Flush Technique Research Articles

Femoral to abdomen tunneling at the bedside for medium/long term venous access.

Femoral to abdomen tunneling of small-bore central venous catheters is a bedside technique for patients with contraindications to a thoracic approach, or as an alternative to a lower extremity catheter exit site. A femoral to abdomen tunneling technique was implemented for patients receiving medium and long-term intravenous treatments with contraindications to the thoracic venous approach or as an alternative to a lower extremity catheter exit site. All venous access devices were inserted with ultrasound guidance under local anesthesia, and catheter tip placement assessed by post procedural radiography. In this case series, from January 2020 to January 2023, a total of eight FTA-tunneled venous access devices were inserted. There were seven ambulatory patients and one bedbound patient. The median length of the subcutaneous tunnel was 20 cm, ranging from 15 to 27 cm. The median length of the intravenous catheter to the terminal tip was 31 cm, ranging from 23 to 40 cm. Tip location was confirmed by post-procedural abdominal radiograph. The catheter tip locations were interpreted to be at the level of T8-T9 (2), T12 (1), L4 (2), L2 (2), L1(1).No insertion or post insertion related complication was reported. Six patients completed the scheduled intravenous treatment. One patient was unable to be tracked due to transfer to an outside facility. One catheter initially demonstrated to be coiled over the left common iliac vessel was repositioned using a high flow flush technique. There was one reported catheter dislodgment by the nurse providing care and maintenance. The overall implant days were 961, with a median dwell time of 125 days ranging from 20 to 399 days. Femoral to abdomen tunneling provides an alternative exit site useful in select patients with complex intravenous access. The data of this small retrospective review suggests this a safe and minimally invasive bedside procedure.

Diagnostic utility of selected faecal biochemical parameters in the determination of acute diarrhoea and associated defecation stooling characteristics in dogs: An observational study

Diarrhoea, which is a clinical manifestation of various illnesses, is frequently observed in dogs. Regrettably, many dog owners find it difficult to provide comprehensive case histories, primarily because of limited interaction with their canine companions. This study aimed to evaluate the potential of faecal biochemical analytes in detecting and characterizing acute diarrhoea in dogs. Sixty-two domestic dogs were selected using the proportionate stratified sample technique. A structured questionnaire was used to collect demographic and clinical data. Faecal stool specimens from the dogs were obtained using the colon flush technique. The specimens were taken through biochemical analysis to determine urea, creatinine, total bilirubin, total cholesterol, triglycerides, gamma-glutamyl transferase and uric acid levels. Results showed a significant association between the diarrhoea status of the participants and their age, weight, breed, body size, source of last diet, period of inappetence, and other gastrointestinal signs (p < 0.050, respectively). Dogs that had not eaten in at least three days were five times more likely (p < 0.05) to have diarrhoea. Furthermore, miniature breeds were about six times more likely to develop diarrhoea (p < 0.05). Of the seven selected biochemical parameters, total faecal cholesterol was the most predictive index in diagnosing acute diarrhoea in dogs, with a likelihood ratio of 6.5, and it was the most accurate in predicting defecation stooling frequency and texture. In summary, in situations of inadequate case histories, measuring total faecal cholesterol could assist veterinarians in detecting diarrhoea and predicting its faecal stooling texture and frequency in dogs.

Safe heart flush technique during recovery from donors after circulatory death.

Donation after circulatory death is the donation after cardiac arrest. This technique has been employed and adopted by clinicians to overcome the shortage of available hearts for transplant. Warm ischemia time plays a pivotal role in the survival outcome of the heart recipients. To assess the efficacy of using the Foley catheter to flush the heart during procurement from donation after circulatory death donors. We utilized a 2-WAY Foley catheter to flush the heart during procurement. The catheter was prepared and modified on the back table. We were successfully able to flush the heart within 3 minutes from skin incision with a good recipient outcome. Using the Foley catheter to flush the heart during recovery from donation after circulatory death donors was both efficient and fast.

Water, Sanitation, and Hygiene (WASH) Practices Among Households in Perambalur District: A Cross-Sectional Study.

Background Sanitation, cleanliness, and access to clean water are essential for maintaining human health and well-being. Poor water, sanitation, and hygiene (WASH) practices are linked to diseases that lead to poor health outcomes, such as pneumonia and diarrhea, trachoma, infestations of soil-transmitted helminths, respiratory tract infections, and pulmonary tuberculosis. The aim of this study is to evaluate household WASH practices in the rural and urban field practice areas of the Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, India, and identify the factors that influence them. Methodology We conducted a five-month cross-sectional survey with 278 households in the rural and urban field practice areas of a tertiary care center in Perambalur district. We gathered data using the core questions developed by the World Health Organization-United Nations Children's Fund (WHO-UNICEF) Joint Monitoring Programme (JMP), which is affiliated with UN-Water. Data analysts used a Pearson chi-square test to assess the relationship between WASH practices and several independent covariates, and we regarded P < 0.05 to be statistically significant. Results Amongthe 278 households, 118 respondents were from rural areas and 160 (57.7%) from urban areas. For drinking water, 31.4% of rural households used tube wells or boreholes, while 56.8% of those used public taps. In metropolitan areas, 25.6% of people used bottled water and 54.4% used water from tanker trucks. In terms of sanitation, 25.2% of households lacked a toilet and 72.7% used the flush/pour flush technique. Water, sanitation, and hygiene practices have been found to be associated with a population's socioeconomic status and place of residence. The Pearson chi-square test revealed that the rural population has 99.1% more improved drinking water sources than the urban population, which was statistically significant (P < 0.001). Conclusion In rural areas, nearly 92% of households used improved sources of drinking water compared to only 55% of households in urban areas. On the other hand, just 47.5% of households in the rural area had improved sanitationcompared to 95% of households in the urban area. Therefore, the Indian government should take steps to enhance urban drinking water quality and rural sanitation infrastructure.

Intracameral vent and flush technique for silicone oil blockade in Ahmed glaucoma valve.

The presence of emulsified silicone oil in the eye can lead to many complications, glaucoma being one of the most common. Adequate IOP control is difficult to achieve with medical management alone; surgical intervention is often required. Glaucoma drainage device implantation is often the preferred line of surgical intervention in such cases due to trabeculectomy failure from emulsified silicone oil droplets and associated conjunctival scarring. However, the silicone tube of Ahmed glaucoma valve (AGV) may attract the silicone oil droplets, causing blockade of the tube with persistent raised IOP postoperatively. We report one such case where post-AGV silicone oil tube occlusion was treated with semi-conservative surgical management instead of revising the entire surgery or implantation of another drainage device. Our surgical technique of intracameral “vent and flush” offers rapid and effective IOP control in such cases. Postoperatively, normal IOP was achieved. Patency of tube continued to be maintained along with normalization of IOP on subsequent follow-ups.

Huffman Coding and Multi-Generation Mixing Assisted Network Coding Based MAC for QoS-Centric Secure Data Communication over MANETs

The exponential rise in wireless transmission has gained widespread attention to meet major mobile communication purposes including, Internet of Things (IoT) and Machine-to-Machine (M2M) communications. Mobile Ad-hoc Network (MANET) has emerged as one of the most viable solution to meet aforesaid mobile communication purposes; however, being decentralized and infrastructure-less network it undergoes adversaries including dynamic topology and security breaches due to malicious node attachment during routing. On the contrary, data security and allied Quality-of-Service (QoS) provision are inevitable in NextGen communication systems. Unlike routing-based security measures, Medium Access Control (MAC) based approaches are found more effective for MANETs. However, most of the classical MAC designs either address QoS or security as standalone objective. Unlike existing MAC solutions, in this paper a state-of-art novel Huffman Coding and Multi-Generation Mixing (MGM) assisted random linear network model-based MAC design (HM2-MAC) is proposed for MANET. Realizing the robustness of the network coding algorithms towards reliable, secure and error-free multicast transmission, we designed HM2-MAC in such manner that Huffman coding helps securing the source data packets, while MGM concept enables reduction in redundant packets to make overall communication resource efficient and secure. Unlike redundant packet-per-generation, MGM concept helps in reducing redundant transmission and hence achieves resource efficiency. Since, in HM2-MAC model the coefficient matrix used to encode the data is known only to the sink, no intermediate node can decode it or can pollute it. It makes multicast transmission more secure over MANET. Additionally, the use of iterative buffer flush technique preserves resources or buffer to accommodate more data for transmission and hence higher throughput. Noticeably, error sensitive packetization and MGM control strengthens our proposed model to retain optimal performance. HM2-MAC has been applied as a sub-layer of native IEEE 802.11 MAC and hence retains backward compatibility towards real-world implementation. MATLAB based simulation revealed that our proposed HM2-MAC protocol achieved almost 99.6% throughput even under varying link-loss patterns, which reveals its robustness to ensure QoS delivery with secure data transmission in MANET.

811. Utilizing IV team in Reducing the Central Line Associated Infections

BackgroundCentral Line-Associated Blood Stream Infections (CLABSI) are defined as the laboratory confirmed blood stream infections after 48 hours of the line placement and excluding other sources of infection. CLABSI can lead to prolonged hospital stay, increased risk of mortality and financial burden on the health care system. In our study, we aimed at evaluating the incidence of CLABSI after involving the IV team in both critically ill and non-critically ill patients.MethodsA retrospective chart review was performed from July 2011 to August 2019 at a 971 bedded community hospital. IV team has been involved in the central line care since 2013 and started changing the scheduled central line dressings. The interventions that were introduced since then include usage of Curos, wearing masks and gloves for any contact with central lines, flushing the central lines using pulsatile method, and not drawing the routine labs. Allpoints program was introduced in July 2018 which is a retraining program to the nurses emphasizing on central line dressing changes using a sterile technique, pulsatile flushing method and medication administration. CLABSI rate was calculated per 1,000 central line days yearly and quarterly and was compared before and after the involvement of IV team.ResultsTotal number of events from July 2011 to August 2019 were 275. Average central line days were 22,350. Most common organisms that were isolated are Staphylococcus aureus (13.45%) followed by Staphylococcus Epidermidis (9.8%), Candida Albicans (8.7%), E. Coli (8.72%) and Klebsiella Pneumonia (6.9%). The average CLABSI rates quarterly and yearly were 1.00 and 1.32 respectively, per 1000 central line days. Average CLABSI rates before and after the involvement of IV team were 1.32 and 1.18 respectively. CLABSI rate has decreased significantly after the involvement of the IV team in 2013. The largest impact on the CLABSI infection rate was between July 2018 to August 2019 which can be attributed to the Allpoints program. CLABSI rate in 2018 and 2019 were 0.86 and 0.6 respectively.ConclusionOur analysis showed that involving the IV team in the central line care and implementing the preventive strategies like usage of curos, pulsatile flush technique, wearing mask and gloves for any contact with central line helped in reducing CLABSI.Disclosures All Authors: No reported disclosures

A RAPID SENSITIVE AND SELECTIVE GC-MS/MS METHOD FOR MULTI RESIDUE ANALYSIS OF A LARGE NUMBER OF PESTICIDES IN CHAMOMILE

Multi-residue methods for pesticide residues analysis in herbal plants, using gas chromatography tandem mass spectrometry (GC–MS/MS), usually carried out by a long run time. These longer run times of analyses are performed to avoid the overlapping of the co-extracted natural components with the analyzed pesticides in herbal samples. In the current study, a rapid sensitive and selective GC-MS/MS method, of run time 25 m, has been developed for the analysis of 212 pesticides in chamomile. The oven temperature program has been optimized to give a better distribution for the eluted pesticides along all the run time. Besides, the back flush technique has been used to remove the less volatile compounds and to decrease the analysis runtime. In addition, the sample preparation was a modification of the known QuEChERS extraction method by applying a freezing step at -20 °C for 20 m before adding the salting out mixture. The developed method enables food safety laboratories to increase the number of analyzed samples per day with a reduction of the total analysis cost. The developed method has been fully validated on chamomile according to SANTE/11813, 2018. The obtained results showed that, more than 206 pesticides have average recoveries between 70-120 % at a concentration level of 50 µg kg-1. Limit of quantitation for 160 of the studied pesticides equal 10 µg kg -1. The developed method was also employed for the analysis of real chamomile samples collected from Al-Fayoum governorate, Egypt. The obtained results showed that most of the collected samples were positive by different pesticide residues. There were three samples contaminated by five to six different pesticides, indicating the presence of uncontrolled pesticide practices.

Myofascial Injection Using Fascial Layer-Specific Hydromanipulation Technique (FLuSH) and the Delineation of Multifactorial Myofascial Pain.

Background and objectives: The aims of this study were to delineate the contribution of specific fascial layers of the myofascial unit to myofascial pain and introduce the use of ultrasound-guided fascial layer-specific hydromanipulation (FLuSH) as a novel technique in the treatment of myofascial pain. Materials and Methods: The clinical data of 20 consecutive adult patients who underwent myofascial injections using FLuSH technique for the treatment of myofascial pain were reviewed. The FLuSH technique involved measuring the pain pressure threshold using an analog algometer initially and after each ultrasound guided injection of normal saline into the specific layers of the myofascial unit (superficial fascia, deep fascia, or muscle) in myofascial points corresponding with Centers of Coordination/Fusion (Fascial Manipulation®). The outcome measured was the change in pain pressure threshold after injection of each specific fascial layer. Results: Deep fascia was involved in 73%, superficial fascia in 55%, and muscle in 43% of points. A non-response to treatment of all three layers occurred in 10% of all injected points. The most common combinations of fascial layer involvement were deep fascia alone in 23%, deep fascia and superficial fascia in 22%, and deep fascia and muscle in 18% of injected points. Each individual had on average of 3.0 ± 1.2 different combinations of fascial layers contributing to myofascial pain. Conclusions: The data support the hypothesis that multiple fascial layers are responsible for myofascial pain. In particular, for a given patient, pain may develop from discrete combinations of fascial layers unique to each myofascial point. Non-response to treatment of the myofascial unit may represent a centralized pain process. Adequate treatment of myofascial pain may require treatment of each point as a distinct pathologic entity rather than uniformly in a given patient or across patients.

Safe Lung Flush Technique During Recovery From Donors After Circulatory Death

Donation after circulatory death is defined as donation after cardiac arrest and circulatory cessation. The number of circulatory death donors is growing and significantly increases the organ donor pool. Shortening the warm ischemia time is pivotal in the outcomes and survival after transplant. We describe simplified and safe technique for lung flush during lung recovery from donors after circulatory death.

The flushing procedure in nursing practices: A cross-sectional study with Portuguese and Brazilian nurses

BackgroundIn patients with peripheral intravenous catheters (PIVCs), performing flushing is an essential procedure to maintain catheter patency and prevent complications. These PIVC related complications can lead to premature removal and therapeutics interruption, which implies the need of a new catheterization thus increasing patient discomfort and pain. AimsTo identify nursing practices related to the flushing procedure, namely: moment(s) of the flushing; the syringe size used; the flush solution, volume and technique; the knowledge and accomplishment of the recommended standards on flushing by nurses. MethodsA cross-sectional study was conducted between July and December 2017, with Brazilian and Portuguese nurses. An online questionnaire was developed based on the international recommendations on flushing procedure. Descriptive analysis was performed. ResultsA total of 76 nurses answered the questionnaire. The majority of nurses (84.2%) performed flushing: the most common technique used was continuous syringe pressure (31.2%), with the push-pause technique being performed by 23.4% of the nurses. Despite the majority performs flushing at four distinct moments (after the PIVC insertion, before, between and after drug delivery), there are inconsistencies in flush solution, volume, and syringe size. The most used volume to perform flushing was 5 mL, filled using normal saline. Despite this, they also recognized the omission of this procedure due to time constrains, no familiarity with the procedure and unavailable material. ConclusionsThis study identified that flushing procedure isn't always performed by nurses in their clinical practice. Also, several inconsistencies were observed between nurses that performed flushing, reflecting the lack of empirical evidence in this area of research.

P1128INTERMITTENT SALINE FLUSH VS CONTINUOUS SALINE INFUSION IN HEPARIN FREE DIALYSIS, A COMPARATIVE ANALYSIS

Abstract Background and Aims Proper anticoagulation during dialysis for the patients with bleeding risk or contraindication for heparin is a challenge. Regional anticoagulation with heparin and protamine or citrate and calcium though accepted has well known complications and has logistic and monitoring problem. Intermittent saline flush is another well accepted techniques. But it is labour intensive and often leads to fiber loss or coagulation of the dialyser. Keeping these in mind we hypothesised continuous prepump saline infusion may be another alternative technique in these situations. In this study We compared the outcome between intermittent saline flush versus continuous saline infusion while dialysing patients without heparine. Method Patients &amp;gt;18 year of age, on mHD @3/wk atleast for 3 months, having mature Avfistula and Hb between 8.5-11.5gm/dl with standard EPO and decided for heparin free dialysis were included for the study. Exclusion criteria were Intradialytic weight gain more than 3kg receiving any blood component transfusion or albumin,parenteral nutritional product infusion, any need for UF /Na/HCO3 profiling. Patients on antiplatelet drug or P-time prolonged &amp;gt; 6sec, APTT &amp;gt; 2 times normal, and platelet count less than 80,000 were also excluded. After inclusion, for each patient 8 session were studied systematically as per the preset protocol. Session 1,3,5,7 was subjected to intermittent saline flush(ISF) where as session 2,4,6,8 were subjected to continuous saline infusion(CSIF). The blood flow during dialysis was kept in the range of 250ml/min to 300ml/min and dialysate flow was kept fixed at 500ml/min. and UF goal was kept between 2.5 to 3.5lit and treatment duration was fixed at 4hrs.In ISF, every 15min 80ml (=priming volume of the dialyser, F6, Polysulphone, Fresenius)0.9%NS was flushed in the dialyser clamping the arterial line where as in CSIF 0.9%NS bottle is connected to the prepump arterial line and saline is infused through saline infusion pump @320ml/hr. The each dialysis session outcome were recorded and analysed. Potential clotting in the bubble trap was visually observed in each hour and graded on a 4 point scale. 1=normal, 2= fibrinous ring,3=clot formation and 4= coagulated system. In either group the total saline infusion volume added in the net UF goal. The dialyser was inspected visually at the end of each session 1= normal,2= a few blood stripes affecting less than 10% of the surface area,3= many blood stripes more than 10% of surface area, 4= coagulated dialyser. URR(as per KDOQI guideline) and kt/v(by diascan software of Gambro AK96 machine) was calculated in each session. Data were analysed with spss v23. Results Total 8 patients(5men 3 women) were included for the study. After exclusion total 54 session of dialysis were finally analysed. The incidence of the of blood clot in the whole dialysis system leading to stopping of dialysis was 3 in ISF and 1 in CSIF (p=0.001).The multiple linear regression analysis with repeated measurememt for the time and UF rate adjusted clot incidence of different grade in bubble trap was significantly low in the CSIF group than the ISF group.(p=0.0001). When adjusted for total body water,net UF,PreHD Urea, blood flow the difference in URR and Kt/v both the group was not significantly different (p=0.8). Among the two group the operational comfort for nurses were significantly better(p=0.3) in the CSIF group than the ISF group. Conclusion While considering heparine free dialysis Continuous saline infusion @320ml/hr is easy less labourintensive method than intermittent saline flush technique with significantly less clotting incidence and without any adverse effect on the dialyser clearance.

Repositioning a peripherally inserted central catheter (PICC) using a high-flow flush technique (HFFT) in an adult patient with non-Hodgkin’s lymphoma

Repositioning a peripherally inserted central catheter (PICC) using a high-flow flush technique (HFFT) in an adult patient with non-Hodgkin’s lymphoma

Effect of a saline flush technique for head and neck imaging in dual-energy CT: improvement of image quality and perivenous artefact reduction using virtual monochromatic imaging

To evaluate the effect of the saline flush (SF) technique on the depiction of lesions and the reduction of perivenous artefacts in the head and neck region using dual-energy computed tomography (CT) with virtual monochromatic imaging (VMI). Fifty patients with head and neck cancer were divided into two groups: group A, without a SF and group B, with a 30-ml SF. All images were acquired using fast kilovolt-switching CT (Revolution HD, GE Healthcare, Milwaukee, WI, USA). Contrast-to-noise ratios (CNRs) of the lesions were calculated at VMI energy levels ranging from 40 to 80 keV. Subjective analysis of overall image quality, delineation of lesions, and perivenous artefacts was conducted by two reviewers at both VMI energy level 40 keV and the optimal energy level (which showed optimal CNR by objective analysis). Optimal energy level was 63 keV for group A and 61 keV for group B. At VMI energy levels ranging from 40 to 80 keV, the CNR was higher for group B. The highest subjective overall image quality was shown for group B at the optimal energy level (subjective image quality mean value, 3.40). Subjective delineation of lesions was comparable. The perivenous artefact score was significantly higher for group B (2.44 versus 2.74 [p<0.05] at 40 keV, 3.20 versus 3.46 [p<0.05] at the optimal energy level). The SF technique results in an improvement of lesion CNR and a reduction of perivenous artefacts in VMI using duel-energy CT, especially at 40 keV.

Comparison of the Effects of Five Semen Extenders on the Quality of Frozen-Thawed Equine Epididymal Sperm

Cryopreservation of epididymal sperm allows the saving of genetic material in case of unexpected death or emergency castration. The aim of the present study was the comparison of five different combinations of extenders commercially available for equine frozen semen processing for cryopreservation of epididymal sperm. Epididymal sperm were harvested from gonads of 10 healthy stallions after routine castration by retrograde flush technique. Then, samples were split and diluted with (1) INRA96 + INRA Freeze, (2) BotuSemen + BotuCRIO, (3) EquiPlus + Gent Freeze, (4) EquiPlus + EquiPlus Freeze, and (5) Gent + Gent Freeze. Extenders 1 and 2 showed higher values for total and progressive motility after thawing compared with extender 4 (P < .05). Extender 3 was in between 1 and 2 (P > .05), and extender 5 resulted in the lowest values (P < .05). The subpopulation of viable frozen-thawed sperm with high mitochondrial membrane potential and low intracellular calcium content was higher using extender 1 compared with extenders 3, 4, and 5 (P < .05) and higher in extender 2 compared with extenders 4 and 5 immediately after thawing (P < .05). After 1 hour of incubation, this subpopulation yielded the highest values in extender 2 (P < .05). Immediately after thawing, extender 1 yielded higher values for percentage of DFI and mean DFI than extenders 3, 4, and 5 (P < .05). Following 1 hour of incubation after thawing, sperm processed with extender 1 resulted in the highest values for percentage of DFI and mean DFI (P < .05). Using extender 2, mean DFI values were lower than those in extender 1 and higher than the extenders 3, 4, and 5 (P < .05). The study revealed that according to the examined sperm quality parameters, freezing extenders (extender 1, extender 2) using low concentrations of glycerol either combined with or without methylformamide were beneficial for cryopreservation of stallion epididymal sperm. For processing of stallion epididymal sperm, an extender containing milk proteins (extenders 1–4) for initial dilution after sperm harvesting is preferable to an extender including egg yolk (extender 5).

Role of semiquantitative roll over technique and flush technique in diagnosing central line associated bloodstream infection (CLABSI) and central line related local infections (CRLI) in MICU patients: A prospective study

Abstract Introduction: Diagnosing Central line associated bloodstream infection (CLABSI) and Central line Related local infections (CRLI) involves doing central line tip culture. The routine method which is followed in every laboratory is the semiquantitative roll plate method. However, the use of a quantitative flush method will add a further advantage, as it may detect endoluminal microorganisms more easily which helps in diagnosing blood stream infections due to central line. Materials and Methods: A prospective study was carried out in MICU of tertiary care hospital. Semiquantitative roll over technique and quantitative flush technique was followed to process central line catheter in patients suspected of CRLI and CLABSI. Results: Of 210 samples processed from patients forty seven patients (47) were diagnosed with CRLI and seven (7) with CLABSI. Semiquantitative technique had superiority in diagnosing local infections whereas flush technique had superiority in diagnosing blood stream infections. Conclusion: Both Semiquantitative and flush techniques are recommended for processing central line catheters for diagnosing CRLI and CLABSI. Early CLABSI can be missed sometimes in samples from ICU patients who have associated comorbid conditions. Thus those laboratories where only semiquantitative roll over technique is followed, quantitative flush technique is recommended which aids in diagnosing CLABSI which can be missed by roll over technique. Keywords: Central line associated bloodstream infections (CLABSI), Central line related local infections (CRLI), Intensive care unit (ICU), Semiquantitative roll over, Quantitative flush technique. Introduction Central line catheter associated bloodstream infection (CLABSI) remains one of the leading causes of nosocomial acquired bacteremia in ICUs leading to increased mortality, whereas Central line related local infections (CRLI) leads to increased morbidity and hospital stay in turn increasing cos

Flush technique to minimize adverse reactions from syringe lubricant (silicone oil)

Flush technique to minimize adverse reactions from syringe lubricant (silicone oil)

Use of Bedside Ultrasonography and Saline Flush Technique for Evaluation of Central Venous Catheter Placement in Children.

Our study investigated the reliability of appearance of rapid atrial swirl flow (RASF) by ultrasonography (US) in the right atrium (RA), which occurred as a result of rapid isotonic saline infusion (RISI) into the central venous catheter (CVC), in predicting catheter tip position. This prospective observational study included 95 CVC procedures performed on 77 pediatric patients (41 boys and 36 girls) with a median age of 0.6 (0.29-1.53) years. Seventy-three (76.84%) catheter tips were found to be correctly placed, and 22 (23.15%) catheter tips were misplaced. While ultrasonographic examination revealed RASF in the RA after 93 catheterization procedures, it was not observed after two catheterization procedures. One of these two catheters was an arterial catheter, and the other was a catheter that was directed toward the subclavian vein after curling around itself. There was no significant difference between the groups with incorrect and correct positioned catheter tip in terms of the appearance of RASF by US after RISI. There was no significant difference between the groups with upward (n = 8) and downward (n = 86) positioned catheter tip in terms of the time until the first appearance of RASF after RISI and the phase of RASF (P > 0.05). There was a significant difference between these two groups in terms of the disappearance time of RASF in the RA (P < 0.001). The mean disappearance time of RASF was 3 (2-3) s for downward positioned catheters and 5 (4-7) s for upward positioned catheters, respectively. When the cut-off for the disappearance time of RASF was set to 3 s, US had a sensitivity of 85.71% and a specificity of 77.91% for detecting upward positioned catheters. In conclusion, the appearance of RASF in the RA in a short time by US is not a reliable finding for correct positioning of the CVC tip in the pediatric patient group. The fact that the disappearance time of RASF in the RA is longer than 3 s indicates upward positioned CVCs. These catheters must never be used without radiological confirmation. In CVCs in which the disappearance time of RASF in the RA is shorter than 3 s, we think that the catheter can be used until radiological confirmation in emergency cases. According to the available literature, our study is the first study in children. There is a need for new studies on this subject.

Follicle Deviation in Miniature Mares

Endometritis constitutes a major problem in the management of broodmares; hence, diagnostic tests with a high sensitivity and specificity are highly appreciated. The aim of this study was to compare the results from endometrial, cytologic, and bacteriologic examinations obtained by a newly developed, double-guarded, flushing technique versus standard diagnostic tests, the double-guarded swab and biopsy. The described double-guarded flush technique requires the use of a disposable uterine flushing tube, a sanitary sleeve, a sterile steel speculum, and a 250 mL fluid bag. Endometrial biopsies, swabs, and low-volume lavage samples were obtained from 34 research mares at six different time points in four estrous cycles and were evaluated cytologically and bacteriologically. Endometrial biopsies from the first cycle (n = 34) were examined for the presence of polymorphonuclear neutrophils (PMNs) in the stratum compactum and stratum spongiosum and used as a gold standard for calculation of diagnostic sensitivity and specificity. In all samples, Escherichia coli was most frequently isolated (lavage, 30%; swab, 21%; and biopsy, 12%) followed by β-hemolytic streptococci (lavage, 11%; swab, 8%; and biopsy, 7%). Positive cytology was less likely to occur when E coli was isolated from the diagnostic tests compared with the growth of β-hemolytic streptococci. Isolation of pathogens from uterine samples was highly associated with the presence of PMNs in the stratum compactum and straum spongiosum on histology. Using the presence of PMNs in the tissue specimens as the gold standard for diagnosing endometritis, the sensitivity of low-volume lavage culture was 0.75 and the specificity was 0.72. In conclusion, the double-guarded, low-volume, lavage technique was a rapid and accurate method for diagnosing mares with endometritis, and the risk of false-positive samples is considered to be minimal compared with other flushing techniques described.

Progesterone and 5α-dihydroprogesterone (DHP) in Cyclic Mares, and in Ovariectomized Mares and Geldings After Progesterone Administration

Endometritis constitutes a major problem in the management of broodmares; hence, diagnostic tests with a high sensitivity and specificity are highly appreciated. The aim of this study was to compare the results from endometrial, cytologic, and bacteriologic examinations obtained by a newly developed, double-guarded, flushing technique versus standard diagnostic tests, the double-guarded swab and biopsy. The described double-guarded flush technique requires the use of a disposable uterine flushing tube, a sanitary sleeve, a sterile steel speculum, and a 250 mL fluid bag. Endometrial biopsies, swabs, and low-volume lavage samples were obtained from 34 research mares at six different time points in four estrous cycles and were evaluated cytologically and bacteriologically. Endometrial biopsies from the first cycle (n = 34) were examined for the presence of polymorphonuclear neutrophils (PMNs) in the stratum compactum and stratum spongiosum and used as a gold standard for calculation of diagnostic sensitivity and specificity. In all samples, Escherichia coli was most frequently isolated (lavage, 30%; swab, 21%; and biopsy, 12%) followed by β-hemolytic streptococci (lavage, 11%; swab, 8%; and biopsy, 7%). Positive cytology was less likely to occur when E coli was isolated from the diagnostic tests compared with the growth of β-hemolytic streptococci. Isolation of pathogens from uterine samples was highly associated with the presence of PMNs in the stratum compactum and straum spongiosum on histology. Using the presence of PMNs in the tissue specimens as the gold standard for diagnosing endometritis, the sensitivity of low-volume lavage culture was 0.75 and the specificity was 0.72. In conclusion, the double-guarded, low-volume, lavage technique was a rapid and accurate method for diagnosing mares with endometritis, and the risk of false-positive samples is considered to be minimal compared with other flushing techniques described.