Needleless Connectors: Improving Practice, Reducing Risks

2011 ◽  
Vol 16 (1) ◽  
pp. 20-33 ◽  
Author(s):  
Lynn Hadaway
Keyword(s):  
Normal Saline ◽  
Healthcare Workers ◽  
Randomized Clinical Trials ◽  
Relevant Literature ◽  
Lock Solution ◽  
Specific Device ◽  
The Usa ◽  
Catheter Lock ◽  
Needleless Connector ◽  
Clamping Sequence

Abstract Purpose: To assess the knowledge gap of healthcare workers about practice with needleless connectors. Background: Catheter-related bloodstream infection (CR-BSI) and lumen occlusion can be directly related to practices of cleaning needleless connectors, IV administration set management, and flushing and clamping methods. Review of Relevant Literature: Five publications report outbreaks of CR-BSI from hospitals in the US and Australia. A significant increase in CR-BSI rates after an organizational change of products was observed. No randomized controlled trials are available from the USA comparing types or designs of needleless connectors. Device instructions state some devices can be locked with normal saline. Two randomized clinical trials assessed outcomes with catheter lock solution. Both reported higher rates of occlusion with the use of normal saline only and one documented a higher rate of CR-BSI. Methods: An invitation to participate in a survey with 22 questions was sent electronically to approximately 4000 healthcare workers with a response from 554 in clinical practice. Results: The specific type of needleless connector being used was unknown by 25% and correct clamping sequence was chosen by 52.8% of respondents. The majority, 94.3% reported that they always clean these devices before each use, however there are differences in technique. Conclusions: There is a significant gap of knowledge about the specific needleless connectors being used, the most appropriate cleaning, flushing, and clamping sequence for the specific device. Implications for Practice: Staff education should focus on the connections between needleless connectors, CR-BSI and lumen occlusion. Frequent product training on needleless connectors, the specific type in use and correct techniques are necessary.

scholarly journals A Novel Nonantibiotic Nitroglycerin-Based Catheter Lock Solution for Prevention of Intraluminal Central Venous Catheter Infections in Cancer Patients

2017 ◽  
Vol 61 (7) ◽  
Author(s):  
Anne-Marie Chaftari ◽  
Ray Hachem ◽  
Ariel Szvalb ◽  
Mahnaz Taremi ◽  
Bruno Granwehr ◽  
...  
Keyword(s):  
Adverse Events ◽  
Cancer Patients ◽  
Randomized Clinical Trials ◽  
Residual Effect ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Current Standard ◽  
Lock Solution ◽  
Catheter Lock

ABSTRACT For long-term central lines (CL), the lumen is the major source of central line-associated bloodstream infections (CLABSI). The current standard of care for maintaining catheter patency includes flushing the CL with saline or heparin. Neither agent has any antimicrobial activity. Furthermore, heparin may enhance staphylococcal biofilm formation. We evaluated the safety and efficacy of a novel nonantibiotic catheter lock solution for the prevention of CLABSI. Between November 2015 and February 2016, we enrolled 60 patients with hematologic malignancies who had peripherally inserted central catheters (PICC) to receive the study lock solution. The study lock consisted of 15 or 30 μg/ml of nitroglycerin in combination with 4% sodium citrate and 22% ethanol. Each lumen was locked for at least 2 h once daily prior to being flushed. After enrollment of 10 patients at the lower nitroglycerin dose without evidence of toxicity, the dose was escalated to the higher dose (30 μg/ml). There were no serious related adverse events or episodes of hypotension with lock administration. Two patients experienced mild transient adverse events (one headache and one rash) possibly related to the lock and that resolved without residual effect. The CLABSI rate was 0 on lock days versus 1.6/1,000 catheter days (CD) off lock prophylaxis, compared with a rate of 1.9/1,000 CD at the institution in the same patient population. In conclusion, the nitroglycerin-based lock prophylaxis is safe and well tolerated. It may prevent CLABSI when given daily to cancer patients. Large, prospective, randomized clinical trials are needed to validate these findings. (This study has been registered at ClinicalTrials.gov under identifier NCT02577718.)

Front-line Healthcare Workers in COVID-19: The Way from Elbow-Bump Greeting to Closing Body Bags

2020 ◽  
Author(s):  
Stefan Bittmann
Keyword(s):  
Health Service ◽  
Healthcare Workers ◽  
Well Being ◽  
The United States ◽  
Angiotensin Ii Receptor ◽  
Front Line ◽  
Resource Center ◽  
Research Activities ◽  
The World ◽  
The Usa

COVID-19 is a serious coronavirus disease that is spreading all over the world. As of the date of this publication, 2.834.134 people have been infected with COVID-19 and 197.924 deaths have been recorded in 185 countries (John Hopkins Corona Resource Center, 25th April 2020) [1]. This overwhelming mortality rate requires intensive research activities around the world. To date, the number of deaths per day in the United States is still killing, indicating an uncontrollable state of infection spread. SARS-CoV-2 binds to the angiotensin II receptor in various tissues of the human body, particularly in the oral cavity and tongue. SARS-CoV-2 requires the cheerful TMPRSS2 to activate this inertia. SARS-CoV-2 uses the ACE2 receptor as a gateway to the lungs. The SARS-CoV-2 virus binds with the spike protein to the ACE2 receptor. COVID-19 is more common among African Americans in the USA (Science 10th April 2020). The comfort and the emotional loading capacity of the employees in the health service are key components for the maintenance of the essential health services during the outbreak of the COVID-19 virus (Coronavirus) [2,3]. Hence, it will be important to anticipate the charges linked with this work and to release support for employees in the health service. The supervision and assessment of the psychic health and the well-being of the employees in the health service will be important, just as the efforts to guarantee a successful reunion with colleagues if they are infected.

Randomized clinical trials and real life studies: Comparison of baseline characteristics of patients in oral target therapies for renal cell carcinoma

2021 ◽  
pp. 107815522110055
Author(s):  
Ruggero Lasala ◽  
Fiorenzo Santoleri ◽  
Alessia Romagnoli ◽  
Felice Musicco ◽  
Paolo Abrate ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Randomized Clinical Trials ◽  
Performance Status ◽  
Relevant Literature ◽  
Real Life ◽  
Ecog Performance Status ◽  
Target Therapies ◽  
Baseline Characteristics

Introduction Pivotal Randomized Controlled Trials (RCTs) constitute scientific evidence in support of therapeutic choices when a drug is authorized in the market. In RCTs, patients are selected in a rigorous manner, in order to avoid bias that may influence efficacy assessments. Therefore, patients who take the drug in Real Life Studies (RLSs) are not the same as those participating in RCTs, which, in turn, leads to low data transferability from RCTs to RLS. The objective of this study was to evaluate the differences between RCTs and RLS, in terms of patient baseline characteristics. Materials and Methods Our study includes all oral target therapies for RCC (Renal Cell Carcinoma) marketed in Europe before March 31, 2019. For each treatment, we considered both RCTs and RLSs, the former gathered from Summary of Product Characteristics published on the European Medicine Agency (EMA) website, and the latter yielded by our search in relevant literature. For each drug considered, we then compared the baseline characteristics of patients included in the RCT samples with those of the samples included in the RLSs using the Chi-squared and Mann-Whitney tests. Results We considered six medicines, for a total of 9 pivotal RCTs and 31 RLSs. RCTs reported the same type of patient baseline characteristics, whereas RLSs are more varied in reporting. Some patient baseline characteristics (metastases, previous treatments, etc.) were significantly different between RCTs and RLs. Other characteristics, such as ECOG Performance Status, brain metastases, and comorbidities, liver and kidney failure, are comprised in exclusion criteria of RCTs, though are included in RLS. Discussion and Conclusion: While evaluating equal treatments for the same indications, RCTs and RLSs do not always assess patients with the same characteristics. It would be necessary to produce evidence from RLSs so as to have an idea of treatment effectiveness in patients groups that are not eligible or underrepresented in RCTs.

scholarly journals Novel repurposing of a Laerdal Airway trainer to simulate aerosolisation

2021 ◽  
pp. bmjstel-2020-000802
Author(s):  
Sven Peter Oman ◽  
Scott Helgeson ◽  
Philip Lowman ◽  
Pablo Moreno Franco ◽  
Jonathan Tomshine ◽  
...  
Keyword(s):  
Airway Management ◽  
Ultraviolet Light ◽  
Healthcare Workers ◽  
Saline Solution ◽  
Size Range ◽  
Ambient Air ◽  
Airborne Particles ◽  
Exposure Risk ◽  
Aerosol Model ◽  
The Usa

COVID-19 has claimed over 200 000 lives in the USA and put healthcare workers at risk. Healthcare workers have an increased exposure risk from aerosol-generating procedures such as endotracheal intubation. New barrier designs such as the acrylic box and horizontal plastic drape have emerged to reduce exposure to airborne particles. Particle generating models are needed to test aerosol generating procedure (AGP) barrier designs. To achieve this, an aerosol model that generates a visible and measurable increase in particles which SARS-CoV-2 could travel on and that can also be intubated was created. The model was created using a Laerdal Airway Management Trainer (Laerdal Medical, Stavanger, Norway) combined with a nebuliser and Ambu bag-valve resuscitator (Ambu, Columbia, Maryland, USA). Nebulised Glo Germ (Glo Germ, Moab, Utah, USA) dissolved in saline solution was moved through the tubing and out of the mannequin’s mouth with compression of the Ambu bag. This nebulisation was visualised under ultraviolet light and the quantity of particles between 0.3 and 10.0 μm was measured with a particle counter. Nebulisation was visible exiting the mouth of the mannequin. Nebulised Glo Germ was visualised under ultraviolet light moving in the ambient air. Particles in the size range of 0.3–0.5 µm increased by 20-fold and 1–10 µm increased by 10 252%. SARS-CoV-2 can travel on aerosol and droplet particles and particle generating models are needed to visualise and measure exposure areas and the path particles take during AGPs. We used existing medical and simulation supplies to create a particle simulator.

scholarly journals Neutralizing Antibodies Titers and Side Effects in Response to BNT162b2 Vaccine in Healthcare Workers with and without Prior SARS-CoV-2 Infection

Vaccines ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 742
Author(s):  
José Javier Morales-Núñez ◽  
José Francisco Muñoz-Valle ◽  
Carlos Meza-López ◽  
Lin-Fa Wang ◽  
Andrea Carolina Machado Sulbarán ◽  
...  
Keyword(s):  
Single Dose ◽  
Side Effects ◽  
Adverse Effects ◽  
Antibody Production ◽  
Neutralizing Antibodies ◽  
Healthcare Workers ◽  
Vaccination Program ◽  
Expected Result ◽  
Neutralizing Capacity ◽  
The Usa

The main expected result of a vaccine against viruses is the ability to produce neutralizing antibodies. Currently, several vaccines against SARS-CoV-2 are being applied to prevent mortal complications, being Pfizer-BioNTech (BNT162b2) one of the first to be authorized in the USA and Mexico (11 December 2020). This study evaluated the efficacy of this vaccine on antibody production with neutralizing capacity and its side effects in healthcare workers with and without prior SARS-CoV-2 infection and in a group of unvaccinated individuals with prior COVID-19. The main findings are the production of 100% neutralizing antibodies in both groups after the second dose, well-tolerated adverse effects, the possible presence of immunosenescence, and finally, we support that a single dose of this vaccine in individuals with prior COVID-19 would be sufficient to achieve an immunization comparable to people without prior COVID-19 with a complete vaccination program (2 doses).

scholarly journals Can dalbavancin be used as a catheter lock solution?

2018 ◽  
Vol 67 (7) ◽  
pp. 936-944 ◽  
Author(s):  
Cristina Díaz-Ruíz ◽  
Beatriz Alonso ◽  
Emilia Cercenado ◽  
Raquel Cruces ◽  
Emilio Bouza ◽  
...  
Keyword(s):  
Lock Solution ◽  
Catheter Lock

A 2% taurolidine catheter lock solution prevents catheter-related bloodstream infection (CRBSI) and catheter dysfunction in hemodialysis patients

2021 ◽  
Vol 30 (14) ◽  
pp. S24-S32
Author(s):  
Matthias Alexander Neusser ◽  
Irina Bobe ◽  
Anne Hammermeister ◽  
Udo Wittmann
Keyword(s):  
Adverse Events ◽  
Bloodstream Infection ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Technical Problems ◽  
Hemodialysis Catheter ◽  
Catheter Dysfunction ◽  
Lock Solution ◽  
Catheter Lock ◽  
Catheter Related Bloodstream Infection

HIGHLIGHTS 2% taurolidine catheter lock solution without additives is safe and efficient. CRBSI and dysfunction rates compare favorably against other studies in hemodialysis Background: In hemodialysis patients, catheter-related bloodstream infection (CRBSI) and catheter dysfunction are common and cause significant morbidity, mortality, and costs. Catheter lock solutions reduce CRBSI and catheter dysfunction rates, but solutions containing heparin, citrate, or antibiotics are associated with adverse effects. Due to its antimicrobial and antithrombotic properties and benign safety profile, taurolidine is suitable for use in catheter lock solutions. In this study the effectiveness and safety of a catheter lock solution containing 2% taurolidine without citrate or heparin (TauroSept®, Geistlich Pharma AG, Wolhusen, Switzerland) in hemodialysis patients were investigated for the first time. Methods: Data from 21 patients receiving chronic hemodialysis via tunneled central venous catheters with 2% taurolidine solution as a catheter lock were analyzed in a single-center retrospective study and compared with the existing literature in a review. The primary endpoint was CRBSI rate. Secondary endpoints included catheter dysfunction, treatment, and costs; catheter technical problems, resolution, and costs; and adverse events. Data were compared to outcomes with standard lock solutions in the literature. Results: No CRBSIs occurred during the observation period of 5,639 catheter days. The catheter dysfunction rate was 0.71 per 1,000 catheter days, and the catheter dysfunction treatment costs were CHF (Swiss Franc) 543 per patient. No technical problems or adverse events related to the use of 2% taurolidine-containing catheter lock solution were observed. These results compare favorably with other catheter lock solutions. Conclusions: A solution containing 2% taurolidine seems suitable as a hemodialysis catheter lock. In a Swiss cohort, it prevented CRBSI, limited catheter dysfunction, and was cost-efficient.

A 2% Taurolidine Catheter Lock Solution Prevents Catheter-Related Bloodstream Infection (CRBSI) and Catheter Dysfunction in Hemodialysis Patients

2020 ◽  
Vol 25 (4) ◽  
pp. 48-56
Author(s):  
Matthias Alexander Neusser ◽  
Irina Bobe ◽  
Anne Hammermeister ◽  
Udo Wittmann
Keyword(s):  
Bloodstream Infection ◽  
Hemodialysis Patients ◽  
Catheter Dysfunction ◽  
Lock Solution ◽  
Catheter Lock ◽  
Catheter Related Bloodstream Infection

Highlights 2% Taurolidine catheter lock solution without additives is safe and efficient. CRBSI and dysfunction rates compare favorably against other studies in hemodialysis.

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