Nurses’ knowledge and experience related to short peripheral venous catheter extravasation

Background: The majority of hospitalized patients receive a Peripheral Venous Catheter (PVC) in the course of their treatment. Extravasation injury is a serious complication of intravenous treatment. Objective: This cross-sectional survey designed study aims to investigate nurses’ knowledge and experience related to short peripheral venous catheter extravasation. Method: The study sample included 145 nurses working in a university hospital in the west of Turkey. A questionnaire developed in accordance with the literature was used for data collection. The data were assessed by frequency and proportions. Results: Of the nurses included in this study, 26.2% reported they had experienced extravasation injury in a patient; 74.5% said they had received no instruction in the management of extravasation during their in-service training program; and 85.5% stated they did not keep a record of extravasation. 89.7% of the nurses reported infused medications as a cause of extravasation, and 81.4% reported catheter sites as a cause. Among the medications reported by the nurses as causing extravasation: 89.7% reported contrast agents; 84.8% TPN solutions; 71.0% cytotoxic agents; and 65.1% mannitol. The symptoms of extravasation reported by nurses included: swelling (97.9%), redness (97.2%), pain (92.4%), rise in temperature (65.5%), and ulceration (60.0%). In responding to the occurrence of extravasation, interventions reported by the nurses included: stopping the flow of fluid (98.6%), elevation (89.7%), cold application (76.6%), and aspiration of drug (40.7%). Conclusion: Based on these results, it is recommended that guidelines are developed for the management of extravasation, that periodic in-service training programs are provided and that observational studies are carried out into the administration of vesicant drugs.

Efficacy Evaluation of Amniotic Membrane in the Treatment of Neonatal Extravasation: a Pilot Study

Intravenous treatment exposes the neonates to extravasation due to fragile and small veins and the long period required for treatment. Extravasation is leakage of fluids, nutrition, or drugs from a peripheral intravenous which could cause tissue damage. The injured complications range from local irritation to skin necrosis and severe scar formation after the healing. Several methods have been used to control the complications of extravasation. We used an Amniotic membrane, a biological dressing, for healing the wounds. Our object in this study is to examine whether the amniotic membrane can induce healing wounds following extravasations.This prospective 13-week single-arm clinical trial study was performed on five neonates from February 2020 till May 2021 in the children's medical center of Tehran University. Neonates with any gestational age and diagnosis of the wound due to extravasation entered our study. Neonates with skin disorders and wound stages of 1 and 2 were excluded from the study. Established wounds without necrosis and infection are treated with an amniotic membrane. The amniotic membrane covers the wound, and after 48 hours, the wound is rechecked. The sequence of replacing or removing the bandages is five to seven days until healing occurs.An amniotic membrane was applied to the wounds and the average time for healing was 2.5 weeks. The average gestational age was 33.6 weeks. We did not report any adverse reaction, and healing was without scar formation.Implementing an amniotic membrane for treating wounds due to Extravasation can be a new approach. This treatment route decreases graft requirement and can be implemented by expert nurses, so in remote NICUs, its usage is easy.

Hypothyroid Crisis: Oral or Intravenous Treatment? A Report of Two Cases

Background: Hypothyroid crisis, or myxoedema coma, is a rare condition with high mortality and must be treated promptly. Even though it may be unfavourable, most guidelines only focus on intravenous drug administration due to lack of data on oral treatment. Methods/Results: The course of oral treatment in two patients admitted in our hospital is described. Patients were treated with levothyroxine 1.3 µg/kg and liothyronine 25 µg twice daily, followed after 1 week with only levothyroxine 1.3 µg/kg daily. Oral treatment was successful in both patients without complications or side-effects. Conclusions: Oral substitution is an appropriate alternative to intravenous substitution, which has potential disadvantages and is associated with higher mortality.

Evaluation efficacy of amniotic membrane in the treatment of neonatal Extravasation: a pilot study

Introduction: Intravenous treatment exposes the neonates to Extravasation due to Fragile and small veins and the long period required for treatment. Extravasation is leakage of fluids, nutrition, or drugs from a peripheral intravenous which could cause tissue damage. Based on extravasated material, volume, and patient-related factors, the injured complications range from local irritation to skin necrosis and severe scar formation after the healing. Several methods have been used to control the complications of Extravasation. We used an Amniotic membrane, a biological dressing, for healing the wounds. Our object in this study is to examine whether can the amniotic membrane induce healing wounds following extravasations. Methods: This prospective 13-week single-arm clinical trial study was performed on five neonates from February 2020 till May 2021 in the children's medical center of Tehran University. Neonates with any gestational age and with the diagnosis of the wound due to Extravasation entered our study. Neonates with skin disorders and wound stages of 1 and 2 were excluded from the study. Established Wounds without necrosis and infection are treated with an amniotic membrane. The amniotic membrane covers the wound, and After 48 hours, the wound is rechecked. Five days after the first bandage, the amniotic membrane is replaced with a new one, and the sequence of removing the bandages is five to seven days until healing occurs. Results: An amniotic membrane was applied to the wounds and the average time for healing was 2.5 weeks. The average gestational age was 33.6 weeks. We did not report any adverse reaction, and healing was without scar formation. Discussion/Conclusion: Implementing an amniotic membrane for treating wounds due to Extravasation can be a new approach. This treatment route decreases graft requirement and can be implemented by expert nurses, so in remote NICUs, its usage is easy.

Colistin neurotoxicity mimicking Guillain-Barré syndrome in a patient with cystic fibrosis: case report and review

ABSTRACT Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy, which is characterized by areflexia and ascending paresthesia which can progress to a respiratory failure. Certain conditions, such as vasculitis and heavy metal and drug toxicity, may have misleadingly similar clinical presentation to GBS. We describe a case of a patient with cystic fibrosis and intravenous colistin-induced neurotoxicity mimicking GBS. The patient had used inhaled colistin on five occasions with no adverse effects, however, developed symptoms on the second day of intravenous treatment. Overlapping findings between immune-mediated polyneuropathy and drug-induced neurotoxicity include limb paresthesia and decreased reflexes. Perioral tingling, however, is a common presentation of colistin-induced neurotoxicity, and therefore, is an important differentiating factor. Early diagnosis prevents further neurologic decline, extensive unnecessary workup and potentially harmful incorrect management.

Comparison of colistin-induced nephrotoxicity between two different formulations of colistin in critically ill patients: a retrospective cohort study

Background Colistin is widely used in the treatment of nosocomial infections caused by carbapenem-resistant gram-negative bacilli (CR-GNB). Colistin-induced nephrotoxicity is one of the major adverse reactions during colistin treatment. Comparisons of colistin-induced nephrotoxicity between different formulations of colistin are rarely reported. Methods In this retrospective cohort study, we enrolled intensive care unit–admitted patients if they had culture isolates of CR-GNB and underwent intravenous treatment with colistin. The occurrence of acute kidney injury (AKI) during intravenous treatment with colistin was recorded. The occurrence of colistin-induced nephrotoxicity was compared between two formulations of colistin, Locolin®, and Colimycin®. Treatment outcomes associated with the occurrence of colistin-induced nephrotoxicity were also investigated. Results Among 195 patients, 95 who were treated with Locolin® and 100 who were treated with Colimycin® were included for analysis. Patients treated with Locolin® had a higher rate of occurrence of stage 2 (46.3% vs. 32%, p = 0.040) and stage 3 (29.5% vs. 13%, p = 0.005) AKI than did those treated with Colimycin®. In multivariate analysis, the presence of septic shock (adjusted odds ratio [aOR] 2.17, 95% confidence interval [CI] 1.10–4.26) and inappropriate colistin dosage (aOR 2.52, 95% CI 1.00–6.33) were clinical factors associated with colistin-induced nephrotoxicity. Treatment with Colimycin® was an independent factor associated with a lower risk of colistin-induced nephrotoxicity (aOR 0.37, 95% CI 0.18–0.77). The mortality rate was comparable between patients with and without colistin-induced nephrotoxicity. Conclusions The risk of colistin-induced nephrotoxicity significantly varied in different formulations of colistin in critically ill patients. Colistin-induced nephrotoxicity was not associated with increased mortality rate.

Population-Based Cohort of Children With Parapneumonic Effusion and Empyema Managed With Low Rates of Pleural Drainage

Introduction: The most appropriate treatment for parapneumonic effusion (PPE), including empyema, is controversial. We analyzed the experience of our center and the hospitals in its reference area after adopting a more conservative approach that reduced the use of chest tube pleural drainage (CTPD).Methods: Review of the clinical documentation of all PPE patients in nine hospitals from 2010 to 2018.Results: A total of 318 episodes of PPE were reviewed; 157 had a thickness of <10 mm. The remaining 161 were 10 mm or thicker and were subdivided into three increasing sizes: PE+1, PE+2, and PE+3. There was a strong relationship between the size of the effusion and complicated effusion/empyema, defined by its appearance on imaging studies or by the physical or bacteriological characteristics of the pleural fluid. The size of effusion was also strongly related to the duration of fever and intravenous treatment and was the best independent predictor of the length of hospital stay (LHS) (p < 0.001). CTPD was placed in 2.9% of PE+1 patients, 19.3% of PE+2, and 63.9% of PE+3 (p < 0.001). The referral of patients with PE+1 decreased over time (p = 0.033), as did the use of CTPD in the combined PE+1/PE+2 group (p = 0.018), without affecting LHS (p = 0.814). There were no changes in the use of CTPD in the PE+3 group (p = 0.721).Conclusions: The size of the PPE is strongly correlated with its severity and with LHS. Most patients can be treated with antibiotics alone.

Ointment therapy and prevention of cannulation-induced superficial phlebitis

The primary aim of this prospective randomized trial is to determine the effect of clobetasol ointment with nitroglycerin ointment on the prevention of phlebitis caused by cannulation. The target sample is 144 patients admitted to surgical ward, randomized to 3 groups. the data collection tools included demographic information, information about intravenous treatment and phlebitis measurement scale. In the intervention groups, after venipuncture, 1.5 cm of ointments (clobetasol and nitroglycerin) was applied n three time periods of 24, 48 and 72 hours from the time of venipuncture. In the first 24 hours after cannulation, there was no significant difference between the three groups. But at 48 and 72 hours after placement, the difference between intervention and control groups was significant (P<0.0001). It is recommended to use clobetasol ointment and nitroglycerin ointment to prevent the occurrence of phlebitis in patients who need long-term use of cannula (more than 48 hours).