Correlation of intra vascular cannula insertion technique and ward practices with local site infection

Background: Peripheral intravascular cannulas are indispensable in modern day medical care. These cannulas, if not inserted properly, predispose a patient to various morbidities. The present study was carried out to assess the incidence of intravascular cannula associated infections and correlate it with cannula insertion techniques and ward practices.     

"Homeward bound": a minimal care rehabilitation unit

A 20 bed minimal care rehabilitation unit was set up by Newham District Health Authority in a small hospital originally scheduled for closure when a new district general hospital was opened. During the first year 114 patients were admitted (throughput 5.7), with a median length of stay of 30 days; in the second year 173 patients were admitted (throughput 8.65) with a median length of stay of 28.5 days. The cost per inpatient day was less than that of an inpatient day at the district's long stay geriatric unit. Before the unit opened 24% of the acute beds had been occupied for more than six weeks, whereas two years later only 6% of the acute beds were occupied for such a period.     

Correlation of Intra Vascular Cannula Insertion Technique and Ward Practices with Local Site Infection

Background

Peripheral intravascular cannulas are indispensable in modern day medical care. These cannulas, if not inserted properly, predispose a patient to various morbidities. The present study was carried out to assess the incidence of intravascular cannula associated infections and correlate it with cannula insertion techniques and ward practices.

Methods

The study was carried out in the wards of a tertiary care hospital. The study was divided into two phases, each phase comprising of 50 patients. In phase 1, cannula insertion was carried out after normal ward cleaning practices. In phase 2, cleaning of the site was done by standard surgical cleaning procedure. The cannula samples after removal were cultured and local signs of thrombophlebitis looked for at the site of insertion. Thrombophlebitis was considered a surrogate marker of local infection in the vessel wall.

Result

The relative risk of acquiring thrombophlebitis increased by 2.18 times (applying univariate analysis) by existing methods as compared to the standard method.

Conclusion

Use of standard cleaning protocol had a significant effect on decreasing the incidence of cannula associated infections and cannula related morbidity.Key Words: Intravascular cannula, Peripheral vein thrombophlebitis, Cannula associated infections     

导管法测定清醒大白鼠的血压及心率

采用聚乙烯导管直接测定清醒大白鼠的血压,导管在麻醉下插入颈总动脉或股动脉固定,测血压时大鼠在清醒状态下,将该导管连接一导管接于压力换能器上,用多道记录仪记录,纸速为10mm/min与 10mm/s,后一纸速的心跳波形可推算心率。血压按平均动脉压的公式计算。结果30只鼠颈总动脉血压为15.35±0.07lkPa,23只鼠股动脉血压为14.6±0.091kPa,两处血压比较P>0.05。45只鼠的心率为422±1.04次/min。20只鼠的右房压为-0.053±0.012kPa。     

Twelfth rib resection as an approach for portal vein cannulation in sheep.

A surgical technique involving resection of the twelfth rib was used to insert silastic cannulas into the portal veins of three sheep to study amino acid metabolism. Good exposure to the vein was achieved by this method although it required positive ventilation due to the penetration of the thoracic cavity. All cannulas were buried subcutaneously and exteriorized near the dorsal midline. This facilitated continuous infusion into the portal cannula without disturbing cannula placement.     

Vancomycin and teicoplanin use in Victorian hospitals. The Victorian Drug Usage Evaluation Group.

OBJECTIVE: To determine patterns of prescribing of glycopeptide antibiotics (vancomycin and teicoplanin) in Victorian hospitals and identify areas for targeted intervention. DESIGN: A concurrent, observational, multisite evaluation of drug use. SETTING: Thirty-five Victorian hospitals, 1-14 September 1997. STUDY POPULATION: Patients commencing a glycopeptide antibiotic course. MAIN OUTCOME MEASURES: Rate of glycopeptide antibiotic use; indications; duration of use; main hospitals using glycopeptide antibiotics. RESULTS: 293 patients (269 adults and 24 neonates) commenced on 302 glycopeptide antibiotic courses: 296 intravenous (i.v.) vancomycin courses and three each of oral vancomycin and parenteral teicoplanin. The overall rate of use was 10.3 courses per 1000 inpatient separations. Of 271 i.v. vancomycin courses for adults, 176 (65%) were for treatment--120 empirically. The median duration of treatment courses was 4.7 days (interquartile range, 2.0-8.2 days). A flucloxacillin-resistant organism was confirmed for 44% of treatment courses. Ninety-five i.v. vancomycin courses were for prophylaxis, including for cardiac (54%) and vascular surgery (21%); 82% of prophylactic courses were administered for less than 24 hours. Of all the glycopeptide antibiotic courses, 69% were administered at five major metropolitan hospitals. CONCLUSIONS: Glycopeptide antibiotic use in Victoria is concentrated in the major metropolitan hospitals. Prolonged durations of vancomycin therapy, including for surgical prophylaxis and empirical therapy not subsequently confirmed by microbiology findings, would be suitable targets for interventional strategies.     

Effects of intradermal bradykinin after inhibition of angiotensin converting enzyme

Inhibitors of angiotensin converting enzyme may cause angio-oedema. To see if this might be due to potentiation of the tissue effects of bradykinin the thickness of weals raised by intradermal injection of saline or 1, 3, or 10 micrograms bradykinin was measured before and three times after single doses of captopril, enalapril, or placebo. The mean thickness increased with increasing doses of bradykinin. It did not change with time after the administration of placebo or captopril but increased from 0.61 mm before enalapril to 1.12 mm two and a half hours and 1.06 mm five hours after enalapril was given. Five subjects flushed when given bradykinin after captopril and four after enalapril, but none flushed when given bradykinin after placebo. It is concluded that angiotensin converting enzyme inhibitors potentiate the effects of intradermal bradykinin in vivo and that this may partially explain why they cause angio-oedema in susceptible patients.     

徒手急诊动脉测压管引导经鼻气管导管置换

目的观察应用动脉测压管做引导,置换经鼻气管导管的临床效果。方法经鼻气管内插管的病人由于呼吸机报警提示气管导管漏气、或气管导管内痰痂阻塞等原因经常规处理无效,需要再次气管插管。实验组12例患者不使用先拔管再插管的老办法,而是徒手(不借助其他如纤支镜等器械)将引导管插入气管导管内至隆突水平,并拔出原气管导管;将欲更换的气管导管套在引导管外,在引导管引导下将新的气管导管插入气管内,完成换置;对照组为20例患者通过常规先拔管再在纤支镜引导下经鼻气管插管,完成更换。结果实验组及对照组全部32例病例均顺利完成更换经鼻气管导管,术后均未发生与更换导管相关重大并发症,但实验组较对照组在换管过程中病人氧合更加稳定,心率血压变化小,鼻出血、心律失常发生率低,耗时短。结论应用气管导管置换,方法安全、简便易行,可替代传统的先拔管再借助纤支镜引导经鼻气管导管换管的方法。     

高渗盐水雾化吸入治疗毛细支气管炎的疗效分析

目的:观察高渗盐水治疗毛细支气管炎的疗效。方法:采用随机、双盲、对照临床研究,将80例毛细支气管炎患儿分为观察组和对照组各40例,观察组雾化吸入3%氯化钠,对照组雾化吸入生理盐水+沙丁胺醇,每8 h 1次,比较两组患儿Lowell评分、肺部哮鸣音、湿罗音消失时间及住院时间。结果:观察组24、48、72 h Lowell评分显著低于对照组,差异有统计学意义;观察组肺部哮鸣音、湿罗音消失时间及住院时间显著低于对照组,差异有统计学意义;观察组及对照组均无明显不良反应。结论:雾化吸入高渗盐水治疗非重症毛细支气管炎安全、有效。     

周剂量紫杉醇联合低剂量5-FU持续输注二线治疗晚期胃癌

[目的]探讨周剂量紫杉醇联合低剂量5-氟尿嘧啶（5-FU）持续输注二线治疗晚期胃癌的疗效和毒性反应。[方法]经病理确诊的晚期胃癌20例,均为一线治疗后失败或复发者,应用PTX 60 mg/m^2,d1、8、15,静脉滴注3 h;5-FU300 mg/d,便携式微量泵持续24 h静脉滴注,连续14 d;DDP5 mg/d,第1-5天,第7-12天,静脉滴注,21-28 d为1周期,中位化疗周期为3周期,共完成64周期化疗。[结果]20例患者均可评价疗效,CR 1例,PR 7例,SD 5例,PD 7例,RR 40%,TCR 65%;中位无进展时间5个月（3-24个月）,中位生存时间8个月（5-30个月）。化疗相关毒性反应主要为骨髓毒性、恶心呕吐、脱发、口腔黏膜炎和神经毒性。[结论]周剂量紫杉醇联合低剂量5-FU持续输注二线治疗晚期胃癌疗效较好,毒性反应轻微,患者能够耐受,值得在临床中进一步研究使用。     

后循环脑梗死治疗方法的临床研究

目的探讨急性后循环脑梗死患者抗凝、静脉溶栓及动静脉联合溶栓治疗的效果。方法回顾性分析60例后循环脑梗死患者资料,发病时间为12～72 h。根据治疗方法不同,将60例患者分为抗凝治疗组(30例)、静脉溶栓组(20例)和动静脉联合溶栓治疗组(联合治疗组,10例),采用美国国立卫生研究院卒中量表(NIHSS)评定患者临床症状改善情况,评价治疗24 h和治疗7 d时的效果。结果 3种方法治疗24 h和治疗7 d的疗效比较,静脉溶栓组的治疗效果优于抗凝治疗组,联合治疗组的治疗效果优于抗凝治疗组和静脉溶栓组,组间比较差异均有统计学意义(P<0.05)。结论后循环脑梗死患者病情危重,可以根据个体情况,采取各种联合治疗,溶栓时间窗可以延长。     

Outcome evaluation of intravenous infusion of urokinase for acute ischemic stroke

The aim of this study was to evaluate the clinical effect of a continuous infusion of urokinase in cerebral stoke patients who were late admitted over 6 hours after onset. From January to December in 2008, acute cerebral stroke patients (n=143) treated with intravenous urokinase infusion (Group I, n=93) or not (Group II, n=50) after 6 hours and within 72 hours of stroke onset were reviewed. Continuous intravenous infusion of urokinase was done for 5 days. The clinical outcome for each patient was evaluated by using the modified National Institutes of Health Stroke Scale (NIHSS) on admission and on the day of discharge. The NIHSS score was decreased at discharge compared with admission in the urokinase treatment group (Group I; from 4.8±2.2 to 3.8±1.9; p=0.002). There was an improvement in the patients who initiated urokinase treatment within 24 hours from stroke onset in Group I (from 5.1±1.9 to 3.9±1.5; p=0.04). In patients with initiated urokinase treatment within 24 hours from stroke onset, intravenous urokinase infusion could be an effective modality in acute ischemic stroke patients admitted later than 6 hours after onset.     

Neuroprotective Effects of Grape Seed Procyanidin Extract on Ischemia-Reperfusion Brain Injury

Objective Oxidative stress (OS) plays a crucial role in ischemic stroke. Grape seed procyanidin extract (GSPE) was reported to be a critical regulator of OS. We hypothesized that GSPE might also be protective in ischemia-reperfusion brain injury. This study aimed to explore whether GSPE administration can protect mice from ischemia-reperfusion brain injury. Methods Transient middle cerebral artery occlusion (MCAO) was conducted followed by reperfusion for 24 hours to make ischemia-reperfusion brain injury in mice that received GSPE (MCAOG, n=60) or normal saline (MCAONS, n=60). Sham-operated mice (GSPE group and normal saline group) were set as controls. The neurological severity score (NSS) was used to evaluate neural function impairment 1 hour, 24 hour, 3 days and 7 days after MCAO. Mice underwent brain T2WI imaging with a 3T animal MRI scanner 24 hours after reperfusion, and the stroke volume of brains were calculated according to abnormal signal intensity. Immunohistopathological analysis of brain tissues at 24 h after reperfusion was performed for neuronal nuclear antigen (NeuN), CD34, Bcl-2, and Bax. Glutathione peroxidation (GSH-Px) activity and the level of malonaldehyde (MDA) of brain tissue were also examined. The above indexes were compared among the groups statistically. Results Significant functional improvement was observed 24 hours after MCAO in MCAOG group compared to MCAONS group (P<0.05). MCAOG group had smaller cerebral stroke volume (22.46 ± 11.45 mm3vs. 47.84±9.06 mm3,P<0.05) than MCAONS group 24 hours after MCAO. More mature NeuN-immunoreactive neurons and more CD34-positive cells in peri-infarct zones were observed in brain tissue of MCAOG mice 24 h after MCAO than that of MCAONS mice (bothP<0.05). MCAONS mice had significantly higher number of Bax-positive cells in brain tissue than MCAOG (P<0.05). The mean MDA level was significantly lower (P<0.05) and the GSH-Px activity was significantly higher (P<0.05) in brains of MCAOG mice compared to those of MCAONS mice. Conclusion GSPE administration protects mice from ischemia-reperfusion brain injury through attenuating oxidative stress and apoptosis, promoting angiogenesis, and activating antioxidant enzyme GSH-Px. GSPE may represent a new therapeutical direction for the treatment of ischemia-reperfusion brain injury.     

The early post-partum insertion of the nylon ring

200 women were fitted within 24 to 48 hours after delivery with Ragab's nylon ring. Only 50 women were followed for 6 months postpartum. The incidence of follow-up was 30% in primaparae and 24% in multiparae. There were 21 women who continued to wear the IUD at 6 months, 2 who had had it removed, and 27 who had expelled the device. (The expulsion rate was 54%). The average insertion to expulsion period was 10 days. The high expulsion rate was felt to be due to the earlier insertion date postpartum than is usual. There were no clinical complications. The early postpartum insertion was recommended for this particurly low socioeconomic group.     

改良直置式套管针替代导入鞘法在新生儿PICC置入中的应用

目的分析改良直置式套管针替代导入鞘法在新生儿外周静脉植入的中心静脉导管(PICC)置入中的应用情况。方法将10例病患随机平均分成实验组和对照组,每组5例。对照组患儿采用安全型撕裂式导入鞘置入PICC进行治疗。对5例实验组病患利用20 g直置式PICC和利用导入鞘置入PICC5例新生儿进行对比,将各项医学指标进行全面比较。结果两组病患的穿刺成功机率以及穿刺时长无统计学意义(P＞0.05)。从换药时间上看,实验组较对照组时间要长(P＜0.05)。结论改良直置式套管针有着经济性,易操作等相关特点,值得在临床治疗中推广使用。     

地塞米松对缺血再灌注鼠视网膜电图的影响

目的观察地塞米松对大鼠视网膜缺血再灌注损伤 (retinalischemiareperfusion ,RIR)视网膜电图 (ERG)的影响。方法应用前房灌注液体升高眼内压的方法 ,建立RIR模型 ,并随机分为防治组和对照组 ,防治组大鼠地塞米松用药从缺血前 6天开始 ,剂量为 1mg/kg ,溶于 1ml生理盐水中腹腔注射 ,给药持续 8天 ,对照组用同体积的生理盐水代替。两组缺血 60分钟后分别再灌注 3 0分钟、2 4小时、72小时 ,进行视网膜电图。结果防治组ERG标化b波振幅显著高于对照组 (P <0 .0 1 )。结论地塞米松对RIR有一定防治作用     

视可尼喉镜气管插管200例临床观察

目的:观察视可尼喉镜在气管插管的安全性和有效性。方法:选择ASA 1～3,年龄18～82岁需气管插管的患者200例,用视可尼喉镜置入气管导管内引导,采用从左侧嘴角进入口腔,放至左侧咽侧壁及目镜确认声门、气管的方法完成气管插管。结果:195例插管成功,成功率为97.5%,其中1次插管成功者151例(75.5%)、2次插管成功者23例(11.5%)、3次插管成功者20例(10.0%),插管失败5例(2.5%)。所有患者均无明显牙齿及咽喉黏膜损伤。结论:视可尼喉镜引导气管插管是一种简便、快捷、安全、高效、损伤小,临床实用有效的新技术。     

温血心停跳液与冷晶体心停跳液对狗心率变异性的影响

为探讨体外循环（ＣＰＢ）导致心脏植物神经系统（ＣＡＳ）损伤的机理，了解温血心停跳液能否防止ＣＰＢ后心率变异性（ＨＲＶ）的降低，采用对照方法观察了温血心停跳液与冷心停跳液对狗ＨＲＶ的影响，结果显示：ＣＰＢ后温血心停跳液组（ＷＢ组）和冷晶体心停跳液组（ＣＣ组）的全频谱（ＴＰ），低频（ＬＦ）和高频（ＨＦ）均较术前明显降低（Ｐ〈０．０５），而且ＣＣ组比ＷＢ 降低更明显（Ｐ〈０．０５），且ＬＦ／ＨＦ在组内及     

温血心停跳液与冷晶体心停跳液对狗心率变异性的影响

为探讨体外循环（ＣＰＢ）导致心脏植物神经系统（ＣＡＳ）损伤的机理,了解温血心停跳液能否防止ＣＰＢ后心率变异性（ＨＲＶ）的降低,采用对照方法观察了温血心停跳液与冷晶体心停跳液对狗ＨＲＶ的影响。结果显示：ＣＰＢ后温血心停跳液组（ＷＢ组）和冷晶体心停跳液组（ＣＣ组）的全频谱（ＴＰ）、低频（ＬＦ）和高频（ＨＦ）均较术前明显降低（Ｐ＜０．０５）,而且ＣＣ组比ＷＢ组降低更明显（Ｐ＜０．０５）,但ＬＦ／ＨＦ在组内及组间均无明显变化（Ｐ＞０．０５）。ＣＰＢ后２４小时平均心率（ＭＨＲ）明显增加（Ｐ＜０．０５）,且ＣＣ组高于ＷＢ组（Ｐ＜０．０５）。本研究表明：采用温血心停跳液或冷晶体心停跳液的ＣＰＢ不会干扰ＣＡＳ平衡,但均能使ＨＲＶ降低,温血心停跳液不能防止ＨＲＶ损害。