scholarly journals Case report: risk of skin necrosis related to injectable vancomycin in critically ill newborn infants

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sixtine Gilliot ◽  
Mohamed Riadh Boukhris ◽  
Morgane Masse ◽  
Laurent Storme ◽  
Bertrand Décaudin ◽  
...  

Abstract Background Vancomycin is commonly used as part of empiric antibiotic therapy in the preterm infants who develop signs and symptoms of infection. Although skin necrosis has been noted to occur following injection of vancomycin into a peripheral vein in an adult patient, this complication has not been previously described in a preterm infant. Case presentation We report the case of a very low birthweight male infant born at 30 weeks gestational age who developed skin necrosis, most likely as a complication of vancomycin administration via a peripheral venous catheter. The immature skin and endothelial cells of this preterm infant may have increased the risk of drugs related venous and skin toxicity. In this case, assumption of a cumulative toxicity with other drugs administered concomitantly via the same catheter can’t be excluded. Conclusions To prevent the risk of skin damage, we advocate that in newborn infants, the administration of vancomycin should be limited to a concentration of < 2.5 mg/mL via a peripheral intravenous catheter if a central venous catheter is not available.

2021 ◽  
Author(s):  
Sixtine Gilliot ◽  
Mohamed Riadh BOUKHRIS ◽  
Morgane Masse ◽  
Laurent Storme ◽  
Bertrand Decaudin ◽  
...  

Abstract Skin necrosis caused by the administration of vancomycin via a peripheral venous catheter is rarely diagnosed. We report a case of a male infant born at 30 weeks’ gestational age who developed a skin necrosis, most probably related to vancomycin administration on a peripheral venous catheter. The frailty of this critically ill newborn probably increased its risk of exposition to adverse events. To prevent any damaging effect, the administration of vancomycin at a concentration lower than 2.5 mg/mL should be recommended when a central venous catheter is not available for the administration of injectable vancomycin in critically ill newborn.


2018 ◽  
Vol 5 (3) ◽  
pp. 668 ◽  
Author(s):  
Satish Kumar Dalai ◽  
Sanghamitra Padhi ◽  
Abhishek Padhi ◽  
Banojini Parida

Background: Peripheral venous catheter related blood stream infections (PVC-BSI) are a common cause of morbidity and mortality in hospitals. Most of the catheter related blood stream infections occurs due to lack of proper aseptic measures. This study points out the risk factors microbial profile and antimicrobial susceptibility of isolates associated with PVC-BSI. The common organisms causing Catheter related BSI are Staphylococcus aureus (41.1%), and Klebsiella species (17.6%) followed by CONS and Enterococcus species. Objective of present study was to isolate and identify the organisms causing PCV-BSI, perform antimicrobial sensitivity testing of isolated organisms and to identify the associated risk factors and preventive measures that should be used.Methods: The study was conducted over a period of one year from August 2015 to July 2016 in the Department of Microbiology. Study group comprised of all the patients with peripheral venous catheterization who developed signs and symptoms of septicemia after 48 hrs of insertion of PVC. These patients were followed up from the time of catheterization till discharge. Peripheral venous catheter tip was collected under aseptic condition along with peripheral blood samples from a site other than the catheterized one. Samples were collected from patients at any point of time who developed signs and symptoms of septicemia after 48 hrs of catheter insertion. The length of time for which the PVC was in place was recorded.Results: In total, 87 cases were included in the study with mean catheter duration of 4.8 days accounting for 418 catheter days. Out of these 87 cases, 17 cases developed PVC-BSI (19.5%) and 34 cases developed colonization (24.1%). Staphylococcus species (41.1%) was the most common isolate.Conclusions: PVC-BSI has a significant role in hospital acquired infections and more studies are needed to establish this.


2011 ◽  
Vol 51 (5) ◽  
pp. 277 ◽  
Author(s):  
Lily Rundjan ◽  
Rinawati Rohsiswatmo ◽  
Sarah Rafika ◽  
Enty Enty ◽  
Lucky H. Moehario

AbstractBackground Vascular access may increase the risk of bloodstream infections, especially in newborn infants with weak immune systems and requiring invasive supportive care. Skin disinfection prior to peripheral venous catheter insertion lowers the risk of infection. However, antiseptics chosen for this task should be effective and safe for newborn infants.Objective To compare the effectiveness of 70% alcohol (BD alcohol swabs ®), 10% povidone-iodine (Pharma-RSUPNCM), and octenidine (Octenisept ®) as antiseptics for reducing skin bacteria for pre-invasive procedures in neonates.Methods Infants aged less than 28 days, regardless of gestational age, at the Neonatal Unit of Cipto Mangunkusumo Hospital (RSUPNCM) were included in our study. Infants were divided into three groups, each tested with different skin antiseptics (alcohol, povidone-iodine or octenidine). Skin swabs were performed before and after application of skin antiseptic, followed by inoculation onto blood agar plates. Colony-forming units were counted after 18 hours of incubation at 37ºC.Results Ninety subjects were divided into 3 groups of 30, each group using either 70% alcohol swabs, 10% povidone-iodine, or octenidine as skin antiseptic. Skin swabs were taken before and after antiseptic application and drying, as well as 5 minutes after application. The mean reductions in CFU/cm2 (%) after antiseptic application (and fully dried) were 97.54% for povidone-iodine, 97.52% for octenidine, and 89.07% for alcohol. There were no significant differences in mean CFU reductions among the three antiseptics groups (P=0.299). Furthermore, 5 minutes after application, there were still no significant differences in the three antiseptic groups (P=0.289).Conclusions Although octenidine showed a significant bacterial count reduction after application, it was not significantly different from those of alcohol or povidone-iodine. [Paediatr Indones. 2011;51:277-81].


2010 ◽  
Vol 5 (1) ◽  
pp. 134
Author(s):  
Paula Elaine Diniz Reis ◽  
Emilia Campos de Carvalho

ABSTRACTObjective: to contribute to the reflection on the mechanisms leading to phlebitis as a complication of intravenous therapy. Methodology: this is about an update paper, which presents the epidemiology, predisposing factors, preventive measures and evaluation methods of phlebitis due to insertion of peripheral venous catheter, in order to subsidize the nursing plan. Results: the phenomenon of phlebitis is quite prevalent in hospitalized patients, related to multiple factors such as hyperosmolarity and pH of the solution infused, type of device used venous and nursing care with regard to the procedure of venipuncture and venous access. It is important for nurses to learn the tools to diagnose phlebitis, identifying signs and symptoms of inflammation, thus being able to intervene according to the degree shown, preventing the occurrence of phlebosclerosis. Conclusion: knowing the types of phlebitis and, consequently, their risk factors helps the nurse to have a better basis for decision making regarding the construction of specific protocols aimed at preventing this complication. Descriptors: phlebitis; catheterization, peripheral; nursing care.RESUMOObjetivo: informar aos leitores sobre os mecanismos que conduzem à flebite enquanto complicação da terapia intravenosa. Metodologia: artigo de atualização, o qual apresenta os aspectos epidemiológicos, fatores predisponentes, medidas preventivas e métodos de avaliação da flebite decorrente de inserção de cateter venoso periférico, com vistas a subsidiar as condutas de enfermagem. Resultados: a flebite consiste em fenômeno bastante prevalente em pacientes hospitalizados, relacionado a múltiplos fatores, tais como hiperosmolaridade e ph da solução infundida, tipo de dispositivo venoso utilizado e o cuidado de enfermagem no que se refere ao procedimento de venopunção e manutenção do acesso venoso. É fundamental que o enfermeiro conheça os métodos disponíveis para diagnosticar a flebite, identificando sinais e sintomas flogísticos, podendo assim intervir de acordo com o grau evidenciado, prevenindo a ocorrência de fleboesclerose. Conclusão: conhecer os tipos de flebite e, consequentemente, seus fatores de risco contribui para que o enfermeiro tenha melhor embasamento para a tomada de decisão no que concerne à construção de protocolos específicos visando à prevenção desta complicação. Descritores: flebite; cateterismo venoso periférico; cuidados de enfermagem.RESUMENObjetivo: contribuir a la discusión de los mecanismos que conducen a la flebitis como complicación de la terapia intravenosa. Metodología: documento de actualización, que presenta la epidemiología, factores predisponentes, las medidas preventivas y métodos de evaluación de flebitis debido a la inserción de catéter venoso periférico, con el fin de subsidiar el plan de enfermería. Resultados: el fenómeno de la flebitis es muy frecuente en pacientes hospitalizados, relacionado con múltiples factores tales como hiperosmolaridad y el pH de la solución infundida, el tipo de dispositivo utilizado atención venosa y de enfermería en relación con el procedimiento de punción venosa y el acceso venoso. Es importante para las enfermeras aprender las herramientas para disgnosticar la flebitis, la identificación de signos y síntomas de inflmación, con lo que haya podido intervenir en función del grado se muestra, evitando la aparición de phlebosclerosis. Conclusión: conocer los tipos de flebitis y, en consecuencia, sus factores de riesgo ayuda a la enfermera para tener una mejor base para la toma de decisiones respecto a la construcción de protocolos específicos para prevenir esta complicación. Descriptores: flebitis; cateterismo periférico; atención de enfermería. 


Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 611
Author(s):  
Aitana Guanche-Sicilia ◽  
María Sánchez-Gómez ◽  
María Castro-Peraza ◽  
José Rodríguez-Gómez ◽  
Juan Gómez-Salgado ◽  
...  

The objective of this work was to identify available evidence on nursing interventions for the prevention and treatment of phlebitis secondary to the insertion of a peripheral venous catheter. For this, a scoping systematic review was carried out following the guidelines in the PRISMA declaration of documents published between January 2015 and December 2020. The search took place between December 2020 and January 2021. Scielo, Pubmed, Medline, Scopus, WOS, CINHAL, LILACS, and Dialnet databases were consulted, and CASPe, AGREE, and HICPAC tools were used for the critical reading. A total of 52 studies were included to analyze nursing interventions for treatment and prevention. Nursing interventions to prevent phlebitis and ensure a proper catheter use included those related to the maintenance of intravenous therapy, asepsis, and choosing the dressing. With regard to the nursing interventions to treat phlebitis, these were focused on vigilance and caring and also on the use of medical treatment protocols. For the prevention of phlebitis, the highest rated evidence regarding asepsis include the topical use of >0.5% chlorhexidine preparation with 70% alcohol or 2% aqueous chlorhexidine, a proper hygienic hand washing, and the use clean gloves to handle connections and devices. Actions that promote the efficacy and safety of intravenous therapy include maintenance of venous access, infusion volume control, verification of signs of phlebitis during saline solution and medication administration, and constant monitoring. It is recommended to remove any catheter that is not essential. Once discharged from hospital, it will be necessary to warn the patient about signs of phlebitis after PVC removal.


2021 ◽  
pp. 112972982110150
Author(s):  
Ya-mei Chen ◽  
Xiao-wen Fan ◽  
Ming-hong Liu ◽  
Jie Wang ◽  
Yi-qun Yang ◽  
...  

Purpose: The objective of this study was to determine the independent risk factors associated with peripheral venous catheter (PVC) failure and develop a model that can predict PVC failure. Methods: This prospective, multicenter cohort study was carried out in nine tertiary hospitals in Suzhou, China between December 2017 and February 2018. Adult patients undergoing first-time insertion of a PVC were observed from catheter insertion to removal. Logistic regression was used to identify the independent risk factors predicting PVC failure. Results: This study included 5345 patients. The PVC failure rate was 54.05% ( n = 2889/5345), and the most common causes of PVC failure were phlebitis (16.3%) and infiltration/extravasation (13.8%). On multivariate analysis, age (45–59 years: OR, 1.295; 95% CI, 1.074–1.561; 60–74 years: OR, 1.375; 95% CI, 1.143–1.654; ⩾75 years: OR, 1.676; 95% CI, 1.355–2.073); department (surgery OR, 1.229; 95% CI, 1.062–1.423; emergency internal/surgical ward OR, 1.451; 95% CI, 1.082–1.945); history of venous puncture in the last week (OR, 1.298, 95% CI 1.130–1.491); insertion site, number of puncture attempts, irritant fluid infusion, daily infusion time, daily infusion volume, and type of sealing liquid were independent predictors of PVC failure. Receiver operating characteristic curve analysis indicated that a logistic regression model constructed using these variables had moderate accuracy for the prediction of PVC failure (area under the curve, 0.781). The Hosmer-Lemeshow goodness of fit test demonstrated that the model was correctly specified (χ2 = 2.514, p = 0.961). Conclusion: This study should raise awareness among healthcare providers of the risk factors for PVC failure. We recommend that healthcare providers use vascular access device selection tools to select a clinically appropriate device and for the timely detection of complications, and have a list of drugs classified as irritants or vesicants so they can monitor patients receiving fluid infusions containing these drugs more frequently.


2014 ◽  
Vol 19 (4) ◽  
pp. 256-261 ◽  
Author(s):  
Stéphanie F. Bernatchez

AbstractPeripheral intravenous (PIV) catheters are the most commonly used catheters in hospitals, with up to 70% of patients requiring a peripheral venous line during their hospital stay. This represents 200 million PIV catheters used per year in acute-care hospitals in the United States alone. These medical devices are also used in other health care settings, such as long-term care facilities and nursing homes, and common indications include the administration of medications, nutrients, and fluids. These catheters require proper maintenance and care to avoid complications such as phlebitis, infiltration, occlusion, local infection, and bloodstream infection. Recently it has been suggested that PIV catheter use may lead to a higher rate of complications than previously thought. This is important because some studies have claimed that the rate of bloodstream infections due to PIV catheters is actually comparable to the rates observed with central venous catheters, rather than much lower as previously thought. Moreover, catheter-related infections are now seen as largely preventable. Our goal was to review the current literature and provide an overview of the various approaches used to manage PIV catheter sites as well as review current recommendations.


2008 ◽  
Vol 29 (10) ◽  
pp. 963-965 ◽  
Author(s):  
Heather Small ◽  
Debra Adams ◽  
Anna L. Casey ◽  
Cynthia T. Crosby ◽  
Peter A. Lambert ◽  
...  

We undertook a clinical trial to compare the efficacy of 2% (w/v) chlorhexidine gluconate in 70% (v/v) isopropyl alcohol with the efficacy of 70% (v/v) isopropyl alcohol alone for skin disinfection to prevent peripheral venous catheter colonization and contamination. We found that the addition of 2% chlorhexidine gluconate reduced the number of peripheral venous catheters that were colonized or contaminated.


Author(s):  
Chiara de Sio ◽  
Mario Venafro ◽  
Giampiero Foccillo ◽  
Riccardo Nevola ◽  
Lucio Monaco

Abstract Purpose Between 15 and 30% of all nosocomial bacteremias and sepsis are associated with the use of intravascular devices. Catheter-related bloodstream infections (CRBI) are infections in which the organism identified in the blood is also present on the tip of the catheter itself or in a blood sample taken through it. The aim of the study was to evaluate the role of ultrasound in the diagnosis of infections related to the use of central catheters. Methods Between January 2018 and June 2019, we carried out a prospective study on 36 patients with a central catheter, such as a central venous catheter (CVC), a central catheter with peripheral insertion (PICC), or a fully implanted central venous catheter (PORT-a-cath) and who had signs and symptoms of infection. These patients were submitted to an ultrasound of the catheter upon arrival in the ward in case of suspected infection, or at the time of the onset of signs and symptoms of infection (if these arose during hospitalization). Patients with a central catheter but without signs and symptoms of infection were not included in the study. The end point of the study was to evaluate sensitivity (SENS), specificity (SPEC), positive and negative predictive value (PPV-NPV) and overall diagnostic accuracy (ODA) of ultrasound in the diagnosis of CRBI through Receiver Operating Characteristic (ROC) curve analysis. Results US showed a SENS of 94%, a SPEC of 84%, a PPV of 84%, an NPV of 94% and an ODA of 88.8% for the diagnosis of CRBI. Conclusions Preliminary data from our study show that US of intravascular devices has a high SENS and SPEC in the diagnosis of CRBI, and can, therefore, be used as a valid tool to decide whether to remove the device early or leave it in place.


Medicines ◽  
2018 ◽  
Vol 5 (4) ◽  
pp. 113
Author(s):  
Mirjam Pocivalnik ◽  
Manfred Danda ◽  
Berndt Urlesberger ◽  
Wolfgang Raith

Background: Selective serotonin reuptake inhibitors are a very common choice of antidepressive drug-therapy during pregnancy. In up to 30% of cases, they have been found to cause neonatal abstinence syndrome in newborn infants. Although often both time-limiting and self-limiting, severe symptoms of neonatal abstinence syndrome (NAS) can occur. Methods/Results: We report a term male infant suffering from a severe brief resolved unexplained event caused by his mother’s sertraline intake during pregnancy. Conclusions: Newborn infants exposed to selective serotonine reuptake inhibitors (SSRIs) during pregnancy should be evaluated very carefully concerning NAS and monitored for NAS symptoms for a minimum of 72–96 h, or until symptoms have fully recovered using standardized protocols. There is a risk of severe NAS symptoms which might occur, and this circumstance should be discussed with the parents and taken into account before administering the drug.


Sign in / Sign up

Export Citation Format

Share Document