Antireflux Valves Research Articles

Bacterial contamination and greenhouse gas emissions: A randomised study of reuse versus single-use of infusion-set components for intravenous anaesthesia.

Reusing anaesthesia infusion-set components may reduce the climate impact from plastic waste and discarded medications. Infusion-set contents can be shielded from patient contact by single use of an infusion line fitted with dual antireflux valves, preventing retrograde entry of microorganisms, and eliminating the risk for patient-to-patient cross-contamination. However, infusion-set contamination from compromised aseptic handling could affect quality of care. To determine the prevalence of infusion-set bacterial contamination and compare the climate effects, we randomised operating rooms scheduled for total intravenous anaesthesia to handle procedures by infusion-set reuse or single-use. Both methods used dual single-use antireflux valves. The primary outcome was infusion-set bacterial contamination assessed by aerobic culture of infusion-set fluid collected after each procedure. The secondary outcome was CO 2 emissions (CO 2 -eq) estimated by life cycle assessment of component and medication use. To assess feasibility of detecting an inter-method difference in bacterial contamination, an interim analysis was planned after including at least 150 procedures per group. After allocating 54 operating rooms per method, 189 and 159 procedures of reuse and single use were included. Reuse permitted a median of three procedures per infusion set (range 1 to 8). Positive cultures occurred in two procedures per method [mean (95% CI)]; prevalence 1.15% (0.03 to 2.27); relative risk of reuse versus single use 0.84 (0.12 to 5.93), P = 0.861. As prespecified, inclusion was stopped due to futility. The median (95% CI) per-procedure climate emissions were 0.43 (0.41 to 0.47) and 1.39 (1.37 to 1.40) kg CO 2 -eq for reuse and single-use respectively; difference -0.96 (-0.99 to -0.93), P < 0.0005. The main sources for climate emissions were production of infusion-set components and waste handling. We conclude that the prevalence of bacterial contamination was low for both methods. A much larger study would be needed to detect an inter-method difference. Reuse of infusion-set components allowed significantly reduced intravenous anaesthesia climate emissions.

326. SPONTANEOUS OESOPHAGEAL PERFORATION TREATED WITH OESOPHAGEAL STENT

Abstract We present the case of a 66-year-old male with spontaneous oesophageal perforation treated with oesophageal stenting. This patient reports sudden onset severe anterior chest pain after coughing and haematemesis with a background medical history of Type II DM, ESRF on Haemodialysis, Hypertension, OSA and takes prophylactic Aspirin. Endoscopy reveals multiple areas of oesophageal perforation in the proximal, middle, and distal oesophagus as well as a haematoma extending the entire length of the oesophagus to the COJ. This was treated with insertion of a WallFlex™ Fully Covered Oesophageal Stent as the patient was unsuitable for surgery. The result was re-epithelialisation of the entire oesophagus and complete resolution of the perforation at the mid-oesophagus. Dutch physician Boerhaave first described spontaneous oesophageal perforation in 1724. Commonly, these were treated surgically with associated high morbidity and mortality. Advances in endoscopic and stent technology has given clinicians a greater armamentarium to treat patients especially in the frail end elderly population. These advances include choices such as stent covers, biodegradable and removable stents, and anti-reflux valves. Complications with oesophageal stents such as fistula formation, stent migration and retrosternal pain are often associated with the length of placement. The choice of a fully covered retrievable oesophageal stent in our case provided reconstitution of oesophageal lumen and minimisation of mediastinal sepsis. With the progress in stent technology, we believe there will be greater use of endoscopic oesophageal stenting for oesophageal perforations bridges the gap between operative and non-operative management.

Securing injection laryngoplasty with anti-reflux valve.

Injection laryngoplasty (IL) is a common procedure performed by the laryngologist to treat glottal insufficiency. It can be performed under general anaesthesia (GA) or as an office-based procedure. One of the common problems faced during IL is the disconnection between the injection needle and injection material syringe due to high-pressure effect. This may lead to leakage of the injectates especially when injecting high-viscosity materials such as calcium hydroxylapatite (CaHa) or injecting through hard fibrotic scar of the vocal fold. Due to this recurring issue, we propose anti-reflux valve as a connector to link up these two devices. The function of anti-reflux valve is to ensure secure connection between these two devices and overcome the problem. The anti-reflux valve that can be used is NeutraClearTM needle-free connector EL-NC1000 or MicroClaveTM clear connector. In our practice, these anti-reflux valves are used together with Integra MicroFrance straight malleable injection needle (0.5 mm diameter, 250 mm length) for IL under GA. However, any other injection needle suitable for IL may also be used with these anti-reflux valves. Our 3 years' experience has shown good outcome with no reported incidence of device detachment or leakage of injectates during IL procedure. Anti-reflux valve is a readily available device in the operating theatre or clinic and only involve simple preparation prior to IL. It is beneficial as an added device in IL procedure.

Evaluation of (Wet) and (Dry) Mediastinal Chest Drainage in Minimally Invasive and Conventional Cardiac Surgery.

Drainage of fluid and evacuation of air from the pericardial and pleural spaces after cardiothoracic surgery is necessary to prevent effusion, tamponade, and pneumothorax, and also to detect hemorrhage. For this purpose, negative-pressure drains are placed in the mediastinum and pleural cavities. We compared the efficacy and safety of two systems wet and dry drainage for the management and monitoring of negative pressure and anti-reflux valve safety systems, to promote healing of the pleural and pericardial cavities. Two devices for mediastinal chest drainage [Venice PAS (Wet) and Rome PAS (Dry); both Eurosets SRL, Medolla, Italy] were evaluated in terms of safety, efficacy and clinical outcomes in a cohort of 60 patients who underwent elective cardiac surgery procedures. The patients were divided into a minimally invasive cardiac surgery (MICS) group [n=30; mitral valve surgery (MVS) by right anterolateral mini-thoracotomy] and a conventional cardiac surgery (CCS) group [n=30; coronary arterial bypass grafting (CABG) in full sternotomy] at a single institution (Anthea Hospital GVM Care & Research, Bari, Italy). Negative pressure was managed with a target value of -20 cmH2O measured in the chest tube and was related to the device: deviation of ± 1 cmH2O for the Venice PAS (Wet) and 0 cmH2O for the Rome PAS (Dry) in the MICS group; deviation of 1 ± 0.8 cmH2O for the Venice PAS (Wet) and 0.8±0.2 cmH2O for the Rome PAS (Dry) in the CCS group. A constant volumetric air leak meter (VALM) value and the absence of air-leak bubbling were correlated with the absence of air in the pleural cavity and complete pulmonary re-expansion to restore normal respiratory dynamics in the MICS group for both models of chest drainage. The maximum total pericardial blood drained was 1104 ± 302 ml with Venice PAS (Wet) and 1530 ± 230 with Rome PAS (Dry) in the CCS group. There were no reports of cardiac tamponade in either group. The two mediastinal chest drainage devices [Venice PAS (Wet) and Rome PAS (Dry)] in this study were effective, accurate for measuring the applied negative pressure, and safe in their application after cardiac surgery procedures via minimally invasive and conventional approaches for blood and liquid drainage, prevention of cardiac tamponade, and restoration of normal respiratory dynamics after surgical pneumothorax. Both systems are equipped with anti-reflux valves to prevent air and blood from entering the drainage, and no adverse events were reported.

WEIGHT LOSS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: THE 4-YEARS EXPERIENCE AT MAGGIORE DELLA CARITÀ HOSPITAL (NOVARA, PIEDMONT)

Bariatric surgery is currently considered the most effective longterm treatment to obtain substantial and sustained Weight Loss (WL) in severe and/or morbid obesity. We present data collected by a multi-disciplinary team between July 2016 and September 2020 at “Maggiore Della Carità” University Hospital (Novara, Piedmont) concerning bariatric procedures performed according to international and national guidelines (1). Among 267 candidates, 92 (34,4%) subjects underwent a bariatric procedure. Laparoscopic Sleeve Gastrectomy (LSG) was performed in 66 (71.7%) subjects, including 4 anti-reflux valves. Other procedures included: 7 (10.6%) Roux-Y Gastric Bypass, 4 (6.1%) Endoscopic Gastric Plication, and 10 (15.2%) Laparoscopic Adjustable Gastric Banding Removal. Among LSG, 35 patients completed at least a 2-year follow-up after surgery: 27 (77.1%) females, 8 (22.9%) males, mean age 44,89 (± 10.1) years old. Table 1 shows significant variations from baseline (p<0.05) after 1, 6, 12, and 24 months observed for body weight, BMI, excess weight, waist circumference, and serum glucose levels. Among complications, no severe adverse events were recorded. Two gastric fistulas were successfully treated by endoscopy. In our multidisciplinary experience, LSG was effective to achieve and maintain a significant weight loss and to improve glucose levels up to 2 years after surgery. Larger cohorts and longer period data will provide further concerns in terms of maintenance, insulin resistance, and long-term metabolic complications decrease.

Antireflux metal stent for biliary obstruction: Any benefits?

Endoscopic retrograde cholangiopancreatography with stent placement has been utilized as standard palliative management of distal malignant biliary obstruction (MBO). Compared to plastic stents, metal stents can provide longer-term relief of symptoms. When a large-bore metal stent is placed across the ampulla, patients are predisposed to the risk of cholangitis or stent dysfunction due to reflux of duodenal contents. To mitigate the risk of adverse events associated with the duodenobiliary reflux, efforts have been directed to development of antireflux metal stents (ARMSs). The antireflux property has been introduced through adding of an antireflux valve to the duodenal stent end. Evidence from clinical studies indicates that ARMSs may not only reduce the risk of ascending cholangitis during follow-up but also prolong stent patency time. However, the results of clinical studies testing ARMSs are inconsistent owing to heterogeneous designs of antireflux valves and stent bodies. Metal stents are increasingly indicated for benign biliary strictures and MBO in the setting of neoadjuvant chemotherapy, and therefore, research is warranted to evaluate ARMSs for those indications. Given that endoscopic ultrasound (EUS)-guided transmural biliary drainage has gained popularity, the optimal timing of placing an ARMS in relation to EUS-guided and percutaneous drainage should be investigated. Development and evaluation of ARMSs require an integrative approach utilizing phantom and animal models, measurements of stent mechanical properties, and in vivo functional study after stent placement. In this review article, we summarize updated evidence on ARMSs for MBO and discuss issues that should be addressed in future studies.

How Does Your PICCOMPARE? A Pilot Randomized Controlled Trial Comparing Various PICC Materials in Pediatrics.

Despite the popularity of peripherally inserted central catheters (PICCs), recent literature highlights their potential injurious complications. Innovative PICC materials have been developed to prevent thrombosis and infection formation (Endexo®) and antireflux valves to prevent occlusion (pressure-activated safety valve®). No large randomized controlled trial has assessed these technologies. Our primary aim was to evaluate the feasibility of a large randomized controlled efficacy trial of PICC materials and design to reduce PICC complication in pediatrics. A randomized controlled feasibility trial was undertaken at the Lady Cilento Children's Hospital in South Brisbane, Australia, between March 2016 and November 2016. Consecutive recruitment of 150 pediatric participants were randomly assigned to receive either (1) polyurethane PICC with a clamp or (2) BioFlo® PICC (AngioDynamics Inc, Queensbury, NY). Primary outcomes were trial feasibility, including PICC failure (thrombosis, occlusion, infection, breakage, or dislodgement). Secondary outcomes were PICC complications during use. Protocol feasibility was established, including staff and patient acceptability, timely recruitment, no missing primary outcome data, and 0% attrition. PICC failure was 22% (16 of 74, standard care) and 11% (8 of 72, BioFlo®) corresponding to 12.6 and 7.3 failures per 1000 hours (risk ratio 0.58; 95% confidence interval, 0.21-1.43; P = .172). PICC failures were primarily due to thrombosis (standard care 7% versus BioFlo® 3%) and complete occlusion (standard care 7% versus BioFlo® 1%). No blood stream infections occurred. Significantly fewer patients with BioFlo® had PICC complications during use (15% vs 34%; P = .009). BioFlo® PICCs appear potentially safer for pediatrics than traditional standard care PICCs with a clamp. Further research is required to definitively identify clinical, cost-effective methods to prevent PICC failure and improve reliability.

Endoscopy Upper

Endoscopy Upper

How physical infusion system parameters cause clinically relevant dose deviations after setpoint changes.

Multi-infusion therapy, in which multiple pumps are connected to one access point, is frequently used in patient treatments. This practice is known to cause dosing errors following setpoint changes in the drug concentrations that actually enter the patients. Within the Metrology for Drug Delivery Project, we analyzed and quantified the two main physical phenomena leading to these errors: the "push-out" effect and the system mechanical compliance. We compared the dosing errors of a three-pump system with two infusion sets, both with and without anti-reflux valves, using in vitro spectrophotometric experiments. Additionally, computer simulations were used to study the compliance effect separately. We found a start-up time of more than 1 h, and a dosing error following a setpoint increase of another pump for the low flow rate pump, corresponding to 0.5 μg noradrenaline delivered in 8 min. We showed that the dead volume inside the tubes and syringe compliance produce opposite deviations from the setpoint values in the actual drug output concentrations, making the net result hard to predict and often counterintuitive. We conclude that metrology on compliance and push-out effects could be used by infusion device manufacturers to successfully improve drug delivery performance and relevant standards for high-risk multi-infusion applications.

Illustrative neonatal cases regarding drug delivery issues.

Illustrative neonatal cases regarding drug delivery issues.

Arrangements of the intravenous parallel infusions with anti-reflux valves decreasing occlusion alarm delay.

BackgroundThe methods of arrangement of combined intravenous parallel infusions using anti-reflux valve (ARV), with and without anti-syphon valve (ASV) that could decrease occlusion alarm delay were investigated.MethodsOcclusion challenge tests were mainly performed as bench experiments of four kinds of multiple parallel infusions (10 ml/h and 50 ml/h infusions), which were connected at the proximal or distal portion of ARV, with or without ASV. Alarm threshold was set to 1000 mmHg. Occlusion alarm delays and the compliances of the infusion systems were compared among groups.ResultsWithout ASV, compared to 10 ml/h infusion alone distal to anti-reflux valve, 50 ml/h infusion distal to anti-reflux valve reduced the mean alarm delay from 416 ± 7 s to 81 ± 3 s (P < 0.001). Compared to 50 ml/h infusion alone, combined 10 ml/h and 50 ml/h infusion distal to ARV prolonged the alarm delay from 81 ± 3 s to 133 ± 6 s (P < 0.001). However, combined infusions distal to ARV with ASV significantly reduced the alarm delay from 133 ± 6 s to 74 ± 5 s (P < 0.001), and also reduced the compliance of the infusion system from 2.31 ± 0.12 to 1.20 ± 0.08 µl/mmHg (P < 0.001).ConclusionsThe infusion setup of faster infusion rate, lower compliant system using ASV could effectively decrease occlusion alarm delay during multiple intravenous parallel infusions using ARV.

Do SmartSite antireflux valves limit the flow rate of 0.9% normal saline through intravenous cannulas?

The aim of the study was to determine whether the placement of a SmartSite antireflux valve between a bag of fluid with line giving set and an intravenous cannula decreases the flow rate. Fluid flow rates were compared in paired experiments with and without an antireflux valve using a pressure infuser or allowing fluid to flow by gravity only for four different sizes of intravenous cannulas (20-14 G). Antireflux valves significantly decreased the fluid flow rates for all cannula sizes, irrespective of whether a pressure infuser was used. The decrease in the flow rate was most marked for larger cannulas [gravity only: 14 G: 52% (95% confidence interval (CI): 37-68), 16 G: 39% (95% CI: 34-43); pressure bag: 14 G: 74% (95% CI: 70-78), 16 G: 56% (95% CI: 54-57); all P<0.001]. Where maximum fluid flow rates are desirable, clinicians should consider not using an antireflux valve.

Clinical advantages of a metal stent with an S‐shaped anti‐reflux valve in malignant biliary obstruction

Transpapillary stent insertion is the standard treatment for palliating malignant biliary obstruction. However, luminal occlusion often occurs due to sludge formation, tumor ingrowth, or tumor overgrowth. Currently, influx of duodenal contents by duodenobiliary reflux is considered a mechanism of stent obstruction. The aim of the present study was to evaluate the efficacy and safety of a metal stent with an anti-reflux valve in distal malignant biliary obstruction. Thirty-two patients diagnosed with unresectable malignant biliary obstruction were enrolled. This trial was conducted at two tertiary hospitals in Korea from June 2009 to June 2011. An uncovered metal stent (M.I.Tech) with an S-type anti-reflux valve was placed. A total of 32 patients were enrolled. The technical success rate of stent insertion was 100%. The median duration of stent patency was 14.4 months. Stent occlusion occurred in 11 cases, which was caused by sludge formation in six cases, tumor ingrowth in four cases, and migration of the stent membrane in one case. During the follow-up period, there were no episodes of ascending cholangitis, acute pancreatitis, or bleeding. The new metal stent with an S-shaped anti-reflux valve demonstrated a relatively long duration of stent patency. This was attributable to reductions in duodenobiliary reflux by the anti-reflux valve. Also, the stent with an S-shaped anti-reflux valve is technically feasible and very safe. However, further prospective, randomized comparison studies of stents with anti-reflux valves and conventional stents are needed to evaluate the duration of stent patency.

Relais des catécholamines en réanimation

Despite being performed several times a day and often in the most critical patients, changeover of catecholamines is not subject to any recommendation of practice. Only few clinical studies are available in the literature. Frequent changes in catecholamine infusion rates are time consuming for nurses and often result in hemodynamic instability. Several techniques for changeover exist, often within the same ICU. Analysis of the literature does not provide enough reasons to prefer one technique over the other. However, teams should be careful with the false impression of security afforded by “smart pumps”. Importantly, it should be clearly stated that efforts should be focused on the rationalization and simplification of the circuits and lines rather than searching for the best changeover technique. Sensitization to and training on the basics of hydraulics and fluid mechanics is essential for medical and nursing staff. Adequate medical devices with the smallest residual volumes, as well as the use of antireflux valves, and the most distal venous access so as to minimize contacts between the different drugs and avoid the propulsion of one drug by another should be recommended.

Infusion Set Characteristics Such as Antireflux Valve and Dead-Space Volume Affect Drug Delivery

The ability of an infusion set to deliver a specific amount of drug to the patient can be directly related to the presence of an antireflux valve and dead-space volume. In this study we quantified separately the impact of these 2 components on drug delivery. Various infusion sets were assessed differing in length, in dead-space volume, and with or without an antireflux valve. Noradrenaline was infused with a syringe pump simultaneously with a carrier flow. Effluent drug concentration was measured using ultraviolet spectrophotometry. Flow change efficiency (FCE) was calculated from the ratio of the area under the experimental mass flow rate curve to the area under the theoretical instantaneous mass flow rate curve. The FCE for infusion sets with or without antireflux valves were significantly different 10 to 15 minutes after the start of an infusion at flow rates of 7 mL/h for noradrenaline and 35 mL/h to 70 mL/h for the carrier fluid. They were not different with a carrier flow of 115 mL/h. These findings suggest that antireflux valves have a significant impact on FCE when the ratio of drug flow rate to carrier fluid flow rate is high. Infusion sets with very low dead-space volume connectors yield better FCE. There is a nonlinear relationship between dead-space volume and FCE 5 to 10 minutes after the onset of drug infusion. Care providers must consider dead-space volume and the presence of an antireflux valve when choosing their infusion sets.

Intrahepatic Biliary Cysts Presenting before Hepatic Portoenterostomy in Biliary Atresia

Intrahepatic Biliary Cysts Presenting before Hepatic Portoenterostomy in Biliary Atresia

An investigation into the reduction in flow rate of intravenous fluid by antireflux valves

We have investigated the extent to which antireflux (non-return) valves impede the maximum flow rate of crystalloid in intravenous infusion systems when administered either under gravity or with 300 mmHg added pressure. When used with a 16G cannula, a reduction in flow rate of 19-38% was consistently seen. With a 20G cannula, no significant reduction in flow was found. The valve tested that produced the least reduction in flow was the Westcott Sae-flo valve.

Management of short‐term indwelling urethral catheters to prevent urinary tract infections

Executive summaryBackground This systematic review updates a previous review published in 2000. The objective of this review was to present the best available evidence relating to the prevention of catheter‐associated urinary tract infections (UTI).Selection criteria This review considered randomised controlled trials (RCTs) of adult patients with short‐term urethral catheters. In the absence of RCTs, other research designs such as non‐randomised controlled trials and before and after studies were considered for inclusion. Interventions of interest were those related to the prevention of catheter‐related UTI and included: sterile versus non‐sterile insertion technique, special coatings to catheters versus standard non‐coated catheters, the use of flush solutions, the use of solutions added to urinary drainage bag, maintenance of a closed urinary drainage circuit, the use of antireflux valves, antibiotic creams applied to the external meatus–catheter interface, meatal care regimens, education programs, and changed care delivery practices. This review was limited to short‐term urethral catheters, and so studies evaluating long‐term or suprapubic catheters were excluded. The primary outcome of interest was the difference in the rates of UTI between experimental intervention and the control.Search strategy The search included both published and unpublished studies with an initial limited search of MEDLINE and CINAHL databases undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant interventions. A second extensive search used all identified key words and index terms. The third step included a search of the reference lists and bibliographies of relevant articles. The databases searched included: CINAHL, MEDLINE, Current Contents, Cochrane Library, Expanded Academic Index, and Embase. The Dissertation Abstracts International database was searched for unpublished studies.Assessment of methodological quality Methodological quality was assessed using a standardised checklist. Critical appraisal and data extraction were conducted by two independent reviewers; discrepancies were addressed through discussion with a third reviewer as required.Results There was no significant difference in infection rate using either sterile surgical or non‐sterile insertion technique. The use of water for cleansing prior to catheter insertion was recommended. There was no additional benefit from specific meatal care other than standard daily personal hygiene and removal of debris. Infection rates were similar for both latex and silicone catheters. Comparisons between silver and Teflon coating clearly favoured the silver alloy coating. The use of a complex closed drainage system in the intensive care environment did not confer any additional benefit. Studies comparing types of junction seals and use of junction seals either prior to or following catheterisation found no clear benefit from using either preconnected sealed systems or sealed systems with the addition of silver releasing devices. Neither the addition of chlorhexidine nor hydrogen peroxide to the drainage bag was found to be effective at reducing UTI rates. The findings indicated there was a higher incidence of bacteriuria associated with Foley catheters compared with intermittent catheterisation (P &lt; 0.025). A single RCT examined the effect on UTI rates of routine bag changes against no routine bag change. Routine bag changes were not advantageous in reducing the risk of infection.Conclusions Current RCT evidence suggests the use of a surgical sterile catheterisation technique is not required, and that tap water is sufficient for cleaning genitalia. Following insertion, daily hygiene around the meatal area is as effective as catheter toilets; and catheters impregnated with silver may reduce the incidence of catheter associated bacteriuria. Sealed (e.g. taped, presealed) drainage systems should not be relied upon as the sole mechanism for prevention of bacteriuria. The addition of antibacterial solutions to drainage bags and the routine change of drainage bags had no effect on catheter associated infection. However, most of the recommendations arising from this review were based on single studies, often with limited numbers of participants. There is an urgent need to replicate these studies in other clinical settings.

Management of short-term indwelling urethral catheters to prevent urinary tract infections

Background This systematic review updates a previous review published in 2000. The objective of this review was to present the best available evidence relating to the prevention of catheter-associated urinary tract infections (UTI). Selection criteria This review considered randomised controlled trials (RCTs) of adult patients with short-term urethral catheters. In the absence of RCTs, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion. Interventions of interest were those related to the prevention of catheter-related UTI and included: sterile versus non-sterile insertion technique, special coatings to catheters versus standard non-coated catheters, the use of flush solutions, the use of solutions added to urinary drainage bag, maintenance of a closed urinary drainage circuit, the use of antireflux valves, antibiotic creams applied to the external meatus–catheter interface, meatal care regimens, education programs, and changed care delivery practices. This review was limited to short-term urethral catheters, and so studies evaluating long-term or suprapubic catheters were excluded. The primary outcome of interest was the difference in the rates of UTI between experimental intervention and the control. Search strategy The search included both published and unpublished studies with an initial limited search of MEDLINE and CINAHL databases undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant interventions. A second extensive search used all identified key words and index terms. The third step included a search of the reference lists and bibliographies of relevant articles. The databases searched included: CINAHL, MEDLINE, Current Contents, Cochrane Library, Expanded Academic Index, and Embase. The Dissertation Abstracts International database was searched for unpublished studies. Assessment of methodological quality Methodological quality was assessed using a standardised checklist. Critical appraisal and data extraction were conducted by two independent reviewers; discrepancies were addressed through discussion with a third reviewer as required. Results There was no significant difference in infection rate using either sterile surgical or non-sterile insertion technique. The use of water for cleansing prior to catheter insertion was recommended. There was no additional benefit from specific meatal care other than standard daily personal hygiene and removal of debris. Infection rates were similar for both latex and silicone catheters. Comparisons between silver and Teflon coating clearly favoured the silver alloy coating. The use of a complex closed drainage system in the intensive care environment did not confer any additional benefit. Studies comparing types of junction seals and use of junction seals either prior to or following catheterisation found no clear benefit from using either preconnected sealed systems or sealed systems with the addition of silver releasing devices. Neither the addition of chlorhexidine nor hydrogen peroxide to the drainage bag was found to be effective at reducing UTI rates. The findings indicated there was a higher incidence of bacteriuria associated with Foley catheters compared with intermittent catheterisation (P < 0.025). A single RCT examined the effect on UTI rates of routine bag changes against no routine bag change. Routine bag changes were not advantageous in reducing the risk of infection. Conclusions Current RCT evidence suggests the use of a surgical sterile catheterisation technique is not required, and that tap water is sufficient for cleaning genitalia. Following insertion, daily hygiene around the meatal area is as effective as catheter toilets; and catheters impregnated with silver may reduce the incidence of catheter associated bacteriuria. Sealed (e.g. taped, presealed) drainage systems should not be relied upon as the sole mechanism for prevention of bacteriuria. The addition of antibacterial solutions to drainage bags and the routine change of drainage bags had no effect on catheter associated infection. However, most of the recommendations arising from this review were based on single studies, often with limited numbers of participants. There is an urgent need to replicate these studies in other clinical settings.

P0747 ONE YEAR ASSESSMENT OF THE ???NUTRIPORT??? SKIN LEVEL GASTROSTOMY DEVICE

Introduction: Low profile gastrostomy tubes are convenient and preferable to conventional gastrostomy feeding tubes in pediatric patients. They are cosmetically pleasing, easier to use and the absence of long tubes allows for greater mobility of the patient. However, the low profile devices often require frequent replacements due to weakened/rupture of the balloon and malfunction of the anti-reflux valves. Insurance carriers therefore limit the number of replacements. Also, granulation tissue is a common problem seen. The aim of the study was to assess the clinical outcome of the use of the Nutriport gastrostomy and provide a one year experience including an assessment of problems with granulation tissue. Methods: The patients required gastrostomy tubes for: neurologic impairment (n =7), dysphagia (n =15), Feeding difficulty (n =5). The majority of the patients had previous experience with frequent replacement of the skin level devices and met problems with malfunction of the valve (n =7), weakened balloon (n =13), granulation tissue (n =12). The patients received most of their nutrition need as well as medications via the tube for a long term. Data were retrospectively collected over more than a year regarding the longevity of the balloon and the progress of the granulation tissue after replacement using the Nutriport. Results: Results: Patients mean age was 61/2 years. 60% female and 40% male. Insertion was as easy as other low profile balloon device. The duration of the tube after placement ranged from 1 week to 10 months, with average of 4 months. One patient pushed the tube out after almost a year due to a broken balloon. 12 patients with granulation tissue received 3–4 weeks Elocon cream treatment at the time of Nutriport placement and follow up evaluation revealed disappearance of the tissue or significant improvement Conclusion: Summary: This study provides evidence that the new low profile device, Nutriport, is tolerated well by pediatric patients and has shown longevity of usage. Existing granulation tissue resolved after the use of the Nutriport gastrostomy tube. Resolution is possible due to aeration underneath the tube provided by the special design which prevents the constant skin contact with the device. The device may be a financially attractive alternate to other devices from perspective of less need of replacement.