MO715PROFILE OF INFECTIVE ENDOCARDITIS IN HEMODIALYSIS PATIENTS

Background and Aims Infectious complications are the second leading cause of death in hemodialysis patients. This population is particularly exposed to bacteremia, on the one hand, because of the vascular access necessary for hemodialysis, which is a gateway to the various micro-organisms, and on the other hand, factors of susceptibility to infections. Infective endocarditis (IE) is the cardiac endothelium infection associated with bacteremia. It is a rare complication but its mortality remains high especially in patients on chronic hemodialysis. The aim of this study was to determine the microbiological profile, clinical and-biological profile, characteristics in the ultrasound, therapeutic modalities, and prognosis of IE in hemodialysis. Method This is a retrospective descriptive study of including chronic hemodialysis patients, admitted in the Nephrology and Internal Medicine Department A of the Charles Nicolle Hospital in Tunis for an IE during the period from 1973 to 2018. We used the modified Duke criteria to confirm the diagnosis of IE. Results Nineteen patients were included, including 12 men and 7 women (gender ratio=1.7). The average age was 49.1 years [29-66 years]. Seven of them (37%) were known to have a valvular disease, two of them had a double mitro-aortic valve replacement. Six of them (32%) were diabetic and two patients (11%) were on immunosuppressive therapy. The vascular access initially used for HD were arteriovenous fistula in 9 cases (47%), internal jugular catheter in 3 cases (16%), subclavian catheter in 1 case (5%), Canaud catheter in 3 cases (16%), and 2 patients were dialyzed by femoral catheter (11%). Clinically, all patients had an altered general condition, fever was present in 14 cases (74%) and a heart murmur in 10 cases (53%). Blood cultures were positive in 14 cases (74%). The isolated germs were Staphylococcus Aureus in 8 cases, Staphylococcus epidermidis in 4 cases, Pseudomonas aerogenosa in 3 cases, Enterobacterium in 1 case, enterococcus faecalis in 1 case, and Klebsielle oxytoca in one patient. On cardiac ultrasound, mitral valve damage was found in 10 patients, aortic sigmoid in 4 patients and tricuspid valve in 3 patients. The treatment included appropriate antibiotic therapy in all cases and a valvuloplasty was indicated in 7 patients. Nine patients (47%) died during their hospitalization. Conclusion Hemodialysis patients are particularly exposed to IE. The most appropriate preventive method is the strict observance of asepsis when handling the vascular access first and the rapid eradication of all infectious outbreaks.

Emergency Central Venous Catheterization during Trauma Resuscitation: A Safety Analysis by Site

Central venous catheterization (CVC) is often necessary during initial trauma resuscitations, but may cause complications including catheter-related blood stream infection (CRBSI), deep venous thrombosis (DVT), pulmonary emboli (PE), arterial injury, or pneumothoraces. Our primary objective compared subclavian versus femoral CVC complications during initial trauma resuscitations. A retrospective review (2010–2011) at an urban, Level-I Trauma Center reviewed CVCs during initial trauma resuscitations. Demographics, clinical characteristics, and complications including: CRBSIs, DVTs, arterial injuries, pneumothoraces, and PEs were analyzed. Fisher's exact test and Student's t test were used; P ≤ 0.05 was considered statistically significant. Overall, 504 CVCs were placed (subclavian, n = 259; femoral, n = 245). No difference in age (47 ± 22 vs 45 ± 23 years) or body mass index (28 ± 6 vs 29 ± 16 kg/m2) was detected ( P > 0.05) in subclavian vs femoral CVC, but subclavian CVCs had more blunt injuries (81% vs 69%), greater systolic blood pressure (95 ± 55 vs 83 ± 43 mmHg), greater Glasgow Coma Scale (10 ± 5 vs 9 ± 5), and less introducers (49% vs 73%) than femoral CVCs (all P < 0.05). Catheter related arterial injuries, PEs, and CRBSIs were similar in subclavian and femoral groups (3% vs 2%, 0% vs 1%, and 3% vs 3%; all P > 0.05). Catheter-related DVTs occurred in 2 per cent of subclavian and 9 per cent of femoral CVCs ( P < 0.001). There was a 3 per cent occurrence of pneumothorax in the subclavian CVC population. In conclusion, both subclavian and femoral CVCs caused significant complications. Subclavian catheter-related pneumothoraces occurred more commonly and femoral CRBSIs less commonly than expected compared with prior literature in nonemergent scenarios. This suggests that femoral CVC may be safer than subclavian CVC during initial trauma resuscitations.

Proceso de Enfermería a paciente con cetoacidosis diabética y riesgo de síndrome de desuso

<div>RES&Uacute;MEN&nbsp;</div><div><br /></div><div>Este trabajo es un PE aplicado al &nbsp;paciente ADPG de la UCI del HGZ 24 utilizando el modelo de los 11 Patrones Funcionales de Marjory Gordon con fecha de valoraci&oacute;n del 2 de abril del 2013, con diagn&oacute;stico m&eacute;dico de cetoacidosis diab&eacute;tica, patolog&iacute;a de base Diabetes Mellitus I, 17 a&ntilde;os de evoluci&oacute;n, actualmente tratada con infusi&oacute;n de insulina glargina. T/A 130/81 mmHg, F.C 99/min., F.R 26/min., SO2 100%. Temp. 37&deg;C, glicemia capilar 40 mg/dl a las 08:00 y de 80 mg/dl a las 10:00. Valores de gasometr&iacute;a pH 7.20, HCO3 19 mol/1, PCO2 35 mmHg, PO2 66 mmHg. ADPG encamado, bajo sedaci&oacute;n con Propofol, Ramsay 4, riesgo alto de ca&iacute;das y &uacute;lceras por presi&oacute;n, inm&oacute;vil, mioclon&iacute;as faciales, ausencia de reflejos oculares, sonda nasog&aacute;strica para alimentaci&oacute;n y drenaje, ventilaci&oacute;n mec&aacute;nica asisto control. Piel seca y palidez, mucosas orales deshidratadas, fisura en labio inferior, lengua con ulceraci&oacute;n en porci&oacute;n distal debido a la c&aacute;nula endotraqueal. Cat&eacute;ter subclavio derecho, monitorizado por electrodos, edema en manos (+), hematoma en yema del dedo &iacute;ndice de MSD. Hipoactividad intestinal, sonda transuretral tipo Foley, &uacute;lcera en regi&oacute;n cox&iacute;gea estad&iacute;o II y en MsPs regi&oacute;n calc&aacute;nea en estadio II, presenta mioclon&iacute;as en extremidades, pie cavo izquierdo. Paciente en abandono por cuidador primario. Se diagnostic&oacute; con Riesgo de s&iacute;ndrome de desuso, identificamos capacidades del paciente se elabor&oacute; un plan con duraci&oacute;n de 4 d&iacute;as, entre las intervenciones ejecutadas estuvieron cuidados a paciente encamado, cuidado de las ulceras por presi&oacute;n principalmente, evaluando que nuestro objetivo se cumpli&oacute; en un 60%.</div><div><br /></div><div><br /></div><div>ABSTRACT</div><div><br /></div><div>This work is a PAE applied to the patient ADPG of the UCI of HGZ 24 using the Marjory Gordon&rsquo;s 11 functional patterns model; assessment dated April 2, 2013 with a medical diagnosis of diabetic ketoacidosis, Diabetes Mellitus underlying pathology I, 17 years of evolution, currently treated with glargine insulin infusion. T / A 130/81 mmHg, HR 99/min., FR 26/min., SO2 100%. Temp. 37 &deg; C, capillary glucose 40 mg / dl at 0800 and 80 mg / dl at 10:00. Blood gas values ​​pH 7.20, HCO3 19 mol / 1, PCO2 35 mmHg, PO2 66 mmHg. ADPG bedridden, under sedation with Propofol, Ramsay 4, and high risk of falls and pressure ulcers, immobile facial myoclonus and absence of eye reflexes, nasogastric feeding and drainage, attend ventilation control. Dry and pale skin, oral mucosa dehydrated, cleft lip, tongue ulceration distal portion due to the endotracheal tube. Right subclavian catheter, monitored by electrodes, edema in hands (+), hematoma index fingertip MSD. Underactive bowel, Foley transurethral catheter type, coccygeal ulcer stage II and stage MSPs calcaneal region II, presents myoclonus in limbs, arched feet left. Patient abandoned by primary caregiver. Was diagnosed with disuse syndrome risk, we identified the patient&rsquo;s capability and elaborated a plan lasting four days, between interventions were executed bedridden patient cares, care of pressure ulcers mainly assessing our objective was met by 60 %.</div>