A Comparison of Ondansetron and Lidocaine in Reducing Injection Pain of Propofol: A Randomized Controlled Study

Background Propofol injection pain is common. Previous studies found that ondansetron can also block sodium channels. Objective The primary outcome was the efficacy of ondansetron compared to lidocaine and placebo for the reduction of propofol injection pain. Method This trial was conducted in 240 patients, American Society of Anesthesiologists classification I-III and aged between 18-65 years old, undergoing elective surgery, and having a 20-gauge intravenous catheter at the hand dorsum. Each group of 80 patients received 8 mg of ondansetron in the O Group, 40 mg of lidocaine in the L Group and normal saline in the C Group. The study medications were blindly given then 1 minute later, the propofol was administered via the syringe pump at the rate of 600 ml/hr. for 30 seconds. Thereafter, the syringe pump of propofol was temporarily paused, and the patients were asked to rate his/her pain. Result The incidence of pain was lowest in the L group (66.2%) compared with the O (82.5%) and the C groups (85.0%) (P<0.01). The median pain score in the L, O, and C groups were 2 (0-4), 4 (2-5), and 4.5 (2-6), respectively (P<0.01). The incidences of no pain, mild, moderate, and severe pain were also significantly different in the L group (33.8%, 37.5%, 21.2%, and 7.5%, respectively) compared with those in the O group (17.5%, 31.2%, 31.2%, and 20.0%, respectively) and the C groups (15.0%, 22.5%, 40.0%, and 22.5%, respectively) (P<0.01).. Conclusion Pretreatment with intravenous lidocaine, rather than ondansetron, can reduce the incidence and intensity of propofol-induced pain.

Clinical presentation and management of leuconostoc bacteremia in patient with prolonged ICU stay: Case report

A 54 years old female came to emergency with the complaints of pain in abdomen, recurrent vomiting, abdominal distention and not able to pass flatus since two days. Patient was managed in intensive care unit and was empirically put on Meropenem and Targocid. She developed multiple episodes of loose motion, and stool culture was sent which was positive for Clostridium defficle. Therefore, patient was put on Vancomycin and Metrogyl. The blood cultures reported growth of Leuconostoc pseudomesenteroides. Infection with Leuconostoc may cause fever, intravenous catheter-related sepsis, bacteremia, abdominal pain, gastroenteritis, colitis or meningitis. To summarize this rare organism which is most commonly seen in immunocompromised patients, was isolated in a previously healthy individual, post Vancomycin therapy with prolonged ICU stays.

Current practices of peripheral intravenous catheter fixation in pediatric patients and factors influencing pediatric nurses’ knowledge, attitude and practice concerning peripheral intravenous catheter fixation: a cross-sectional study

Background Peripheral intravenous catheters (PIVCs) are the most widely used intravenous treatment tools for hospitalized patients. Compared to adult patients, PIVC fixation issues are more likely to occur in pediatric patients and can be more complex. However, research on PIVC fixation in pediatric patients is rare. This study aimed to investigate the pass rate for PIVC fixation in pediatric patients and the factors that influence pediatric nurses’ knowledge, attitude, and practice (KAP) concerning PIVC fixation. Methods An on-site investigation using a self-designed PIVC fixation standard inspection checklist for first insertion and routine maintenance in pediatric patients and a follow-up questionnaire survey investigating pediatric nurses’ KAP concerning PIVC fixation was conducted in a hospital in China between November 1 and December 31, 2019. Data were analyzed using SPSS 21.0. Results The pass rate for PIVC fixation in pediatric patients was 52.02%. The pediatric nurses’ knowledge, attitude and practice scores on PIVC fixation were 7.2 ± 1.36, 28.03 ± 2.42, and 31.73 ± 2.94, respectively. The multivariate linear regression analysis results show that department (where nurses are working in) and job position are the factors that influence knowledge score (B > 0, P < 0.05); department is also a factor that influences attitude score (B > 0, P < 0.05); and department and nursing hierarchy are the factors that influence practice score (B > 0, P < 0.05). Conclusion PIVC fixation in pediatric patients is affected by multiple factors. The level of pediatric nurses’ KAP on PIVC fixation needs to be improved. It is suggested that guidelines for PIVC fixation in pediatric patients be formulated and that training on PIVC fixation in pediatric patients be provided for pediatric nurses in an effort to raise the pass rate in terms of PIVC fixation in pediatric patients.

FAKTOR RISIKO EKSTERNAL KEJADIAN PHLEBITIS PADA PEMASANGAN KATETER INTRAVENA PERIFER: STUDI DOKUMENTASI

Intravenous insertion therapy given for a long time can cause complications such as phlebitis. Phlebitis is an inflammatory reaction in the veins along with signs of pain, redness, swelling, heat, and hardening at the puncture site and along the vein. One main factor that influence the incidence of phlebitis are external factors such as inappropriate intravenous (IV) catheters, length of catheter insertion, location of the catheter, pH and fluid osmolarity and internal factors include age, sex and comorbidities. External factors are factors that can be modified according to the authority of the nurse, so that the modification can reduce the incidence of phlebitis in the hospital. The aim of this study was to identify the external risk factors for phlebitis on peripheral intravenous catheter insertion in the inpatient room of a private Indonesian hospital. This research method was descriptive quantitative. Samples based on population, obtained from the Slovin formula were 95 medical records of inpatients with purposive sampling technique. Data collection obtained from medical record documents, included in the observation sheet. This study showed that more than half of the patients with intravenous catheters had the incidence of phlebitis (53%). Patients who experienced the incidence of phlebitis used an intravenous catheter size of 24G (88,89%), the location was in the metacarpal (56,33%), used hipotonic fluid (81,25%) and had an intravenous catheter inserted for more or equal to three days (63,41%). It is important to be able to increase the knowledge and skills of nurses, especially regarding the standard procedure for infusion and treatment as well as external factors that influence the occurrence of phlebitis. Keywords: Intravenous therap;, Phlebitis; Eksternal factors AbstrakTerapi pemasangan intravena yang diberikan dalam jangka waktu yang lama dapat menimbulkan komplikasi seperti adanya kejadian phlebitis. Phlebitis adalah reaksi peradangan pada pembuluh darah vena beserta dengan tanda-tanda nyeri, kemerahan, bengkak, panas, serta pengerasan pada daerah tusukan dan sepanjang pembuluh darah vena. Salah satu faktor utama yang memengaruhi kejadian phlebitis adalah faktor eksternal seperti ukuran kateter intravena/IV yang tidak sesuai, lama pemasangan kateter IV, lokasi pemasangan kateter IV, pH dan osmolaritas cairan. Faktor lainnya yaitu faktor internal seperti usia, jenis kelamin dan penyakit penyerta. Faktor eksternal merupakan faktor yang dapat di modifikasi sesuai kewenangan perawat, sehingga dapat menurunkan angka kejadia phlebitis di rumah sakit. Tujuan penelitian ini untuk mengidentifikasi faktor risiko eksternal kejadian phlebitis pada pemasangan kateter intravena perifer di ruang rawat inap di satu rumah sakit swasta Indonesia. Metode penelitian ini adalah deskriptif kuantitatif. Sampel berdasarkan populasi, yang didapatkan dari rumus Slovin adalah 95 rekam medis pasien rawat inap dengan teknik purposive sampling. Pengumpulan data yang didapatkan dari dokumen rekam medis di masukkan dalam lembar observasi. Penelitian ini menunjukkan bahwa lebih separuh pasien yang terpasang kateter intravena mengalami kejadian phlebitis (53%). Pasien yang mengalami kejadian phlebitis tersebut menggunakan ukuran kateter intravena 24G (88,89%), lokasi pada metacarpal (56,33%), menggunakan jenis cairan hipotonik (81,25%) serta terpasang kateter intravena lebih atau sama dengan tiga hari (63,41%). Penting untuk dapat meningkatkan pengetahuan dan keterampilan perawat khususnya tentang standar prosedur pemasangan infus dan perawatannya serta faktor eksternal yang memengaruhi terjadinya phlebitis.

Invasive Infections Associated with the Use of Probiotics in Children: A Systematic Review

Although the effectiveness of probiotics has only been proven in specific conditions, their use in children is massively widespread because of their perception as harmless products. Recent evidence raises concerns about probiotics’ safety, especially but not only in the paediatric population due to severe opportunistic infections after their use. This review aimed at summarising available case reports on invasive infections related to probiotics’ use in children. For this purpose, we assessed three electronic databases to identify papers describing paediatric patients with documented probiotic-derived invasive infections, with no language restrictions. A total of 49 case reports from 1995 to June 2021 were identified. The infections were caused by Lactobacillus spp. (35%), Saccharomyces spp. (29%), Bifidobacterium spp. (31%), Bacillus clausii (4%), and Escherichia coli (2%). Most (80%) patients were younger than 2 years old and sepsis was the most observed condition (69.4%). All the patients except one had at least one condition facilitating the development of invasive infection, with prematurity (55%) and intravenous catheter use (51%) being the most frequent. Three (6%) children died. Given the large use of probiotics, further studies aiming at evaluating the real incidence of probiotic-associated systemic infections are warranted.