Cannula Site Research Articles

Intravenous iron staining: real-world incidence, preventability, and mitigation tools from a long-term quality improvement project.

Iron deficiency is the leading cause of anaemia worldwide and is increasingly treated with intravenous (IV) iron therapy. Staining from IV iron therapy is a rare but significant and preventable adverse event. To mitigate patient harm, a health-service-wide quality improvement project was implemented. This study aimed to determine the real-world impact of a quality improvement project on IV iron staining incidents and preventability. A retrospective chart audit was undertaken for all IV iron staining episodes reported in a directorate-wide clinical incident reporting database (RiskMan) between 2016 and 2022. Incidence rates of IV iron staining, preventability, and stain severity were compared pre- and post-implementation of a standardized IV iron procedure. Over 7 years, 103 IV iron stains were identified, resulting in a staining rate of 0.31 stains per 100 infusions (pre 0.27% and post 0.34%, P = .25). Implementation of the standardized IV iron procedure resulted in improvements in pharmacist review of the medication order (61.8% versus 89.7%, P < .01), use of the statewide IV iron infusion consent form (27.3% versus 76.9%, P < .01), and appropriate cannula site (14.3% versus 52.5%, P < .01). Smaller stain sizes were associated with cessation of the infusion at identification of extravasation (312 cm2 versus 35 cm2) (P = .04). Preventability was assigned to 86% of stains. The incidence rate of IV iron staining in a real-world clinical setting is 0.31%. There was increased compliance with several best practice principles and 86% of stains were preventable. Early identification and intervention of potential staining incidents results in smaller iron stains for patients. Quality improvement tools developed for this project can contribute to patient outcomes internationally.

74: Use of Negative Pressure Wound Therapy in Management of Extracorporeal Membrane Oxygenation (ECMO) Cannula Sites in Adults

74: Use of Negative Pressure Wound Therapy in Management of Extracorporeal Membrane Oxygenation (ECMO) Cannula Sites in Adults

997 Ascending Aorta Pseudoaneurysm 40 Years Following Surgical Atrial Septal Defect Repair

Abstract Background Ascending aorta pseudoaneurysm is a rare postoperative complication of cardiac surgery. It is often attributed to infection and dehiscence at sites of aortotomy, cannulation, cross-clamp placement, and proximal coronary anastomoses. Mortality risk is 29-46% and this requires prompt surgical intervention. Case summary A 48-year-old woman who underwent atrial septal defect repair at 8 years of age, presented with chest pain radiating to the right shoulder and dyspnoea. Cardiac-gated CT angiography demonstrated a 21mm pseudoaneurysm arising anteriorly from the proximal ascending aorta, 6mm above the right coronary artery ostium, likely the site of previous cardioplegia cannula. There was active blood flow from the aorta into the pseudoaneurysm sac. It was heavily calcified, apart from a thinned irregular wall inferiorly, from which rupture was imminent. She underwent emergency surgery. Using femoro-femoral cardiopulmonary bypass, the chest was safely re-entered. Under mild hypothermia and distal ascending aorta cross-clamping, the pseudoaneurysm was resected and aorta repaired using a Gelweave patch. The patient recovered uneventfully and was discharged home after one week. Discussion Accurate imaging, primarily via cardiac-gated CT angiography, is crucial for diagnosis and surgical planning in patients presenting with aortic pseudoaneurysm, particularly those close to the aortic valve and coronary arteries. Operative strategy, including need for deep hypothermic circulatory arrest and/or graft replacement of aorta, depends on pseudoaneurysm anatomy. It is recommended that preventative measures are taken during the primary operation, inserting the cardioplegia cannula tip through full-thickness purse-strings and/or addition of separate oversewing sutures after decannulation. Alternative techniques of pseudoaneurysm repair are also discussed.

Multiple Immune Dysregulation Conditions with a Single Underlying Root Cause of NRAS Gene-Positivity: A Case Report

Hematological malignancies in particular are recognized to be linked to immunological dysregulated disorders such hematolytic anemia, immunodeficiency, and autoimmune illnesses. We describe a rare case that had multiple immune dysregulation symptoms and was subsequently found to be positive for the NRAS gene. A male, 29, complained of pleuritic chest pain. On the ECG, he showed broad PR depression and elevated PR in aVR, along with elevated troponin. He received colchicine and NSAIDs as treatment with a good response and resolution of his symptoms. After four weeks, he developed a fever which thought to be secondary to perianal abscess, and a surgical incision and drainage along with broad spectrum antibiotics was used to treat a perianal abscess. Despite receiving extensive medical and surgical care, his fever persisted. His blood film started to show circulating blast cells. Following an immediate bone marrow aspiration and biopsy, there were no notable abnormalities seen, and a 1% blast was present, which was assumed to be the result of stress or infection. Later, a weak positive +1 Coombs (DAT) test is developed and caused active hemolytic anemia required blood transfusion. Along with the anemia, a wrist expanding wound was discovered in the previous IV cannula site. Clinically wound appears as a pyoderma gangrenosum. Histopathology showed purulent dermal inflammation including many neutrophils and macrophages. This feature of micro abscess formation was consisting with the diagnosis of pyoderma gangrenosum. An intravenous steroid (1 mg/kg) was administered in response to a positive Coombs test and pyoderma gangrenosum. The patient's condition greatly improved overall. His wound began to heal as his white blood cell count dropped. After being given oral steroids with a titration-down plan, the patient was sent home. A whole genome sequence was performed on him because he had peri myocarditis, pyoderma gangrenosum, and hematolytic anemia. The results show that he is NRAS gene positive. He was attentively observed clinically with regular out-patient follow-ups as this gene is strongly associated with hematological cancers. He developed symptomatic normocytic anemia a few months later, and a bone marrow aspiration and biopsy were performed to confirm the presence of Myelodysplastic syndromes (MDS). He was transferred to another facility and underwent chemotherapy and bone marrow transplant. In otherwise healthy individuals, the idea of offering a single explanation—Occam's razor—must be considered and investigated. Finding the underlying reason could improve patient care, enable precision therapy, and alter the course of events.

Innovative Percutaneous 3-Stitch Suture Technique for Site Closure in Venoarterial Extracorporeal Membrane Oxygenation Decannulation Without Direct Artery Repair: A Case Series.

No previous studies have reported the use of a percutaneous suture technique performed by bedside intensivists for site closure during decannulation without direct artery repair in venoarterial extracorporeal membrane oxygenation (VA-ECMO) cases. Thus, the objective of this study was to evaluate the safety and effectiveness of this alternative approach. This retrospective study included 26 consecutive patients who underwent percutaneous VA-ECMO decannulation at Maoming People's Hospital. Bedside percutaneous suture technique performed by intensivists facilitated cannula site closure. Primary outcome was successful closure without additional interventions. Secondary outcomes included procedural time, surgical conversion rate, complications (bleeding, vascular/wound complications, neuropathy, lymphocele), procedure-related death. Follow-up ultrasound were conducted within 6 months after discharge. All patients achieved successful site hemostasis with a median procedural time of 28 minutes. Procedure-related complications included minor bleeding (7.7%), acute lower limb ischemia (15.4%), venous thrombus (11.5%), minor arterial stenosis (7.7%), wound infection (4.2%), delayed healing (15.4%), and wound secondary suturing (6.3%). No procedure-related deaths occurred. Follow-up vascular ultrasound revealed two cases (7.7%) of minor arterial stenosis. The perivascular suture technique may offer intensivists a safe and effective alternative method for access site closure without direct artery suture during ECMO decannulation.

Axillary vein as an alternative venous access site for VV-ECMO cannulation: a case report

BackgroundUltrasound-guided percutaneous axillary vein cannulation can reduce cannulation failure and mechanical complications, is as safe and effective as internal jugular vein cannulation, and is superior to subclavian vein cannulation using landmark technique. As far, reports of venovenous extracorporeal membrane oxygenation (VV-ECMO) with percutaneous axillary vein cannulation are rare.Case presentationA 64-year-old man presenting with dyspnea and chest tightness after aspirating sewage was admitted to the emergency department. Computed tomography (CT) showed diffuse exudation of both lungs and arterial blood gas analysis showed an oxygenation index of 86. He was diagnosed with aspiration pneumonia-induced acute respiratory distress syndrome (ARDS) and intubated for deteriorated oxygenation. Despite the combination therapy of protective mechanical ventilation and prone position, the patient’s oxygenation deteriorated further, accompanied with multiple organ dysfunction syndrome, which indicated the requirement of support with VV-ECMO. However, vascular ultrasound detected multiple thrombus within bilateral internal jugular veins. As an alternative, right axillary vein was chosen as the access site of return cannula. Subsequently, femoral-axillary VV-ECMO was successfully implemented under the ultrasound guidance, and the patient’s oxygenation was significantly improved. Unfortunately, the patient died of hyperkalemia-induced ventricular fibrillation after 36 h of VV-ECMO running. Despite the poor prognosis, the blood flow during ECMO run was stable, and we observed no bleeding complication, vascular injury, or venous return disorder.ConclusionsAxillary vein is a feasible alternative access site of return cannula for VV-ECMO if internal jugular vein access were unavailable.

Negative pressure therapy for ECMO cannula stabilization.

Cannula stabilization for extracorporeal membrane oxygenation (ECMO) is important for patient mobilization and rehabilitation. Limitations to mobilization on ECMO include staff discomfort and cannula instability. We utilized the technique of negative pressure therapy for ECMO cannula stabilization to improve mobilization. Negative pressure therapy for ECMO cannula stabilization can be utilized safely for a variety of cannulation sites in any patient age from newborns to adults. This wound management strategy may facilitate patient mobilization and rehabilitation therapies in addition to extending cannula site duration.

Computed tomography pulmonary angiogram in a poly-trauma patient undergoing veno venous extracorporeal membrane oxygenation: our experience in diagnosing pulmonary embolism

Extracorporeal membrane oxygenation (ECMO) is an adapted form of the heart–lung machine that provides cardiopulmonary bypass life support for critically ill patients with acute cardiac and/or respiratory failure who are unresponsive to standard medical and surgical therapies. Although ECMO therapy has advanced significantly, complications like thrombosis and bleeding continue to be substantial, necessitating rapid transport of patients to the radiology suite to reveal crucial findings for further treatment plans or care. Even though the low flow rate for veno-arterial ECMO (VA-ECMO) support during contrast-enhanced CT is well known, the flow rate for veno-venous ECMO support during CT, especially computed tomography pulmonary angiography, is not well understood. Our case emphasizes that CTPA can be performed safely in trauma patients with ECMO runs and any suspected complications during ECMO runs may delay or worsen the clinical prognosis therefore immediate radiological verdicts may reveal significant findings to plan the treatment accordingly. Also, there were no complications associated with our examinations or transport. Our case highlights that VV-ECMO like VA-ECMO induces flow-dependent alterations in the patient’s circulation due to contrast injections, which might lead to an incorrect interpretation of CTPA. However, CTPA is safe, and bringing down the VV-ECMO flow rate of zero with vigilant monitoring of vitals and ventilation support helps radiologists to predict and interpret the contrast flow based on injection and cannula sites in the diagnosing and evaluation of pulmonary embolism patients with acute respiratory failure during ECMO.

Outcomes With Single-Site Dual-Lumen Versus Multisite Cannulation for Adults With COVID-19 Respiratory Failure Receiving Venovenous Extracorporeal Membrane Oxygenation.

To determine whether multisite versus single-site dual-lumen (SSDL) cannulation is associated with outcomes for COVID-19 patients requiring venovenous extracorporeal membrane oxygenation (VV-ECMO). Retrospective analysis of the Extracorporeal Life Support Organization Registry. Propensity score matching (2:1 multisite vs SSDL) was used to control for confounders. The matched cohort included 2,628 patients (1,752 multisite, 876 SSDL) from 170 centers. The mean ( sd ) age in the entire cohort was 48 (11) years, and 3,909 (71%) were male. Patients were supported with mechanical ventilation for a median (interquartile range) of 79 (113) hours before VV-ECMO support. None. The primary outcome was 90-day survival. Secondary outcomes included survival to hospital discharge, duration of ECMO support, days free of ECMO support at 90 days, and complication rates. There was no difference in 90-day survival (49.4 vs 48.9%, p = 0.66), survival to hospital discharge (49.8 vs 48.2%, p = 0.44), duration of ECMO support (17.9 vs 17.1 d, p = 0.82), or hospital length of stay after cannulation (28 vs 27.4 d, p = 0.37) between multisite and SSDL groups. More SSDL patients were extubated within 24 hours (4% vs 1.9%, p = 0.001). Multisite patients had higher ECMO flows at 24 hours (4.5 vs 4.1 L/min, p < 0.001) and more ECMO-free days at 90 days (3.1 vs 2.0 d, p = 0.02). SSDL patients had higher rates of pneumothorax (13.9% vs 11%, p = 0.03). Cannula site bleeding (6.4% vs 4.7%, p = 0.03), oxygenator failure (16.7 vs 13.4%, p = 0.03), and circuit clots (5.5% vs 3.4%, p = 0.02) were more frequent in multisite patients. In this retrospective study of COVID-19 patients requiring VV-ECMO, 90-day survival did not differ between patients treated with a multisite versus SSDL cannulation strategy and there were only modest differences in major complication rates. These findings do not support the superiority of either cannulation strategy in this setting.

Extracorporeal Life Support for Cardiogenic Shock in Adult Congenital Heart Disease-An ELSO Registry Analysis.

There are minimal data on the use of venoarterial extracorporeal membrane life support (VA-ECLS) in adult congenital heart disease (ACHD) patients presenting with cardiogenic shock (CS). This study sought to describe the population of ACHD patients with CS who received VA-ECLS in the Extracorporeal Life Support Organization (ELSO) Registry. This was a retrospective analysis of adult patients with diagnoses of ACHD and CS in ELSO from 2009-2021. Anatomic complexity was categorized using the American College of Cardiology/American Heart Association 2018 guidelines. We described patient characteristics, complications, and outcomes, as well as trends in mortality and VA-ECLS utilization. Of 528 patients who met inclusion criteria, there were 32 patients with high-complexity anatomy, 196 with moderate-complexity anatomy, and 300 with low-complexity anatomy. The median age was 59.6 years (interquartile range, 45.8-68.2). The number of VA-ECLS implants increased from five implants in 2010 to 81 implants in 2021. Overall mortality was 58.3% and decreased year-by-year (β= -2.03 [95% confidence interval, -3.36 to -0.70], p = 0.007). Six patients (1.1%) were bridged to heart transplantation and 21 (4.0%) to durable ventricular assist device. Complications included cardiac arrhythmia/tamponade (21.6%), surgical site bleeding (17.6%), cannula site bleeding (11.4%), limb ischemia (7.4%), and stroke (8.7%). Utilization of VA-ECLS for CS in ACHD patients has increased over time with a trend toward improvement in survival to discharge.

Extracorporeal Life Support in Critical Care Medicine

Veno-arterial extracorporeal life support (ECLS) may be indicated in patients with refractory heart failure. The list of conditions in which ECLS is successfully used is growing and includes cardiogenic shock following myocardial infarction, refractory cardiac arrest, septic shock with low cardiac output and severe intoxication. Femoral ECLS is the most common and often preferred ECLS-configuration in the emergency setting. Although femoral access is usually quick and easy to establish, it is also associated with specific adverse haemodynamic effects due to the direction of blood flow and access-site complications are inherent. Femoral ECLS provides adequate oxygen delivery and compensates for impaired cardiac output. However, retrograde blood flow into the aorta increases left ventricular afterload and may worsen left ventricular stroke work. Therefore, femoral ECLS is not equivalent to left ventricular unloading. Daily haemodynamic assessments are crucial and should include echocardiography and laboratory tests determining tissue oxygenation. Common complications include the harlequin-phenomenon, lower limb ischaemia or cerebral events and cannula site or intracranial bleeding. Despite a high incidence of complications and high mortality, ECLS is associated with survival benefits and better neurological outcomes in selected patient groups.

Transthoracic Aortic Clamp Technique for Port-Only Endoscopic Robotic Mitral Surgery.

Many robotic mitral surgeons utilize right thoracotomy with transthoracic clamping of the aorta, while a smaller number employ a port-only endoscopic approach with endoaortic balloon occlusion of the aorta. We present our technique for a port-only endoscopic robotic approach with transthoracic clamping. From July 2019 through December 2022, 133 patients underwent port-only endoscopic robotic mitral surgery with transthoracic clamp aortic occlusion and antegrade cardioplegia. Perfusion was through the femoral artery in 101 patients (76%) and axillary in 32 patients (24%). Clamp technique involved placing the clamp at the mid-ascending aorta, dynamic valve testing to 90 mm aortic root pressure, and closure of the cardioplegia cannula site prior to clamp removal. Indications for clamp utilization over balloon occlusion included both balloon supply issues and aortoiliac anatomy. Mitral repair was performed in 122 patients (92.7%) and mitral valve replacement in 11 patients (8.3%). Mean aortic occlusion time was 92 ± 21.4 min. Mean time from left atrial closure to clamp removal was 8.7 (7.2 to 12.8) min. There were no injuries to the aorta or surrounding structures, mortality, strokes, or renal failure. For robotic teams with endoaortic balloon capability, this technique may be useful in certain patients with aorto-iliac pathology or limited femoral artery access. Alternatively, robotic teams who employ transthoracic aortic clamping through a thoracotomy may find this technique useful to transition to a port-only endoscopic approach.

Intensivist-Led Transportation of Patients on Extracorporeal Membrane Oxygenation: A Single Center Experience.

This study evaluated the suitability, feasibility, safety, and outcomes of transport of the ECMO-dependent patient (EDP) by EDP transport team (EDPTT) in China. Eighty-two EDPs (forty-one cases on VV ECMO and forty-one cases on VA ECMO) received transport between June 2018 and June 2021 and were retrospectively analyzed. ECMO circulation was performed by the outlying hospital, mainly using percutaneous ECMO cannulation. The EDPTT consists of three intensive therapists, one of whom serves as a team leader, and one intensive care unit nurse. Of these, 81 (98.8%) patients were transferred by ambulance, no deaths occurred during transport, the EDP-related complications were 19% (n = 16); bleeding at the cannula site (n = 7, 8.5%) was the most prominent; equipment-related problems accounted for 14.6% of the problems requiring urgent intervention, with hand cranking being the most common (9.7%). The survival rate during transport was 100%, with 36 (43.9%) patients surviving to discharge. The ECMO weaning rate was 61% for VV ECMO and 63.7% for VA ECMO. The results demonstrated the suitability, feasibility, and safety of transporting EDP in a team led by an intensivist, with few complications and no deaths during transport. This may be the recommended staffing model for EDP transport in developing countries.

A Rare Complication of Intravenous Phenytoin Induced Purple Glove Syndrome

Purple Glove Syndrome is a relatively uncommon complication of intravenous phenytoin administration withclinical manifestations of pain, edema, and purple-blue discoloration at the injection site. Here we report a caseof Purple Glove syndrome induced by intravenous administration of phenytoin. The case report describes about a75-year-old male, who presented to the Emergency Department with chief complaints of generalized tonic - clonicseizures for which he was managed with Inj. Phenytoin. Later patient sensorium improved and 4 hours later thepatient had pain and swelling over the left hand and wrist distal to the IV cannula site followed by reddish-purplediscoloration over the edematous site. Left upper limb Doppler was done &amp; it showed left-hand cellulitis with noevidence of thrombus. Then the patient was reassured and treated with removal of IV cannula, left-hand elevation,warmth application, analgesics and change of antiepileptics. Such medications like phenytoin should be handledcarefully to avoid difficulties in the future. Early detection, rapid monitoring, and management are essential.

Risk of cannulation site bleeding during physical therapy mobilization during extracorporeal membrane oxygenation : A retrospective analysis in patients with acute respiratory failure

Patients suffering from acute respiratory distress syndrome receive extracorporeal membrane oxygenation (ECMO) as the last possible therapy. At the University Hospital Tübingen, these patients also receive physical therapy during this phase from aspecially trained team to counteract physical deconditioning. In this work, the risk of cannula site bleeding during physiotherapy mobilization is investigated and aspects regarding safety are described. From 2013 to 2018, 83patients matching the inclusion criteria were treated at the Anesthesiology Intensive Care Unit at the University Hospital Tübingen. The datasets were retrospectively analyzed by means of acase-control study. For comparison, the patients were divided into apassive and an active group according to the achieved level of mobilization. Bleeding events, ECMO implantation duration, and other aspects were taken into consideration in the analysis. There were two bleeding events in the passive and two bleeding events in the active group, but these were not related to physical therapy mobilization. The ECMO implantation duration varied between 1and 77days. Physical therapy mobilization by aspecially trained interdisciplinary team did not increase the risk of bleeding at the cannulation site.

Experience with Liposuction for the Treatment of Subcutaneous Lipoma: A Case Series from a Tertiary Health Institution in Nigeria.

Lipomas are the commonest benign tumours in the body. Treatment is often by excision biopsy. Liposuction has traditionally been used for body sculpturing, but recently, it was introduced for the operative management of lipomas. The aim of this study was to present our experience with liposuction lipectomy-assisted lipoma aspiration in terms of its efficacy, complications, risk of recurrence, and patient satisfaction. A retrospective review of 16 patients with solitary or multiple lipomas managed with liposuction over a 5-year period was done. All the patients had a prior fine needle aspiration cytology, which was reported as benign. Informed consent was obtained, and the procedures were performed as a day case under tumescent anaesthesia. Lipo-aspiration was done with manual liposuction device. The patients were discharged on oral analgesics and antibiotics. Sixteen patients (10 females and six males) with 21 lesions were managed. The median age was 43 years (23-66 years). All the patients had satisfactory outcomes. The procedure was converted to open-excisional surgery in one patient, and the histology was reported as fibro lipoma. Friction burn at the cannula site occurred in one patient, which subsequently healed with scars. No recurrence was reported in any of the patients. In well-selected patients, liposuction-assisted lipectomy may have an advantage over the classical open technique. All patients should have a minimum investigation of fine needle aspiration cytology because of the risk of atypical lipomas or liposarcoma, which might have similar features as subcutaneous lipoma.

P44 Rapidly progressive cutaneous ulceration in a toddler

Abstract Introduction/Background Pyoderma gangrenosum is a rare ulcerative inflammatory cutaneous condition of unknown aetiology which is uncommon in childhood. Only 4% of reported cases occur in individuals younger than 15. The initial lesion in PG is commonly a painful hemorrhagic nodule or pustule that rapidly progresses into a large necrotic boggy ulcer that may resolve with cribriform scars. About 50% of patients with PG are associated with an underlying systemic disease, including inflammatory bowel disease, hematologic malignancies disease, and arthritis. It may occur in the context of classic syndromes like PAPA. Description/Method A 3-year-old male child was admitted to the Rheumatology ward with fever and generalized ulcers for two months. The ulcers started as multiple small pustules over the buttock, bilateral thigh, and extensor aspect of upper limbs and evolved into large ulcers within two months. Ulcers were round to oval in shape with irregular margins, undermined edges and violaceous borders. He also developed similar ulcers at intravenous cannula sites over the dorsum of hands suggesting the pathergy phenomenon. Laboratory reports suggested increased inflammatory markers. Skin biopsy showed dense dermal neutrophilic infiltration without vasculitis, suggesting pyoderma gangrenosum. Bacterial fungal and tubercular cultures from the biopsy tissue were normal. Bone marrow examination ruled out hematopoietic malignancy. Colonoscopy was normal ruling out subclinical IBD. Whole exome sequencing for auto inflammatory panel didn’t reveal any pathogenic variant. Diagnosis was considered as childhood-onset idiopathic pyoderma gangrenosum. The child was started on steroids along with cyclosporine, ulcers slowly started to heal over a period of two months and started to recur on the buttocks at sites of minor trauma. Discussion/Results The most common underlying etiologies in pediatric PG are IBD (inflammatory bowel disease), hematologic malignancies, immune deficiencies, vasculitis, PAPA syndrome (pyogenic arthritis, pyoderma gangrenosum and acne), SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis), and as well as PASH (pyoderma gangrenousm, acne and hidradenitis suppurevitiva). Idiopathic cases account for 49% of cases. Adult PG, most commonly occurs in lower limbs, but lesions in pediatric PG are multiple and disseminated without any specific location. Cyclosporine, Methotrexate, Mycophenolate mofetil, and cyclophosphamide can be used as steroid-sparing agents.TNF inhibitors and Anakinra can be used as biological agents. Key learning points/Conclusion Pediatric PG can be misdiagnosed due to its rarity and atypical presentation; a thorough clinically oriented workup is mandatory to make the correct diagnosis and choose the appropriate treatment. Treating a resistant PG can be challenging. Further growth in the field of genomic sequencing paves the way for a new diagnosis.

Prevalence of peripheral venous cannula-related colonization and infections in pediatric intensive care unit

Background: Intravenous (IV) access exposes patients to risk of catheter-related infections. The source of infection is either microbial colonization of the cannula or contamination of the hub or drugs. The study objectives were to estimate the prevalence of the peripheral venous cannula (PVC)-related infection and the factors associated with colonization and the antibiotic sensitivity pattern of the organisms causing infection. Subjects and Methods: It was a cross-sectional study which included infants and children who required an indwelling PVC. Visual infusion phlebitis (VIP) score was recorded for insertion site changes. Cannula tip and blood were sent for culture and antibiotic sensitivity. Catheter-related bloodstream infection was diagnosed based on bacterial growth in both the cannula tip and blood culture. Results: Out of the 256 children recruited in the study, 57% were males and 13% were undernourished. The most common primary illness was respiratory disease. Cannula tip growth was noted in 8.5%. The PVC colonization rate was 37.9/1000 catheter days. Multivariate analysis showed significant association between the primary illness, multiple attempts for insertion, longer duration of IV fluid use, retention of cannula beyond 96 h, and higher VIP scores &gt;2 and cannula colonization. Conclusions: Apart from strict adherence to infection prevention techniques, disposal of cannula after one failed attempt, changing IV cannula after 96 h, inspection of cannula site to identify phlebitis early, and removal of the cannula when the VIP score is &gt;2 may help to minimize cannula-related colonization and infection.

PERIPHERAL INFUSION RELATED THROMBOPHLEBITIS- A HEALTH PROBLEM

Objectives : Peripheral infusion related thrombophlebitis has documented high incidence in hospitalised patients, making it a common complication. Heparin reduces the supercial thrombophlebitis. In this prospective randomised study, our aim was to evaluate the efcacy of Heparin Sodium Topical Solution. The patients were divided into two groups. Group I included 20 patients who did not receive heparinMethods : and Group II who received topical heparin sodium. The efcacy of the solution was assessed on the basis of phlebitis scale for 48 hours. Results : There was signicantly lesser score in Group I (receiving topical heparin) in all time periods Our study showed relatively lessConclusion : frequent occurrence and milder severity of catheter related phlebitis when topical heparin is applied on insertion site of cannula. Aims And Objectives: To Evaluate the Efcacy of Heparin Sodium Topical Solution in Prevention of Intra Venous Cannula Related Thrombophlebitis

Parameters of Ionic and Acid-Base Balance during Assist Circulation with a LVAD Disc Pump.

In chronic experiments on calves, the effect of the left-ventricular assist device (LVAD) technique by using a disc pump on the indicators of ionic and acid-base homeostasis. At blood velocity of 20% from the total volume, a trend towards an increase in K+ concentration and a slight decrease in the concentration of Na+, pH, and standard base excess in animal plasma were observed. If the blood velocity increased up to 90%, the indicators of ionic and acid-base homeostasis returned to their baseline values. In parallel, stroke volume and cardiac output as well as BP at the outlet of the heart and inside it and HR increased simultaneously with a blood pressure decrease in the input cannula site. There were no differences in plasma concentrations of Ca2+ and Cl- at different blood flow volumes.