hospital in Belo Horizonte. Methods: Descriptive, observational, cross-sectional cohort study with a quantitative approach, using data from electronic medical records and carried out in a public health hospital in the state of Minas Gerais in the period from 2017 to 2018. Results: 27 patients who used hypodermoclysis n=17 (56%) were under the age of five years, the indication of the catheter was more usual in the palliative care unit n=12 (43%). The subclavicular region was the most punctured site n=31 (51,7%), catheter dwell time between 1 and 5 days n=31 (51,7%) and the main reasons for the withdrawal were: inflammatory signs n=12 (20%) and accidental externalization of the device n=10 (16,7%) 12 different drugs were prescribed by this route, with morphine being the most used n=15 (28,9%) and the main indication was for comfort and pain control n=22 (42%). Conclusion: Hypodermoclysis is a safe and low-cost method. New research in the general and pediatric population is essential to produce evidence of the safety and effectiveness of this route.

Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pacientes , Pediatria , Hipodermóclise , Infusões Subcutâneas
J Allergy Clin Immunol ; 148(6): 1387-1393, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34688495


Atopic diathesis encompassing atopic dermatitis (AD), allergic rhinoconjunctivitis, food allergy, eosinophilic esophagitis, and asthma is a widely prevalent condition with a broad heterogeneity in clinical course, age of onset, and lifespan persistence. A primary event in AD is the commonly inherited epidermal barrier dysfunction. Together with the host-microbiome interactions, barrier defect and allergen exposure modulate both innate and adaptive immunity, thus triggering and maintaining the inflammatory response. Microbiome diversity, together with the host's contact with nonpathogenic microbes in childhood, is a prerequisite for functional maturation of the immune system, which is in part mediated by microbiome-induced epigenetic changes. Yet, whether microbiome alterations are the result or the reason for barrier impairment and inflammatory response of the host is unclear. Exposure to locally prevalent microbial species could contribute to further modification of the disease course. The objective of this review is to reveal the link between changes in the skin microbiota, barrier dysfunction, and inflammation in AD. Addressing unmet needs includes determining the genetic background of AD susceptibility; the epigenetic modifications induced by the microbiota and other environmental factors; the role of globally diverse provoking factors; and the implementation of personalized, phenotype-specific therapies such as a epidermal barrier restoration in infancy and microbiota modulation via systemic or topical interventions, all of which open gaps for future research.

Dermatite Atópica/imunologia , Microbiota/imunologia , Pele/imunologia , Animais , Dermatite Atópica/microbiologia , Epigênese Genética , Humanos , Hipodermóclise , Medicina de Precisão , Pele/microbiologia , Junções Íntimas/metabolismo , Perda Insensível de Água
Parkinsonism Relat Disord ; 89: 38-40, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34218046
Headache ; 61(7): 1092-1101, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34324700


OBJECTIVE: To determine the efficacy and safety of fremanezumab administration in Japanese and Korean patients with chronic migraine (CM). BACKGROUND: Available preventive treatments for CM are limited by various efficacy and safety issues. Fremanezumab, a monoclonal antibody that targets the calcitonin gene-related peptide pathway involved in migraine pathogenesis, has been shown to be effective and well tolerated in large-scale, international Phase 3 trials. METHODS: Randomized, placebo-controlled trial of patients with CM who received subcutaneous fremanezumab monthly (675 mg at baseline and 225 mg at weeks 4 and 8), fremanezumab quarterly (675 mg at baseline and placebo at weeks 4 and 8), or matching placebo. Primary endpoint was the mean change from baseline in the monthly (28-day) average number of headache days of at least moderate severity during the 12 weeks after the first dose. RESULTS: Among 571 patients randomized (safety set, n = 569; full analysis set, n = 566), the least-squares mean (±standard error [SE]) reduction in the average number of headache days of at least moderate severity per month during 12 weeks was significantly greater with fremanezumab monthly (-4.1 ± 0.4) and fremanezumab quarterly (-4.1 ± 0.4) than with placebo (-2.4 ± 0.4). The difference from the placebo group in the mean change (95% confidence interval [CI]) was -1.7 days (-2.54, -0.80) for the fremanezumab monthly group and -1.7 days (-2.55, -0.82) for the fremanezumab quarterly group (p < 0.001 vs. placebo for both fremanezumab groups). The percentage of patients with a ≥50% reduction in the average number of headache days of at least moderate severity per month (response rate) was higher with fremanezumab monthly (29.0%) and fremanezumab quarterly (29.1%) than with placebo (13.2%) in addition to other improvements in secondary endpoints, including reduction of acute medication use (mean change from baseline during 12-week period ± SE: fremanezumab monthly, -3.7 ± 0.4; fremanezumab quarterly, -3.9 ± 0.4; placebo, -2.4 ± 0.4) and improvements in disability scores (mean change from baseline in six-item Headache Impact Test score at 4 weeks after third injection ± SE: fremanezumab monthly, -8.1 ± 0.7; fremanezumab quarterly, -8.0 ± 0.7; placebo, -6.5 ± 0.7). Fremanezumab was well tolerated with a similar incidence of adverse events including injection-site reactions as placebo (patients with at least one treatment-emergent adverse event: fremanezumab total, n = 232 [61.4%]; placebo, n = 118 [61.8%]). CONCLUSION: Fremanezumab effectively prevents CM in Japanese and Korean patients and was well tolerated. No safety signal was detected.

Anticorpos Monoclonais/farmacologia , Peptídeo Relacionado com Gene de Calcitonina/imunologia , Transtornos de Enxaqueca/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Fragmentos de Peptídeos/imunologia , Adulto , Anticorpos Monoclonais/administração & dosagem , Doença Crônica , Método Duplo-Cego , Feminino , Humanos , Hipodermóclise , Japão , Masculino , Pessoa de Meia-Idade , República da Coreia
Sci Rep ; 11(1): 14917, 2021 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-34290317


We have developed a COVID-19 vaccine, hAd5 S-Fusion + N-ETSD, that expresses SARS-CoV-2 spike (S) and nucleocapsid (N) proteins with modifications to increase immune responses delivered using a human adenovirus serotype 5 (hAd5) platform. Here, we demonstrate subcutaneous (SC) prime and SC boost vaccination of CD-1 mice with this dual-antigen vaccine elicits T-helper cell 1 (Th1) biased T-cell and humoral responses to both S and N that are greater than those seen with hAd5 S wild type delivering only unmodified S. We then compared SC to intranasal (IN) prime vaccination with SC or IN boosts and show that an IN prime with an IN boost is as effective at generating Th1 biased humoral responses as the other combinations tested, but an SC prime with an IN or SC boost elicits greater T cell responses. Finally, we used a combined SC plus IN (SC + IN) prime with or without a boost and found the SC + IN prime alone to be as effective in generating humoral and T-cell responses as the SC + IN prime with a boost. The finding that SC + IN prime-only delivery has the potential to provide broad immunity-including mucosal immunity-against SARS-CoV-2 supports further testing of this vaccine and delivery approach in animal models of viral challenge.

Vacinas contra COVID-19/administração & dosagem , COVID-19/imunologia , COVID-19/prevenção & controle , SARS-CoV-2/imunologia , Adenoviridae/genética , Administração Intranasal , Animais , Anticorpos Neutralizantes , Anticorpos Antivirais/biossíntese , Anticorpos Antivirais/imunologia , Vacinas contra COVID-19/imunologia , Feminino , Vetores Genéticos , Hipodermóclise , Imunidade Celular/imunologia , Imunidade nas Mucosas/imunologia , Imunização Secundária , Camundongos , Camundongos Endogâmicos , Vacinação/métodos
Rev. enferm. UFPE on line ; 15(2): [1-15], jul. 2021. ilus, graf, tab
Artigo em Português | BDENF - Enfermagem | ID: biblio-1290986


Objetivo: Descrever as evidências disponíveis na literatura acerca dos conhecimentos e das práticas da administração de fluidos por via subcutânea em pacientes oncológicos. Metodologia: Revisão integrativa de literatura, utilizando os descritores enfermagem, hipodermóclise, terapia subcutânea e câncer; nos idiomas inglês, português e espanhol, sem data limite de publicação. Dos 160 artigos encontrados, 11 compuseram a amostra. Resultados: Destes artigos, 54% (n=6) estavam publicados na língua inglesa, 63% (n=7) foram publicados nos últimos cinco anos. Dentre eles 81% (n=9) são classificados com nível de evidência seis por constituírem estudos observacionais ou relatos de experiências, enquanto dois estudos são revisões de literatura. Quanto ao assunto principal dos estudos, a maioria das pesquisas aponta a utilização da via subcutânea em pacientes em cuidados paliativos domiciliares. Conclusão: Nesta pesquisa foi possível conhecer a hipodermóclise, suas indicações, finalidades, vantagens e desvantagens, concluindos, a partir dos estudos analisados, ser essa via de administração de fluidos e/ou fármacos uma possibilidade de uso em pacientes oncológicos, tendo como ênfase nos pacientes em cuidados paliativos.(AU)

Objective: To describe the evidence available in the literature about the knowledge and practices of subcutaneous fluid administration in cancer patients. Methodology: Integrative literature review, using the keywords nursing, hypodermoclysis, subcutaneous therapy, and cancer; in English, Portuguese and Spanish, with no publication deadline. Of the 160 articles found, 11 comprised the sample. Results: Of these articles, 54% (n = 6) were published in the English language, 63% (n = 7) were published in the last five years. Among them, 81% (n = 9) are classified with the level of evidence six because they are observational studies or reports of experiences, while two studies are literature reviews. As for the main subject of the studies, most research points to the use of the subcutaneous route in patients under palliative care at home. Conclusion: In this research, it was possible to know hypodermoclysis, its indications, purposes, advantages, and disadvantages, concluding, from the studies analyzed, that this route of administration of fluids and/or drugs is a possibility of use in cancer patients, with an emphasis on palliative care patients.(AU)

Objetivo: Describir la evidencia disponible en la literatura sobre el conocimiento y las prácticas de la administración de fluidos subcutáneos en pacientes con cáncer. Metodología: Revisión integrativa de la literatura, utilizando las palabras clave enfermería, hipodermoclisis, terapia subcutánea y cáncer; en inglés, portugués y español, sin fecha límite de publicación. De los 160 artículos encontrados, 11 componen la muestra. Resultados: De estos artículos, 54% (n = 6) fueron publicados en idioma inglés, 63% (n = 7) fueron publicados en los últimos cinco años. Entre ellos, el 81% (n = 9) se clasifican con nivel de evidencia seis porque constituyen estudios observacionales o relatos de experiencias, mientras que dos estudios son revisiones de literatura. En cuanto al tema principal de los estudios, la mayoría de las investigaciones apuntan al uso de la vía subcutánea en pacientes en cuidados paliativos domiciliarios. Conclusión: En esta investigación se pudo conocer la hipodermoclisis, sus indicaciones, propósitos, ventajas y desventajas, concluyendo, a partir de los estudios analizados, que esta vía de administración de líquidos y / o fármacos es una posibilidad de uso en pacientes oncológicos, con un énfasis en los pacientes de cuidados paliativos.(AU)

Humanos , Masculino , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Tela Subcutânea , Hipodermóclise , Neoplasias , Neoplasias/enfermagem , Neoplasias/tratamento farmacológico , PubMed
Rev. enferm. UFSM ; 11: e76, 2021. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1343505


Objetivo: identificar complicações relacionadas à punção venosa periférica e à hipodermóclise em pacientes oncológicos hospitalizados sob cuidados paliativos. Método: estudo descritivo e longitudinal. Foi utilizado questionário para caracterização sociodemográfica e clínica dos participantes, roteiro para a avaliação e acompanhamento da punção. Os dados foram analisados por meio da estatística descritiva. Resultados: participaram do estudo 70 pacientes, sendo 54,3% (n=38) do sexo feminino e com idade média de 68,8 anos (DP = 15,0), cujas principais doenças oncológicas de base foram câncer de cabeça e pescoço e de pulmão. Ademais, 90% das punções avaliadas foram endovenosas e as complicações mais frequentes foram dor local, extravasamento e cateter dobrado ou tracionado. Conclusão: as complicações observadas no período do estudo foram relacionadas apenas às punções venosas. Houve predominância da punção venosa periférica em detrimento da via subcutânea, uma alternativa viável e recomendada para os pacientes oncológicos sob cuidados paliativos.

Objective: to identify complications related to peripheral venipuncture and hypodermoclysis in cancer patients hospitalized under palliative care. Method: this is a descriptive and longitudinal study. A questionnaire was used for the sociodemographic and clinical characterization of participants, a script for puncture assessment and monitoring. The data were ran through descriptive statistics. Results: seventy patients participated in the study, 54.3% (n=38) of whom were female and with a mean age of 68.8 years (SD = 15.0), whose main underlying oncological diseases were head cancer and neck and lung. Furthermore, 90% of assessed punctures were intravenous and the most frequent complications were localized pain, extravasation and a bent or pulled catheter. Conclusion: the complications observed during the study period were related only to venipunctures. There was a predominance of peripheral venipuncture due to the subcutaneous route, a viable and recommended alternative for cancer patients under palliative care.

Objetivo: identificar las complicaciones relacionadas con la venopunción periférica y la hipodermoclisis en pacientes con cáncer hospitalizados bajo cuidados paliativos. Método: estudio descriptivo y longitudinal. Se utilizó un cuestionario para la caracterización sociodemográfica y clínica de los participantes, un guión para la valoración y seguimiento de la punción. Los datos fueron analizados utilizando estadística descriptiva. Resultados: en el estudio participaron 70 pacientes, de los cuales el 54,3% (n=38) eran mujeres y con una edad media de 68,8 años (DE=15,0), cuyas principales patologías oncológicas de base fueron cabeza y cuello y pulmón. Además, el 90% de las punciones evaluadas fueron intravenosas y las complicaciones más frecuentes fueron dolor local, extravasación y catéter doblado o tirado. Conclusión: las complicaciones observadas durante el período de estudio se relacionaron únicamente con las punciones venosas. Predominó la punción venosa periférica en detrimento de la vía subcutánea, alternativa viable y recomendada para pacientes oncológicos en cuidados paliativos.

Humanos , Cuidados Paliativos , Cateterismo Periférico , Infusões Subcutâneas , Hipodermóclise , Oncologia
Hist. enferm., Rev. eletronica ; 12(2): a4, 20210000.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1377557


Objetivo: Analisar a construção histórica entre a hipodermóclise e a enfermagem brasileira sob a ótica da dialética marxista. Métodos: Revisão integrativa com discussão sócio-histórica. A coleta de dados foi baseada em livros publicados no Brasil até o ano de 1949. Extraíram-se informações sobre o tema. As atribuições da enfermagem foram discutidas à luz do materialismo histórico-dialético. Resultados:Os autores disponibilizaram o posicionamento dos enfermeiros sobre conceito, indicação terapêutica, material de consumo, local de administração, precaução, evento adverso e cuidado. Houve maior ênfase a algumas atribuições em detrimento de outras, empoderando os enfermeiros preferencialmente nas questões operacionais. Esse fato influenciou as relações de produção e estabeleceu uma dialética entre o fazer de médicos e enfermeiros. Considerações finais: Dentro da produção econômica da hipodermóclise, houve visões convergentes que fizeram com que as atribuições da enfermagem ganhassem mais empoderamento profissional, situando a posição da enfermagem na infraestrutura do cuidado.

Objective: Analyze the historical construction between hypodermoclysis and Brazilian nursing from the perspective of the Marxist dialectics. Methods: Integrative review with socio-historical discus-sion. Data collection was based on books published in Brazil until 1949. Information on the subject was extracted. The attributions of nursing were discussed in the light of the historical-dialectical materialism. Results: The authors provided the nurses' position on the concept, therapeutic indica-tion, consumption material, place of administration, precaution, adverse event and care. There was greater emphasis on some assignments to the detriment of others, empowering nurses preferentially in operational matters. This fact influenced the production relations and established a dialectic be-tween the actions of doctors and nurses. Final considerations: Within the economic production of hypodermoclysis, there were converging views that made nursing attributions gain more professional empowerment, placing the position of nursing in the care infrastructure.

Objetivo: Analizar la construcción histórica entre la hipodermoclisis y la enfermería brasileña desde la perspectiva de la dialéctica marxista. Métodos: Revisión integradora con discusión sociohistórica. La re-copilación de datos se basó en libros publicados en Brasil hasta 1949. Se extrajo información sobre el tema. Las atribuciones de la enfermería se discutieron a la luz del materialismo histórico-dialéctico. Resultados:Los autores aportaron la posición de los enfermeros sobre el concepto, indicación terapéutica, material de consumo, lugar de administración, precaución, evento adverso y cuidados. Se destacaron algunas asignaciones en detrimento de otras, empoderando preferentemente a los enfermeros en cuestiones operativas. Este hecho influyó en las relaciones de producción y estableció una dialéctica entre las acciones de médicos y enfermeros. Consideraciones finales: Dentro de la producción económica de la hipodermoclisis, hubo visiones convergentes que hicieron que las atribuciones de la enfermería ganaran un mayor empoderamiento profesional, ubicando la posición de la enfermería en la infraestructura asistencial.

História do Século XX , Hipodermóclise , Enfermeiras e Enfermeiros , Relações Médico-Enfermeiro , História da Enfermagem
Huesca; Hospital Sagrado Corazón de Jesús de Huesca; 10 dic. 2020. 82 p.
Não convencional em Espanhol | BIGG - guias GRADE | ID: biblio-1177403


La elaboración de esta GPC, se enmarca dentro del Proyecto de Calidad "Elaboración de una Guía de Práctica Clínica para el Manejo de la Vía Subcutánea", seleccionado en la convocatoria del año 2016, del programa de apoyo a las iniciativas de mejora de la calidad en el Servicio Aragonés de Salud e incluido en el Acuerdo de Gestión Clínica de 2017 del Hospital Sagrado Corazón de Jesús. Este trabajo es aprobado por la Dirección Asistencial del Hospital. El objetivo general de esta Guía de Práctica Clínica es aportar un conjunto de recomendaciones basadas en la evidencia científica y cuando ésta no exista, basadas en la experiencia y el consenso, sobre el adecuado uso de la terapia a través de un catéter por vía subcutánea, para el tratamiento de los pacientes de manera segura y sin disminuir la eficacia de los fármacos que pueden ser administrados a través de esta vía, proporcionando recomendaciones a profesionales y pacientes, para ofrecer una atención sanitaria de calidad.

Humanos , Adulto , Infusões Intravenosas/enfermagem , Infusões Intravenosas/métodos , Cateteres/normas , Qualidade da Assistência à Saúde/organização & administração , Administração Cutânea , Hipodermóclise/enfermagem
Biochem Biophys Res Commun ; 533(4): 1102-1108, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33028486


An itch is defined as an unpleasant sensation that evokes a desire to scratch. Glutamate is a major excitatory neurotransmitter in the mammalian central nervous system and has a crucial role in pruriceptive processing in the spinal dorsal horn. It is well known that glutamate exerts its effects by binding to various glutamate receptors including α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptors, and that AMPA/kainate receptors play a crucial role in pruriceptive processing; however, the precise role of AMPA receptors remains uncertain. Perampanel, an antiepileptic drug, is an antagonist of AMPA receptors. Pretreatment with perampanel dose-dependently attenuated the induction of scratching, a behavior typically associated with pruritus, by intradermal administration of the pruritogen chloroquine. In addition, the induction of scratching in mice painted with diphenylcyclopropenone and NC/Nga mice treated with Biostir AD, animal models of contact dermatitis and atopic dermatitis, respectively, was dose-dependently alleviated by administration of perampanel. These findings indicate that AMPA receptors play a crucial role in pruriceptive processing in mice with acute or chronic pruritus.

Comportamento Animal/efeitos dos fármacos , Prurido/tratamento farmacológico , Prurido/metabolismo , Piridonas/administração & dosagem , Receptores de AMPA/metabolismo , Animais , Cloroquina/toxicidade , Ciclopropanos/toxicidade , Modelos Animais de Doenças , Histamina/toxicidade , Hipodermóclise , Injeções Espinhais , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Nitrilas , Piridonas/uso terapêutico , Quinoxalinas/administração & dosagem , Quinoxalinas/uso terapêutico , Receptores de AMPA/antagonistas & inibidores
Rev. enferm. Cent.-Oeste Min ; 10(1): 4032, out. 2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1150282


Objetivo: caracterizar os pacientes oncológicos internados sob cuidados paliativos submetidos à punção venosa periférica e a hipodermóclise, segundo as variáveis sociodemográficas e clínicas. Método: estudo observacional, descritivo e prospectivo. Foram realizadas entrevistas com o paciente e/ou seu cuidador, consulta ao prontuário, avaliação e acompanhamento diário da punção. Resultados: participaram do estudo 45 pacientes de ambos os sexos e com idade superior a 18 anos. A avaliação funcional dos pacientes, no momento da internação, foi de 30%, indicando pacientes extremamente incapacitados e com necessidade de hospitalização. Os sintomas mais frequentes apresentados pelos pacientes no dia da internação foram inapetência, sonolência, fadiga, dispneia e dor. O número de punções venosas periféricas foi superior ao número de hipodermóclises realizadas. Conclusão: os dados analisados permitiram caracterizar o perfil de pacientes oncológicos internados sob cuidados paliativos e a terapêutica adotada para a terapia medicamentosa. Pôde-se, ainda, identificar a baixa adesão da equipe à realização da hipodermóclise, o que remete à necessidade da realização de mais estudos com altos níveis de evidência para embasar a prática assistencial da equipe de enfermagem e contribuir para a qualidade de vida do paciente.(AU)

Objective: To characterize cancer patients hospitalized under palliative care who underwent peripheral venipuncture and hypodermoclysis according to sociodemographic and clinical variables. Method: This is an observational, descriptive, and prospective study. Interviews were carried out with the patients and/or their caregiver, as well as consultation of medical records, evaluation, and daily monitoring of the puncture. Results: 45 patients of both genders and of 18+ years of age participated in the study. The functional assessment of patients at admission was 30%, indicating extremely disabled patients and in need of hospitalization. The most frequent symptoms presented by patients on the day of hospitalization were lack of appetite, drowsiness, fatigue, dyspnea, and pain. The number of peripheral venipunctures was higher than the number of hypodermoclyses performed. Conclusion: The analyzed data allowed to characterize the profile of cancer patients hospitalized under palliative care and the therapy adopted for drug therapy. It was also possible to identify the low adherence of the team to the performance of hypodermoclysis, which refers to the need for further studies with high levels of evidence to support the care practice of the nursing team and contribute to the patient's quality of life(AU)

Objetivo: caracterizar los pacientes con cáncer hospitalizados bajo cuidados paliativos, que se sometieron a venopunción periférica e hipodermoclisis de acuerdo con variables sociodemográficas y clínicas. Método: estudio observacional, descriptivo y prospectivo. Se realizaron entrevistas con el paciente y / o su cuidador, consulta de historias clínicas, evaluación y seguimiento diario de la punción. Resultados: 45 pacientes de ambos sexos y mayores de 18 años participaron en el estudio. La evaluación funcional de los pacientes al ingreso fue del 30%, lo que indica pacientes extremadamente discapacitados y que necesitan hospitalización. Los síntomas más frecuentes que presentaron el día de la hospitalización fueron: falta de apetito, somnolencia, fatiga, disnea y dolor. El número de punciones venosas periféricas fue mayor que el número de hipodermoclisis realizado. Conclusión: los datos analizados permitieron caracterizar el perfil de pacientes con cáncer hospitalizados bajo cuidados paliativos y el tratamiento adoptado para la terapia farmacológica. También fue posible identificar la baja adhesión del equipo a la realización de la hipodermoclisis, lo que remite a la necesidad de realizar más estudios con altos niveles de evidencia para apoyar la práctica de atención del equipo de enfermería y contribuir a la calidad de vida del paciente(AU)

Cuidados Paliativos , Cateterismo Periférico , Enfermagem , Infusões Subcutâneas , Hipodermóclise
J Infus Nurs ; 43(5): 283-291, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881815


Subcutaneous rehydration is an optional infusion route in hospitalized older adults. This meta-analysis sought to compare the effectiveness of subcutaneous versus intravenous (IV) fluid administration to reverse mild-to-moderate dehydration in hospitalized older adults. A literature search was performed. No restrictions were imposed regarding language. Three randomized clinical trials conducted with patients 60 years of age or older treated with subcutaneous or IV rehydration were included, with a total sample size of 197 patients. Controlled quasi-randomized and crossover trials were excluded. The primary end point was reversal of dehydration. Secondary end points were patient satisfaction and frequency of adverse events (eg, cellulitis, edema, phlebitis, erythema, hyponatremia, and pain). Both treatments were effective in rehydrating the patients within 48 hours, with no statistically significant difference between the groups. Subcutaneous fluid administration effectively reversed dehydration while protecting against phlebitis. Since the quality of evidence was considerably low, further multicenter randomized clinical trials of efficient methodological quality should be conducted to consolidate the body of evidence.

Desidratação/terapia , Hipodermóclise , Infusões Intravenosas , Soluções para Reidratação/administração & dosagem , Idoso , Humanos , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto
PLoS One ; 15(8): e0237572, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32833979


OBJECTIVE: To synthesize the current evidence for subcutaneous hydration and medication infusions from systematic reviews and to assess their methodological quality. INTRODUCTION: Peripheral intravascular cannula/catheter insertion is a common invasive procedure for administering fluids and medications. Venous depletion is a growing concern for several patient populations. Subcutaneous access for the administration of isotonic solutions and medications is an alternative; however, vascular access assessment and planning guidelines rarely consider this route. METHODS: Systematic review of systematic reviews (PROSPERO CRD42018046504). We searched 6 databases published in English language from 1990 to June 2020, identifying subcutaneous infusions an alternate route for fluids or medication. Methodological quality was evaluated using AMSTAR 2 criteria and data for mechanisms of infusion and outcomes related to effectiveness, safety, efficiency and acceptability extracted. The Johanna Briggs Institute's grades of recommendation informed the strength of recommendation. RESULTS: The search yielded 1042 potential systematic reviews; 922 were excluded through abstract and duplicate screen. Of the remaining articles, 94 were excluded, and 26 were included. Overall, evidence is strong for recommending subcutaneous hydration infusions for older adults, weak for pediatric patients and inconclusive for palliative patients. There is strong evidence for 10 medications; weak evidence supporting 28 medications; however, there are eight medications with inconclusive evidence to make a recommendation and four medications not appropriate for subcutaneous delivery. CONCLUSION: Subcutaneous access should be considered alongside intravenous therapy for hydration in older adults, and several medications. There are additional benefits in terms of ease of use and cost-effectiveness of this mode. Inclusion of subcutaneous access in clinical guidelines may promote uptake of this route to help preserve vessel health of vulnerable patients. Further high-quality research is needed to inform subcutaneous infusion therapy in a variety of populations (including pediatrics and palliative care) and medications and clarifying the mechanism of delivery.

Desidratação/terapia , Hidratação/métodos , Hipodermóclise/métodos , Humanos , Infusões Subcutâneas
Mol Biol Rep ; 47(9): 6545-6559, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32770526


Exposure to environmental toxicants such as Bisphenol A (BPA) has raised serious health issues globally particularly in developing countries. It is ubiquitously used in the manufacturing of canned food and feeding bottles. BPA generated reactive oxygen species can lead to several diseases including cardiotoxicity. However, the endpoints stimulated in BPA cardiotoxicity yet need to be investigated. The current study was aimed to investigate the underlying molecular pathways which may contribute in revealing the protective effects of Pistacia integerrima against BPA induced oxidative stress. The dose of 100 µg/kg BW of BPA, 200 mg/kg BW P. integerrima, and 4 mg/kg BW melatonin was administered to Sprague Dawley rats. Present results of western blotting and qRT-PCR showed the increased expression of p53, PUMA and Drp1, while downregulation of Ubc13 in heart tissues of BPA treated group whereas the levels were reversed upon treatment with P. integerrima. The role of BPA in heart tissue apoptosis was further confirmed by the increased level of P-p53, cytochrome C and disrupted cellular architecture whereas the P. integerrima has shown its ameliorative potential by mitigating the adverse effects of BPA. Moreover, the oxidant, antioxidant, lipid, and liver markers profile has also revealed the therapeutic potential of P. integerrima by maintaining the levels in the normal range. However, melatonin has also manifested the normalized expression of apoptotic markers, biochemical markers, and tissue architecture. Conclusively, the data suggest that P. integerrima may be a potential candidate for the treatment of BPA induced toxicity by neutralizing the oxidative stress through Ubc13/p53 pathway.

Apoptose/efeitos dos fármacos , Compostos Benzidrílicos/toxicidade , Fígado/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Fenóis/toxicidade , Pistacia/química , Extratos Vegetais/farmacologia , Proteína Supressora de Tumor p53/metabolismo , Enzimas de Conjugação de Ubiquitina/metabolismo , Animais , Antioxidantes/administração & dosagem , Antioxidantes/farmacologia , Apoptose/genética , Proteínas Reguladoras de Apoptose/genética , Proteínas Reguladoras de Apoptose/metabolismo , Compostos Benzidrílicos/administração & dosagem , Glicemia/efeitos dos fármacos , Citocromos c/metabolismo , Dinaminas/genética , Dinaminas/metabolismo , Feminino , Hipodermóclise , Rim/citologia , Rim/efeitos dos fármacos , Rim/patologia , Metabolismo dos Lipídeos/efeitos dos fármacos , Fígado/citologia , Fígado/efeitos dos fármacos , Fígado/patologia , Masculino , Melatonina/administração & dosagem , Melatonina/farmacologia , Fenóis/administração & dosagem , Extratos Vegetais/administração & dosagem , Extratos Vegetais/química , Tumores de Planta , Ratos , Ratos Sprague-Dawley , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Proteína Supressora de Tumor p53/genética , Enzimas de Conjugação de Ubiquitina/genética , Regulação para Cima
Sci Rep ; 10(1): 8960, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32488022


Allergen specific immunotherapy (AIT) can provide long-term alleviation of symptoms for allergic disease but is hampered by suboptimal efficiency. We and others have previously shown that 1,25(OH)2-VitaminD3 (VitD3) can improve therapeutic efficacy of AIT. However, it is unknown whether VitD3 supplementation has similar effects in sublingual and subcutaneous immunotherapy. Therefore, we aimed to test VitD3 supplementation in both grass pollen (GP) subcutaneous-IT (SCIT) and sublingual-IT (SLIT) in a mouse model for allergic airway inflammation. To this end, GP-sensitized BALB/c mice received GP-SCIT or GP-SLIT with or without 10 ng VitD3, followed by intranasal GP challenges and measurement of airway hyperresponsiveness (AHR) and inflammation. VitD3 supplementation of GP-SCIT resulted in enhanced induction of GP-specific (sp)-IgG2a and suppression of spIgE after challenge. In addition, eosinophil numbers were reduced and levels of IL10 and Amphiregulin were increased in lung tissue. In GP-SLIT, VitD3 supplementation resulted in enhanced sp-IgG2a levels in serum, enhanced suppression of eosinophils and increased IL10 levels in lung tissue, as well as suppression of AHR to methacholine. These data show that VitD3 increases efficacy of both SCIT and SLIT, by enhancing induction of blocking antibodies and suppression of airway inflammation, underscoring the relevance of proficient VitD3 levels for successful AIT.

Asma/imunologia , Calcitriol/farmacologia , Dessensibilização Imunológica/métodos , Administração Sublingual , Alérgenos/imunologia , Animais , Calcitriol/metabolismo , Colecalciferol/farmacologia , Modelos Animais de Doenças , Eosinófilos/imunologia , Hipersensibilidade/imunologia , Hipodermóclise/métodos , Pulmão/imunologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Poaceae/imunologia , Pólen/imunologia , Hipersensibilidade Respiratória/imunologia