Reliability of blood test results in samples obtained using a 2-mL discard volume from the proximal lumen of a triple-lumen central venous catheter in the critically ill patient.

BACKGROUND: Intensive care patients require a high frequency of blood testing, which results in a significant amount of blood loss. When blood is obtained from a central venous catheter (CVC), a large volume is usually discarded to obtain an unaltered sample for testing. AIM: To determine the reliability of complete blood test results in blood samples obtained from the proximal lumen of a triple-lumen CVC using a 2-mL discard volume DESIGN: Observational study with the prospective collection of data METHODS: The subjects enrolled were all patients with a subclavian triple-lumen CVC, older than 17 years and consecutively admitted to intensive care over a 2-year period. In each of the 54 participants, one blood sample was drawn from the proximal lumen of the catheter, discarding 1·61 mL of blood plus 0·39 mL of catheter deadspace (2 mL) and without interrupting infusion in the middle and distal lumens. A second sample was then obtained by direct venous puncture. The reliability of blood test results was determined by comparing sets of variables recorded for the two sampling methods through intraclass correlation coefficients in the Bland-Altman method. RESULTS: Inter-method reliability for the variables examined was excellent, >0·75; range (0·868-0·998). Mean differences between the two sample types for the variables most often determined in critically ill patients were leukocytes: 0·200 × 103 /µL, 95% confidence interval (CI) (0·025 to 0·375); erythrocytes: 0·045 × 106 /uL, 95% CI (-0·003 to 0·094); sodium: 0·074 mEq/L, 95% CI (-0·369 to 0·517); potassium: -0·002mEq/L, 95% CI (-0·065 to 0·061) and glucose: 2·426 mg/dL, 95% CI (0·498-4·354). CONCLUSIONS: The sampling method proposed minimizes blood loss while offering reliable blood test results. RELEVANCE TO CLINICAL PRACTICE: The main benefit of the method proposed is reduced blood loss, improving the care of a critically ill patient.

Tratamiento potencialmente inapropiado en oposición a futilidad y otras cuestiones éticas del caso de Charlie Gard / Potentially inappropriate treatment as opposed to futility and other ethical issues in the Charlie Gard case / Tractament potencialment inadequat en oposició a futilitat i altres qüestions ètiques del cas Charlie Gard

Durante los primeros 6 meses de 2017 se desarrolló un encendido debate sobre el caso de un niño inglés con una enfermedad rara y muy grave. Charlie Gard permaneció 9 meses en una unidad de cuidados intensivos paralizado, sometido a ventilación mecánica y con una función neurológica en constante deterioro. Mientras, en la prensa especializada y en los medios de comunicación general se desarrollaba un debate sobre quien tenía que tomar la decisión de retirar o continuar con los tratamientos de soporte vital y cuáles eran los criterios que había que utilizar para tomarla. En este artículo, analizamos estos y otros problemas éticos y sugerimos que, para tomar las mejores decisiones, se ha ido evolucionando de los intentos de definir la futilidad y determinar quién decide, hacia el concepto de tratamientos potencialmente inapropiados y el recurso a estrategias de toma de decisiones compartidas

In the first 6 months of 2017, there was a heated debate about the case of an English child with a rare and serious illness. Charlie Gard spent 9 months in an Intensive Care Unit paralyzed, undergoing mechanical ventilation and with a deteriorating neurological function. Meanwhile, a debate took place in the specialized press and general media about who had to make the decision to withdraw or continue with life support treatments, and on the criteria necessary to make that decision. In this article, we analyze these and other ethical problems, and suggest that in order to make the best decisions, attempts to define futility, and determine who decides has evolved into the concept of potentially inappropriate treatments and shared decision-making strategies

Durant els primers 6 mesos de 2017 es va desenvolupar un encès debat sobre el cas d'un nen anglès amb una malaltia rara i molt greu. Charlie Gard va romandre 9 mesos en una unitat de vigilància intensiva paralitzat, sotmès a ventilació mecànica i amb una funció neurològica en constant deterioració. Mentre, en la premsa especialitzada i en els mitjans de comunicació generals, tenia lloc un debat sobre qui havia de prendre la decisió de retirar o de continuar amb els tractaments de suport vital i quins eren els criteris que calia utilitzar per prendre-la. En aquest article analitzem aquests i altres problemes ètics i suggerim que, a fi de prendre les millors decisions, s'ha anat evolucionant dels intents de definir la futilitat, i determinar qui decideix, cap al concepte de tractaments potencialment inadequats i el recurs a estratègies de presa de decisions compartides