Efficacy and safety associated with the infusion speed of intravenous immunoglobulin for the treatment of Kawasaki disease: a randomized controlled trial

Background High-dose intravenous immunoglobulin (IVIG) is the mainstay of treatment for Kawasaki disease (KD). Usually, 2 g/kg of IVIG is administered over 10–24 h, depending on the institution or physician, but the association between infusion speed and effectiveness has not been reported. In this study, we evaluated the differences in efficacy and safety between two different IVIG administration speeds. Methods This was a multicenter, unblinded, randomized controlled study. Patients newly diagnosed with KD were randomized into two groups: one who received IVIG over 12 h (12H group, double speed), and one that received IVIG over 24 h (24H group, reference speed). The endpoints included the duration of fever, incidence of coronary artery abnormalities (CAAs) and of adverse events. Laboratory data were evaluated before and after IVIG administration. Results A total of 39 patients were enrolled. There was no difference between groups in fever duration after the initiation of IVIG (21 h vs. 21.5 h, p = 0.325), and no patient experienced CAAs. Two adverse events were observed in the 12H group (elevation of aspartate aminotransferase and vomiting), however no severe adverse events requiring treatments or extension of hospital stay were observed in either group. After initial IVIG administration, the change ratio of inflammatory markers, such as white blood cell counts, neutrophils, C-reactive protein, and albumin, did not show significant differences between the two groups. On the other hand, a greater increase of serum immunoglobulin G from its baseline level was observed in the 24H group compared to the 12H group (3037 ± 648 mg/dl vs. 2414 ± 248 mg/dl, p < 0.01). Conclusion The efficacy and safety of IVIG administered over 12 h (double speed) were similar to those administered over 24 h (reference speed). Trial registration University Hospital Medical Information Network (UMIN000014665). Registered 27 July 2014 – Prospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000017058

Immediate aspiration of the drug infused via central venous catheter through the distally positioned central venous dialysis catheter: An experimental study

Objectives: The aim of this study was to construct an experimental model replicating blood flow within human superior vena cava and to determine the degree of the immediate aspiration of the drug introduced via central venous catheter through the distally positioned dialysis catheter. Methods: A model replicating superior vena cava was built, catheters were inserted into the model, placing the orifice of the central venous catheter in positions regarding the orifice of the arterial lumen in central venous dialysis catheter (from +2 to −8 cm). Methylene blue was used as a tracer, and the concentration was determined by ultraviolet-visible spectroscopy. Four different sets of samples were generated according to infusion and aspiration speeds: continuous–slow, continuous–fast, bolus–slow, and bolus–fast. Results: The concentration of the tracer was related to the distance between the catheter tips, representing a bimodal dependence. When the central venous catheter was placed distally to the central venous dialysis catheter, the aspiration of the tracer was minimal. When withdrawing the central venous catheter proximally, the aspiration of the tracer increased, reaching its peak at −4 cm with aspiration rates form 4.2% to 140.7%. Furthermore, the infusion speed of the tracer had more effect on the aspirated concentrations than the aspiration speed. Conclusion: Findings of our experimental model suggest that concentration of aspired drug is effected by the distance between the central venous catheter and central venous dialysis catheter, being lowest when the drug is infused distally to central venous dialysis catheter. Furthermore, the concentration of the tracer is directly proportional to the infusion speed and far less effected by the aspiration rate of the drug.

Nurses’ beliefs and practices regarding intravenous opioid use for breakthrough cancer pain.

222 Background: Faster intravenous (IV) opioid administration speed is associated with increased adverse effects and subsequent increased opioid intake. Infusion rates ≥ 2 minutes are recommended. Data on nurse practices regarding IV opioid administration are limited. We assessed the frequency of nurse-reported speeds of IV opioid bolus infusion in the inpatient oncology units, and nurses’ beliefs and perceptions about opioids in cancer pain management. Methods: A cross-sectional survey among inpatient nurses working in the medical, surgical, intensive care unit (ICU), and emergency department (ED) work areas was conduceted. We defined fast IV opioid bolus infusion speed as < 120 seconds(s). Results: The participant response rate was 60% (731/1234).57%, 55%, and 58% of all nurses administered morphine, hydromorphone, and fentanyl in < 120s.Overall median (IQR) infusion speed of IV morphine, hydromorphone, and fentanyl were 60s (40-120), 90s (45-120), and 60s (30-120) respectively. Correlation between morphine, hydromorphone, and fentanyl infusion speeds were 0.93, 0.90, and 0.90 respectively (p <0 .0001). Median infusion speed of morphine was 55s for ICU nurses, 60s for both surgical unit and emergency department nurses, and 85s for medical unit nurses (p=0.0002). The odds ratio for fast IV opioid infusion was 2.22 for ED nurses (p= 0.027), 2.67 for ICU nurses (p= 0.001), 0.27 and 0.18 for frequent (p=0.003) and very frequent(p=0.001) use a timing device respectively, and 0.86 for hydromorphone infusion compared with morphine (< 0.0001). Fast infusion was also independently associated with perception that suboptimal pain control as the reason for increased patient opioid requests(p=0.009), clinician reluctance to prescribe opioids(p=0.008), lack of psychosocial support services (p= 0.03), and patient’s reluctance to take opiates (p=0.015). Conclusions: More than half the nurses working in the inpatient setting reported administering IV opioids at a faster speed than recommended. Nurses who frequently use a timing device are more likely to infuse at a more optimal speed. Further research is needed to standardize and improve safe intermittent infusion of parenteral opioids.

The Effect of In-Line Infusion Filtering on In-Line Pressure Monitoring in an Experimental Infusion System for Newborns

Aim: To study the effect of in-line filtering on in-line pressure measurement in a simulated infusion system.Methods: The experimental setup consisted of a syringe pump, syringe, intravenous (IV) line, and extension line. For aqueous fluids, a 0.2-μm infusion filter was used, and for lipid emulsions, a 1.2-μm filter. Infusion speed varied from 0.5 to 10.0 mL/h. First, the effect of clamping the extension line was studied on reaching alarm threshold. Second, the effect of aqueous and lipid fluids was evaluated on in-line pressure measurements.Results: In-line placement of an infusion filter did not prolong the time to alarm threshold after occlusion. During 24 hours of monitoring, lipid emulsions and all-in-one admixture only caused a moderate increase in in-line pressure.Conclusion: Placement of an infusion filter does not have a significant effect on the in-line pressure monitoring and has no adverse effect on detecting pressure-related complications of IV administration.

The Design of Electronic Monitor Used in Hospital

An electronic monitor for hospital inpatients is designed in this paper. Patients can give a calling signal by button, and the monitor can detect and display the infusion speed and give a alarm in time when the speed is too fast or too slow, in addition, it also can set various time for activity to inform medical staff. The whole system is divided into the host and the extension, the host display the current time and set various time for activities by DS1302 chip, the extension give the calling signal by keyboard, the host receive it through communication and display the bed number, the infusion speed is detected through the photoelectric method and is send to the extension for display and alarm. The monitoring instrument has great application value which can avoid failure during the process of transfusion and improve working efficiency.

The Design of Infusion Monitoring System Based on STM32 Microcontroller

conventional manual adjustment to control the drop speed in clinical infusion has more unadvantageous and cannot realize automatic controlling and monitoring of the infusion speed. According to this condition, the infusion monitoring system is designed based on the STM32 microcontroller and one pair of infrared emitting and receiving diode, and the experimental is done. The result shows that this designed monitoring system can reach high accuracy, high reliability and low adjust time.