scholarly journals Features of the infusion therapy at the prehospital stage with the ongoing bleeding

2021 ◽  
Vol 22 (3) ◽  
pp. 71-78
Author(s):  
A. V. Shchegolev ◽  
A. N. Gricaj ◽  
A. G. Klimov ◽  
V. N. Lapshin ◽  
V. S. Afonchikov ◽  
...  
Keyword(s):  
Blood Loss ◽  
Capillary Pressure ◽  
Scientific Work ◽  
Venous Access ◽  
Infusion Therapy ◽  
Crystalloid Solutions ◽  
Optimal Approach ◽  
Uncontrolled Bleeding

The article covers the principles of holding the infusion therapy at the prehospital stage with the ongoing uncontrolled bleeding. The scientific work shows the effectiveness of isoosmolar crystalloid solutions in conditions of low capillary pressure, which is typical for blood loss. The article shows that the concept of an acceptable hypotension is the most optimal approach to the infusion therapy if the ongoing bleeding is suspected in peacetime as well as in combat conditions. Recommendations are given for ensuring and maintaining venous access during short, long and delayed evacuation of victims with the suspected ongoing bleeding.

scholarly journals STRATEGY OF INFUSION-TRANSFUSION THERAPY IN OPERATIONS WITH MASSIVE BLOODWORK IN CHILDREN WITH TUMOR ABOMALOMAL LOCALIZATION TUMORS

2018 ◽  
Vol 8 (2) ◽  
pp. 56-64 ◽  
Author(s):  
E. I. Belousova ◽  
N. V. Matinyan ◽  
L. А. Martynov
Keyword(s):  
Blood Loss ◽  
Malignant Tumors ◽  
Electrolyte Imbalance ◽  
Coagulation System ◽  
Infusion Therapy ◽  
Transfusion Therapy ◽  
Group I ◽  
Crystalloid Solutions ◽  
Combined Anesthesia ◽  
Balanced Crystalloid

Surgeries for thoracoabdominal tumors in children predispose to water and electrolyte imbalance, imbalance in the coagulation system, etc. In spite of abundance of recommendations for children, the volume of basic infusion therapy is uncertain.Study purpose. To estimate the clinical effectiveness of the conducted infusion therapy with isotonic balanced electrolyte solution in children who underwent thoracoabdominal surgeries accompanied with massive blood loss and a complex estimation of the conducted infusion and transfusion therapy.Materials and methods. The intraoperative and early postoperative (days 1–5) periods were analyzed in 22 patients (ASA II–III) who underwent an operation for thoracoabdominal malignant tumors with massive perioperative blood loss in 2016–2017. Group I included 11 patients who had infusion with balanced crystalloid solutions of 5 to 10 ml/kg/hour under combined anesthesia. Group II includes 11 patients who had infusion with balanced crystalloid solutions of 11 to 20 ml/kg/hour under combined anesthesia.Results. According to the conducted study, a higher hemodynamic stability was observed in patients from the group of basic infusion therapy with balanced crystalloid solutions of 11–20 ml/kg/hour. It was expressed as the decrease of the mean dose of the used vasopressors and volume of the infusion of colloidal solutions. The patients also had a less intense response to stress.

The Multi-lumen Catheter: Proposed Guidelines for Its Use

1988 ◽  
Vol 9 (5) ◽  
pp. 206-208 ◽  
Author(s):  
Bruce F. Farber
Keyword(s):  
Jugular Vein ◽  
Venous Access ◽  
Infusion Therapy ◽  
Blood Products ◽  
Invasive Procedures ◽  
Intravenous Catheter ◽  
Nosocomial Bacteremia ◽  
Lumen Catheter ◽  
Minimal Data ◽  
Risk Cost

Infusion therapy for the administration of blood products, fluids, and parenteral nutrition are essential parts of medical practice. The risks associated with such therapy are well documented but frequently unappreciated. Intravascular infusions are the single most common cause of nosocomial bacteremia.’ Many studies have focused on the epidemiology, microbiology, and pathophysiology of these infections.In recent years, several companies have introduced a multi-lumen intravenous catheter that is placed through the subclavian or internal jugular vein. Unlike a multi-lumen pulmonary artery catheter, the multi-lumen intravenous catheter is designed solely for intravenous access. The first of these catheters was introduced in 1983, and it was soon followed by several others. These catheters have been designed to allow multiple infusions to be given simultaneously. In addition, one of the ports can be used for venous access. The advantages of these catheters are obvious. The clinician is given three ports for use instead of one. The catheter may be used to simplify infusion therapy. In some instances, cut-downs and other invasive procedures (Hickmans, Broviacs, Mediports) may be avoided. It is not surprising that the use of these catheters has grown. In many institutions, multi-lumen catheters account for a majority of all centrally placed catheters, and in some intensive care units, they are used almost exclusively. The enormous growth of the use of the multi-lumen catheter has occurred despite minimal data regarding risk, cost, and the proper procedures needed for its care.

scholarly journals BLOOD VOLUME AND HEMODYNAMIC CHANGES IN PREGNANTS, PARTURIENTS AND PUERPERAE

2018 ◽  
Vol 5 (1) ◽  
pp. 4-8
Author(s):  
Aleksandr M. Ronenson ◽  
E. M Shifman ◽  
A. V Kulikov
Keyword(s):  
Blood Loss ◽  
Cardiovascular System ◽  
Blood Volume ◽  
Postpartum Period ◽  
Structural Changes ◽  
Volume Status ◽  
Infusion Therapy ◽  
Circulating Blood Volume ◽  
Functional Changes

In the article, there are considered questions of physiological changes of the blood volume status during pregnancy, parturition and in the postpartum period, features of functional and structural changes of the cardiovascular system. The determination of the circulating blood volume is still a stumbling block for obstetrician-gynecologists and anesthesiologists-resuscitators. Our view of the normal blood volume status during pregnancy is important in light of the assessment of the blood loss in the development of massive obstetric hemorrhage. The doctor needs to know what changes in the cardiovascular system are physiological and which are pathological in case of blood loss, with taking into account the functional changes in the heart that occur during pregnancy, parturition and in the earliest postpartum period. A deeper understanding of this problem will help the doctor avoid aggressive infusion therapy, which can lead to complications.

scholarly journals Extreme blood loss in cancer surgery: is it a verdict to the patient or a challenge to the staff?

2019 ◽  
Vol 10 (3) ◽  
pp. 42-48 ◽  
Author(s):  
Pavel I. Feoktistov ◽  
I. E. Кarmanov
Keyword(s):  
Blood Loss ◽  
Malignant Tumors ◽  
Locally Advanced ◽  
Venous Access ◽  
Multiple Organ ◽  
Early Postoperative Period ◽  
Cancer Surgery ◽  
Septic Complications ◽  
Massive Blood Loss ◽  
Combined Operations

Background. The development of anesthesiology allows performing combined operations in patients with locally advanced malignant tumors. A logical companion of aggressive cancer surgery is a massive blood loss, which can be so pronounced that it poses a threat to the life of the patient. Objective. The presented experience is an example of transformation of a nearly fatal situation into a curable one and can be useful in choosing an active treatment strategy in most desperate situations. Methods. This research includes 25 patients with the blood loss of 20 liters or more during surgery. Results. The median ratio of infusion to blood loss was 133%, and the ratio of the infusion to all fluid losses amounted to 118%. In 100% of cases, catecholamines were used to support the blood circulation: one drug used in 12% of observations and two to five drugs used in 88% of observations. 2 patients died during the operation. 5 patients died in the early postoperative period from multiple organ failure. The cause of death of another 5 patients was septic complications before the 28th post-op day. Discussion. Performing operations accompanied by acute massive blood loss requires an effective anesthetic support. Conclusions. Enforcement of certain diagnostic and therapeutic conditions (stage construction of anesthesia, hemodynamic and laboratory monitoring, adequate venous access, rational infusion, timely use of catecholamines, using cell-saver device) in the majority of cases allows completing the operation with the surgical control of hemostasis and successfully enduring traumatic and complicated surgery in half of cases.

scholarly journals Infusion-transfusion therapy in the treatment of patients with acute bleedings from the upper gastrointestinal tract

2012 ◽  
Vol 93 (2) ◽  
pp. 390-394
Author(s):  
G R Khalikova ◽  
I S Malkov ◽  
V V Fattakhov ◽  
M N Nasrullaev
Keyword(s):  
Gastrointestinal Tract ◽  
Blood Loss ◽  
Fresh Frozen Plasma ◽  
Endoscopic Hemostasis ◽  
Upper Gastrointestinal Tract ◽  
Infusion Therapy ◽  
Transfusion Therapy ◽  
Fresh Frozen ◽  
Upper Gastrointestinal ◽  
Frozen Plasma

Aim. To improve the treatment outcomes of patients with acute bleedings from the upper gastrointestinal tract by improving methods of endoscopic hemostasis and prediction of disease recurrence. Methods. The results of treatment of 776 patients with bleedings from the upper gastrointestinal tract have been analyzed. Methods of conservative therapy, endoscopic hemostasis and surgical treatment were used in combination with infusion therapy. Results. Established was the necessity of a differentiated method of endoscopic hemostasis, depending on the localization of the bleeding source, its intensity and effectiveness during ongoing bleedings. Infusion therapy should be initiated from the moment of verification of the diagnosis of acute bleeding from the upper gastrointestinal tract, regardless of the degree of blood loss, and already in the hospital’s emergency department. In cases of mild bleedings the infusion volume is 800-1000 ml: 80% crystalloids + 20% of colloids. The volume of infusion in moderate blood loss is 1500-2300 ml: 60% crystalloids + 20 colloids % + 20% fresh frozen plasma. The volume of infusion in severe blood loss is 2700 ml and more: 20% of crystalloids + 30% colloids + 30% fresh frozen plasma + 20% erythrocyte mass. Replacement therapy requires careful monitoring of the hemodynamic parameters and infusion load due to the unpredictability of body reactions to blood loss and its replacement. In the absence of an effect of conservative treatment within 6-24 hours an emergency operation is indicated with the choice of an optimal method based on an assessment of the physiological status on a POSSUM scale of assessment. Conclusion. Implementation of substitution therapy, which correlates to the degree of blood loss, critically important in order to eliminate ischemia of the wall of the gastrointestinal tract and prevent recurrence of bleeding; the usage of new approaches to the prediction of recurrent bleedings and improvement of methods of endoscopic haemostasis reduces the frequency of their occurrence, duration of in-hospital stay of patients and postoperative mortality.

scholarly journals Infusion and transfusion therapy: main aspects

2021 ◽  
Vol 17 (3) ◽  
pp. 25-29
Author(s):  
V.V. Nikonov ◽  
K.I. Lyzohub ◽  
M.V. Lyzohub
Keyword(s):  
Perioperative Period ◽  
Surgical Patients ◽  
Infusion Therapy ◽  
Evidence Based ◽  
Consensus Guidelines ◽  
Successful Management ◽  
Transfusion Therapy ◽  
Vital Functions ◽  
Crystalloid Solutions ◽  
Based Medicine

The adequate choice of strategy for infusion therapy is an essential component of successful management of critically ill patients. Infusion therapy is one of the main methods of maintai-ning vital functions of patients in the perioperative period. In the practice of a doctor, there are reasonable doubts about the feasibility and safety of various solutions for infusion therapy. Both are fundamental principles of infusion therapy, and the changes that have taken place, of course, need to be understood from the standpoint of evidence-based medicine. Balanced crystalloid solutions were safe and clinically effective, their use is provided by the Bri-tish Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients.

Continuous infusion chemotherapy: a critical review.

1984 ◽  
Vol 2 (11) ◽  
pp. 1289-1304 ◽  
Author(s):  
N J Vogelzang
Keyword(s):  
Continuous Infusion ◽  
Therapeutic Index ◽  
Venous Access ◽  
Chemotherapeutic Agents ◽  
Infusion Therapy ◽  
Infusion Chemotherapy ◽  
Antineoplastic Effect ◽  
Randomized Controlled Studies ◽  
Continuous Infusion Chemotherapy ◽  
The Cost

With the development of reliable drug pumps and safe long-term venous access catheters, the continuous infusion of chemotherapeutic agents has become clinically feasible. The available studies on infusion therapy with 37 antineoplastic drugs are analyzed. With the majority of agents, infusion studies have either not been performed or the completed studies have failed to demonstrate improved effectiveness over bolus therapy. In some continuous infusion studies, effectiveness has been retained but with no apparent improvement in the therapeutic index. Several other drugs such as bleomycin, cytosine arabinoside, and doxorubicin have apparent improvement in the therapeutic index when given as a continuous infusion. The improved therapeutic index of the fluorinated pyrimidines when given via continuous infusion must be explored in randomized controlled studies using malignancies other than colorectal cancer. The cost effectiveness of such studies must be carefully assessed. Since this method of administration of chemotherapeutic agents offers the potential for less toxicity and retained antineoplastic effect, such investigations are highly desirable for improved patient care.

scholarly journals Usability Assessment of an Innovative Device in Infusion Therapy: A Mix-Method Approach Study

2020 ◽  
Vol 17 (22) ◽  
pp. 8335
Author(s):  
Pedro Parreira ◽  
Liliana B. Sousa ◽  
Inês A. Marques ◽  
Paulo Santos-Costa ◽  
Sara Cortez ◽  
...  
Keyword(s):  
Venous Access ◽  
Point Of View ◽  
Ease Of Use ◽  
Infusion Therapy ◽  
Comprehensive Overview ◽  
Four Dimensions ◽  
New Device ◽  
Nurses Perceptions ◽  
Functional Prototype ◽  
Double Chamber

Background: Flushing a venous access device is an important procedure to maintain their patency and prevent malfunctioning and complications. An innovative double-chamber syringe was developed, allowing for the assessment of catheter patency, drug delivery and final flush. This study aims to assess the usability of this new device, considering three development stages (concept, semi-functional prototype, functional prototype). Methods: An iterative methodology based on a mix-method design (qualitative and quantitative) enabled the assessment of the devices’ usability by their primary end-users. A usability questionnaire was developed and applied, along with focus groups and individual interviews to nurses. Results: The usability questionnaire integrated 42 items focused on four dimensions (usefulness; ease of use; ease of learning; satisfaction and intention to use). The initial psychometric findings indicate a good internal consistency and the conceptual relevance of the items. The scores seem to be sensitive to the usability evaluation of the medical devices in different stages of product development (with lower values on functional prototype evaluation), and related to nurses’ perceptions about functional and ergonomic characteristics. Conclusions: Quantitative and qualitative data provided a comprehensive overview of the double-chamber syringes’ usability from the nurses’ point of view, informing us of features that must be addressed.

scholarly journals Should we use a patient’s port as the preferred intravenous route rather than inserting an additional venous access?

2021 ◽  
pp. 112972982110150
Author(s):  
Roberto Biffi ◽  
Antonio La Greca
Keyword(s):  
Central Venous Access ◽  
Venous Access ◽  
Infusion Therapy ◽  
Intravenous Route ◽  
Standards Of Practice ◽  
Frequent Use ◽  
Practice Recommendation ◽  
Therapy Standards ◽  
Important Evidence

Early in 2021, the Infusion Nursing Society has released the latest version of the Infusion Therapy Standards of Practice. In the last two decades, these Standards have been representing one of the most important evidence-based documents available in the world of venous access. Nevertheless, we were quite concerned reading a recommendation included in chapter 26 (Vascular Access Device Planning: practice recommendation I, C): “Use a patient’s port, unless contraindicated (e.g. existing complication) as the preferred IV route in preference to insertion of an additional VAD.” Such recommendation is offered not on the basis of evidence, but as experts’ opinion (“Committee Consensus”). This Editorial deals with the opinion of GAVeCeLT (The Italian Study Group for Long Term Central Venous Access) that strongly discourage the use of ports for intravenous treatment different from chemotherapy (or from the therapy that specifically required that long term, infrequent access). The rationale for this choice is based on the consideration that the patient’s port—if used in a non-specialty ward—would be at high risk of complications, some of them potentially leading to the loss of the device, and that such complications might be particularly difficult to manage in this setting. The continuous or frequent use of a port transforms it into an external device, thus cancelling the main advantage of a totally subcutaneous location, while adding a significant disadvantage (need for repeated percutaneous punctures and risk of extravasation/infiltration due to improper insertion or dislocation of the non-coring needle). One exception is the possible use of port for radio-diagnostic purposes (as long as the port is power injectable). This strategy may be associated with advantages for the patient, and imaging quality improvement, but requires the adoption of specific protocols for prevention of infective and mechanical complications.

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