Intravenous Fluid Bags Research Articles

Use of a two-bag fluid administration protocol in the treatment of paediatric diabetic ketoacidosis: A retrospective review

ABSTRACT Objectives The ‘two-bag method’ for the treatment of diabetic ketoacidosis (DKA) uses two intravenous fluid bags, only one of which contains 10% dextrose. The bags are run concurrently with rates adjusted according to a rate change table to allow the relative amount of dextrose administered to be adjusted over time, without the need for bag replacements. The Children’s Hospital at London Health Sciences Centre (CHLHSC) two-bag protocol is a simplified version of that used by other centres. The objective of this study was to ensure implementation of the CHLHSC two-bag protocol continues to provide safe and effective treatment of paediatric DKA and decreases resource utilization. Methods This retrospective chart review compared treatment pre- and post-protocol implementation. Results A total of 22 admissions were included. No significant differences in efficacy or safety outcomes were found between the protocol groups. There was no statistically significant difference between the two and one-bag protocols in time to normalization of serum bicarbonate (13.80 ± 7.68 versus 15.01 ± 7.53 h, P = 0.714), blood glucose correction (8.75 ± 4.86 versus 11.85 ± 4.92 h, P = 0.152), and critical care unit length of stay (24.26 ± 9.94 versus 32.30 ± 13.36, P = 0.399). The nursing staff appeared to appropriately implement the rate change table, but the chart documentation was poor. Conclusions The CHLHSC simplified two-bag protocol provides a safe and effective alternative to the one-bag protocol for DKA correction in paediatric patients and may also result in decreased resource utilization.

How much do we throw away in the intensive care unit? An observational point prevalence study of Australian and New Zealand ICUs

ObjectiveDuring the current COVID pandemic, waste generation has been more evident with increased use of single use masks, gowns and other personal protective equipment. We aimed to understand the scale of waste generation, recycling rates and participation in Australian and New Zealand (ANZ) ICUs. DesignThis is a prospective cross-sectional point prevalence study, as part of the 2021 ANZICS Point Prevalence Program. Specific questions related to waste and sustainability practices were asked at the site and patient level. Setting and participantsANZ adult ICUs and their patients on the day of the study. Main outcome measuresAmount of single use items disposed of per shift, as well as the engagement of the site with sustainability and recycling practices. ResultsIn total, 712 patients (median number of patients per ICU = 17, IQR 11–30) from 51 ICUs across ANZ were included in our study; 55% of hospitals had a sustainability officer, and recycling paper (86%) and plastics (65%) were frequent, but metal recycling was limited (27%). Per patient bed space per 12-h shift there was recycling of less than 40% paper, glass, intravenous fluid bags, medication cups and metal instruments. A median of 10 gowns (IQR 3–19.5), 10 syringes (4.5–18) and gloves 30 (18–49) were disposed of per bed space, per 12-h shift. These numbers increased significantly when comparing patients with and without infection control precautions in place. ConclusionsIn ANZ ICUs, we found utilisation of common ICU consumables to be high and associated with low recycling rates. Interventions to abate resource utilisation and augment recycling are required to improve environmental sustainability in intensive care units.

Intravenous Fluid Bag as a Substitute for Gel Standoff Pad in Musculoskeletal Point-of-care Ultrasound.

Point-of-care ultrasound (POCUS) is a tool undergoing expanding use in military medicine, including routine inpatient, outpatient, and operational environments. Specific musculoskeletal POCUS examinations require additional equipment in the form of a standoff assist device to maximize image acquisition. These devices may not be readily available to POCUS users in more austere or resource-constrained environments. We devised a study to determine if intravenous fluid bags of various volumes could be substituted for standard standoff devices in musculoskeletal POCUS. Sequential images of a soft tissue foreign body model, an interphalangeal joint, and a chest wall were taken using a gel standoff pad or water bath and compared to images acquired using three different sizes of intravenous fluid bags after removing excess air from the bags. Images were de-identified and scored for quality using a visual analog scale. We used a two-factor analysis of variance without replication to analyze the differences in image quality between standoff devices, with a P-value less than.05 considered statistically significant. We performed 13 POCUS studies and had a group of eight POCUS-trained physicians and physician assistants score these studies, resulting in 104 total quality scores. There was no significant difference in image quality between standoff devices for chest (P-value.280) and hand (P-value 0.947) images. We found a significant difference in image quality between standoff devices for the soft tissue foreign body model (P-value 0.039), favoring larger intravenous fluid bag standoff over standard devices. In the absence of a standard commercial gel standoff device or water bath, intravenous fluid bags of 50, 100, and 250 mL can facilitate quality image acquisition for musculoskeletal POCUS.

A simple improvised prehospital method to warm intravenous fluid.

Study ObjectiveUse of warmed intravenous fluid by emergency medical services (EMS) for prehospital injured patients is recommended to avoid iatrogenic hypothermia. We hypothesized that an improvised heating method would significantly increase the temperature of an intravenous fluid bag in a simulated prehospital environment.MethodsThe change from baseline in the temperature of a 1‐L intravenous fluid bag positioned above the vehicle windshield defroster vent was measured for 30 minutes using a thermocouple probe. Temperature changes were compared with a control fluid bag positioned on the vehicle console armrest. A total of 10 independent experiments were performed.ResultsThe defroster vent method increased intravenous fluid bag temperature from a mean starting temperature of 19.4°C (95% confidence interval [CI], 17.4°C–21.4°C) to a mean end temperature of 32.6°C (95% CI, 30.6°C–34.6°C) after 30 minutes. The temperature of a control intravenous fluid bag (mean starting temperature of 20.1°C; 95% CI, 19.0°C–21.2°C) exposed to a warmed (mean 33.2°C) passenger compartment changed little during the same time period (mean end temperature of 22.3°C; 95% CI, 19.4°C–25.2°C).ConclusionsConvective warming of an intravenous fluid bag using the dashboard defroster vent significantly raised the fluid temperature. Such a method should be readily available to EMS or first responders.

819-P: Comparison of Two Nurse-Driven Adult Diabetic Ketoacidosis (DKA) Treatment Protocols Using a Single Bag vs. Simultaneous Two-Bag Maintenance Intravenous Fluids

Objective: Evaluate safety and efficacy of a novel, simultaneous 2-bag (2B) maintenance intravenous fluid (IVF) DKA protocol compared with a conventional, single 1-bag (1B) protocol in adults. Methods: Retrospective, observational review of patients treated with a DKA protocol from March-June 2017 (1B group) and March-June 2019 (2B group). One bag (1B) protocol: individual infusion of 1B IVF of ½ NS, ½ NS + KCL, D5W, OR D5W + KCL. Two bag (2B) protocol: simultaneous IVF infusion of 2B of D10W + KCL AND ½ NS + KCL. Safety endpoints of hypoglycemia, hyperkalemia, hypokalemia as well as efficacy endpoints of DKA resolution, incidence of rebound hyperglycemia, and hospital length of stay (LOS) were evaluated. Results: A total of 605 patients were included (1B: n=204; 2B: n=401). Both groups had similar baseline characteristics except a higher baseline beta-hydroxybutyrate level in the 2B group than 1B (3.2 vs. 2.4; P=0.02) and differences in distribution of Body Mass Index (BMI) categories. Safety: Significantly fewer patients had hypoglycemia (BG <70 mg/dL) in the 2B group than 1B (15% vs. 22%, P=0.04), but severe hypoglycemia (BG < 40 mg/dL) was not different (0.5% vs. 1.5%, P=0.3). Incidence of hyperkalemia (K > 5.2 mEq/L) was significantly lower in the 2B group than 1B (10% vs. 21%, P<0.01), but hypokalemia (K < 3.3 mEq/L) was not different (21% vs. 24%, P=0.4). Efficacy: Median time to DKA resolution was similar between the 2B and 1B (15.0 vs. 15.6 hours, P=0.6). Rebound hyperglycemia (BG > 250 mg/dL) was less in 2B than 1B (29% vs. 44%, P<0.01). The 2B group had a trend of decreased LOS, but the difference was not statically significant (3.7 vs. 4.3 days, P=0.06). Conclusion: In adult patients with DKA, a 2-bag protocol performed better in hypoglycemia, hyperkalemia, and rebound hyperglycemia without changing time to DKA resolution or LOS. In addition, the 2-bag protocol offered simplicity by decreasing the number of IVF bag options for the nurse. Disclosure R. Halfon: Stock/Shareholder; Spouse/Partner; Pfizer Inc. D. Dreucean: None. M. Sirimaturos: None. A. R. Sadhu: None.

The Two-bag System for Intravenous Fluid Management of Children with Diabetic Ketoacidosis: Experience from a Community-Based Hospital.

Objectives: Intravenous fluid (IVF) administration using the two-bag system compared with the one-bag system in children with diabetic ketoacidosis (DKA) admitted between January 1, 2015 and December 31, 2016. Design: Retrospective cohort study. Setting: Community-based hospital. Results: A total of 109 patients were enrolled with a mean age of 13.24 years. The 2 groups had comparable demographics. Initial laboratory results were similar except for initial PH and Sodium. The two bag system had significantly less number of calls compared to one bag system (25.2 vs 5.2 P = .0001). One bag system had fewer hypoglycemia <60 mg/dl (4 vs 12 P = .049). No statistically significant observations noted in regards to glucose drop rate, number of intravenous fluid bags used, amount of fluid boluses given, hospital stay and Pediatric ICU stay. Conclusions: The two-bag system has less resource utilization and slower blood glucose drop rate, but higher hypoglycemic events

Novel implementation of IoT based non-invasive sensor system for real-time monitoring of intravenous fluid level for assistive e-healthcare

PurposeThe purpose of the study is to design and develop an pervasive and smart Internet of Things (IoT)-based sensor system to monitor he real-time intravenous (IV) fluid bag level.Design/methodology/approachThis paper investigates such issue and performs several experiments to develop a non-invasive, semi-automatic system to monitor IoT-based IV fluid level in real-time.FindingsThe outcome of this study is a prototype hardware that includes an ESP8266 based embedded Web server to disseminate the fluid exhaust status flag to its connected users. Nurses can get the prompt intimation about the status of IV fluid bag whether it is about to get empty.Research limitations/implicationsIoT is the backbone of the proposed system. Multi-master system need to be studied in future.Practical implicationsNon-invasive and real-time IoT-based novel technique is developed with power-efficient and cost-effective pervasive sensors.Social implicationsThis is applicable for pervasive and assistive e-health-care services by care givers and medical professionals.Originality/valueThe deployed system is controlled by ATtiny85 with help of LM35 temperature sensor. The results show a promising future of the proposed development in enhancing IoT-based smart health-care service in the coming days.

Evaluation of the Two-Bag System in Adult Diabetic Ketoacidosis Patients

Purpose: Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus (DM). This study was designed to assess if the two-bag (TB) system, which utilizes 2 intravenous (IV) fluid bags, one containing sodium chloride and the other containing sodium chloride and dextrose, is an effective and safe alternative to the traditional one-bag (OB) system in adults with DKA. Methods: A retrospective review was performed at an academic medical center. Adults with DKA were included if treated with the OB or TB system. The primary outcome was time to anion gap closure. Secondary outcomes included duration of insulin infusion, time to serum bicarbonate correction, number of continuous IV fluid orders, intensive care unit (ICU) and hospital length of stay (LOS), and rates of hypoglycemia and hypokalemia. Results: One hundred twenty-two patients were included. Sixty-eight were treated with the OB system and 54 with the TB system. There were no differences in time to anion gap closure, duration of insulin infusion, ICU LOS, or hospital LOS. Time to bicarbonate correction was shorter in the OB group (13.5 [IQR: 7-29] vs 25 [IQR: 11-50] hours; P = .03). There were no differences in rates of hypoglycemia or hypokalemia between groups. Conclusion: The TB system had similar efficacy and safety when compared to the OB system. Both approaches can be considered in adults with DKA.

Is reattaching an open intravenous fluid bag ever justified?

Is reattaching an open intravenous fluid bag ever justified?

Influence of hang time and location on bacterial contamination of intravenous bags in a veterinary emergency and critical care setting.

To assess the rate of bacterial contamination of fluid and ports in intravenous bags in a veterinary emergency room (ER) and intensive care unit (ICU). Experimental model. Ninety intravenous fluid bags of lactated balanced-electrolytes solution (1 L) hung in a university hospital. Bags were hung in 2 different locations in the ER (sink and bins) and one location in the ICU (sink) for 11 days. Bags were punctured 3 times daily with a sterile needle to simulate clinical use. Injection ports were swabbed and 50 mL of fluid were collected in duplicates on days 0, 2, 4, 7, and 10. Aerobic bacterial cultures were performed on the fluid and injection port. Contamination was defined as bacterial growth of a similar phenotype across 2 consecutive times. Increase in the fluid contamination rate from day 0 was tested using an exact binomial test. Port contamination rate between locations was tested using Fisher's exact test. Combined bacterial growth on injection ports reached a mean (95% confidence interval) of 8.1 (0.005-16.2) cfu/port on day 10. The combined port contamination was 3.3%, 11.1%, 17.8%, and 31.1% on days 0, 2, 4, and 7, respectively. Port contamination was similar between ER and ICU. However, port contamination was higher in the sink versus the bins area (38.3% vs 16.7%, P = 0.032). No fluid bag was contaminated at days 0 and 2. The contamination rate of fluid bag was 1.1% and 4.4% on days 4 and 7, respectively. All bags with contaminated fluid were in the ER (6.7%, 95% exact binomial confidence interval 1.9-16.2%). Injection port contamination reached 31.1% on day 7. Contamination was more likely when the bags were hung next to a sink. In our model of bag puncture, fluid contamination occurred between days 2 and 4.

How Long Is Too Long? The Prespiked Intravenous Debate.

As the number of operative cases increases, there is a greater emphasis on reducing inefficiency while maintaining patient safety. Recently, the issue of prespiking intravenous (IV) bags was raised. No study has assessed whether the risk of infection is related to the length of time a sterile (IV) fluid bag has been spiked. After completion of a pilot study revealed no microbial growth within 24 hours of an IV spike, a larger formal study was undertaken to determine whether there was an increased infection risk within 4 hours of spiking an intravenous fluid bag. Five IV administration sets were spiked and hung in busy perioperative areas once a week for a 5-week period. Five samples were drawn from each IV set. Approximately 10 mL was collected per sample. All samples were inoculated in 2 separate growth media. If any growth was noted, the sample was marked as positive. A total of 125 samples were collected over a period of 5 weeks, yielding 250 specimens. No samples were excluded from the study. No growth was identified in any of the specimens. The 95% confidence interval was estimated to be 0, 0.063. There was no bacterial growth in prespiked normal saline IV bags in a perioperative environment. Thus, prespiking of normal saline IV bags in advance should pose no risk of infection to a patient if prepared within 4 hours.

No bacterial growth found in spiked intravenous fluids over an 8-hour period.

Protocol changes prompted by the Joint Commission mandating intravenous (IV) fluid bags to be used within 1 hour of spiking because of possible bacterial contamination have sparked clinical and economic concerns. This study investigated the degree of bacterial growth in which samples were obtained from spiked IV fluid bags at the time of spiking and 1, 2, 4, and 8 hours after spiking. No bacterial growth occurred in any of the 80 bags of Lactated Ringer's (LR) IV solutions sampled. This study demonstrated that LR IV bags do not support any bacterial growth for up to 8 hours after spiking.

Efficiency of the Thermal Jacket on the delivered temperature of prewarmed crystalloid intravenous fluid.

Warming of intravenous fluids can decrease the incidence of hypothermia in surgical patients. A quasi-experimental research design was used to compare the delivered temperature of fluids using a conventional blood warmer and the Thermal Jacket, an insulation device designed for intravenous fluid bags. Fluids were divided into one control and three experimental groups. Fluids were initially either room temperature (22.05 +/- 0.45 degrees C) or prewarmed to 41.45 +/- 1.05 degrees C and infused using no temperature maintenance device, a Thermal Jacket, or a water bath blood warmer. Temperatures were recorded at 10-minute intervals at flow rates ranging from 100 to 1,000 mL/hr. Analysis of variance showed a highly significant difference between the delivered temperatures using the various temperature maintenance devices, as well as varying flow rates. The Thermal Jacket, used with prewarmed intravenous fluids, was as effective as the conventional method of delivering warmed fluids. Also, within the range of flow rates studied, faster flow rates tended to yield higher delivered temperatures.

In vitro quantitative determination of the concentration of the polymerization agent methyl 2-benzoylbenzoate in intravenous injection solution and the cytotoxic effects of the chemical on normal human peripheral blood mononuclear cells.

In previous studies, we detected the photoinitiators 1-hydroxycyclohexyl phenyl ketone (1-HCHPK) and 2-methyl-4'-(methylthio)-2-morpholinopropiophenone (MTMP) in an intravenous injection solution. Importantly, 1-HCHPK and MTMP have been demonstrated to be cytotoxic to normal human peripheral blood (PB) mononuclear cells (MNC). Cell death (apoptosis) pathways can be classified into two modes, caspase-dependent and -independent pathways. However, it is unclear whether methyl 2-benzoylbenzoate (MBB) induces the caspase-dependent and/or -independent pathway in normal human PBMNC. In the present in vitro study, we examined the levels of MBB in a solution from an intravenous fluid bag and the cytotoxicity of MBB towards normal human PBMNC via the caspase-8-, caspase-9-, or apoptosis-inducing factor (AIF)-mediated apoptosis pathways. We found that extracts from the injection solution had been contaminated with approximately 80μM of the photoinitiator MBB. In addition, MBB induced apoptosis in the high concentration range in normal human PBMNC in vitro. Moreover, we found that MBB-induced apoptosis occurs via the caspase-9 pathway, but not the AIF pathway. In conclusion, we suggest that MBB has cytotoxic effects on normal human PBMNC in vitro, which are mediated via the caspase-dependent pathway.

Are cast application and maintenance of complications a lost art? Commentary on an article by Christian J. Zaino, MD, et al.: "The effectiveness of bivalving, cast spreading, and webril cutting to reduce cast pressure in a fiberglass short arm cast".

Commentary Nonoperative treatment of fractures with a cast is an art form that is transferred to each generation of orthopaedic surgeons and, now, advanced practice professionals (physician assistants, nurse practitioners, cast technicians, and medical assistants). With newer and advanced methods and emphasis on surgical intervention, this art form is being taught less frequently and with less emphasis or, sometimes, not at all. Furthermore, many emergency departments have nonorthopaedic professionals perform the initial attempt at closed reduction of fractures before sending the patient home or scheduling the patient for surgery. In addition, the traditional and moldable plaster of Paris has been replaced with the inextensible fiberglass cast material. Fiberglass casting is more durable and less prone to pressure sites with application and comes in patient-friendly assorted colors. With potentially higher numbers of patients selecting nonoperative treatment of fractures to avoid higher out-of-pocket expenses, a perfect storm of inadequately trained musculoskeletal medical professionals who have less experience with nonoperative fracture treatment may be upon us. Therefore, appropriate cast application and the treatment of ensuing problems of edema, pain, and increasing compartmental pressure are paramount1. The excellent article “The Effectiveness of Bivalving, Cast Spreading, and Webril Cutting to Reduce Cast Pressure in a Fiberglass Short Arm Cast” is one that all medical providers taking call, providing emergency services, or applying casts should read. Ninety wrists (forty-five subjects with bilateral involvement) were randomized to a cast-cutting method group for a fiberglass short arm cast. With an intravenous fluid bag under the cast simulating high-risk injury or patient factors such as swelling, infused air increased skin surface pressures to 11.4 mm Hg at 10 mL and 92.5 mm Hg at 50 mL. Therefore, small changes in post-injury and fracture reduction edema or swelling can affect cast pressure and can potentially create irreversible changes. The triple-cut method (92 mm Hg or 99.9%), the double-cut method (79 mm Hg or 85%), or the single-cut method (65.5 mm Hg or 71%) of cast cutting decreased skin surface pressures. Therefore, in high-risk patients, a short arm cast should potentially be triple-cut to decrease potentially untoward effects of swelling. Unexpectedly, Ace (elastic) bandage application increased skin surface pressure for each cast-cutting method, with the greatest effect noted with the triple-cut and double-cut settings. Women had significantly higher skin surface pressure than men. This could arise from differences in forearm size, muscularity, and obesity. A small but important weakness of this article is the lack of evaluation of casting in the differentiated groups of normal, obese, or muscular individuals. No control for body mass index, muscularity, age (with regard to less muscle with older age), or forearm size was performed. Obesity is a relative contraindication for fracture reduction maintenance in a cast2. In addition, another weakness of this study is that a single experienced individual applied and cut the casts. The ability to apply a cast without overcompression, wrinkles, or pressure areas is a learned skill3-5. Furthermore, no mention of arm position during cast application, cutting, Ace application, and pressure measuring was noted. Limb position can affect both the inflow (elevation) and outflow (dependency) of blood; therefore, the position of the limb can affect the compartmental pressures and theoretically the cast tightness6. In conclusion, this article reinforces the important and learned skills of cast management that can potentially affect patient and injury outcome. Skin surface pressures and compartmental pressures are fluid and change on the basis of swelling, limb position, and cast tightness. Triple-cut casts result in the biggest change in skin surface pressure but are affected most adversely by Ace application. If the casts are too tight, irreversible soft-tissue changes can occur. If the casts are too loose, the fracture reduction can displace, leading to suboptimal outcome or the need for surgical intervention. Cast management should be taught, evaluated, and maintained as much as surgical skills.

The effectiveness of bivalving, cast spreading, and webril cutting to reduce cast pressure in a fiberglass short arm cast.

A fiberglass short arm cast can be used to treat a distal radial fracture, but posttraumatic edema may lead to excessive cast tightness and resultant soft-tissue injury. We sought to quantify a simulated edema-induced pressure within a fiberglass short arm cast and to determine the effectiveness of different cast-cutting methods for pressure reduction. We hypothesized that cast cutting could eliminate all clinically relevant pressure and Ace wrap would insignificantly increase pressure. Skin surface pressure under fiberglass short arm casts was measured on ninety wrists from forty-five volunteers randomly assigned to one cast-cutting method: single-cut (cast bivalve and Ace wrap), double-cut (cast bivalve, spread, and Ace wrap), or triple-cut (cast bivalve, spread, Webril cut, and Ace wrap). Each wrist was immobilized in a cast in the neutral position with one roll of 2-inch (5.1-cm) cotton Webril and one roll of 2-inch (5.1-cm) fiberglass. Each fiberglass short arm cast contained an empty intravenous fluid bag in which we infused air. This simulated edema, which generated a skin surface pressure, which was measured by a pressure transducer. Each cast-cutting method significantly reduced (p < 0.0001) the skin surface pressure from the average maximum of 92.5 mm Hg in a non-fracture setting. Prior to Ace wrapping, there was a reduction in skin surface pressure of 70.8% for the single-cut method, 85.1% for the double-cut method, and 99.9% for the triple-cut method. Ace wrap significantly increased skin surface pressure (p < 0.0001), lessening the effectiveness of cast cutting. There was an overall reduction in skin surface pressure of 55.9% for the single-cut method, 64.3% for the double-cut method, and 77.2% for the triple-cut method. Throughout our study, women had significantly higher skin surface pressure than men (p < 0.0001); the average maximum was 104.4 mm Hg for women and 81.1 mm Hg for men. The single-cut method provides the greatest pressure reduction, but only the triple-cut method eliminated all relevant skin surface pressure. Ace wrapping a cut cast noticeably increased skin surface pressure. In volunteers without a fracture, only the triple-cut method is effective enough to eliminate clinically relevant skin surface pressure. Ace wrap should be applied with caution after the cast is cut. The specific effect on pressure reduction in a patient who requires some soft-tissue pressure to maintain fracture reduction was not studied.

NOVEL BIOACTIVE AND BIODEGRADABLE MATERIALS FOR MEDICAL APPLICATIONS

Poly(vinyl chloride) (PVC) is the most widely used material for the production of medical devices such as intravenous fluid bags and tubing, enteral feeding, dialysis equipment and catheters. Despite of their numerous advantages, the plastic medical devices are non biodegradable and prone to microbial colonization causing biofilm associated infections which are difficult to treat and tend to chronicisation. A possible solution to surpass these limitations could be the fabrication of new biodegradable polymeric materials with optimized biocompatibility and antimicrobial properties. In this regard, biodegradable polymeric materials, such as poly(e-caprolactone) (PCL), poly(DL-lactic acid) (PLA) etc. have been considered the most desirable solution from the environment management point of view. In this paper, Alg(1%)Zn, Alg(2%)Zn, Alg(3%)Zn compounds were obtained from sodium alginate (AlgNa) crosslinked with ZnCl2. Antimicrobial activity of the AlgZn compounds was assessed by the microdilutions and the diffusion methods, towards Gram-positive and Gram-negative bacterial strains (reference and clinical isolates). The Alg(3%)Zn compound was selected as antimicrobial agent to obtain the biocomposites encoded: PLA/PCL/AlgZn0.1 and PLA/PCL/AlgZn0.3. The PLA/PCL sample was used as control. Antibiofilm activity against Staphylococcus xylosus, cytotoxic effect on mammalian cells and thermal analysis by DSC were investigated for the obtained biocomposites. The obtained results show that the addition of the Alg(3%)Zn compound in the biocomposites decreased the glass transition temperature as well as the degree of crystallinity both of the PCL and PLA components in samples. Although the results suggest that the biocomposites containing Alg(3%)Zn did not inhibit the staphylococcal colonization and mature biofilm formation, the high degree of biocompatibility of blends leads to conclusion that these materials could be used for the development of novel bioactive and biodegradable polymeric materials with medical applications.

My experience as an Ebola patient.

I was one of the doctors in the medical team that treated the Liberian index case of Ebola virus disease (EVD) after he flew to Lagos from Liberia on the 20th of July 2014. I am not exactly sure when I came into contact with the virus. It may have been on the night (before we ever suspected Ebola) when I touched his intravenous fluid bag with my bare right hand and probably touched my eyes, mouth, or nose before I washed my hand. I worked at a private medical center, which is one of the best in Lagos. As soon as we began to suspect that the patient had EVD, we immediately notified the relevant Nigerian authorities.

A prospective evaluation of the contribution of ambient temperatures and transport times on infrared thermometry readings of intravenous fluids utilized in EMS patients.

BackgroundDuring cold weather months in much of the country, the temperatures in which prehospital care is delivered creates the potential for inadvertently cool intravenous fluids to be administered to patients during their transport and care by emergency medical services (EMS). There is some potential for patient harm from unintentional infusion of cool intravenous fluids. Prehospital providers in these cold weather environments are likely using fluids that are well below room temperature when prehospital intravenous fluid (IVF) warming techniques are not being employed. It was hypothesized that cold ambient temperatures during winter months in the study location would lead to the inadvertent infusion of cold intravenous fluids during prehospital patient care.MethodsTrained student research assistants obtained three sequential temperature measurements using an infrared thermometer in a convenience sample of intravenous fluid bags connected to patients arriving via EMS during two consecutive winter seasons (2011 to 2013) at our receiving hospital in Syracuse, New York. Intravenous fluids contained in anything other than a standard polyvinyl chloride bag were not measured and were not included in the study. Outdoor temperature was collected by referencing National Weather Service online data at the time of arrival. Official transport times from the scene to the emergency department (ED) and other demographic data was collected from the EMS provider or their patient care record at the time of EMS interaction.ResultsTwenty-three intravenous fluid bag temperatures were collected and analyzed. Outdoor temperature was significantly related to the temperature of the intravenous fluid being administered, b = 0.69, t(21) = 4.3, p < 0.001. Transport time did not predict the measured intravenous fluid temperatures, b = 0.12, t(20) = 0.55, p < 0.6.ConclusionsUse of unwarmed intravenous fluid in the prehospital environment during times of cold ambient temperatures can lead to the infusion of cool intravenous fluid and may result in harm to patients. Short transport times do not limit this risk. Emergency departments should not rely on EMS agencies’ use of intravenous fluid warming techniques and should consider replacing EMS intravenous fluids upon ED arrival to ensure patient safety.

Effective use of the Bakri postpartum balloon for posthysterectomy pelvic floor hemorrhage

After hysterectomy, massive pelvic floor hemorrhage sometimes occurs, especially in those who underwent complicated procedures. Conventional methods frequently fail to control this type of life-threatening bleeding. This report demonstrates the successful application of the large-volume Bakri balloon as a pelvic pressure pack for the control of intractable pelvic floor hemorrhage after hysterectomy in 3 consecutive cases. The Bakri balloon was introduced through the laparotomy incision and was passed inflation port first through a small posterior culdotomy to the vagina. The shaft of the balloon then was pulled through the vaginal canal. When proper tamponade position was achieved, the balloon was inflated gradually with sterile normal saline solution up to the minimal volume that effectively compressed against the pelvic floor and successfully controlled the hemorrhage. Continuous traction was used by the connection of the balloon shaft to a1-L intravenous fluid bag that was hanging from the end of the bed. In all cases, the bleeding was controlled promptly when the balloons were filled up to 400-550 mL. The balloons were removed at bedside 24-30 hours after the operation. On follow-up examination, all patients recovered well without complication. From the author's experience, pelvic pressure packing with the Bakri balloon can be an immediate lifesaver. It is safe and readily applicable and provides a period of temporary hemostasis during which time volume replacement and coagulation defect correction can be obtained. The balloon pack can be removed vaginally without the need for reexploration. It is easy and fast to assemble, apply, and remove. In addition, the size of the balloon pack is adjustable easily to match the size of hemorrhagic areas by merely inflating or deflating the balloon. Furthermore, it is convenient to monitor continuing intraabdominal blood loss through the balloon's drainage port without the need for an additional drain. Further exploration on its use would be worthwhile.