Reverse tapered versus non-tapered peripherally inserted central catheters: A narrative review

Safety And Efficacy ◽

Introduced over 20 years ago, the reverse tapering design for PICC catheters is supposed to have some benefits in terms of both efficacy and safety. In particular, it would ensure less postoperative bleeding at the exit site and greater effectiveness in preventing kinking or twisting of the same. Since its introduction, these hypothesized advantages have never been demonstrated in clinical studies, however very scarce, which have highlighted neither advantages nor disadvantages of reverse tapered catheters when compared to non-reverse tapered ones. This narrative review analyzes some aspects of the use of reverse tapered PICCs, also paying attention to some possible undesirable effects that have arisen from the introduction into clinical practice of new subcutaneous systems of securement of PICCs to the skin. Clinicians should be aware of the fact that reverse tapering design does not represents a sure improvement in terms of safety and efficacy of PICCs and its adoption should be weighed against possible clinical disadvantages.

What Evidence Do We Have for Pharmaceutical Galactagogues in the Treatment of Lactation Insufficiency?—A Narrative Review

Nutrients ◽

10.3390/nu11050974 ◽

2019 ◽

Vol 11 (5) ◽

pp. 974 ◽

Cited By ~ 7

Author(s):

Luke E. Grzeskowiak ◽

Mary E. Wlodek ◽

Donna T. Geddes

Keyword(s):

Clinical Practice ◽

Breast Milk ◽

Milk Composition ◽

Narrative Review ◽

Pharmacological Intervention ◽

Future Research ◽

Individual Treatment ◽

Efficacy And Safety ◽

Milk Supply ◽

Insufficient Milk

Inadequate breast milk supply is a frequently reported reason for early discontinuation of breastfeeding and represents a critical opportunity for intervening to improve breastfeeding outcomes. For women who continue to experience insufficient milk supply despite the utilisation of non-pharmacological lactation support strategies, pharmacological intervention with medications used to augment lactation, commonly referred to as galactagogues, is common. Galactagogues exert their pharmacological effects through altering the complex hormonal milieu regulating lactation, particularly prolactin and oxytocin. This narrative review provides an appraisal of the existing evidence regarding the efficacy and safety of pharmaceutical treatments for lactation insufficiency to guide their use in clinical practice. The greatest body of evidence surrounds the use of domperidone, with studies demonstrating moderate short-term improvements in breast milk supply. Evidence regarding the efficacy and safety of metoclopramide is less robust, but given that it shares the same mechanism of action as domperidone it may represent a potential treatment alternative where domperidone is unsuitable. Data on remaining interventions such as oxytocin, prolactin and metformin is too limited to support their use in clinical practice. The review provides an overview of key evidence gaps and areas of future research, including the impacts of pharmaceutical galactagogues on breast milk composition and understanding factors contributing to individual treatment response to pharmaceutical galactagogues.

Alteplase for Treatment of Occluded Peripherally Inserted Central Catheters: Safety and Efficacy in 240 Patients

Journal of Vascular and Interventional Radiology ◽

10.1097/01.rvi.000099538.29957.f7 ◽

2004 ◽

Vol 15 (1) ◽

pp. 45-49 ◽

Cited By ~ 13

Author(s):

Rita Ng ◽

Xin Li ◽

Tri Tu ◽

Charles P. Semba

Keyword(s):

Safety And Efficacy ◽

COVID-19 Pandemic - A Narrative Review of the Potential Roles of Chloroquine and Hydroxychloroquine

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/s351 ◽

2020 ◽

Vol 4S;23 (8;4S) ◽

pp. S351-S366

Author(s):

Vanessa B. Boralli

Keyword(s):

Adverse Effects ◽

Cardiac Arrhythmias ◽

Clinical Studies ◽

Narrative Review ◽

Efficacy And Safety ◽

Length Of Treatment ◽

Lack Of Information ◽

Small Patient ◽

High Doses

Background: Chloroquine (CQ) and hydroxychloroquine (HCQ) are old drugs used against malaria, rheumatism, inflammation in the joints, lupus, among others. These drugs showed positive results in preliminary scientific research for treatment of the severe acute respiratory syndrome coronavirus (SARS-CoV-2). Since the studies with CQ and HCQ are initial with small patient populations, it is not yet known whether there are adverse effects from the use of CQ and HCQ for patients infected with the coronavirus. Objectives: The aim of this study was to evaluate the evidence regarding the efficacy and safety of CQ and HCQ used against viral infection caused by SARS-CoV-2. Study Design: This is a narrative review of the traditional prescriptions of CQ and HCQ efficacy and adverse effects as well as their employment for coronavirus disease 2019 (COVID-19). Setting: In vitro and clinical studies comparing the antiviral efficacy and adverse effect profile of CQ and HCQ against COVID-19 in adult patients were evaluated. Methods: A systemic search of reviews, including in vitro and clinical trial studies in English focusing on CQ and HCQ effects and adverse effects against COVID-19 in the adult patient population from PubMed was performed. It included studies reporting chloroquine and hydroxychloroquine effects and adverse effects against COVID-19. Results: A total of 42 articles published between 2004 and April 2020 were reviewed for therapeutic use of CQ and HCQ. Both these drugs showed a significant in vitro potential against coronavirus. Many studies for clinical use of CQ and HCQ showed that patients presented adverse reactions on high doses. Limitations: Clinical studies have some methodology shortcomings, such as lack of information about the treatment and small number of experimental patients, leading to a misinterpretation of the data. Besides, there are few clinical studies with a limited sample size. Moreover, most of them did not present control groups, and some patients had died during these protocols. Discussion: Despite both CQ and HCQ in vitro antiviral evidence, clinically, both drugs, either alone or combined with other medications, may increase the risk of cardiac arrhythmias, leading to cardiac arrest and sudden death. Besides, a lot of uncertainty still remains, such as starting administration period, dose prescribed, length of treatment, patients’ condition, concomitant drug use, among others. Conclusion: From the studies reviewed, it is not possible to state the precise efficacy and safety of CQ and HCQ use in the treatment of COVID-19 at any time in the course of the disease. Future studies are warranted. Key words: SARS-CoV-2; COVID-19; chloroquine; hydroxychloroquine; pandemic; coronavirus; adverse effects; side effects; cardiac arrhythmias; ocular toxicity, retinopathy; pharmacokinetic.

Reduction of bacterial colonization at the exit site of peripherally inserted central catheters: A comparison between chlorhexidine-releasing sponge dressings and cyano-acrylate

The Journal of Vascular Access ◽

10.1177/1129729820954743 ◽

2020 ◽

pp. 112972982095474

Author(s):

Emanuele Gilardi ◽

Alfonso Piano ◽

Pietro Chellini ◽

Barbara Fiori ◽

Laura Dolcetti ◽

...

Keyword(s):

Bacterial Colonization ◽

Central Venous Access ◽

Exit Site ◽

Cyanoacrylate Glue ◽

Skin Culture ◽

Local Bleeding ◽

Group A ◽

Group B ◽

Introduction: A serious complication associated with Central Venous Access Device (CVAD) is infection because of bacterial contamination, either by the extra-luminal or by the intra-luminal route. We evaluated the efficacy, the safety, and the cost-effectiveness of two strategies for non-inferiority in controlling bacterial colonization of the exit-site of Peripherally-Inserted Central Catheters (PICC). Methods: After PICC placement, a skin swab of the exit site was taken and cultured. In group A the exit site was sealed with N-butyl-cyanoacrylate glue, while in group B a chlorhexidine-releasing sponge dressing was applied. A second skin culture was taken at day 7. Results: A total of 51 patients were enrolled in each group. In 42 patients the second skin culture was not performed because of 20 patients were lost at follow-up or deceased and in 22 patients the dressing needed to be changed early, because of local bleeding (13 cases, in group B) or because of dressing detachment (four in group A and five in group B). The microbiological study was completed in 36 patients in group A and 24 in group B. No microorganisms were isolated in any patient. Conclusions: Both strategies were effective in controlling bacterial colonization. Glue was effective in reducing local bleeding, and it was more cost-effective than sponge dressing. During the first week, when local bleeding and bacterial colonization must be prevented, glue might be more appropriate than chlorhexidine-releasing dressing; after the first week chlorhexidine-releasing dressing might be preferable, considering that the safety of glue application on the skin for prolonged periods is still questionable.

Whole Medical Systems versus the System of Conventional Biomedicine: A Critical, Narrative Review of Similarities, Differences, and Factors That Promote the Integration Process

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2017/4904930 ◽

2017 ◽

Vol 2017 ◽

pp. 1-13 ◽

Cited By ~ 7

Author(s):

Erik W. Baars ◽

Harald J. Hamre

Keyword(s):

Clinical Practice ◽

Conventional Medicine ◽

Narrative Review ◽

Future Research ◽

Integration Process ◽

Medical Systems ◽

Methodological Issues ◽

High Quality Research ◽

Safety And Efficacy ◽

Legal Frameworks

Background. There is an increasing need for a worldwide professional integration of conventional medicine and traditional/complementary whole medical systems (WMSs). However, the integration is perceived by conventional medicine as problematic or unacceptable, because of a supposed lack of evidence for specific effects of WMSs therapies and supposed prescientific or unscientific paradigms of WMSs. Objectives. To review the literature on the features of WMSs, similarities and differences between conventional medicine and WMSs, and scientific and clinical practice issues that should be dealt with in order to promote the integration process. Methods. A critical, narrative review of the literature on six WMSs. Results and Conclusions. Key factors for the integration of WMSs and conventional medicine are as follows: legal frameworks, quality standards, high-quality research on safety and efficacy of WMS interventions, infrastructure, and financial resources. For scientific assessment of WMSs, there are unresolved ontological, epistemological, and methodological issues and issues of diagnostics, therapy delivery, and outcome assessment in clinical practice. Future research not only should be directed at quality assurance and generating the necessary data on safety and efficacy/effectiveness but also should address more fundamental (ontological, epistemological, and methodological) issues, in order to overcome the differences between WMSs and conventional medicine.

Short- and Intermediate-Term Use of Peripherally Inserted Central Catheters in Europe: A Systematic Literature Review

Journal of the Association for Vascular Access ◽

10.2309/j.java.2019.004.008 ◽

2019 ◽

Vol 24 (4) ◽

pp. 45-56

Author(s):

Baudolino Mussa ◽

Kim Alsbrooks ◽

Robert Hutcheson

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Efficacy And Safety ◽

Limited Evidence ◽

Highlights Fifty-six studies were included in a systematic literature review. PICCs were compared to CICCs and PIVCs for short/intermediate-term use in Europe. Several efficacy and safety benefits were shown with PICCs. Limited evidence showed higher costs with PICCs.

Results of clinical studies PLATO and place of ticagrelor in the treatment of acute coronary syndrome

Cardiosomatics ◽

10.26442/cs45160 ◽

2015 ◽

Vol 6 (1) ◽

pp. 53-59

Author(s):

A. D Erlih

Keyword(s):

Clinical Trial ◽

Acute Coronary Syndrome ◽

Clinical Practice ◽

Randomized Clinical Trial ◽

Study Design ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Clinical Studies ◽

Efficacy And Safety ◽

Coronary Syndrome

This article provides an analysis of the results of a large international randomized clinical trial PLATO, in which to learn a new antiplatelet ticagrelor compared with clopidogrel in addition to aspirin in patients with acute coronary syndrome (ACS). Material contains a description of the study design, the main results concerning the efficacy and safety of ticagrelor. In addition, the material presented those parts of modern clinical practice guidelines, which describes the location of ticagrelor in the treatment of ACS and which are modified according to a PLATO study.

Efficacy and safety of peripherally inserted central catheters in patients receiving chemotherapy

Palliative Care Research ◽

10.2512/jspm.6.233 ◽

2011 ◽

Vol 6 (2) ◽

pp. 233-236 ◽

Cited By ~ 1

Author(s):

Nobuhiro Asai ◽

Yoshihiro Ohkuni ◽

Ikuo Yamazaki ◽

Yasutaka Kawamura ◽

Ryo Matsunuma ◽

...

Keyword(s):

Efficacy And Safety ◽

Efficacy and safety of peripherally inserted central venous catheters in acute cardiac care management

The Journal of Vascular Access ◽

10.1177/1129729818758984 ◽

2018 ◽

Vol 19 (5) ◽

pp. 455-460 ◽

Cited By ~ 4

Author(s):

Fabrizio Poletti ◽

Claudio Coccino ◽

Davide Monolo ◽

Paolo Crespi ◽

Giorgio Ciccioli ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Stream Infection ◽

Blood Stream ◽

Efficacy And Safety ◽

Central Venous ◽

Cardiac Intensive Care Unit ◽

Cardiac Intensive Care ◽

Purpose: Patients admitted to cardiac intensive care unit need administration of drugs intravenously often in concomitance of therapeutic techniques such as non-invasive ventilation, continuous renal replacement therapy and intra-aortic balloon counterpulsation. Therefore, the insertion of central venous catheters provides a reliable access for delivering medications, laboratory testing and hemodynamic monitoring, but it is associated with the risk of important complications. In our study, we tested the efficacy and safety of peripherally inserted central catheters to manage cardiac intensive care. Methods: All patients admitted to cardiac intensive care unit with indication for elective central venous access were checked by venous arm ultrasound for peripherally inserted central catheter’s implantation. Peripherally inserted central catheters were inserted by ultrasound-guided puncture. After 7 days from the catheter’s placement and at the removal, vascular ultrasound examination was performed searching signs of upper extremity deep venous thrombosis. In case of sepsis, blood cultures peripherally from the catheter and direct culture of the tip of the catheter were done to establish a catheter-related blood stream infection. Results: In our cardiac intensive care unit, 137 peripherally inserted central catheters were placed: 80.3% of patients eligible for a peripherally inserted central catheter were implanted. The rate of symptomatic catheter-related peripheral venous thrombosis was 1.4%. Catheter-related blood stream infection was diagnosed in one patient (0.7%; 5.7 × 1000 peripherally inserted central catheter days). All peripherally inserted central catheters were inserted successfully without other major complications. Conclusions: In patients admitted to cardiac intensive care unit, peripherally inserted central catheters’ insertion was feasible in a high percentage of patients and was associated with low infective complications and clinical thrombosis rate.