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https://www.readbyqxmd.com/read/29472511/development-and-implementation-of-an-antimicrobial-lock-therapy-guideline-in-a-pediatric-hospital
#1
Tracy N Zembles, Linda S Flannery, Anna R Huppler
PURPOSE: The development and implementation of an antimicrobial lock therapy guideline at a large pediatric hospital are described. SUMMARY: Central venous access devices (CVADs) are essential in the medical management of patients requiring long-term total parenteral nutrition, chemotherapy, or hemodialysis. However, the use of a CVAD carries a significant risk of the development of central line-associated bloodstream infection (CLABSI). Antimicrobial lock therapy is indicated for patients with CLABSIs who have no signs of exit site or tunnel infection and for whom catheter salvage is a goal...
March 1, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29472415/cluster-randomized-trial-of-devices-to-prevent-catheter-related-bloodstream-infection
#2
Steven M Brunelli, David B Van Wyck, Levi Njord, Robert J Ziebol, Laurie E Lynch, Douglas P Killion
Central venous catheters (CVCs) contribute disproportionately to bloodstream infection (BSI) and, by extension, to infection-related hospitalization, mortality, and health care costs in patients undergoing dialysis. Recent product advancements may reduce BSIs, but a sufficiently powered comparative-effectiveness study is needed to facilitate evidence-based patient care decisions. In a 13-month, prospective, cluster-randomized, open-label trial, we compared BSI rates in facilities using ClearGuard HD antimicrobial barrier caps (ClearGuard group) with those in facilities using Tego hemodialysis connectors plus Curos disinfecting caps (Tego+Curos group)...
February 22, 2018: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/29471458/pro-the-rationale-for-dietary-therapy-for-patients-with-advanced-chronic-kidney-disease
#3
Joel D Kopple, Denis Fouque
Dietary treatment offers many benefits to patients with advanced chronic kidney disease (CKD) who are approaching the need for renal replacement therapy. A large number of these benefits are independent of whether diets slow the rate of progression of CKD. These diets are low in protein and many minerals, and provide adequate energy for the CKD patient. The diets can reduce accumulation of potentially toxic metabolic products derived from protein and amino acid degradation, maintain a healthier balance of body water, sodium, potassium, phosphorus, calcium and other minerals, and prevent or improve protein-energy wasting...
February 19, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29470531/epidemiology-and-risk-factors-of-extensively-drug-resistant-pseudomonas-aeruginosa-infections
#4
Nattawan Palavutitotai, Anupop Jitmuang, Sasima Tongsai, Pattarachai Kiratisin, Nasikarn Angkasekwinai
BACKGROUND: The incidence of nosocomial infections from extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) has been increasing worldwide. We investigated the prevalence and factors associated with XDR-PA infections, including the factors that predict mortality. METHODS: We retrospectively studied a cohort of adult, hospitalized patients with P. aeruginosa (PA) infections between April and December 2014. RESULTS: Of the 255 patients with PA infections, 56 (22%) were due to XDR-PA, 32 (12...
2018: PloS One
https://www.readbyqxmd.com/read/29470434/pharmacokinetics-and-scintigraphic-imaging-of-the-hypoxia-imaging-agent-123-i-iaza-in-healthy-adults-following-exercise-based-cardiac-stress-%C3%A2
#5
Daria Stypinski, Stephen A McQuarrie, Alexander J B McEwan, Leonard I Wiebe
The objective of this work is to evaluate the potential effect of cardiac stress exercise on the accumulation of [123 I]IAZA, a radiopharmaceutical used to image focal tissue hypoxia, in otherwise normal myocardium in healthy volunteers, and to determine the impact of exercise on [123 I]IAZA pharmacokinetics. The underlying goal is to establish a rational basis and a baseline for studies of focal myocardial hypoxia in cardiac patients using [123 I]IAZA. Three healthy male volunteers ran the 'Bruce' treadmill protocol, a clinically-accepted protocol designed to expose myocardial ischemia in patients...
February 22, 2018: Pharmaceutics
https://www.readbyqxmd.com/read/29468780/efficacy-analysis-of-routine-catheter-tip-cultures-in-a-neonatal-intensive-care-unit
#6
Taito Kitano, Kumiko Takagi, Ikuyo Arai, Hajime Yasuhara, Reiko Ebisu, Ayako Ohgitani, Daisuke Kitagawa, Miyako Oka, Kazue Masuo, Hideki Minowa
OBJECTIVES: Although routine catheter tip cultures are not recommended, previous reports have indicated that some cases of colonization, such as with S. aureus, can lead to subsequent bacteremia. To evaluate the safety of colonized cases without antimicrobial treatment, as well as the effectiveness of routine catheter tip cultures in the neonatal intensive care unit (NICU), we performed a retrospective data analysis in a Japanese community hospital. METHODS: We reviewed all peripherally inserted central venous catheter tip culture results from the NICU ward between April 2012 and June 2017 to determine whether they had antimicrobial treatments or subsequent infections...
February 22, 2018: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/29467481/the-mechanistic-causes-of-peripheral-intravenous-catheter-failure-based-on-a-parametric-computational-study
#7
Russell Piper, Peter J Carr, Lachlan J Kelsey, Andrew C Bulmer, Samantha Keogh, Barry J Doyle
Peripheral intravenous catheters (PIVCs) are the most commonly used invasive medical device, yet up to 50% fail. Many pathways to failure are mechanistic and related to fluid mechanics, thus can be investigated using computational fluid dynamics (CFD). Here we used CFD to investigate typical PIVC parameters (infusion rate, catheter size, insertion angle and tip position) and report the hemodynamic environment (wall shear stress (WSS), blood damage, particle residence time and venous stasis volumes) within the vein and catheter, and show the effect of each PIVC parameter on each hemodynamic measure...
February 21, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29465449/a-comparison-of-approaches-for-mastery-learning-standard-setting
#8
Jeffrey H Barsuk, Elaine R Cohen, Diane B Wayne, William C McGaghie, Rachel Yudkowsky
PURPOSE: Defensible minimum passing standards (MPSs) must be used to evaluate learner performance outcomes in health professions education. In this study, the authors compared the results of traditional Angoff and Hofstee standard-setting exercises with the Mastery Angoff and Patient-Safety approaches for central venous catheter (CVC) insertion skills examinations. The authors also evaluated how these standards affected evaluation of the historical performance of residents who participated in a simulation-based mastery learning (SBML) curriculum for CVC insertion skills...
February 20, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/29463280/prophylactic-platelet-transfusion-prior-to-central-venous-catheter-placement-in-patients-with-thrombocytopenia-study-protocol-for-a-randomised-controlled-trial
#9
Emma K van de Weerdt, Bart J Biemond, Sacha S Zeerleder, Krijn P van Lienden, Jan M Binnekade, Alexander P J Vlaar
BACKGROUND: Severe thrombocytopenia should be corrected by prophylactic platelet transfusion prior to central venous catheter (CVC) insertion, according to national and international guidelines. Even though correction is thought to prevent bleeding complications, evidence supporting the routine administration of prophylactic platelets is absent. Furthermore, platelet transfusion bears inherent risk. Since the introduction of ultrasound-guided CVC placement, bleeding complication rates have decreased...
February 20, 2018: Trials
https://www.readbyqxmd.com/read/29462817/the-interaction-of-n-acetylcysteine-and-serum-transferrin-promotes-bacterial-biofilm-formation
#10
Supeng Yin, Bei Jiang, Guangtao Huang, Yulong Zhang, Bo You, Yu Chen, Yali Gong, Jing Chen, Zhiqiang Yuan, Yan Zhao, Ming Li, Fuquan Hu, Zichen Yang, Yizhi Peng
BACKGROUND/AIMS: N-acetylcysteine (NAC) is a novel and promising agent with activity against bacterial biofilms. Human serum also inhibits biofilm formation by some bacteria. We tested whether the combination of NAC and human serum offers greater anti-biofilm activity than either agent alone. METHODS: Microtiter plate assays and confocal laser scanning microscopy were used to evaluate bacterial biofilm formation in the presence of NAC and human serum. qPCR was used to examine expression of selected biofilm-associated genes...
February 15, 2018: Cellular Physiology and Biochemistry
https://www.readbyqxmd.com/read/29461683/therapeutic-antibiotic-serum-concentrations-by-two-blood-collection-methods-within-the-pediatric-patient-a-comparative-effectiveness-trial
#11
Royanne L Lichliter, Lynea E Tremewan, Nicole M Shonka, Jennifer E Mehnert, Laney Brennan, Jodi M Thrasher, Teri L Hernandez
Repeated venipunctures and fingersticks to confirm serum drug concentrations cause pain and dissatisfaction for pediatric patients and their families. In many organizations, the standard of care to obtain therapeutic serum drug concentrations by peripheral venipuncture or capillary fingerstick, even when the patient has an existing peripheral intravenous catheter (PIV) or central venous catheter (CVC). The primary objective of this study was to assess agreement between serum tobramycin/vancomycin concentrations collected from a CVC or PIV, versus venipuncture or fingerstick...
February 20, 2018: Journal for Specialists in Pediatric Nursing: JSPN
https://www.readbyqxmd.com/read/29460300/catheter-associated-venous-air-embolism-in-hospitalized-horses-32-cases
#12
Nicholas J Parkinson, Harold C McKenzie, Michelle H Barton, Jennifer L Davis, Bettina Dunkel, Amy L Johnson, Elizabeth S MacDonald
BACKGROUND: Venous air embolism is a potentially life-threatening complication of IV catheter use in horses. Despite widespread anecdotal reports of their occurrence, few cases have been reported in the literature and the prognosis is currently unknown. HYPOTHESIS/OBJECTIVES: Our objective was to describe the surrounding circumstances, clinical signs, treatment, progression, and outcome of venous air embolism in hospitalized horses. ANIMALS: Thirty-two horses with acute onset of compatible clinical signs associated with IV catheter disconnection or damage...
February 20, 2018: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/29458366/inequity-in-dialysis-related-practices-and-outcomes-in-aotearoa-new-zealand-a-kaupapa-m%C3%A4-ori-analysis
#13
Tania Huria, Suetonia Palmer, Lutz Beckert, Jonathan Williman, Suzanne Pitama
BACKGROUND: In Aotearoa/New Zealand, Māori, as the indigenous people, experience chronic kidney disease at three times the rate of non-Māori, non-Pacific New Zealanders. Māori commence dialysis treatment for end-stage kidney disease at three times the rate of New Zealand European adults. To examine for evidence of inequity in dialysis-related incidence, treatment practices, and survival according to indigeneity in Aotearoa/New Zealand, utilising a Kaupapa Māori approach. METHODS: We conducted a retrospective cohort study involving adults who commenced treatment for end-stage kidney disease in Aotearoa/New Zealand between 2002 and 2011...
February 20, 2018: International Journal for Equity in Health
https://www.readbyqxmd.com/read/29458321/differential-effects-of-isotonic-and-hypotonic-4-albumin-solution-on-intracranial-pressure-and-renal-perfusion-and-function
#14
Naoya Iguchi, Junko Kosaka, Joseph Bertolini, Clive N May, Yugeesh R Lankadeva, Rinaldo Bellomo
OBJECTIVES: Albumin is used to resuscitate trauma patients but may increase intracranial pressure (ICP). Its effects on renal blood flow and function are unknown. Our aim was to examine the effects of hypertonic albumin on ICP and renal function, and if any effects are due to the hypotonicity of the solution containing albumin or to albumin itself. DESIGN, SETTING AND SUBJECTS: Cross-over, randomised controlled experimental study of six adult Merino ewes in the animal facility of a research institute...
March 2018: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/29458311/double-superior-vena-cava-presentation-of-two-cases-and-review-of-the-literature
#15
Christos Farazi-Chongouki, Ioannis Dalianoudis, Anestis Ninos, Pantelis Diamantopoulos, Dimitrios Filippou, Stefanos Pierrakakis, Panagiotis Skandalakis
INTRODUCTION: Various anomalies in the development of the great thoracic veins of the embryo can be incidentally discovered in the normal adult. Duplication of superior vena cava (SVC) is a rare abnormality, but the most common thoracic venous congenital anomaly. Case reports-methods: We present two cases in the intensive care unit of our hospital, of asymptomatic patients who underwent an uneventful central line placement in the left subclavian vein. The track of the catheter, as shown in the X-ray, was misplaced to the left of the aorta and further investigation with computed tomography angiography confirmed a persistent left SVC...
February 19, 2018: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/29456597/insertion-rates-and-complications-of-central-lines-in-the-uk-population-a-pilot-study
#16
Adrian Vk Wong, Nitin Arora, Olusegun Olusanya, Ben Sharif, Robert M Lundin, A Dhadda, S Clarke, R Siviter, M Argent, Gavin Denton, Anna Dennis, Angela Day, Tamas Szakmany
Background: Central venous catheters are inserted ubiquitously in critical care and have roles in drug administration, fluid management and renal replacement therapy. They are also associated with numerous complications. The true number of central venous catheters inserted per year and the proportion of them associated with complications are unknown in the UK. Methods: We performed a prospective audit at five hospitals, as a feasibility pilot for a larger, nationwide audit...
February 2018: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29456363/inadvertent-central-arterial-catheterization-an-unusual-cause-of-ischemic-stroke
#17
Nakul Katyal, Amanda Korzep, Christopher Newey
Central venous catheter (CVC) insertion is extensively utilized in Intensive Care Units for evaluation of hemodynamic status, administration of intravenous drugs, and for providing nutritional support in critically ill patients. Unfortunately, CVC use is associated with complications including lung injury, bleeding, infection, and thrombosis. We present a patient with an acute ischemic stroke from an inadvertently placed CVC into the right common carotid artery. A 57-year-old male presented to our institution for left hemiplegia and seizures 2 days after a CVC was placed...
January 2018: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/29455444/persistent-left-superior-vena-cava-with-thrombus-formed-in-the-catheter-lumen-4-h-after-dialysis-catheter-placed
#18
Tomoki Kawasaki, Hiroyuki Tanaka, Miki Oba, Megumi Takada, Haruna Tanaka, Shin Suda
Persistent left superior vena cava (PLSVC) is one of the most common thoracic venous anomaly and rarely noticed, because it is asymptomatic. However, for nephrologists, it is frequent enough to be encountered while placing hemodialysis catheters through the jugular vein. We report the case of 66-year-old patient with PLSVC presenting intrinsic thrombosis formation 4 h after dialysis catheter placed. Dialysis catheter was placed in the left internal jugular vein without resistance and any complication. PLSVC was detected after dialysis catheter insertion...
February 17, 2018: CEN Case Reports
https://www.readbyqxmd.com/read/29454036/percutaneous-endovenous-intervention-plus-anticoagulation-versus-anticoagulation-alone-for-treating-patients-with-proximal-deep-vein-thrombosis-a-meta-analysis-and-systematic-review
#19
Chao-Nan Wang, Hong-Ru Deng
BACKGROUND: Combination treatment with percutaneous endovenous intervention (PEVI) and anticoagulation has been proposed for treating lower-extremity proximal deep vein thrombosis (DVT). We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of PEVI plus anticoagulation versus anticoagulation alone in patients with lower-extremity proximal DVT. METHODS: We systematically searched PubMed, Embase, and the Cochrane Library from inception to May 2016...
February 14, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29446865/european-guidance-on-paediatric-use-of-probiotics-states-that-benefits-are-limited-to-several-conditions-and-urges-caution-with-specific-vulnerable-groups
#20
REVIEW
Iva Hojsak, Valentina Fabiano, Tudor Lucian Pop, Olivier Goulet, Gian Vincenzo Zuccotti, Fugen Cullu Çokuğraş, Massimo Pettoello-Mantovani, Sanja Kolaček
AIM: The use of probiotics has been covered by many guidelines, position papers and evidence-based recommendations, but few have referred to specific patient groups or clinical indications. This European study summarises recommendations and scientifically credited guidelines on the use of probiotics for children and provides practice points. METHODS: An expert panel was convened by the European Paediatric Association in June 2017 to define the relevant clinical questions for using probiotics in paediatric healthcare and review and summarise the guidelines, recommendations, position papers and high-quality evidence...
February 15, 2018: Acta Paediatrica
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