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Worthington P, Gura KM, Kraft MD, Nishikawa R, Guenter P, Sacks GS. Update on the Use of Filters for Parenteral Nutrition: An ASPEN Position Paper. Nutr Clin Pract 2020; 36:29-39. [DOI: 10.1002/ncp.10587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 01/05/2023] Open
Affiliation(s)
- Patricia Worthington
- Department of Nursing Thomas Jefferson University Hospital Philadelphia Pennsylvania USA
| | - Kathleen M. Gura
- Pharmacy Clinical Research Program Boston Children's Hospital Harvard Medical School Boston Massachusetts USA
| | - Michael D. Kraft
- Department of Pharmacy Services Education and Research–Michigan Medicine University of Michigan College of Pharmacy Ann Arbor Michigan USA
| | | | - Peggi Guenter
- Clinical Practice Quality and Advocacy American Society for Parenteral and Enteral Nutrition Silver Spring Maryland USA
| | - Gordon S. Sacks
- Medical Affairs for PN Market Unit Fresenius Kabi USA, LLC Lake Zurich Illinois USA
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Bolisetty S, Osborn D, Schindler T, Sinn J, Deshpande G, Wong CS, Jacobs SE, Phad N, Pharande P, Tobiansky R, Luig M, Trivedi A, Mcintosh J, Josza E, Opie G, Downe L, Andersen C, Bhatia V, Kumar P, Malinen K, Birch P, Simmer K, McLeod G, Quader S, Rajadurai VS, Hewson MP, Nair A, Williams M, Xiao J, Ravindranathan H, Broadbent R, Lui K. Standardised neonatal parenteral nutrition formulations - Australasian neonatal parenteral nutrition consensus update 2017. BMC Pediatr 2020; 20:59. [PMID: 32035481 PMCID: PMC7007668 DOI: 10.1186/s12887-020-1958-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The first consensus standardised neonatal parenteral nutrition formulations were implemented in many neonatal units in Australia in 2012. The current update involving 49 units from Australia, New Zealand, Singapore, Malaysia and India was conducted between September 2015 and December 2017 with the aim to review and update the 2012 formulations and guidelines. METHODS A systematic review of available evidence for each parenteral nutrient was undertaken and new standardised formulations and guidelines were developed. RESULTS Five existing preterm Amino acid-Dextrose formulations have been modified and two new concentrated Amino acid-Dextrose formulations added to optimise amino acid and nutrient intake according to gestation. Organic phosphate has replaced inorganic phosphate allowing for an increase in calcium and phosphate content, and acetate reduced. Lipid emulsions are unchanged, with both SMOFlipid (Fresenius Kabi, Australia) and ClinOleic (Baxter Healthcare, Australia) preparations included. The physicochemical compatibility and stability of all formulations have been tested and confirmed. Guidelines to standardise the parenteral nutrition clinical practice across facilities have also been developed. CONCLUSIONS The 2017 PN formulations and guidelines developed by the 2017 Neonatal Parenteral Nutrition Consensus Group offer concise and practical instructions to clinicians on how to implement current and up-to-date evidence based PN to the NICU population.
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Affiliation(s)
- Srinivas Bolisetty
- Royal Hospital for Women, Locked Bag 2000, Randwick NSW, Sydney, 2031 Australia
- Conjoint Lecturer, University of New South Wales, Sydney, Australia
| | - David Osborn
- Royal Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Tim Schindler
- Royal Hospital for Women, University of New South Wales, Sydney, Australia
| | - John Sinn
- University of Sydney, Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | | | | | - Susan E. Jacobs
- Deputy Clinical Director and Neonatal Paediatrician, The Royal Women’s Hospital, Parkville, Victoria Australia
| | - Nilkant Phad
- John Hunter Children’s Hospital, Newcastle, Australia
| | | | | | | | - Amit Trivedi
- The Children’s Hospital at Westmead, Sydney, Australia
| | | | - Eszter Josza
- Royal Hospital for Women, Locked Bag 2000, Randwick NSW, Sydney, 2031 Australia
| | - Gillian Opie
- Head and Neonatal Paediatrician, Mercy Hospital for Women, Heidelberg, Victoria Australia
| | | | - Chad Andersen
- Head of Neonatology, Women’s and Children’s Hospital, North Adelaide, Australia
| | - Vineesh Bhatia
- Head of Neonatology, Women’s and Children’s Hospital, North Adelaide, Australia
| | | | - Katri Malinen
- PGCert Clinical Education, PGDip Child Health (associate), Advanced Pharmacist, Townsville Hospital, Townsville, Australia
| | - Pita Birch
- Gold Coast University Hospital, Southport, Australia
| | - Karen Simmer
- King Edward Memorial Hospital for Women, Subiaco, Australia
| | - Gemma McLeod
- King Edward Memorial and Princess Margaret Hospitals, Subiaco, Australia
| | - Suzanne Quader
- The Sydney Children’s Hospital Network, Sydney, Australia
| | | | | | - Arun Nair
- Waikato Hospital, Hamilton, New Zealand
| | | | | | | | | | - Kei Lui
- University of New South Wales, Sydney, Australia
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Omran EA, Eisa FF, Bakr WMK. Microbial Contamination of Neonatal Injectable Lipid Emulsions at 12 and 24 Hours' Infusion Time With Evaluation of Infection Control Measures. J Pediatr Pharmacol Ther 2020; 25:53-60. [PMID: 31897076 DOI: 10.5863/1551-6776-25.1.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to assess the microbial contamination rate of injectable lipid emulsion (ILE) repackaged syringes at 12 and 24 hours of their infusion time. Probable risk factors associated with contamination of the ILEs were also assessed. In addition, the antimicrobial resistance pattern of the bacterial isolates was also determined. METHODS Samples of ILE were collected from 152 repackaged syringes and their infusion lines after 12 hours and 24 hours of infusion time (73 and 79 samples, respectively). Samples were cultured, the isolates were identified, and the antimicrobial resistance pattern of the bacterial isolates was identified. A checklist was completed throughout the study to observe the compliance to infection control measures by pharmacists (who prepare) and nurses (who administer) the ILE infusions. Results of septic neonatal cultures were taken from records. RESULTS Microbial contamination was found in 15.8% of ILE samples. The 2 most common pathogens found among positive samples were Klebsiella pneumoniae (29.2%) and Candida albicans (20.8%). Microbial contamination of repackaged syringes increased from 9.6% at 12 hours to 21.5% at 24 hours. This difference was found to be statistically significant (p = 0.044). A similar trend of predominance of those 2 pathogens, in both ILE and neonatal cultures, was observed. There was a statistically significant better performance of infection control measures of pharmacists rather than nurses. The K pneumoniae isolates (n = 7) showed antibiotic resistance in the following pattern: gentamicin (71.4%), cefazolin (85.7%), and cefoxitin (85.7%). CONCLUSIONS The rate of ILE contamination was less at 12 hours' than at 24 hours' infusion time. However, contamination rates at 12 hours were unacceptably high. Klebisella pneumoniae and C albicans were the most common pathogens isolated from ILE. Compliance with infection control measures was significantly worse among nurses compared with pharmacists.
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:171-206. [DOI: 10.1007/s00103-016-2487-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Duesing LA, Fawley JA, Wagner AJ. Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies. Nutr Clin Pract 2016; 31:490-501. [PMID: 27032770 DOI: 10.1177/0884533616640454] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Central venous catheters are often necessary in the pediatric population. Access may be challenging, and each vessel presents its own unique set of risks and complications. Central venous catheterization is useful for hemodynamic monitoring, rapid fluid infusion, and administration of hyperosmolar medications, including vasopressors, antibiotics, chemotherapy, and parenteral nutrition. Recent advances have improved the catheters used as well as techniques for insertion. A serious complication of central access is infection, which is associated with morbidity, mortality, and significant financial costs. Reduction of catheter-related bloodstream infections is realized with use of ethanol locks, single lumens when appropriate, and prudent adherence to insertion and maintenance bundles. Ultrasound guidance used for central venous catheter placement improves accuracy of placement, reducing time and unsuccessful insertion and complication rates. Patients with central venous catheters are best served by multidisciplinary team involvement.
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Affiliation(s)
- Lori A Duesing
- Division of Pediatric Neurosurgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jason A Fawley
- Department of Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy J Wagner
- Department of Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA
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Rickard CM, Marsh NM, Webster J, Gavin NC, McGrail MR, Larsen E, Corley A, Long D, Gowardman JR, Murgo M, Fraser JF, Chan RJ, Wallis MC, Young J, McMillan D, Zhang L, Choudhury MA, Graves N, Playford EG. Intravascular device administration sets: replacement after standard versus prolonged use in hospitalised patients-a study protocol for a randomised controlled trial (The RSVP Trial). BMJ Open 2015; 5:e007257. [PMID: 25649214 PMCID: PMC4322194 DOI: 10.1136/bmjopen-2014-007257] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Vascular access devices (VADs), such as peripheral or central venous catheters, are vital across all medical and surgical specialties. To allow therapy or haemodynamic monitoring, VADs frequently require administration sets (AS) composed of infusion tubing, fluid containers, pressure-monitoring transducers and/or burettes. While VADs are replaced only when necessary, AS are routinely replaced every 3-4 days in the belief that this reduces infectious complications. Strong evidence supports AS use up to 4 days, but there is less evidence for AS use beyond 4 days. AS replacement twice weekly increases hospital costs and workload. METHODS AND ANALYSIS This is a pragmatic, multicentre, randomised controlled trial (RCT) of equivalence design comparing AS replacement at 4 (control) versus 7 (experimental) days. Randomisation is stratified by site and device, centrally allocated and concealed until enrolment. 6554 adult/paediatric patients with a central venous catheter, peripherally inserted central catheter or peripheral arterial catheter will be enrolled over 4 years. The primary outcome is VAD-related bloodstream infection (BSI) and secondary outcomes are VAD colonisation, AS colonisation, all-cause BSI, all-cause mortality, number of AS per patient, VAD time in situ and costs. Relative incidence rates of VAD-BSI per 100 devices and hazard rates per 1000 device days (95% CIs) will summarise the impact of 7-day relative to 4-day AS use and test equivalence. Kaplan-Meier survival curves (with log rank Mantel-Cox test) will compare VAD-BSI over time. Appropriate parametric or non-parametric techniques will be used to compare secondary end points. p Values of <0.05 will be considered significant. ETHICS AND DISSEMINATION Relevant ethical approvals have been received. CONSORT Statement recommendations will be used to guide preparation of any publication. Results will be presented at relevant conferences and sent to the major organisations with clinical practice guidelines for VAD care. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN 12610000505000).
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Affiliation(s)
- Claire M Rickard
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Nicole M Marsh
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Joan Webster
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nicole C Gavin
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Emily Larsen
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Amanda Corley
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Debbie Long
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Lady Cilento Children's Hospital, Brisbane, Australia
| | - John R Gowardman
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Marghie Murgo
- Clinical Excellence Commission, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
| | - John F Fraser
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Raymond J Chan
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Marianne C Wallis
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- School of Nursing and Midwifery, University of the Sunshine Coast, Maroochydore, Australia
| | - Jeanine Young
- Lady Cilento Children's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, University of the Sunshine Coast, Maroochydore, Australia
| | - David McMillan
- Inflammation and Healing Research Cluster, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - Li Zhang
- Inflammation and Healing Research Cluster, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - Md Abu Choudhury
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - E Geoffrey Playford
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
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Rickard CM, Lipman J, Courtney M, Siversen R, Daley P. Routine Changing of Intravenous Administration Sets Does Not Reduce Colonization or Infection in Central Venous Catheters. Infect Control Hosp Epidemiol 2015; 25:650-5. [PMID: 15357156 DOI: 10.1086/502456] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AbstractObjective:To determine the effect of routine intravenous (IV) administration set changes on central venous catheter (CVC) colonization and catheter-related bacteremia.Design:Prospective, randomized, controlled trial.Setting:Eighteen-bed intensive care unit (ICU) in a large metropolitan hospital.Participants:Two hundred fifty-one patients with 404 chlorhexidine gluconate and silver sulfadiazine–coated multilumen CVCs.Interventions:CVCs inserted in the ICU and in situ on day 4 were randomized to have their IV administration sets changed on day 4 (n = 203) or not at all (n = 201). Use of fluid containers and blood product administration sets was limited to 24 hours. CVCs were removed when not required, infection was suspected, or in place on day 7. Catheter cultures were performed on removal by blinded laboratory staff. Catheter-related bacteremia was diagnosed by a blinded intensivist using strict definitions. Data were collected regarding catheter duration, site, Acute Physiology and Chronic Health Evaluation (APACHE) II score, patient age, diagnosis, hyperglycemia, hypoalbuminemia, immune status, number of fluid containers and IV injections, and administration of propofol, blood, total parenteral nutrition, or lipid infusion.Results:There were 10 colonized CVCs in the group receiving a set change and 19 in the group not receiving one. This difference was not statistically significant on Kaplan–Meier survival analysis. There were 3 cases of catheter-related bacteremia per group. Logistic regression found that burns diagnosis and increased ICU stay significantly predicted colonization.Conclusion:IV administration sets can be used for 7 days in patients with short-term, antiseptic-coated CVCs.
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Bolisetty S, Osborn D, Sinn J, Lui K. Standardised neonatal parenteral nutrition formulations - an Australasian group consensus 2012. BMC Pediatr 2014; 14:48. [PMID: 24548745 PMCID: PMC3996091 DOI: 10.1186/1471-2431-14-48] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/13/2014] [Indexed: 12/15/2022] Open
Abstract
Standardised parenteral nutrition formulations are routinely used in the neonatal intensive care units in Australia and New Zealand. In 2010, a multidisciplinary group was formed to achieve a consensus on the formulations acceptable to majority of the neonatal intensive care units. Literature review was undertaken for each nutrient and recommendations were developed in a series of meetings held between November 2010 and April 2011. Three standard and 2 optional amino acid/dextrose formulations and one lipid emulsion were agreed by majority participants in the consensus. This has a potential to standardise neonatal parenteral nutrition guidelines, reduce costs and prescription errors.
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Affiliation(s)
- Srinivas Bolisetty
- Division of Newborn Services, Royal Hospital for Women, Barker Street, Locked Bag 2000, Randwick, 2031 Sydney NSW, Australia.
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Ullman AJ, Cooke ML, Gillies D, Marsh N, Daud A, McGrail MR, O'Riordan E, Rickard CM. Optimal timing for intravascular administration set replacement. Cochrane Database Syst Rev 2013; 2013:CD003588. [PMID: 24037784 PMCID: PMC6516986 DOI: 10.1002/14651858.cd003588.pub3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The tubing (administration set) attached to both venous and arterial catheters may contribute to bacteraemia and other infections. The rate of infection may be increased or decreased by routine replacement of administration sets. This review was originally published in 2005 and was updated in 2012. OBJECTIVES The objective of this review was to identify any relationship between the frequency with which administration sets are replaced and rates of microbial colonization, infection and death. SEARCH METHODS We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 6), MEDLINE (1950 to June 2012), CINAHL (1982 to June 2012), EMBASE (1980 to June 2012), reference lists of identified trials and bibliographies of published reviews. The original search was performed in February 2004. We also contacted researchers in the field. We applied no language restriction. SELECTION CRITERIA We included all randomized or controlled clinical trials on the frequency of venous or arterial catheter administration set replacement in hospitalized participants. DATA COLLECTION AND ANALYSIS Two review authors assessed all potentially relevant studies. We resolved disagreements between the two review authors by discussion with a third review author. We collected data for seven outcomes: catheter-related infection; infusate-related infection; infusate microbial colonization; catheter microbial colonization; all-cause bloodstream infection; mortality; and cost. We pooled results from studies that compared different frequencies of administration set replacement, for instance, we pooled studies that compared replacement ≥ every 96 hours versus every 72 hours with studies that compared replacement ≥ every 48 hours versus every 24 hours. MAIN RESULTS We identified 26 studies for this updated review, 10 of which we excluded; six did not fulfil the inclusion criteria and four did not report usable data. We extracted data from the remaining 18 references (16 studies) with 5001 participants: study designs included neonate and adult populations, arterial and venous administration sets, parenteral nutrition, lipid emulsions and crystalloid infusions. Most studies were at moderate to high risk of bias or did not adequately describe the methods that they used to minimize bias. All included trials were unable to blind personnel because of the nature of the intervention.No evidence was found for differences in catheter-related or infusate-related bacteraemia or fungaemia with more frequent administration set replacement overall or at any time interval comparison (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.67 to 1.69; RR 0.67, 95% CI 0.27 to 1.70). Infrequent administration set replacement reduced the rate of bloodstream infection (RR 0.73, 95% CI 0.54 to 0.98). No evidence revealed differences in catheter colonization or infusate colonization with more frequent administration set replacement (RR 1.08, 95% CI 0.94 to 1.24; RR 1.15, 95% CI 0.70 to 1.86, respectively). Borderline evidence suggested that infrequent administration set replacement increased the mortality rate only within the neonatal population (RR 1.84, 95% CI 1.00 to 3.36). No evidence revealed interactions between the (lack of) effects of frequency of administration set replacement and the subgroups analysed: parenteral nutrition and/or fat emulsions versus infusates not involving parenteral nutrition or fat emulsions; adult versus neonatal participants; and arterial versus venous catheters. AUTHORS' CONCLUSIONS Some evidence indicates that administration sets that do not contain lipids, blood or blood products may be left in place for intervals of up to 96 hours without increasing the risk of infection. Other evidence suggests that mortality increased within the neonatal population with infrequent administration set replacement. However, much the evidence obtained was derived from studies of low to moderate quality.
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Affiliation(s)
- Amanda J Ullman
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland170 Kessels RoadBrisbaneQueenslandAustralia4111
| | - Marie L Cooke
- Griffith UniversityAlliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland170 Kessels RoadBrisbaneQueenslandAustralia4111
| | | | - Nicole Marsh
- Griffith UniversityNHMRC Centre of Research Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute QueenslandLevel 2, Building 34Butterfield StreetBrisbaneQueenslandAustralia4029
| | - Azlina Daud
- Griffith UniversitySchool of Nursing and Midwifery170 Kessels RoadNathanQueenslandAustralia4111
| | - Matthew R McGrail
- Monash UniversityGippsland Medical SchoolNorthways RoadChurchillVictoriaAustralia3825
| | - Elizabeth O'Riordan
- The University of Sydney and The Children's Hospital at WestmeadFaculty of Nursing and MidwiferySydneyNew South WalesAustralia2006
| | - Claire M Rickard
- Griffith UniversityNational Centre of Research Excellence in Nursing, Menzies Health Institute QueenslandBrisbaneQueenslandAustralia4111
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Kumar M, Vandermeer B, Bassler D, Mansoor N. Low-dose heparin use and the patency of peripheral IV catheters in children: a systematic review. Pediatrics 2013; 131:e864-72. [PMID: 23439893 DOI: 10.1542/peds.2012-2403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To assess evidence from randomized controlled trials (RCTs) on the efficacy of low-dose heparin for prolonging patency of peripheral intravenous (PIV) catheters in the pediatric population. METHODS We searched Medline, Embase, CINAHL, and Cochrane Central Register of Controlled Trials to identify studies up to June 6, 2012. Additional citations were retrieved from the bibliography of selected articles. The eligible studies were RCTs of low-dose heparin used in PIV catheters as compared with control and measured any one of the following outcomes: duration of catheter patency, infusion failure rates, or phlebitis. Data were extracted by 1 reviewer by using a standardized form and checked for accuracy by a second reviewer. Discrepancies were resolved by consensus. RESULTS Thirteen RCTs were identified (3 RCTs of continuous infusion and 10 RCTs of intermittent flush). Catheters using heparin had longer patency (mean difference [95% confidence interval]: 26.51 hours [2.37 to 50.65], P < .001, for the infusion studies and 2.82 hours [-0.04 to 5.67], P = .05, for intermittent flush studies). Heparin usage also resulted in a lower rate of infusion failure (rate ratio [95% confidence interval]: 0.78 [0.62 to 0.99], P = .04, for the infusion studies and 0.88 [0.72 to 1.09], P = .25, for intermittent flush studies). Lower phlebitis rates were also observed with heparin usage; however, the results did not reach significance. There was no increase in heparin-related side effects noted. CONCLUSIONS Low-dose heparin as continuous infusion in PIV catheters resulted in clinically significant benefits in terms of catheter patency and fewer episodes of infusion failures. Heparin's use in intermittent flush solutions showed minimal benefits.
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Affiliation(s)
- Manoj Kumar
- Department of Pediatrics, University of Alberta, Edmonton, Canada.
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Balegar V KK, Azeem MI, Spence K, Badawi N. Extending total parenteral nutrition hang time in the neonatal intensive care unit: is it safe and cost effective? J Paediatr Child Health 2013; 49:E57-61. [PMID: 23320598 DOI: 10.1111/jpc.12023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2011] [Indexed: 11/28/2022]
Abstract
AIM To investigate the effects of prolonging hang time of total parenteral nutrition (TPN) fluid on central line-associated blood stream infection (CLABSI), TPN-related cost and nursing workload. METHODS A before-after observational study comparing the practice of hanging TPN bags for 48 h (6 February 2009-5 February 2010) versus 24 h (6 February 2008-5 February 2009) in a tertiary neonatal intensive care unit was conducted. The main outcome measures were CLABSI, TPN-related expenses and nursing workload. RESULTS One hundred thirty-six infants received 24-h TPN bags and 124 received 48-h TPN bags. Median (inter-quartile range) gestation (37 weeks (33,39) vs. 36 weeks (33,39)), mean (±standard deviation) admission weight of 2442 g (±101) versus 2476 g (±104) and TPN duration (9.7 days (±12.7) vs. 9.9 days (±13.4)) were similar (P > 0.05) between the 24- and 48-h TPN groups. There was no increase in CLABSI with longer hang time (0.8 vs. 0.4 per 1000 line days in the 24-h vs. 48-h group; P < 0.05). Annual cost saving using 48-h TPN was AUD 97,603.00. By using 48-h TPN, 68.3% of nurses indicated that their workload decreased and 80.5% indicated that time spent changing TPN reduced. CONCLUSION Extending TPN hang time from 24 to 48 h did not alter CLABSI rate and was associated with a reduced TPN-related cost and perceived nursing workload. Larger randomised controlled trials are needed to more clearly delineate these effects.
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Affiliation(s)
- Kiran Kumar Balegar V
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney University, Sydney, New South Wales, Australia.
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Chirinian N, Shah V. Does decreasing the frequency of changing intravenous administration sets (>24 h) increase the incidence of sepsis in neonates receiving total parenteral nutrition? Paediatr Child Health 2012. [DOI: 10.1093/pch/17.9.501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Vibhuti Shah
- Department of Paediatrics, Mount Sinai Hospital
- Department of Paediatrics and Instiute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario
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Lee JH. Catheter-related bloodstream infections in neonatal intensive care units. KOREAN JOURNAL OF PEDIATRICS 2011; 54:363-7. [PMID: 22232628 PMCID: PMC3250601 DOI: 10.3345/kjp.2011.54.9.363] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 08/16/2011] [Indexed: 11/27/2022]
Abstract
Central venous catheters (CVCs) are regularly used in intensive care units, and catheter-related bloodstream infection (CRBSI) remains a leading cause of healthcare-associated infections, particularly in preterm infants. Increased survival rate of extremely-low-birth-weight infants can be partly attributed to routine practice of CVC placement. The most common types of CVCs used in neonatal intensive care units (NICUs) include umbilical venous catheters, peripherally inserted central catheters, and tunneled catheters. CRBSI is defined as a laboratory-confirmed bloodstream infection (BSI) with either a positive catheter tip culture or a positive blood culture drawn from the CVC. BSIs most frequently result from pathogens such as gram-positive cocci, coagulase-negative staphylococci, and sometimes gram-negative organisms. CRBSIs are usually associated with several risk factors, including prolonged catheter placement, femoral access, low birth weight, and young gestational age. Most NICUs have a strategy for catheter insertion and maintenance designed to decrease CRBSIs. Specific interventions slightly differ between NICUs, particularly with regard to the types of disinfectants used for hand hygiene and appropriate skin care for the infant. In conclusion, infection rates can be reduced by the application of strict protocols for the placement and maintenance of CVCs and the education of NICU physicians and nurses.
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Affiliation(s)
- Jung Hyun Lee
- Department of Pediatrics, The Catholic University of Korea School of Medicine, Seoul, Korea
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Jauch KW, Schregel W, Stanga Z, Bischoff SC, Brass P, Hartl W, Muehlebach S, Pscheidl E, Thul P, Volk O. Access technique and its problems in parenteral nutrition - Guidelines on Parenteral Nutrition, Chapter 9. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2009; 7:Doc19. [PMID: 20049083 PMCID: PMC2795383 DOI: 10.3205/000078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Indexed: 02/08/2023]
Abstract
Catheter type, access technique, and the catheter position should be selected considering to the anticipated duration of PN aiming at the lowest complication risks (infectious and non-infectious). Long-term (>7-10 days) parenteral nutrition (PN) requires central venous access whereas for PN <3 weeks percutaneously inserted catheters and for PN >3 weeks subcutaneous tunnelled catheters or port systems are appropriate. CVC (central venous catheter) should be flushed with isotonic NaCl solution before and after PN application and during CVC occlusions. Strict indications are required for central venous access placement and the catheter should be removed as soon as possible if not required any more. Blood samples should not to be taken from the CVC. If catheter infection is suspected, peripheral blood-culture samples and culture samples from each catheter lumen should be taken simultaneously. Removal of the CVC should be carried out immediately if there are pronounced signs of local infection at the insertion site and/or clinical suspicion of catheter-induced sepsis. In case PN is indicated for a short period (max. 7-10 days), a peripheral venous access can be used if no hyperosmolar solutions (>800 mosm/L) or solutions with a high titration acidity or alkalinity are used. A peripheral venous catheter (PVC) can remain in situ for as long as it is clinically required unless there are signs of inflammation at the insertion site.
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Affiliation(s)
- K W Jauch
- Dept. Surgery Grosshadern, University Hospital, Munich, Germany
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15
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Wolf HH, Leithäuser M, Maschmeyer G, Salwender H, Klein U, Chaberny I, Weissinger F, Buchheidt D, Ruhnke M, Egerer G, Cornely O, Fätkenheuer G, Mousset S. Central venous catheter-related infections in hematology and oncology. Ann Hematol 2008; 87:863-76. [DOI: 10.1007/s00277-008-0509-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 05/10/2008] [Indexed: 10/21/2022]
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16
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Strategies for the prevention of hospital-acquired infections in the neonatal intensive care unit. J Hosp Infect 2008; 68:293-300. [DOI: 10.1016/j.jhin.2008.01.011] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 01/08/2008] [Indexed: 11/19/2022]
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17
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[Recommendation for the prevention of nosocomial infections in neonatal intensive care patients with a birth weight less than 1,500 g. Report by the Committee of Hospital Hygiene and Infection Prevention of the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008. [PMID: 18041117 PMCID: PMC7080031 DOI: 10.1007/s00103-007-0337-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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18
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Abstract
Central venous access plays an important role in modern medical patient assessment and treatment. The use of central venous access devices has become routine in the oncology setting. Clinical oncology nurses need to know how the devices function, how to provide proper care, and how to manage potential side effects. The focus of this article will be on the navigation of implanted, skin-tunneled ports.
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Affiliation(s)
- Penelope Arch
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Ohio State University, Dublin, USA.
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19
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[Recommendation for the prevention of nosocomial infections in neonatal intensive care patients with a birth weight less than 1,500 g. Report by the Committee of Hospital Hygiene and Infection Prevention of the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50:1265-303. [PMID: 18041117 PMCID: PMC7080031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
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20
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Infections Acquired in the Nursery: Epidemiology and Control. INFECTIOUS DISEASES OF THE FETUS AND NEWBORN INFANT 2006:1179-1205. [PMCID: PMC7150280 DOI: 10.1016/b0-72-160537-0/50037-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
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Gillies D, O'Riordan L, Wallen M, Morrison A, Rankin K, Nagy S. Optimal timing for intravenous administration set replacement. Cochrane Database Syst Rev 2005:CD003588. [PMID: 16235329 DOI: 10.1002/14651858.cd003588.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Administration of intravenous therapy is a common occurrence within the hospital setting. Routine replacement of administration sets has been advocated to reduce intravenous infusion contamination. If decreasing the frequency of changing intravenous administration sets does not increase infection rates, a change in practice could result in considerable cost savings. OBJECTIVES The objective of this review was to identify the optimal interval for the routine replacement of intravenous administration sets when infusate or parenteral nutrition (lipid and non-lipid) solutions are administered to people in hospital via central or peripheral venous catheters. SEARCH STRATEGY We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, EMBASE: all from inception to February 2004; reference lists of identified trials, and bibliographies of published reviews. We also contacted researchers in the field. We did not have a language restriction. SELECTION CRITERIA We included all randomized or quasi-randomized controlled trials addressing the frequency of replacing intravenous administration sets when parenteral nutrition (lipid and non-lipid containing solutions) or infusions (excluding blood) were administered to people in hospital via a central or peripheral catheter. DATA COLLECTION AND ANALYSIS Two authors assessed all potentially relevant studies. We resolved disagreements between the two authors by discussion with a third author. We collected data for the outcomes; infusate contamination; infusate-related bloodstream infection; catheter contamination; catheter-related bloodstream infection; all-cause bloodstream infection and all-cause mortality. MAIN RESULTS We identified 23 references for review. We excluded eight of these studies; five because they did not fit the inclusion criteria and three because of inadequate data. We extracted data from the remaining 15 references (13 studies) with 4783 participants. We conclude that there is no evidence that changing intravenous administration sets more often than every 96 hours reduces the incidence of bloodstream infection. We do not know whether changing administration sets less often than every 96 hours affects the incidence of infection. In addition, we found that there were no differences between participants with central versus peripheral catheters; nor between participants who did and did not receive parenteral nutrition, or between children and adults. AUTHORS' CONCLUSIONS It appears that administration sets that do not contain lipids, blood or blood products may be left in place for intervals of up to 96 hours without increasing the incidence of infection. There was no evidence to suggest that administration sets which contain lipids should not be changed every 24 hours as currently recommended.
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Affiliation(s)
- D Gillies
- Sydney West Area Health Service, Locked Bag 7118, Parramatta BC, NSW, Australia 2150.
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22
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Abstract
AIM This paper describes the current infection control practices for CVC care and compares these to evidence-based practice guidelines. BACKGROUND Intensive care patients with central venous catheters (CVCs) are at risk of catheter-related infection, which increases morbidity, mortality and health care costs. Infection control practices, including care of intravenous administration sets and catheter sites, are undertaken by nurses in an attempt to avoid infection. Although practice guidelines are available, infection control practices may vary between practitioners and institutions; however, current practice has not been formally surveyed. METHOD A prospective, cross-sectional descriptive survey was carried out. Intensive care units (n = 14) in Australia were surveyed about their infection control policies for CVC care. Results were tabulated and compared with evidence-based practice guidelines. RESULTS A wide variety of responses was received about duration of administration set use for standard, parenteral nutrition and propofol (lipid-based anaesthetic) infusions; ad hoc administration set connection technique; dressing frequency, materials and solutions; and barrier precautions used during procedures. There was inconsistent adherence to the guidelines. CONCLUSION There is variation in the infection control approach to CVC care. Greater adherence to existing Centers for Disease Control Guidelines would assist in the standardization of best practice and facilitate evidence-based care.
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Affiliation(s)
- Claire M Rickard
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
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Reiter PD, Robles J, Dowell EB. Effect of 24-Hour Intravenous Tubing Set Change on the Sterility of Repackaged Fat Emulsion in Neonates. Ann Pharmacother 2004; 38:1603-7. [PMID: 15328398 DOI: 10.1345/aph.1e141] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Duration of intravenous fat emulsion (IVFE) infusions, precise method of administration (manufactured bottle vs repackaged syringe), and interval for administration set change continue to be debated. OBJECTIVE To determine the contamination rate associated with replacing IVFE administration sets every 24 hours in newborn infants receiving fat emulsion repackaged into unit-of-use syringes. METHODS This was a prospective, microbiologic study of 90 administration sets used in 19 neonates. IVFE samples were obtained from administration sets at the end of a 19– to 23–hour infusion and prior to daily tubing set change from infants who received repackaged IVFE. Samples of IVFE (1–3 mL) were aseptically removed at the catheter connection site proximal to the patient, transferred into BACTEC PEDSPlus culture media, and continuously monitored for 5 days to detect gram-positive and gram-negative organisms, as well as yeast. RESULTS Two samples (2.27%) grew coagulase-negative Staphylococcus. Both samples were from the same asymptomatic patient and were obtained on consecutive days. A blood sample obtained through this infant's central catheter grew the same organism and suggested catheter hub colonization as the primary site of microbe origin. CONCLUSIONS Microbial contamination of IVFE infusion sets changed at 24–hour intervals, using unit-of-use syringes in neonates, was low at 2.2%.
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Affiliation(s)
- Pamela D Reiter
- The Children's Hospital, School of Pharmacy, Department of Pharmacy and University of Colorado Health Sciences Center, Denver, CO, USA.
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Péculo Carrasco JA, Cosano Prieto I, Gómez Escorza J, Avecilla Sánchez JL, Casal Sánchez MDM, Rodríguez Bouza M. Physico-chemical stability and sterility of previously prepared saline infusion solutions for use in out-of-hospital emergencies. Resuscitation 2004; 62:199-207. [PMID: 15294406 DOI: 10.1016/j.resuscitation.2004.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2003] [Accepted: 03/13/2004] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The topic of this research was to determine whether out-of-hospital emergency teams could make use of previously prepared saline solutions (SS). The objective was to discover the physical, chemical and sterility characteristics of previously prepared saline infusions stored in ambulances and ascertain how long they remained in optimum condition. METHOD Randomised clinical trial, triple blind, where study units consisted of saline solutions prepared with an infusion system and a three-way valve. The duration of the study was 12 months. Six intervention groups were designed on the basis of time of exposure and location. Samples consisted of 672 units. Twelve microbiological cultures were made and the pH, density, viscosity and CINa concentration were determined. We compared hypotheses with four models of linear regression for the variables and a model of logistic regression for the variables. A value of P < 0.05 was considered significant. RESULTS We obtained results from 669 saline solutions (98.82%). Neither multivariant analysis nor ANOVA tests showed any significant association for a power greater than 99% with regard to the physical-chemical characteristics. The model of logistic regression also did not find any significant association for sterility. Colonisation was present in 1.7% of the 8,028 cultures made and more than 5 CFU per millilitre was found in only two cases. CONCLUSION There is no evidence to suggest that recently prepared saline infusion solutions are any different from a physical-chemical and sterility point of view than those exposed for 24, 48, or 72 h. It was concluded that use can be made of previously prepared saline solutions with a guarantee their stability and sterility.
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Gillies D, O'Riordan L, Wallen M, Rankin K, Morrison A, Nagy S. Timing of intravenous administration set changes: a systematic review. Infect Control Hosp Epidemiol 2004; 25:240-50. [PMID: 15061417 DOI: 10.1086/502385] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the optimal time interval for the routine replacement of intravenous administration sets when crystalloids or parenteral nutrition are administered via a central or peripheral catheter in an acute care setting. DESIGN Systematic review of all randomized or systematically allocated controlled trials addressing the frequency of replacing intravenous administration sets. METHODS The Cochrane Controlled Trials Register (June 2001) and the Ovid databases (Medline, CINAHL, and CancerLit-July 2001) were searched. Bibliographies, relevant conference proceedings, and any product information were also checked for references. RESULTS Eighteen studies were selected for review. The 12 included studies were separated into 3 intravenous administration set change comparisons: 24 hours versus 48 hours or more; 48 hours versus 72 hours or more; and 72 hours versus 96 hours or more. There was good evidence that changing intravenous administration sets every 72 hours or more does not increase the risk of infusate-related bloodstream infection (BSI) in patients with central or peripheral catheters and a fair level of evidence that it does not increase the risk of catheter-related BSI. There were insufficient data regarding the incidence of BSI among patients receiving parenteral nutrition, particularly lipid-containing parenteral nutrition. CONCLUSIONS It appears that intravenous administration sets containing crystalloids can be changed in patients with central or peripheral catheters every 72 hours or more without increasing the risk of BSI. However, it is not possible to conclude that intravenous administration sets containing parenteral nutrition, particularly lipid-containing parenteral nutrition, can be changed at this interval.
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Affiliation(s)
- Donna Gillies
- The Research Development Unit, The School of Nursing, Family and Community Health, The University of Western Sydney, New South Wales, Australia
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26
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Ortolano GA, Russell RL, Angelbeck JA, Schaffer J, Wenz B. Contamination Control in Nursing With Filtration. JOURNAL OF INFUSION NURSING 2004; 27:89-103. [PMID: 15085036 DOI: 10.1097/00129804-200403000-00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Filters often are viewed as screens with openings smaller than the particles intended to be removed by a process technically known as direct interception. However, filter manufacturing embraces far more advanced technological approaches, with an evolution toward selective removal of cells or soluble constituents from complex physiologic solutions. An appreciation of filtration development makes it easy to understand how differently manufactured filters with the same claims may not perform identically. This article focuses on the filtration of intravenous solutions and point-of-use hospital water.
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Abstract
Infants in the neonatal intensive care unit (NICU) have many risk factors for infection. Compared with older children and adults, infants, particularly premature infants, are relatively immunocompromised. Patients in the NICU have intrinsic risk factors for infections due to immunological "deficiencies" or inadequate development of mechanical barriers such as skin and gastrointestinal tract mucosa. Like other ICU populations, NICU patients have extrinsic risk factors for infection such as prolonged hospitalization, invasive procedures, instrumentation, medical treatments and concomitant medical conditions. Compared with healthy full-term infants, patients in the NICU develop abnormal flora, which is generally acquired in the NICU from patient-to-patient transmission via hand carriage of healthcare workers. This flora is frequently multidrug-resistant as it has developed under the selective pressure of antibiotics and can cause invasive disease. An understanding of the risk factors that are associated with hospital-acquired infections is essential to design preventive strategies.
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Affiliation(s)
- Lisa Saiman
- Division of Infectious Diseases, Department of Pediatrics, Columbia University, New York, NY 10032, USA.
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28
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Rickard CM, Wallis SC, Courtney M, Lipman J, Daley PJP. Intravascular administration sets are accurate and in appropriate condition after 7 days of continuous use: an in vitro study. J Adv Nurs 2002; 37:330-7. [PMID: 11872102 DOI: 10.1046/j.1365-2648.2002.02099.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The ideal duration of intravascular administration set use is unknown. Studies have compared the infective implications of 1--7 days of use. The Centers for Disease Control recommend at least 3 days usage. No previous study has evaluated the accuracy of volume delivery or integrity of administration sets after prolonged use. AIM To evaluate the accuracy and condition of intravascular administration sets used continuously for 7 days. DESIGN Prospective, randomized, experimental study in the laboratory setting. METHODS Four administration sets were randomly assigned to deliver 2 mL/hour (IMEDreg syringe set 2280--0000), 20, 50 or 100 mL/hour (IMEDreg infusion sets 2210--0500) of crystalloid solution continuously for 7 days through an IMEDreg Geminireg four channel infusion pump (PC4). At study commencement and daily for 7 days, a 4-hour volume measurement and an inspection for leaks/erosion of administration sets occurred for each administration set (total measurements = 32). RESULTS Mean volume outputs over 4 hours were 7.84 mL (2 mL/hour), 80.66 mL (20 mL/hour), 205.35 (50 mL/hour) and 406.37 (100 mL/hour). These differed significantly from the programmed volumes (P=0.00--0.01). Usage duration did not influence performance (F=0.866, P=0.55). Accuracy of volume delivery differed significantly with pump speed (F=106.933, P < 0.001) exhibiting increased volume to 50 mL/hour then a reduction at 100 mL/hour. Differences were within manufacturer specifications (+/-5%) and were clinically acceptable. All administration sets remained in appropriate condition displaying no leakage or erosion. CONCLUSION There were small inaccuracies found between programmed and delivered volumes, however, there was no deterioration in performance over time. This suggests that inaccuracies were because of normal pump performance rather than the administration sets. Administration sets retain acceptable accuracy and condition after 7 days continuous use. Further research should assess the infective and other impacts of prolonged usage.
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Affiliation(s)
- Claire M Rickard
- School of Rural Health, Monash University, Traralgon, Australia.
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29
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Raad I, Hanna HA, Awad A, Alrahwan A, Bivins C, Khan A, Richardson D, Umphrey JL, Whimbey E, Mansour G. Optimal frequency of changing intravenous administration sets: is it safe to prolong use beyond 72 hours? Infect Control Hosp Epidemiol 2001; 22:136-9. [PMID: 11310690 DOI: 10.1086/501879] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the safety and cost-effectiveness of replacing the intravenous (IV) tubing sets in hospitalized patients at 4- to 7-day intervals instead of every 72 hours. DESIGN Prospective, randomized study of infusion-related contamination associated with changing IV tubing sets within 3 days versus within 4 to 7 days of placement. SETTING A tertiary university cancer center. PATIENTS AND METHODS Cancer patients requiring IV infusion therapy were randomized to have the IV tubing sets replaced within 3 days (280 patients) or within 4 to 7 days of placement (232 patients). Demographic, microbiological, and infusion-related data were collected for all participants. The main outcome measures were infusion- or catheter-related contamination or colonization of IV tubing, determined by quantitative cultures of the infusate, and infusion- or catheter-related bloodstream infection (BSI), determined by quantitative culture of the infusate in association with blood cultures in febrile patients. RESULTS The two groups were comparable in terms of patient and catheter characteristics and the agents given through the IV tubing. Intent-to-treat analysis demonstrated a higher level of tubing colonization in the 4- to 7-day group versus the 3-day group (median, 145 vs 50 colony-forming units; P=.02). In addition, there were three episodes of possible infusion-related BSIs, all of which occurred in the 4- to 7-day group (P=.09). However, when the 84 patients who received total parenteral nutrition, blood transfusions, or interleukin-2 through the IV tubing were excluded, the two groups had a comparable rate of colonization (0.4% vs 0.5%), with no catheter- or infusion-related BSIs in either group. CONCLUSION In patients at low risk for infection from infusion- or catheter-related infection who are not receiving total parenteral nutrition, blood transfusions, or interleukin-2, delaying the replacement of IV tubing up to 7 days may be safe, as well as cost-effective
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Affiliation(s)
- I Raad
- University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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30
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Fraenkel DJ, Rickard C, Lipman J. Can we achieve consensus on central venous catheter-related infections? Anaesth Intensive Care 2000; 28:475-90. [PMID: 11094662 DOI: 10.1177/0310057x0002800501] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Central venous catheter-related bacteraemia is a substantial and preventable source of iatrogenic morbidity and mortality. A single episode of catheter-related bacteraemia has an estimated cost of A$50,000, with an attributable mortality between 10 and 35%. Catheter colonization is diagnosed with standard culture techniques. Diagnostic criteria for catheter-related bacteraemia include the results of cultures from the catheter tip, the peripheral blood and other possible sites of infection. The presence of clinical symptoms and subsequent defervescence may assist in making the diagnosis. This review explores the existing definitions of catheter-related infections and proposes a new and more rigorous classification with criteria for definite, probable and possible catheter-related bacteraemia. The authors hope that this classification will enhance the interpretation of the literature and the planning of new investigations. Infection rates can be reduced by appropriate site selection, adequate skin preparation, sterile technique and appropriate dressings. Decreased manipulation of administration sets, with more careful technique and less frequent set replacement, may reduce hub contamination. Infection rates increase with the duration in situ of the catheter, however are not reduced by regular scheduled catheter replacement or guide-wire exchanges. A range of antimicrobial catheter materials and coatings are under investigation, some of which are effective in reducing the rate of catheter-related bacteraemia. Chorhexidine-silver sulphadiazine and rifampicin-minocycline are the best studied combinations to date. Further developments are expected, although none are likely to be as effective as not inserting or removing the central venous catheter when it is not required.
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