Transparent film for intravascular catheter exit-site dressings

Transparent polyurethane film is recommended for catheter site insertion dressing by the American guidelines for the prevention of infections associated with intravascular catheters. It has been proven to offer the advantages of excellent adhesion, firm support of the catheter, good tolerability, ease of application and fewer replacements per catheter lifetime. The last two features save nursing time and result in healthcare cost savings.     

Peritoneal dialysis catheter management and exit-site care: an Australian survey of current practices

Summary: In view of the apparently high prevalence of patient dropout from peritoneal dialysis due to peritoneal catheter related issues, a national survey was undertaken to examine current unit practices and to identify areas in which changes in procedure might lead to improved results. Problems related to the catheter itself accounted for 28% of the principal indications for removal of the peritoneal catheter. A number of practices were identified as potentially suboptimal, which, if changed, might lead to improved outcomes. In determining placement, the exit-site was marked while the patient was seated, and patient preference taken into account in less than two thirds of the units. Skin preparation, including shaving of the abdominal wall prior to catheter insertion, and administration of prophylactic antibiotics were not universally practised. Dedicated surgeons performing the procedure were available in less than half of the units. Techniques to expel air from the dacron cuffs at the time of placement were used in only one-third of the units. Laparoscopy was used in only a small percentage of units. Other practices identified as potential means of improving outcomes were use of a stylet to manoeuvre the catheter into place and a trocar to create the exit-site, facing the exit-site in a downward position, creating the exit-site the same diameter as the catheter, not using sutures at the exit-site, delaying the use of the catheter for dialysis, delaying showering early after implantation and not using strong oxidants such as povidone iodine. It is hoped that review of some current procedures in light of these results might reduce the high prevalence of loss of peritoneal catheters.     

Outpatient CAPD catheter salvage for persistent exit-site/tunnel infection.

BACKGROUND: Partial replantation (i.e. replacement of the extraperitoneal portion of the catheter with creation of a new subcutaneous tunnel) has been suggested to avoid catheter removal in patients with persistent exit-site/tunnel infection (ESTI). However, published experience with this technique is limited. METHODS: Partial replantation was performed on an outpatient basis under local anesthesia for seven patients with persistent ESTI of >3 months duration. All patients resumed CAPD immediately following surgery. RESULTS: One patient had dialysate leakage less than 1 week after surgery that required catheter removal. The other patients had no complications and mean catheter survival following surgery was 7. 7 months (range 3.5-13 months). There was no recurrence of ESTI after surgery, although two patients presented with exit-site infection unrelated to the initial episode (i.e. different organism, long latency). Three other patients presented with episodes of peritonitis unrelated to surgery (i.e. delay >1 month) or ESTI (i.e. different organism). CONCLUSIONS: Partial replantation allows significant prolongation of catheter survival without major complications or interruption of CAPD. This novel procedure appears to be an appropriate alternative to catheter removal for the management of persistent ESTI. However, further studies are needed to prospectively compare partial replantation with catheter removal.     

Chlorhexidine-impregnated sponge dressing for prevention of catheter exit-site infection in peritoneal dialysis patients: a pilot study

International Urology and Nephrology - The study aimed to examine effect of chlorhexidine dressing in the prevention of peritoneal dialysis (PD)-related infection in PD patients. This single-center...     

Adherence of Staphylococcus aureus isolated in peritoneal dialysis-related exit-site infections to HEp-2 cells and silicone peritoneal catheter materials

Background. Peritoneal catheter exit-site infections cause a relevant morbidity in peritoneal dialysis patients and are frequently caused by Staphylococcus aureus. We tested the hypothesis that adherence of exit-site-derived S.aureus to epithelial cells and peritoneal catheter silicone tubes discriminates virulent and less virulent strains. Methods. The binding of isolated S. aureus to an epithelial cell line (HEp-2) and to silicone tubes was analyzed using light-microscopy or radioactive labeling of bacteria. Results. Of 378 exit-site swabs, 99% (26%) were positive for microbial growth. S. aureus was cultured in 25 of 99 positive swabs; three of 13 swabs taken in exit-site infections grade 3 and 4 that had tested positive for S. aureus. Adherence of S. aureus from exit-site infections grade 2, 3 and 4 to Hep-2 cells did not differ from adherence of bacteria isolated from asymptomatic or moderately inflamed catheter exit sites (grade 0-2). However, binding of S. aureus to silicone tubes was enhanced in grade 0/1 compared with grade 2-4 exit-site isolates. Conclusions. Staphylococcus aureus is an important pathogen in CAPD-related exit-site infection being isolated in about 6.6% of all exit-site swabs (and in 25% of all positive swabs). Silicone-adhesive strains may be of more clinical significance in peritoneal dialysis patients since adhesion to silicone was increased in S. aureus strains isolated in more severe exit-site infections.     

Databases in routine care: possible and necessary

Patient questionnaires are valuable quantitative tools used by rheumatologists to monitor a patient's health status and response to therapy. The health assessment questionnaire (HAQ) and its derivatives have been shown to be the most significant predictors of functional and work disability, costs, joint replacement surgery, and mortality and, generally, at higher levels of significance than joint counts, radiographs, and laboratory tests. Yet, patient questionnaires, which can be used in all rheumatic diseases, are not included in routine care by most rheumatologists. Data that are feasible to collect during clinical care provide the optimal approach to quantitatively assess how patients are doing.     

集束化管理对静脉留置针预防静脉炎的护理研究

目的 探讨应用集束化管理（Bundles of Care）对静脉留置针的ICU患者预防静脉炎的临床实践和护理研究。方法 将2012-01-2013-12 ICU222例应用静脉留置针的患者作为研究对象,随机分为对照组和集束化组,对照组采用常规的静脉留置针护理方法;集束化组采用集束化管理方法进行静脉留置针的护理;比较2组静脉炎的发生率。结果 集束化组静脉炎发生率为8.11%,对照组为28.83%,2组比较有显著差异（P〈0.05）;集束化组在应用静脉留置针的ICU患者中预防静脉炎发生率方面明显低于对照组。结论 集束化管理措施能有效预防应用静脉留置针ICU患者静脉炎的发生率。     

Cuff-shaving procedure. A rescue treatment for exit-site infection unresponsive to medical therapy

We performed 41 cuff-shaving procedures in 38 patients on continuousambulatory peritoneal dialysis (CAPD) with exit-site infectionunresponsive to medical treatment. Cuff shaving was performedon three patients with two catheters each. This procedure waseffective in eliminating 50% of S. aureus exit-site infectionand all S. epidermidis exit-site infection, but was ineffectivein Gram-negative exit-site infection. After cuff-shaving procedure,20 catheters (49%) were removed; 11 for persistent tunnel infectionand nine because of development of secondary peritonitis. Theprobability of catheter survival at 1 year was 50% and remainedstable thereafter. Cuff-shaving procedure may be a valuablemode of therapy for treating patients with S. aureus and/orS. epidermidis exit-site infection unresponsive to medical treatment.     

导管护理安全管理的对策与效果

目地:探讨导管护理安全管理方法.方法:组建三级导管安全管理监控网络、建立导管标识、制定有效的导管滑脱管理流程及导管滑脱报告制度.结果:提高护理人员对导管护理安全的认识,快速识别各种管道,为患者提供高效、安全的护理措施.结论:实施导管护理安全管理对策是保证患者护理安全管理最有效地方法,从而提高了护理质量.     

32 胆囊切除术是否常规胃肠减压、留置导尿的探讨

为探讨胆囊切除术常规胃肠减压、留置导尿的利弊。笔者回顾分析10年间行单纯胆囊切除术726例患者的临床资料。其中常规胃肠减压、留置导尿(I组)380例，非常规肠胃减压、留置导尿(Ⅱ组)346例。结果示I组痛苦和不适明显增加，胃肠功能恢复未见明显改善，有2例因插胃管致环杓关节脱位，55例拔除胃管后有咽喉部疼痛或吞咽不适感，35例出现尿路感染。Ⅱ组术后12例出现腹胀，对症治疗后5例仍需胃肠减压；有23例因尿潴而留置导尿，出现尿路感染2例。提示术前常规胃肠减压，留置导尿弊多利少。但有少数患者术前或术后需胃肠减压或留置导尿。     

Sevoflurane for central catheter placement in neonatal intensive care: a randomized trial

Objective: To compare the efficacy and safety of sevoflurane deep sedation with glucose and nonnutritive sucking (GNNS) in reducing the duration of the procedure and in preventing pain‐related effects during peripherally inserted central catheter (PICC) placement. Background: PICC placement in neonatal intensive care is a delicate and stressful procedure that requires pain prevention. GNNS has been recommended in this situation but remain often inefficient. Methods: We designed a randomized controlled study in a sixteen‐bed pediatric and neonatal unit in a tertiary hospital. Fifty‐nine neonates at >28 weeks of gestation with continuous positive airway pressure or invasive mechanical ventilation and requiring PICC placement were included. Patients were randomized to receive inhaled sevoflurane (IS) or glucose and non‐nutritive sucking (GNNS). Procedural duration and conditions, hemodynamic and respiratory parameters, occurrence of movements and complications were compared ( http://clinicaltrials.gov trial register no. NCT00420693). Results: The two groups had similar demographics. There were no between‐group differences in procedural duration (P = 0.84) despite greater immobility in IS group (P = 0.017). IS was also associated with fewer episodes of hypertension (P = 0.003), tachycardia (P < 0.001), and bradycardia (P = 0.02). Occurrences of hypotension were not different between the groups (P = 0.06). The GNNS group showed more desaturation during the 4 h after the procedure (P = 0.03). Complications during intensive care stay did not differ between groups. Conclusion: Inhaled sevoflurane does not make easier catheters placement but prevent pain‐related symptoms. Because sevoflurane is responsible for hypotension, it requires careful monitoring and treatment adaptation.     

Drug wastage contributes significantly to the cost of routine anesthesia care.

STUDY OBJECTIVE: To complement previous studies that employed indirect methods of measuring anesthesia drug waste. DESIGN: Prospective, blinded observational study. SETTING: Operating rooms of a single university hospital. SUBJECTS: Anesthesia providers practicing in this setting who were completely unaware of the conduct of the study. MEASUREMENTS: All opened and unused or unusable intravenous (IV) anesthesia drugs left over at the end of each workday were collected over a randomly selected typical 2-week period. MAIN RESULTS: 166 weekday cases were performed. Thirty different drugs were represented in the 157 syringes and 139 ampoules collected. Opioid waste as well as opened vials that became outdated were counted in the tally. Based on actual hospital drug acquisition costs, $1,802 of drugs were wasted during this 2-week period ($300/OR), amounting to an average cost per case of $10.86. On a cost basis, six drugs accounted for three quarters of the total wastage: phenylephrine (20.8%), propofol (14.5%), vecuronium (12.2%), midazolam (11.4%), labetalol (9.1%), and ephedrine (8.6%). Because incompletely used syringes or vials that were discarded in the trash were not measured in this analysis, the results may underestimate the total cost of drug wastage at this institution by up to 40%. CONCLUSIONS: The results of this study are similar to those of previous studies that employed electronic record keeping techniques to calculate drug waste. Intravenous drugs that are prepared but unused may be a significant cost of intraoperative anesthesia care. Methods to reduce the amount of drug wasted are proposed.