The document summarizes a literature review of 45 studies on peripheral venous catheter (PVC) infections. The review found reported PVC infection rates ranging from 0.1 to 0.4 bloodstream infections per 100 devices/1000 device days. Colonization of PVC tips with skin organisms was found in 5-25% of catheters upon removal and in 11.25-20.72% of studied catheters. Rates of phlebitis/thrombophlebitis ranged widely from 2-80% across studies. An estimated 165,000 patients in the US experience PVC-related bloodstream infections annually, despite PVCs having the lowest reported infection rates of all intravascular devices.
Arab Health 2011: PET/CT in Chest ImagingTom Heston MD
This document discusses the use of PET/CT imaging in chest imaging. It begins by explaining the Warburg effect, where cancer cells rely more on glycolysis than oxidative phosphorylation. PET/CT imaging takes advantage of this effect by using 18F-FDG, which is taken up by glycolytic cancer cells and detected by PET. The document then presents three case studies where PET/CT altered patient management by detecting unknown cancers or metastatic disease not seen on other imaging. It concludes that multiple studies have shown PET/CT can identify unexpected metastases in 10-20% of NSCLC patients and is more accurate than CT for staging lung cancer.
The document discusses the prevalence and incidence of invasive fungal infections in Nigeria, finding rates of 5-12% for various fungi like Candida and Cryptococcus in various studies. It notes that invasive fungal infections have increased globally in recent decades and are often identified post-mortem rather than pre-mortem. Major risk factors for invasive fungal infections include neutropenia, use of antibiotics, immunosuppression, and prolonged ICU stays.
This case report describes a 57-year-old woman with newly diagnosed HIV who presented with axillary lymphadenopathy. Histopathological analysis of an excisional lymph node biopsy showed rare nests of Burkitt cells exclusively located within hyperplastic monocytoid B-cell areas, representing Burkitt microlymphoma (BmL). Follow-up PET/CT scans showed persistent lymphadenopathy, and a subsequent core needle biopsy confirmed Burkitt lymphoma (BL). This case provides novel insights into the early histopathogenesis of HIV-associated BL, showing that it can arise as nests of cells within prominent monocytoid B-cell areas seen in HIV lymphadenitis.
Infective endocarditis is a life-threatening disease caused by bacterial infection of the endothelium and cardiac valves, either native or prosthetic. In the present work the role of the new microbiological techniques (techniques of detection and amplification of the subunit 16 ribosomal sRNA by means of the chain reaction of the polymerase in blood or tissue, fluorescent in situ hybridization, and matrix-assisted laser is reviewed desorption/ ionization time-of-flight mass spectrometry (MALDI-TOF MS) in the diagnosis of infective endocarditis.
The document discusses principles for antibiotic use in critically ill patients, including:
1) Starting with broad-spectrum empiric therapy based on local microbiological data and guidelines.
2) Reassessing and de-escalating treatment based on culture results and the patient's clinical response.
3) Factors that increase the risk of resistant pathogens like hospital-acquired infections require broader initial coverage.
This document discusses healthcare-associated pneumonia (HCAP). It defines HCAP, hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). It discusses the challenges in diagnosing and treating HCAP due to imperfect diagnostic tests and conditions that can mimic pneumonia. The document also summarizes several studies comparing the etiology and outcomes of HCAP versus community-acquired pneumonia (CAP), finding higher rates of drug-resistant pathogens and worse outcomes in HCAP. It recommends antibiotics that provide coverage for possible multidrug-resistant pathogens in patients at risk.
This document discusses accuracy and cost-effectiveness in diagnosing catheter-related bloodstream infections (CRBSI). It covers several topics:
1. Comparing roll plate (Maki) culture to sonication culture methods for diagnosing CRBSI, concluding that roll plate remains the preferred method.
2. Exploring the strengths and limitations of differential time to positivity (DTTP) as an in vivo diagnostic method for CRBSI. DTTP has good sensitivity and specificity but sample collection requirements limit its practicality.
3. Evaluating the potential role of surveillance surface cultures in anticipating catheter tip colonization, finding that positive previous surface cultures accurately predicted all subsequent CR
Yeasts such as Candida are common causes of bloodstream infections in ICU patients. Candida infections in the ICU have a high mortality rate of 15-25% and are the 4th most common cause of hospital-acquired bloodstream infections. Diagnosis can be challenging due to low sensitivity of blood cultures, but newer tests such as PCR, antigen detection assays, and MALDI-TOF mass spectrometry provide more rapid detection of Candida compared to standard culture methods. The presence of risk factors such as abdominal surgery, central venous catheters, antibiotics use, and prolonged ICU stay increase the risk of developing Candida bloodstream infections in critically ill patients.
Arab Health 2011: PET/CT in Chest ImagingTom Heston MD
This document discusses the use of PET/CT imaging in chest imaging. It begins by explaining the Warburg effect, where cancer cells rely more on glycolysis than oxidative phosphorylation. PET/CT imaging takes advantage of this effect by using 18F-FDG, which is taken up by glycolytic cancer cells and detected by PET. The document then presents three case studies where PET/CT altered patient management by detecting unknown cancers or metastatic disease not seen on other imaging. It concludes that multiple studies have shown PET/CT can identify unexpected metastases in 10-20% of NSCLC patients and is more accurate than CT for staging lung cancer.
The document discusses the prevalence and incidence of invasive fungal infections in Nigeria, finding rates of 5-12% for various fungi like Candida and Cryptococcus in various studies. It notes that invasive fungal infections have increased globally in recent decades and are often identified post-mortem rather than pre-mortem. Major risk factors for invasive fungal infections include neutropenia, use of antibiotics, immunosuppression, and prolonged ICU stays.
This case report describes a 57-year-old woman with newly diagnosed HIV who presented with axillary lymphadenopathy. Histopathological analysis of an excisional lymph node biopsy showed rare nests of Burkitt cells exclusively located within hyperplastic monocytoid B-cell areas, representing Burkitt microlymphoma (BmL). Follow-up PET/CT scans showed persistent lymphadenopathy, and a subsequent core needle biopsy confirmed Burkitt lymphoma (BL). This case provides novel insights into the early histopathogenesis of HIV-associated BL, showing that it can arise as nests of cells within prominent monocytoid B-cell areas seen in HIV lymphadenitis.
Infective endocarditis is a life-threatening disease caused by bacterial infection of the endothelium and cardiac valves, either native or prosthetic. In the present work the role of the new microbiological techniques (techniques of detection and amplification of the subunit 16 ribosomal sRNA by means of the chain reaction of the polymerase in blood or tissue, fluorescent in situ hybridization, and matrix-assisted laser is reviewed desorption/ ionization time-of-flight mass spectrometry (MALDI-TOF MS) in the diagnosis of infective endocarditis.
The document discusses principles for antibiotic use in critically ill patients, including:
1) Starting with broad-spectrum empiric therapy based on local microbiological data and guidelines.
2) Reassessing and de-escalating treatment based on culture results and the patient's clinical response.
3) Factors that increase the risk of resistant pathogens like hospital-acquired infections require broader initial coverage.
This document discusses healthcare-associated pneumonia (HCAP). It defines HCAP, hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). It discusses the challenges in diagnosing and treating HCAP due to imperfect diagnostic tests and conditions that can mimic pneumonia. The document also summarizes several studies comparing the etiology and outcomes of HCAP versus community-acquired pneumonia (CAP), finding higher rates of drug-resistant pathogens and worse outcomes in HCAP. It recommends antibiotics that provide coverage for possible multidrug-resistant pathogens in patients at risk.
This document discusses accuracy and cost-effectiveness in diagnosing catheter-related bloodstream infections (CRBSI). It covers several topics:
1. Comparing roll plate (Maki) culture to sonication culture methods for diagnosing CRBSI, concluding that roll plate remains the preferred method.
2. Exploring the strengths and limitations of differential time to positivity (DTTP) as an in vivo diagnostic method for CRBSI. DTTP has good sensitivity and specificity but sample collection requirements limit its practicality.
3. Evaluating the potential role of surveillance surface cultures in anticipating catheter tip colonization, finding that positive previous surface cultures accurately predicted all subsequent CR
Yeasts such as Candida are common causes of bloodstream infections in ICU patients. Candida infections in the ICU have a high mortality rate of 15-25% and are the 4th most common cause of hospital-acquired bloodstream infections. Diagnosis can be challenging due to low sensitivity of blood cultures, but newer tests such as PCR, antigen detection assays, and MALDI-TOF mass spectrometry provide more rapid detection of Candida compared to standard culture methods. The presence of risk factors such as abdominal surgery, central venous catheters, antibiotics use, and prolonged ICU stay increase the risk of developing Candida bloodstream infections in critically ill patients.
This document discusses central venous catheter-related bloodstream infections (CRBSIs) in intensive care units. It provides details on:
1) CRBSI rates found in different ICUs, with the highest rate in neonatal ICUs.
2) Common organisms that cause CRBSIs, led by coagulase-negative staphylococci.
3) Factors that contribute to CRBSIs, including skin flora migration into catheters and direct contamination during insertion or maintenance.
This study evaluated the diagnostic utility of combined fine needle aspiration and core biopsy (CFNACB) in patients with prior non-diagnostic thyroid nodule FNAs. CFNACB was performed on 90 thyroid nodules in 82 patients with prior non-diagnostic FNAs. CFNACB yielded a diagnostic result in 87% of nodules, with core biopsy alone diagnostic in 77% of nodules. Core biopsy demonstrated superior diagnostic performance compared to repeat FNA. CFNACB was shown to be a safe procedure with no reported complications.
Are peripheral-i vs-an-overlooked-source-of-infection-dinner-meeting-2013-07-25AYM NAZIM
This document discusses the potential risks of infection from peripheral intravenous catheters (PIVs). It provides definitions of primary bloodstream infections and central line-associated bloodstream infections. Several studies are referenced that found infection rates of 0.07-0.3 infections per 1,000 PIV days, with some cases resulting in serious complications like death. Risk factors for PIV infections included placement in the antecubital fossa, outside of the hospital, or remaining in place for over 3 days. The document argues that PIVs are commonly used but often overlooked as a potential source of healthcare-associated infections.
This document discusses a study that used next-generation DNA sequencing to analyze the microbiome of neuropathic diabetic foot ulcers. The study found that DNA sequencing identified more bacterial diversity in the ulcers than traditional cultures. DNA sequencing also showed higher microbial loads in the ulcers compared to cultures. This demonstrates that cultures underrepresent the true bacteria present in chronic wounds like diabetic foot ulcers. The study provides support for using molecular diagnostic approaches like DNA sequencing rather than solely relying on traditional cultures to identify bacteria in chronic wounds.
This document discusses advanced next-generation DNA sequencing techniques for identifying bacteria, fungi, and viruses. It highlights how DNA sequencing can identify over 13,000 pathogen DNA codes and is not affected by transport or culture issues. Examples are given where DNA sequencing identified chronic infections that cultures failed to detect. The document emphasizes how biofilms are difficult to culture but can be identified by DNA sequencing, and are responsible for 80% of infections. It provides examples comparing DNA sequencing to traditional cultures for identifying pathogens in chronic wounds and urine samples. The document also discusses using DNA diagnostic tests to provide treatment recommendations like customized topical therapies and antibiograms.
It is important to realize that guidelines cannot always account for individual
variation among patients. They are not intended to supplant physician judgment
with respect to particular patients or special clinical situations. The IDSA considers
adherence to these guidelines to be voluntary, with the ultimate determination
regarding their application to be made by the physician in the light of each patient’s
individual circumstances.
This document provides guidance on collecting blood for culturing to detect bloodstream infections. Key points include:
- Blood cultures involve injecting blood into bottles with culture media to identify microorganisms in the bloodstream. They are essential for diagnosis, prognosis, and treatment.
- Proper collection technique is critical to avoid contamination, including aseptically collecting at least 10ml of blood via venipuncture and injecting equal amounts into aerobic and anaerobic bottles.
- Multiple blood cultures may be needed depending on the type of bacteremia, usually collecting from different body sites. Proper labeling and documentation is also important.
Advanced Next Generation DNA sequencing can more accurately diagnose infections by identifying bacteria, fungi, and viruses compared to traditional culture techniques. This allows for better treatment decisions. PathoGenius Laboratory uses Next Generation Sequencing to identify microbes in samples, providing physicians with diagnostic results to inform customized treatment. Previous methods of relying only on culture were found to significantly underrepresent the microbes present. Molecular diagnostic techniques provide more comprehensive information about biofilms and chronic infections compared to traditional approaches.
This document discusses next generation sequencing to identify bacteria, fungi, and viruses from patient samples. It summarizes discussions and presentations from several ear, nose, and throat doctors and researchers on using DNA sequencing to diagnose biofilm infections. DNA sequencing was able to identify more pathogens than traditional cultures and provided faster results. Identifying biofilms is important as they are resistant to antibiotics and cause chronic infections. The document promotes using a molecular diagnostic test from PathoGenius to identify pathogens in patient samples, which it says provides faster, more comprehensive results than cultures and is covered by Medicare.
The research interest of the investigator has focused on the molecular and cellular pathogenesis of sepsis. In particular, he has worked on soluble proteins involved in the innate recognition of bacteria such as soluble CD14 and MD-2, as well as in the Toll-like receptors activated by Gram-negative and Gram-positive bacteria. Another area of study is the molecular pathogenesis and cell signaling of ventilator-induced lung injury, and lung inflammation in the context of acute respiratory distress syndrome. He has also identified and tested biomarkers in the field of clinical sepsis.
Watch the presentation on Youtube: https://www.youtube.com/watch?v=CyWN7JlhlmI&
Prospective, randomized comparison of 2 methods of cold snare polypectomy for...ENDONOTICIAS
This study compared two methods of cold snare polypectomy for removing small colorectal polyps: 1) using a dedicated cold snare designed specifically for cold polypectomy, and 2) using a traditional polypectomy snare for cold polypectomy. The study found that using the dedicated cold snare resulted in a significantly higher rate of complete polyp removal compared to the traditional snare, especially for polyps between 8-10mm. Rates of immediate bleeding were similar between the two groups. Histological examination found similar rates of arteries and injured arteries in the submucosa between groups.
class GERONTOLOGICAL NURSINGJournal Article Summary AssignmentT.pdflanuszickefoosebr429
class GERONTOLOGICAL NURSING
Journal Article Summary Assignment:
The purpose of the journal article summary assignment is for students to improve their
knowledge of evidence-based geriatric nursing practice and evidence-based protocols.
Students will review evidence-based literature and reflect on how the literature impacts
their professional nursing practice. Students will summarize two articles published in a
peer-reviewed journal within the last 10 years. The journal articles must address the
geriatric population. Topics will be chosen from the provided list (unless prior approval is
given), and the topic may not be repeated on the two journal article summaries. The
student should summarize each article and discuss how the findings are significant to
clinical practice. Article summaries should use APA format (double spaced, but no cover
page) and should be no more than 3 pages. The two article summaries are 10% of the total
class grade (2 x 5%).
Journal summaries should use the following format:
• Purpose: Describe the purpose of the article/study.
• Strength of Evidence: Identify the type of evidence used to support the findings, and
the strength of the evidence. If the article is based on research, describe the study
design, setting, subjects, and sample size.
• Results: Summarize the findings of the study.
• Limitations: Identify study limitations that may weaken evidence or limit
generalizability.
• Significance: Describe how the findings are significant to geriatric nursing practice.
Do the findings represent a change in practice and how do the findings inform your
nursing practice (what did you learn)?
Topics for journal article summaries and class presentations choose one of those topic and APA
styles
• Pain
• Heart Failure
• Stroke
• Substance/Alcohol Abuse
• Urinary Incontinence
• Sexuality Issues
• Frailty/Fall Risk
• Iatrogenesis
• Sleep Disturbances
• Nutrition
• Hydration
• Orthostatic Hypotension
• Dementia
• Vision
• Hearing
• Polypharmacy
• Cultural Considerations
• Elder Communities
Solution
Ques-1: Purpose:
The purpose of the article is to examine the evidence-based practice of geriatric patients who
have been suffering from “urinary tract infection induced- urinary incontinence”. So that
catheterization of urinary tract have reduce urinary incontinence in geriatric patients thereby it is
essential implement to procedures to reduce urinary infection induced incontinence using
catheters for overflow incontinence
Ques-2:
Catheterization regimen:
\"RCT\" (simple randomized control design) and randomized trial: These two methods used
synonymously. However, it has illustrated that RCT is pertaining to trail design that include
control groups. In this design, patient groups who are receiving experimental treatment compared
with control groups (placebo groups).
In the above design it has clearly can be seen a randomized RCT was performed in two intensive
units of respiratory care of total 2990 bedded tertiary referral medical ce.
Journal Club - Discussion of Heriot et al. Criteria for identifying patients ...Salpy Kelian
Discussing, using many Bobs, how a monte carlo simulation works for a Journal Club paper regarding the modality used for detection of infectious endocarditis.
Hallie Prescott tells us about why the back-end of sepsis matters and is a neglected aspect of our management. This sub-acute phase can really affect long term outcomes. Long term exposure to broad-spectrum antibiotics and too much fluid are aspects that matter and that we can modify.
Introduction: Bloodstream infections (BSIs) are associated with a high mortality rate of 20%-50%. Blood culture is paramount to identify causative agents of BSIs to choose an appropriate antimicrobial therapy. Objectives: The present study was undertaken to analyze the various microorganisms causing BSIs and study their antimicrobial resistance patterns in a tertiary care hospital, Eastern India. Materials and Methods: A total of 239 blood specimens from clinically suspected cases of BSIs were studied for 6 months from July 2015 to December 2015. Blood specimens were incubated in BacT/ALERT ® 3D system (bioMerieux, Durham, NC, USA) a fully automated blood culture system for detection of aerobic growth. Identification and antimicrobial susceptibility testing were conducted on VITEK ® 2 (bioMerieux, Durham, NC, USA) as per Clinical Laboratory Standards Institute guidelines. Results: Out of 239 specimens, 41 (17.2%) yielded growth of different microorganisms. From these isolates, 20 (48.8%) were Gram-negative bacilli, 18 (43.9%) were Gram-positive cocci and rest 3 (7.3%) were yeasts. Among Gram-negative bacilli, Klebsiella pneumoniae sub spp. pneumoniae (70%) was most commonly isolated. Coagulase-negative staphylococci (88.9%) were the most common isolate among Gram-positive cocci. All three Candida spp. isolated were nonalbicans Candida (two Candida tropicalis and one Candida krusei). Gram-negative isolates were least resistant to tigecycline and colistin. All Gram-positive cocci were sensitive to linezolid. Conclusion: Monitoring of data regarding the prevalence of microorganisms and its resistance patterns would help in currently prescribing antimicrobial regimens and improving the infection control practices by formulating policies for empirical antimicrobial therapy.
The document discusses urinary catheters and catheter-associated urinary tract infections (CAUTIs). It provides information on:
- The history and development of urinary catheters from the 1920s to present.
- Risk factors for bacteriuria associated with urinary catheters. Studies show rates of bacteriuria increase significantly within the first week of catheter placement.
- Core strategies and supplemental strategies recommended by healthcare organizations to prevent CAUTIs, such as only using catheters when necessary, maintaining a closed drainage system, and hand hygiene.
This presentation focuses on a recently published paper aiming to create an algorithm for the investigation of patients with new onset fever or instability
This study was designed to investigate the infection rate of nosocomial Acinetobacter spp. in Khalifa hospital, Ajman. A retrospective study was carried out from 2005 to 2008. Bacteriological cultures were used to isolate the organisms by the DADE BEHRING Microscan® to identify the organisms and their antibiotic sensitivity.
The document discusses the future of blood purification techniques for treating sepsis. While recent large RCTs have been negative, the author argues that more research is still warranted for several reasons: (1) Past studies showed promise but had limitations; (2) Different patient populations and timing may yield better results; (3) The exact mechanisms and optimal targets (e.g. cytokines, endotoxins) are still unknown; (4) Many techniques like Oxiris have yet to be thoroughly evaluated in large trials. Overall, the author believes ongoing research into hybrid and futuristic removal of various inflammatory mediators could help modulate the immune response to sepsis.
This document summarizes research on complications from intraosseous vascular access. It finds that serious complications are rare, with osteomyelitis occurring in only a few isolated case reports since 1985. Other rare complications include compartment syndrome (18 cases reported), fractures (3 cases), skin necrosis (2 cases), and suspected air embolism (2 cases). The document concludes that with proper technique and monitoring, complications can be avoided, and intraosseous access has been shown to decrease time to vascular access and speed delivery of lifesaving medications.
This document discusses central venous catheter-related bloodstream infections (CRBSIs) in intensive care units. It provides details on:
1) CRBSI rates found in different ICUs, with the highest rate in neonatal ICUs.
2) Common organisms that cause CRBSIs, led by coagulase-negative staphylococci.
3) Factors that contribute to CRBSIs, including skin flora migration into catheters and direct contamination during insertion or maintenance.
This study evaluated the diagnostic utility of combined fine needle aspiration and core biopsy (CFNACB) in patients with prior non-diagnostic thyroid nodule FNAs. CFNACB was performed on 90 thyroid nodules in 82 patients with prior non-diagnostic FNAs. CFNACB yielded a diagnostic result in 87% of nodules, with core biopsy alone diagnostic in 77% of nodules. Core biopsy demonstrated superior diagnostic performance compared to repeat FNA. CFNACB was shown to be a safe procedure with no reported complications.
Are peripheral-i vs-an-overlooked-source-of-infection-dinner-meeting-2013-07-25AYM NAZIM
This document discusses the potential risks of infection from peripheral intravenous catheters (PIVs). It provides definitions of primary bloodstream infections and central line-associated bloodstream infections. Several studies are referenced that found infection rates of 0.07-0.3 infections per 1,000 PIV days, with some cases resulting in serious complications like death. Risk factors for PIV infections included placement in the antecubital fossa, outside of the hospital, or remaining in place for over 3 days. The document argues that PIVs are commonly used but often overlooked as a potential source of healthcare-associated infections.
This document discusses a study that used next-generation DNA sequencing to analyze the microbiome of neuropathic diabetic foot ulcers. The study found that DNA sequencing identified more bacterial diversity in the ulcers than traditional cultures. DNA sequencing also showed higher microbial loads in the ulcers compared to cultures. This demonstrates that cultures underrepresent the true bacteria present in chronic wounds like diabetic foot ulcers. The study provides support for using molecular diagnostic approaches like DNA sequencing rather than solely relying on traditional cultures to identify bacteria in chronic wounds.
This document discusses advanced next-generation DNA sequencing techniques for identifying bacteria, fungi, and viruses. It highlights how DNA sequencing can identify over 13,000 pathogen DNA codes and is not affected by transport or culture issues. Examples are given where DNA sequencing identified chronic infections that cultures failed to detect. The document emphasizes how biofilms are difficult to culture but can be identified by DNA sequencing, and are responsible for 80% of infections. It provides examples comparing DNA sequencing to traditional cultures for identifying pathogens in chronic wounds and urine samples. The document also discusses using DNA diagnostic tests to provide treatment recommendations like customized topical therapies and antibiograms.
It is important to realize that guidelines cannot always account for individual
variation among patients. They are not intended to supplant physician judgment
with respect to particular patients or special clinical situations. The IDSA considers
adherence to these guidelines to be voluntary, with the ultimate determination
regarding their application to be made by the physician in the light of each patient’s
individual circumstances.
This document provides guidance on collecting blood for culturing to detect bloodstream infections. Key points include:
- Blood cultures involve injecting blood into bottles with culture media to identify microorganisms in the bloodstream. They are essential for diagnosis, prognosis, and treatment.
- Proper collection technique is critical to avoid contamination, including aseptically collecting at least 10ml of blood via venipuncture and injecting equal amounts into aerobic and anaerobic bottles.
- Multiple blood cultures may be needed depending on the type of bacteremia, usually collecting from different body sites. Proper labeling and documentation is also important.
Advanced Next Generation DNA sequencing can more accurately diagnose infections by identifying bacteria, fungi, and viruses compared to traditional culture techniques. This allows for better treatment decisions. PathoGenius Laboratory uses Next Generation Sequencing to identify microbes in samples, providing physicians with diagnostic results to inform customized treatment. Previous methods of relying only on culture were found to significantly underrepresent the microbes present. Molecular diagnostic techniques provide more comprehensive information about biofilms and chronic infections compared to traditional approaches.
This document discusses next generation sequencing to identify bacteria, fungi, and viruses from patient samples. It summarizes discussions and presentations from several ear, nose, and throat doctors and researchers on using DNA sequencing to diagnose biofilm infections. DNA sequencing was able to identify more pathogens than traditional cultures and provided faster results. Identifying biofilms is important as they are resistant to antibiotics and cause chronic infections. The document promotes using a molecular diagnostic test from PathoGenius to identify pathogens in patient samples, which it says provides faster, more comprehensive results than cultures and is covered by Medicare.
The research interest of the investigator has focused on the molecular and cellular pathogenesis of sepsis. In particular, he has worked on soluble proteins involved in the innate recognition of bacteria such as soluble CD14 and MD-2, as well as in the Toll-like receptors activated by Gram-negative and Gram-positive bacteria. Another area of study is the molecular pathogenesis and cell signaling of ventilator-induced lung injury, and lung inflammation in the context of acute respiratory distress syndrome. He has also identified and tested biomarkers in the field of clinical sepsis.
Watch the presentation on Youtube: https://www.youtube.com/watch?v=CyWN7JlhlmI&
Prospective, randomized comparison of 2 methods of cold snare polypectomy for...ENDONOTICIAS
This study compared two methods of cold snare polypectomy for removing small colorectal polyps: 1) using a dedicated cold snare designed specifically for cold polypectomy, and 2) using a traditional polypectomy snare for cold polypectomy. The study found that using the dedicated cold snare resulted in a significantly higher rate of complete polyp removal compared to the traditional snare, especially for polyps between 8-10mm. Rates of immediate bleeding were similar between the two groups. Histological examination found similar rates of arteries and injured arteries in the submucosa between groups.
class GERONTOLOGICAL NURSINGJournal Article Summary AssignmentT.pdflanuszickefoosebr429
class GERONTOLOGICAL NURSING
Journal Article Summary Assignment:
The purpose of the journal article summary assignment is for students to improve their
knowledge of evidence-based geriatric nursing practice and evidence-based protocols.
Students will review evidence-based literature and reflect on how the literature impacts
their professional nursing practice. Students will summarize two articles published in a
peer-reviewed journal within the last 10 years. The journal articles must address the
geriatric population. Topics will be chosen from the provided list (unless prior approval is
given), and the topic may not be repeated on the two journal article summaries. The
student should summarize each article and discuss how the findings are significant to
clinical practice. Article summaries should use APA format (double spaced, but no cover
page) and should be no more than 3 pages. The two article summaries are 10% of the total
class grade (2 x 5%).
Journal summaries should use the following format:
• Purpose: Describe the purpose of the article/study.
• Strength of Evidence: Identify the type of evidence used to support the findings, and
the strength of the evidence. If the article is based on research, describe the study
design, setting, subjects, and sample size.
• Results: Summarize the findings of the study.
• Limitations: Identify study limitations that may weaken evidence or limit
generalizability.
• Significance: Describe how the findings are significant to geriatric nursing practice.
Do the findings represent a change in practice and how do the findings inform your
nursing practice (what did you learn)?
Topics for journal article summaries and class presentations choose one of those topic and APA
styles
• Pain
• Heart Failure
• Stroke
• Substance/Alcohol Abuse
• Urinary Incontinence
• Sexuality Issues
• Frailty/Fall Risk
• Iatrogenesis
• Sleep Disturbances
• Nutrition
• Hydration
• Orthostatic Hypotension
• Dementia
• Vision
• Hearing
• Polypharmacy
• Cultural Considerations
• Elder Communities
Solution
Ques-1: Purpose:
The purpose of the article is to examine the evidence-based practice of geriatric patients who
have been suffering from “urinary tract infection induced- urinary incontinence”. So that
catheterization of urinary tract have reduce urinary incontinence in geriatric patients thereby it is
essential implement to procedures to reduce urinary infection induced incontinence using
catheters for overflow incontinence
Ques-2:
Catheterization regimen:
\"RCT\" (simple randomized control design) and randomized trial: These two methods used
synonymously. However, it has illustrated that RCT is pertaining to trail design that include
control groups. In this design, patient groups who are receiving experimental treatment compared
with control groups (placebo groups).
In the above design it has clearly can be seen a randomized RCT was performed in two intensive
units of respiratory care of total 2990 bedded tertiary referral medical ce.
Journal Club - Discussion of Heriot et al. Criteria for identifying patients ...Salpy Kelian
Discussing, using many Bobs, how a monte carlo simulation works for a Journal Club paper regarding the modality used for detection of infectious endocarditis.
Hallie Prescott tells us about why the back-end of sepsis matters and is a neglected aspect of our management. This sub-acute phase can really affect long term outcomes. Long term exposure to broad-spectrum antibiotics and too much fluid are aspects that matter and that we can modify.
Introduction: Bloodstream infections (BSIs) are associated with a high mortality rate of 20%-50%. Blood culture is paramount to identify causative agents of BSIs to choose an appropriate antimicrobial therapy. Objectives: The present study was undertaken to analyze the various microorganisms causing BSIs and study their antimicrobial resistance patterns in a tertiary care hospital, Eastern India. Materials and Methods: A total of 239 blood specimens from clinically suspected cases of BSIs were studied for 6 months from July 2015 to December 2015. Blood specimens were incubated in BacT/ALERT ® 3D system (bioMerieux, Durham, NC, USA) a fully automated blood culture system for detection of aerobic growth. Identification and antimicrobial susceptibility testing were conducted on VITEK ® 2 (bioMerieux, Durham, NC, USA) as per Clinical Laboratory Standards Institute guidelines. Results: Out of 239 specimens, 41 (17.2%) yielded growth of different microorganisms. From these isolates, 20 (48.8%) were Gram-negative bacilli, 18 (43.9%) were Gram-positive cocci and rest 3 (7.3%) were yeasts. Among Gram-negative bacilli, Klebsiella pneumoniae sub spp. pneumoniae (70%) was most commonly isolated. Coagulase-negative staphylococci (88.9%) were the most common isolate among Gram-positive cocci. All three Candida spp. isolated were nonalbicans Candida (two Candida tropicalis and one Candida krusei). Gram-negative isolates were least resistant to tigecycline and colistin. All Gram-positive cocci were sensitive to linezolid. Conclusion: Monitoring of data regarding the prevalence of microorganisms and its resistance patterns would help in currently prescribing antimicrobial regimens and improving the infection control practices by formulating policies for empirical antimicrobial therapy.
The document discusses urinary catheters and catheter-associated urinary tract infections (CAUTIs). It provides information on:
- The history and development of urinary catheters from the 1920s to present.
- Risk factors for bacteriuria associated with urinary catheters. Studies show rates of bacteriuria increase significantly within the first week of catheter placement.
- Core strategies and supplemental strategies recommended by healthcare organizations to prevent CAUTIs, such as only using catheters when necessary, maintaining a closed drainage system, and hand hygiene.
This presentation focuses on a recently published paper aiming to create an algorithm for the investigation of patients with new onset fever or instability
This study was designed to investigate the infection rate of nosocomial Acinetobacter spp. in Khalifa hospital, Ajman. A retrospective study was carried out from 2005 to 2008. Bacteriological cultures were used to isolate the organisms by the DADE BEHRING Microscan® to identify the organisms and their antibiotic sensitivity.
The document discusses the future of blood purification techniques for treating sepsis. While recent large RCTs have been negative, the author argues that more research is still warranted for several reasons: (1) Past studies showed promise but had limitations; (2) Different patient populations and timing may yield better results; (3) The exact mechanisms and optimal targets (e.g. cytokines, endotoxins) are still unknown; (4) Many techniques like Oxiris have yet to be thoroughly evaluated in large trials. Overall, the author believes ongoing research into hybrid and futuristic removal of various inflammatory mediators could help modulate the immune response to sepsis.
Similar to 12.15 12.30 lynn hadaway - publiceren (20)
This document summarizes research on complications from intraosseous vascular access. It finds that serious complications are rare, with osteomyelitis occurring in only a few isolated case reports since 1985. Other rare complications include compartment syndrome (18 cases reported), fractures (3 cases), skin necrosis (2 cases), and suspected air embolism (2 cases). The document concludes that with proper technique and monitoring, complications can be avoided, and intraosseous access has been shown to decrease time to vascular access and speed delivery of lifesaving medications.
This document discusses central line-associated bloodstream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs). It provides definitions of CLABSI and CRBSI from the CDC and notes the key differences. It also discusses various prevention strategies matched to the different sources of organisms that can cause infections, including the skin, infusate, and catheter hub manipulation. The document emphasizes the importance of a multidisciplinary approach involving education and training as well as monitoring and surveillance to effectively reduce CLABSIs.
This study examined the use of prefilled saline syringes compared to manually filled syringes for flushing and locking implanted port devices in cancer patients. The study retrospectively analyzed 801 implanted ports, with 303 patients using manually filled syringes and 498 using prefilled saline syringes. The primary outcome was the incidence of catheter-related bloodstream infections requiring port removal. The study found a significantly lower rate of CRBSI in the prefilled saline syringe group compared to the manually filled syringe group. Further controlled studies are needed to confirm these results and examine additional benefits of using prefilled saline syringes.
The document summarizes initiatives at Sutter Roseville Medical Center to reduce central line-associated bloodstream infections (CLABSIs). It describes the hospital's transition from primarily using peripheral IVs and centrally inserted central catheters to now preferring peripherally inserted central catheters (PICCs) placed by ultrasound guidance in the basilic vein, with the goal of reducing CLABSIs. It also outlines enhancements to the hospital's central line bundle, including the addition of maximal barrier precautions and chlorhexidine preparations, to strengthen infection prevention practices for central line insertion and maintenance.
The document compares guidelines from different organizations (RCN, INS, CDC) on various elements of vascular access device (VAD) insertion and maintenance to prevent infection. It discusses recommendations around education and training of healthcare personnel, hand hygiene techniques, use of barrier precautions like masks and gowns, appropriate skin preparation, and securing dressing regimens. The guidelines generally agree but some organizations provide more detailed or stringent recommendations for certain elements like use of maximal sterile barrier precautions during all central line insertions and exchanges. Comparing standards across multiple oversight groups can help clarify best practices.
This document discusses factors that increase the risk of central venous catheter infection related to exit site selection. It identifies moisture, warmth, hair distribution, and poor dressing adherence as increasing contamination risk. The groin is considered very high risk due to these factors. The neck and chest areas are also relatively high risk, especially higher on the neck. More stable, dry sites like the base of the neck and upper arm are lower risk. Proper skin antisepsis and securement are important to prevent bacterial colonization and infection.
This document discusses strategies for preventing catheter-related infections in hemodialysis patients. Central venous catheters are increasingly used for hemodialysis but carry a risk of infectious complications. Several preventive approaches are outlined, including universal precautions, sutureless securement devices, topical antiseptic ointments at exit sites, antimicrobial locking solutions, needleless connectors, and coated catheters. Proper hand hygiene and skin cleansing are also emphasized. Sutureless devices and antimicrobial locks may help reduce infections, but evidence on other strategies like chlorhexidine dressings is less clear. Overall prevention requires a multifaceted approach.
This document summarizes evidence from multiple studies on the use of antimicrobial-coated central venous catheters. It finds that silver alloy and iontophoretic coatings are associated with lower rates of bloodstream infection compared to standard catheters, with silver alloy coatings showing a 58% lower rate. Miconazole/rifampin coatings are also effective at reducing colonization compared to standard and benzalkonium chloride coatings. However, the duration of activity of miconazole/rifampin appears to be greater than chlorhexidine/silver sulfadiazine coatings based on studies of catheter cultures. Cost-effectiveness analyses also indicate that antimicrobial coatings can reduce infection
The document discusses proper maintenance of central line exit sites to prevent catheter-related bloodstream infections (CRBSIs). It recommends:
1) Using 2% chlorhexidine for skin antisepsis before insertion and during dressing changes due to its broad-spectrum antimicrobial activity.
2) Covering the exit site with a semipermeable transparent dressing or gauze/tapes, changing every 2-7 days depending on the dressing.
3) Securing the catheter with sutureless devices instead of sutures to avoid inflammation and heavy skin colonization. Proper exit site care is important for multi-faceted CRBSI prevention bundles.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Financial
Disclosure
• Disclosure
– Literature
search
commissioned
and
funded
by
BD
Medical,
Inc.
– Lynn
Hadaway
is
a
paid
consultant
for
BD
Medical,
Inc.
3. Peripheral
IV
Catheters
• 1.7
Billion
sold
worldwide
– 330
million
sold
annually
in
the
USA
• Even
small
rates
equal
large
number
of
infec6ons
• Many
unanswered
ques6ons
about
outcomes
with
their
use
– Very
liPle
aPen6on
to
infec6on
risks
• Integra6ve
literature
review
to
thoroughly
evaluate
what
is
known
5. Literature
Review
1400
4
case
reports
abstracts
reviewed, 45
met
22
descrip6ve
studies
inclusion
1
cohort
study
588
studies
3
case
controlled
studies
examined
criteria
1
correla6on
study
9
randomized
controlled
trials
4
systema6c
literature
reviews
1
meta-‐analysis
Final
report
will
be
published
in
Journal
of
Infusion
Nursing,
July/August
2012
6. Literature
Review
• 22
countries
– Canada
– Lebanon
– Spain
– Scotland
– Taiwan
– Israel
– Uganda
– Chile
– Korea
– Germany
– Barxil
– USA
– United
– Switzerland
– Italy
Kingdom
– Netherlands
– Australia
– Turkey
– England
– Austria
– New
Zealand
– Japan
7. Types
of
Infec6ons
• Local
infec6ons
(case
reports)
• Celluli6s
and
sob
6ssue
infec6ons
• Osteomyeli6s
• 3
children
with
osteomyeli6s
in
close
proximity
to
peripheral
catheter
site;
skin
organisms
lead
to
thrombophlebi6s
and
then
osteomyeli6s
8. Types
of
Infec6ons
• Phlebi6s/thrombophlebi6s
– Ranges
from
2%
to
80%
– 5%
to
25%
of
peripheral
catheters
colonized
with
bacteria
at
removal
– No
data
on
rates
of
each
type
of
phlebi6s
• Suppura6ve
thrombophlebi6s-‐
purulent
drainage
from
inser6on
site
9. Types
of
Infec6ons
–
BSI/Bacteremia
Systema6c
Literature
Review
(Maki,
2006)
• Studies
from
January
1966-‐July
1,
2005
• 110
studies
of
plas6c
catheters
• 10,910
catheters;
28,720
device-‐days
• 13
BSIs
=
pooled
mean
rate
of
0.1
event
per
100
devices
• 0.4
pooled
mean
events
per
1000
device
days
• Lowest
rates
of
all
devices
by
percentage
10. Types
of
Infec6ons
–
BSI/Bacteremia
Lowest
Rates
but
High
Absolute
Numbers
• 330
million
catheter
sold
annually
in
USA
• 2
aPempts,
2
catheters
per
site
• 165
million
inserted
• 165,000
pa6ents
with
BSI
annually
11. Types
of
Infec6on
–
BSI/Bacteremia
• Retrospec6ve
• 544
cases
analysis
of
S.
• 18
definite,
6
probably
cases
of
bacteremia
aureus
related
to
short
peripheral
IV
catheters
bacteremia
• 12%
of
all
S.
aureus
bacteremias
from
July
2005
• 67%
of
definite
cases
inserted
in
Emergency
thru
March
Dept;
46%
in
right
antecubital,
21%
in
leb
2008
antecubital
• Calculated
rate
of
0.06
bacteremias
per
1000
• Blood
and
catheter
days
catheter
6p
• Annual
adult
pa6ent
discharge
data
from
USA
cultures
• Es6mated
10,028
S.
aureus
bacteremias
correlated
to
annually
in
hospitalized
adults
clinical
findings
12. Author,
Year,
Numbers
PVC
Infection
Rates
Reported
Country
Maki,
USA,
2006
110
studies
0.1
BSIs
per
100
devices
Literature
review
10,910
PVCs
0.4
mean
#
BSIs
per
1000
device
days
spanning
38.5
years
28,720
device-‐days
Pujol,
Spain,
2007
147
patients
PVC=
77
(51%)
or
0.19
cases/1000
patient
days
Descriptive
study
over
CVC=
73
(49%)
or
0.18
cases/1000
18
months
patient
days
Nahirya,
Uganda,
2008
391
PVC
cultured
81
(20.72%)
colonized
PVC
tip
catheter
tip,
hub,
and
44
(11.25%)
colonized
PVC
hub
blood
19
(4.86%)
with
same
organism
at
tip
and
hub
16
(4.09%)
PVC
tip
with
same
organism
as
blood
7
(1.79%)
with
same
organisms
at
tip,
hub
and
in
blood
13. Author,
Year,
Numbers
PVC
Infection
Rates
Reported
Country
Lee,
Taiwan,
2009
3165
patients
with
160/162
PVCs
(98.8%)
with
phlebitis;
6538
PVCs
showed
no
microbiological
evidence
of
Semi-‐quantitative
infection
culture
of
all
catheters
No
purulent
exit
site
infection
at
removal.
No
CRBSI
Webster,
Australia,
6
RCTs
comparing
Catheter
related
bacteremia:
2010
routine
change
at
• Low
risk
population
=
1/1000
device
_ixed
time
interval
vs
days
in
both
groups
when
clinically
• High
risk
population
=
7/1000
indicated
device
days
in
routine
removal
3455
participants
group;
4/1000
removal
when
1
trial
in
England
clinically
indicated
5
in
Australia
4
published
2
unpublished
14. BSI/Bacteremia
–
USA
• Retrospec6ve
• 544
cases
analysis
of
S.
• 18
definite,
6
probably
cases
of
bacteremia
aureus
related
to
short
peripheral
IV
catheters
bacteremia
• 12%
of
all
S.
aureus
bacteremias
from
July
2005
• 67%
of
definite
cases
inserted
in
Emergency
thru
March
Dept;
46%
in
right
antecubital,
21%
in
leb
2008
antecubital
• Calculated
rate
of
0.06
bacteremias
per
1000
• Blood
and
catheter
days
catheter
6p
• Annual
adult
pa6ent
discharge
data
from
USA
cultures
• Es6mated
10,028
S.
aureus
bacteremias
correlated
to
annually
in
hospitalized
adults
clinical
findings
15. Pathophysiology
• Not
well
understood
• Most
likely
mechanism
of
peripheral
catheter-‐BSI
– Coloniza6on
of
the
vascular
catheter
tract
– Biofilm
forma6on
– Occurs
during
inser&on
and
manipula&on
– No
evidence
about
the
connec6on
between
thrombophlebi6s
and
BSI
(Zingg
&
PiPet,
2009)
16. Iden6fied
Clinical
Issues
–
Catheter
Design
• Ported
catheters
– German
study
found
27%
of
pa6ents
with
possible
infec6on
from
ported
catheters
(Grune,
2004)
• 2495
catheters,
1582
pa6ents
• 104
events
per
1000
catheter
days
• Fever
and
local
signs
and
symptoms
• No
culture
data
provided
17. Iden6fied
Clinical
Issues
–
Skin
An6sepsis
• No
studies
suppor6ng
applica6on
technique
– Circular
mo6on
or
back
and
forth?
• Specific
agents,
applica6on
&
drying
6me
• Venipuncture
for
blood
culture
and
blood
donor
collec6on
focuses
on
skin
an6sepsis
with
chlorhexidine
gluconate
18. Iden6fied
Clinical
Issues
–
Skill
of
Inserters
Taiwanese
study
(Lee,
2009)
• By
emergency
dept
nurses
–
3.7%
with
phlebi6s
• By
IV
nurses
–
2.1%
with
phlebi6s
• All
phlebi6s
was
considered
to
be
infec6ous
• 160/162
phlebi6s
cases
had
microbial
evidence
of
coloniza6on
• No
purulence
or
BSIs
reported
USA
study
(Palefski,
2001)
• 639
catheters
inserted
by
IV
nurses;
137
inserted
by
generalists
nurses
• 36%
by
generalist
nurses,
20%
by
IV
nurses
removed
for
complica6on
• No
reports
of
infec6on
in
either
group
19. Iden6fied
Clinical
Issues
–
Predisposi6on
to
Phlebi6s
Higher
rates
with
more
than
1
catheter
site
• 1st
catheter
with
phlebi6s
=
5.1
X
more
likely
to
have
phlebi6s
with
subsequent
catheter
• Pain
on
infusion
with
1st
catheter
=
11.7
X
more
likely
with
subsequent
catheters
(Palefski,
2001)
• 1st
catheter
–
phlebi6s
rates
of
2.7%
• 2
or
more
catheters
=
phlebi6s
rate
of
13.4%
(Gallant,
2006)
20. Iden6fied
Clinical
Issues
–
Vein
Visualiza6on
Technology
Infrared
light
• No
infec6on
data
reported
yet
• ED
physicians
inser6ng
18
g
into
deep
basilic
or
brachial
veins
• Chlorhexidine
skin
prep,
sterile
coupling
gel,
sterile
transparent
dressing
covering
probe
Ultrasound
• No
infec6ons,
47%
with
infiltra6ons
within
24
hours
(Dargin,
2009)
–
2
studies
• Retrospec6ve
data
on
804
ED
pa6ents
• 402
with
tradi6onal
methods;
3
skin/sob
6ssue
infec6ons
• 402
with
ultrasound;
nonsterile
glove
and
nonsterile
bacteriosta6c
lubricant
gel;
2
skin/sob
6ssue
infec6ons
(Adhikari,
2010)
21. Iden6fied
Clinical
Issues
–
Catheter
Stabiliza6on
Catheter
with
Tradi6onal
catheter
hub
Mul6ple
studies
on
stabiliza6on
plamorm
plus
with
stabiliza6on
device
securement
dressing
added
stabiliza6on
devices
• None
have
included
data
on
any
type
of
infec6ons
• Fewer
unplanned
restarts
due
to
phlebi6s
reported
22. Issues
Iden6fied
• Many
prac6ce
differences
between
countries
• Varia6ons
in
study
design
• Varia6ons
in
data
analysis
– Infec6ous
episodes
per
1000
catheter
days
vs
1000
pa6ent
days
23. Issues
Iden6fied
• No
data
on
each
type
of
phlebi6s
– Mechanical
• Catheter
size
in
rela6on
to
vein
diameter
• Catheter
stabiliza6on
– Chemical
• pH
• Osmolarity
• Vesicant
nature
– Infec6ous
24. Unanswered
Ques6ons
• Many
aspects
are
NOT
addressed
in
studies
– Hand
hygiene
– Catheter
and
site
selec6on
– Skin
an6sepsis
– Catheter
stabiliza6on
– Catheter
dressing
– Use
of
add-‐on
devices
(e.g.,
extension
sets,
needleless
connectors)
– Catheter
removal
– Tourniquet
use
–
single
pa6ent?
– Source
of
flush
solu6on
–
single
dose
container?
25. Peripheral
Catheters
Cause
Infec6on
Exact
number
and
rates
are
hard
to
determine
with
current
studies
Pathophysiology
is
not
well
understood
Many
cases
go
undetected
Preven6on
is
dependent
upon
knowledge
and
skill
of
caregiver
following
published
standards
and
guidelines
More
studies
are
needed!!