scholarly journals Reducing catheter-associated complications using 4% sodium citrate versus sodium heparin as a catheter lock solution

2019 ◽  
Vol 47 (9) ◽  
pp. 4204-4214
Author(s):  
He-ming Huang ◽  
Xin Jiang ◽  
Ling-bing Meng ◽  
Chen-yi Di ◽  
Peng Guo ◽  
...  
Keyword(s):  
Sodium Citrate ◽  
Decisive Role ◽  
Indwelling Catheters ◽  
Sodium Heparin ◽  
Lock Solution ◽  
Catheter Obstruction ◽  
Different Types ◽  
Catheter Lock ◽  
Better Than

Objective Use of a catheter lock solution plays a decisive role in vascular access. The effects of different concentrations of heparin and different types of catheter lock solutions are controversial. Therefore, this study aimed to compare the efficacy and safety of sodium citrate and sodium heparin catheter lock solutions. Methods A total of 120 patients were divided into four groups (30 patients per group) according to the use of catheter lock solution as follows: 6250 U/mL sodium heparin, 5000 U/mL sodium heparin, 2500 U/mL sodium heparin, and 4% sodium citrate. Coagulation function and the incidence of catheter occlusion, hemorrhage, and catheter-related infections were recorded. Results The different catheter lock solutions were significantly related to conduit blockage, hemorrhage, infection, and leakage levels. In the 4% sodium citrate group, the odds ratio was 0.688 for conduit blockage (95% confidence interval [CI], 0.206–2.297), 0.286 for hemorrhage (95% CI, 0.091–0.899), 0.266 for infection (95% CI, 0.073–0.964), and 0.416 for leakage (95% CI, 0.141–1.225) compared with the 6250 U/mL sodium heparin. Conclusions The solution 4% sodium citrate can effectively reduce the risk of catheter obstruction, bleeding, infection, and leakage better than sodium heparin in patients with long-term intravenous indwelling catheters.

scholarly journals Compatibility, Stability, and Efficacy of Vancomycin Combined With Gentamicin or Ethanol in Sodium Citrate as a Catheter Lock Solution

2017 ◽  
Vol 52 (10) ◽  
pp. 685-690
Author(s):  
Yangjie Wei ◽  
Joshua WonJoon Yang ◽  
Sai HS. Boddu ◽  
Rose Jung ◽  
Mariann D. Churchwell
Keyword(s):  
Chemical Stability ◽  
Sodium Citrate ◽  
Chronically Ill ◽  
Storage Conditions ◽  
Entire Study ◽  
Indwelling Catheters ◽  
Source Of Infection ◽  
Lock Solution ◽  
All Solutions

Background: Indwelling catheters deliver lifesaving medical treatments for many chronically ill patients but are frequently a source of infection. Treatment may include an antimicrobial agent(s) and anticoagulant solution dwelling within the catheter. In vitro determinations of solution compatibility and stability are necessary prior to use in patients. Objective: The aim of this study was to determine the physical compatibility, chemical stability, and antimicrobial activity of vancomycin (5 or 10 mg/mL) with gentamicin (1 mg/mL) or 40% ethanol in 4% sodium citrate lock solution over 72 hours. Methods: All solutions were prepared per manufacturer’s instructions. Samples were studied under 4 conditions: (1) 25°C with light, (2) 25°C without light, (3) 37°C with light, and (4) 37°C without light. Physical compatibility and chemical stability were assessed at 0, 24, 48, and 72 hours. Antimicrobial susceptibility testing was conducted at 0 and 72 hours. All studies were carried out in triplicate. Results: All solution combinations under each condition remained patent from baseline to 48 hours. One solution combination of vancomycin (5 mg/mL) and ethanol (40% v/v) in 4% sodium citrate revealed a slight turbidity at 72 hours. Clarity and pH remained stable in all other solutions during the entire study period. Chemical compatibility and antibiotic activity ranged from 95% to 105% and 95% to 106% of initial baseline values, respectively, for all solutions under 4 storage conditions. Conclusions: All antibiotic-anticoagulant lock solutions were found to be physically, chemically, and microbiologically stable during the 72-hour study period except vancomycin (5 mg/mL) and ethanol (40% v/v) in 4% sodium citrate solution which showed slight turbidity at 72 hours.

scholarly journals Optimal Antimicrobial Catheter Lock Solution, Using Different Combinations of Minocycline, EDTA, and 25-Percent Ethanol, Rapidly Eradicates Organisms Embedded in Biofilm

2006 ◽  
Vol 51 (1) ◽  
pp. 78-83 ◽  
Author(s):  
Issam Raad ◽  
Hend Hanna ◽  
Tanya Dvorak ◽  
Gassan Chaiban ◽  
Ray Hachem
Keyword(s):  
Antimicrobial Agents ◽  
Candida Parapsilosis ◽  
Triple Combination ◽  
Intravenous Therapy ◽  
Indwelling Catheters ◽  
Methicillin Resistant ◽  
Lock Solution ◽  
Colonization Model ◽  
Catheter Lock ◽  
Number Of Segments

ABSTRACT Antimicrobial lock solutions may be needed to salvage indwelling catheters in patients requiring continuous intravenous therapy. We determined the activity of minocycline, EDTA, and 25% ethanol, alone or in combination, against methicillin-resistant Staphylococcus aureus and Candida parapsilosis catheter-related bloodstream infection strains in two established models of biofilm colonization. Biofilm-colonized catheter segments from a modified Robbins device and a silicone disk biofilm colonization model were exposed to these antimicrobial agents for 15 or 60 min, respectively. After exposure, segments were sonicated and cultured. To determine regrowth after incubation at 37°C, following the brief exposure to the antimicrobial agents, an equal number of segments were washed, reincubated for 24 h, and then sonicated and cultured. The triple combination of minocycline-EDTA (M-EDTA) in 25% ethanol was the only antimicrobial lock solution that completely eradicated S. aureus and C. parapsilosis in biofilm of all segments tested in the two models, and it completely prevented regrowth. In addition, M-EDTA in 25% ethanol was significantly more effective in rapidly eradicating the growth or regrowth of methicillin-resistant S. aureus and C. parapsilosis biofilm colonization in the two models than the other solutions—minocycline, EDTA, M-EDTA, 25% ethanol, and EDTA in ethanol. We conclude that M-EDTA in 25% ethanol is highly effective at rapidly eradicating S. aureus and C. parapsilosis embedded in biofilm adhering to catheter segments.

Salvage of Long-Term Central Venous Catheters During an Outbreak ofPseudomonas putidaandStenotrophomonas maltophiliaInfections Associated With Contaminated Heparin Catheter-Lock Solution

2008 ◽  
Vol 29 (2) ◽  
pp. 125-130 ◽  
Author(s):  
M. Beatriz Souza Dias ◽  
Alina Bernardes Habert ◽  
Vera Borrasca ◽  
Valeska Stempliuk ◽  
Aina Ciolli ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Central Venous Catheters ◽  
High Response Rate ◽  
Care Hospital ◽  
Central Venous ◽  
Blood Samples ◽  
Asymptomatic Patients ◽  
Lock Solution ◽  
Catheter Lock

Objective.To describe the management of patients with long-term central venous catheters (CVCs) during an outbreak of infection due toPseudomonas putidaandStenotrophomonas maltophiliaassociated with contaminated heparin catheter-lock solution.Design.Descriptive study.Setting.Private, 250-bed tertiary-care hospital.Methods.In March 2003, we identified 2 febrile cancer patients withP. putidabacteremia. Over 2 days, 7 cases of bacteremia were identified; lots of syringes prefilled with heparin catheter-lock solution, supplied by a compounding pharmacy, were recalled and samples were cultured. More cases of bacteremia appeared during the following days, and any patient who had had a catheter lock infused with the suspect solution was asked to provide blood samples for culture, even if the patient was asymptomatic. Isolates that were recovered from culture were typed by pulsed-field gel electrophoresis. Antimicrobial salvage treatment of long-term CVCs was attempted.Results.A total of 154 patients had had their catheter lock infused with solution from the lots that were suspected of being contaminated. Only 48 of these patients had CVCs. By day 7 of the outbreak, 18 of these patients had become symptomatic. Twenty-six of the remaining 30 asymptomatic patients then also provided blood samples for culture, 10 of whom developed fever shortly after samples were collected. Thirty-two patients were identified who hadP. putidabacteremia; 9 also had infection due toS. maltophilia. Samples from 1 of the 3 lots of prefilled syringes in use at the time of the outbreak also grewP. putidaon culture. Molecular typing identified 3 different clones ofP. putidafrom patients and heparin catheter-lock solution, and 1 clone ofS. maltophilia. A total of 27 patients received antimicrobial therapy regimens, some of which included decontamination of the catheter lock with anti-infective lock solution. Of 27 patients, 19 (70%) retained their long-term CVC during the 6-month follow-up period.Conclusions.To our knowledge, this is one of the largest prospective experiences in the management of bloodstream infection associated with long-term CVCs. The infections were caused by gram-negative bacilli and were managed without catheter removal, with a high response rate. We emphasize the risks of using intravenous formulations of medications supplied by compounding pharmacies that produce large quantities of drugs.

scholarly journals Undercatch Adjustments for Tipping-Bucket Gauge Measurements of Solid Precipitation

2020 ◽  
Vol 21 (6) ◽  
pp. 1193-1205 ◽  
Author(s):  
John Kochendorfer ◽  
Michael E. Earle ◽  
Daniel Hodyss ◽  
Audrey Reverdin ◽  
Yves-Alain Roulet ◽  
...  
Keyword(s):  
Transfer Functions ◽  
Test Results ◽  
Monitoring Networks ◽  
New Approach ◽  
Solid Precipitation ◽  
New Methods ◽  
Different Types ◽  
Precipitation Records ◽  
Better Than

AbstractHeated tipping-bucket (TB) gauges are used broadly in national weather monitoring networks, but their performance for the measurement of solid precipitation has not been well characterized. Manufacturer-provided TB gauges were evaluated at five test sites during the World Meteorological Organization Solid Precipitation Intercomparison Experiment (WMO-SPICE), with most gauge types tested at more than one site. The test results were used to develop and evaluate adjustments for the undercatch of solid precipitation by heated TB gauges. New methods were also developed to address challenges specific to measurements from heated TB gauges. Tipping-bucket transfer functions were created specifically to minimize the sum of errors over the course of the adjusted multiseasonal accumulation. This was based on the hypothesis that the best transfer function produces the most accurate long-term precipitation records, rather than accurate catch efficiency measurements or accurate daily or hourly precipitation measurements. Using this new approach, an adjustment function derived from multiple gauges was developed that performed better than traditional gauge-specific and multigauge catch efficiency derived adjustments. Because this new multigauge adjustment was developed using six different types of gauges tested at five different sites, it may be applicable to solid precipitation measurements from unshielded heated TB gauges that were not evaluated in WMO-SPICE. In addition, this new method of optimizing transfer functions may be useful for other types of precipitation gauges, as it has many practical advantages over the traditional catch efficiency methods used to derive undercatch adjustments.

MO786HEPARIN VERSUS SODIUM BICARBONATE CATHETER LOCK SOLUTION: AN ALTERNATIVE LOCK HEMODIALYSIS CATHETER?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Francesca Partipilo ◽  
Francesco Detomaso ◽  
Stefania Pietanza ◽  
Giuseppe Gernone
Keyword(s):  
Sodium Bicarbonate ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Exit Site Infection ◽  
Hemodialysis Catheter ◽  
Sodium Heparin ◽  
Lock Solution ◽  
Catheter Lock ◽  
The Many ◽  
Wbc Count

Abstract Background and Aims Infections and thrombosis of central venous catheter (CVC) in hemodialysis patients are the major causes of catheter loss resulting in hospitalization and increased costs. Interdyalitic catheter lock solutions, usually heparin, avoid these complications. Among the many, sodium bicarbonate has been proved as effective and safe catheter lock solution due to its antimicrobial and antithrombotic properties. The aim of this study was to compare the efficacy of two different CVC lock solution: sodium heparin versus sodium bicarbonate, to prevent catheter–related thrombosis and infection in hemodialysis patients Method They were enrolled, in a 12 months case-control study, 17 hemodialysis patients with tunneled hig-flux CVC (femoral or internal jugular). Each patient was evaluated in its common treatment for CVC dysfunction (Qb, CVC that works in reverse branches during the hemodialysis session, use of urokinase or extra lock with sodium heparin or 4% citrate) and infection (WBC count, C reactive protein -CRP, bloodstream culture, exit-site infection -ESI) during standard sodium heparin CVC lock solution (hep-lock), for the first 6 months, and then, during sodium bicarbonate lock solution (10 mEq/10 ml, bic-lock) for following 6 months. aPTT, PLT, Hct and albumin are also montly evaluated. Type and anticoagulant dose during hemodialysis sessions were unchanged over the study as well as any antiplatelet/anticogulant home therapy. Results Fifteen patients on 17 completed the study and the main results are reported in table 1. There were no significant differences between patients on demographics and number of catheter days treatments for both study periods. The blood flow was similar in either study phases and stable during the hemodialysis sessions (Qb 225±13 ml/m’ at 2-hours vs 225±15 ml/min at start of dialysis), even the use of reverse branches was similar. Hep-lock showed a lower usage of extra lock drug in comparison with Bic-lock (0,4% vs 3,1%, p<0,05), data confirmed also for Urokinase (1,9% vs 3,4%, p=0,274). None bloodstream are registred while ESI and WBC count show no significant differences between two study periods. No HD catheter was loss during the study due to thrombosis or infection. Finally, Hct, CRP and Albumin was found slightly lower on Bic-lock phase. Conclusion There is no CVC ideal lock solution and although sodium bicarbonate is inexpensive and readily avalaible our data shows better CVC performances with sodium heparin.

Evaluating Reminders for Medication Adherence and Side Effects in M-Health Environment

2020 ◽  
Vol 12 (3) ◽  
pp. 57-73
Author(s):  
Neetu Singh ◽  
Upkar Varshney
Keyword(s):  
Medication Adherence ◽  
Side Effects ◽  
Mobile Health ◽  
Healthcare Providers ◽  
Context Aware ◽  
Policy Makers ◽  
Different Types ◽  
Future Work ◽  
Better Than

Reminders are a very promising intervention for improving medication adherence in mobile health environment. From the published literature, this research find that effectiveness of reminders varies widely and side effects of reminders have not been studied. To address these, this article develops an analytical model to evaluate different types of reminders for medication adherence. The model is also used to estimate side effects of the reminders. The results indicate that context-aware reminders perform better than simple reminders in improving medication adherence for willing patients in mobile health environment. Simple and persistent reminders also lead to more side effects than context-aware reminders. The results of this study will be useful for patients, healthcare providers, researchers and policy makers in improved decision making for medication adherence. The future work can include development of smart reminders to meet different requirements of patients, healthcare professionals and payers in terms of personalization, performance, long-term effectiveness, reliability, and health outcomes.

scholarly journals GC-FID and Olfactometry-Assisted Assessment of Odors from Polymeric Foams under Normal and Repeated-Use Conditions

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Alena Capíková ◽  
Daniela Tesařová ◽  
Josef Hlavaty ◽  
Adam Ekielski ◽  
Pawan Kumar Mishra
Keyword(s):  
Decisive Role ◽  
Average Score ◽  
Polymeric Foams ◽  
Ionization Detector ◽  
Flame Ionization ◽  
Pu Foam ◽  
Different Types ◽  
Repeated Use ◽  
Use Studies

Polymeric foams are the primary components of upholstered furniture, and their emissions play a decisive role in the acceptability of the final furniture product. This study is focused on passive emissions and odors from commercial foams under normal and repeated-use conditions. Six different types of foams, viz., highly elastic foam K5040, standard PU foam N5063, bonded polyurethane foam R100, viscoelastic foam V5020, self-extinguishing foam KF5560, and foam rubber, were used. The samples were collected at the intervals of 72 hours and 672 hours (28 days) to identify the odors due to chemical reactions in the material or slowly released due to its porous structure. Additionally, repeated-use studies were done to understand the effect of prolonged usage/natural ageing on emitted odors from the foams. The samples were tested as per ČSN EN 13 725 (2005) and ISO 16000-6 (2011) criteria using GC-FID (gas chromatography-flame ionization detector) and olfactometry. The most unpleasant substance was found to be nonanal, with an average score of -4 (unpleasant). A total of 23 compounds were identified (5 unidentified) using olfactometry; however, only 11 of them were confirmed by GC-FID-based testing. Any new compound or increase in odor intensity was not observed in long-term measurements and simulated repeated-use conditions.

The Acute Effect of Alcohol on Various Memory Processes

2010 ◽  
Vol 24 (4) ◽  
pp. 249-252 ◽  
Author(s):  
Márk Molnár ◽  
Roland Boha ◽  
Balázs Czigler ◽  
Zsófia Anna Gaál
Keyword(s):  
Low Dose ◽  
Short Term Memory ◽  
Acute Effect ◽  
Long Term Memory ◽  
Term Memory ◽  
Memory Processes ◽  
Different Types ◽  
The Brain ◽  
Legal Consequences

This review surveys relevant and recent data of the pertinent literature regarding the acute effect of alcohol on various kinds of memory processes with special emphasis on working memory. The characteristics of different types of long-term memory (LTM) and short-term memory (STM) processes are summarized with an attempt to relate these to various structures in the brain. LTM is typically impaired by chronic alcohol intake but according to some data a single dose of ethanol may have long lasting effects if administered at a critically important age. The most commonly seen deleterious acute effect of alcohol to STM appears following large doses of ethanol in conditions of “binge drinking” causing the “blackout” phenomenon. However, with the application of various techniques and well-structured behavioral paradigms it is possible to detect, albeit occasionally, subtle changes of cognitive processes even as a result of a low dose of alcohol. These data may be important for the consideration of legal consequences of low-dose ethanol intake in conditions such as driving, etc.

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