Intravenous Tubing Research Articles

Central lines, aseptic batching services, and infection rates: A pharmacy-led initiative of intravenous tube priming within a NICU.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Central line-associated bloodstream infections (CLABSIs) are hospital-acquired, serious complications that greatly affect many vulnerable neonates throughout their hospital stay. This article describes the implementation of a unique practice in which pharmacy primes continuous infusions through medication tubing for neonatal central lines in a cleanroom at Children's Hospital Colorado - Colorado Springs (CHCO-CSH). This institution is a freestanding children's hospital with a level III neonatal intensive care unit (NICU) that opened in April 2019. Since then, the pharmacy department has been priming central line tubing for continuous infusions for all patients in the NICU. Neonates are at increased risk for developing CLABSIs due to their immature immune systems and frequent need for central line placement. With that in mind, the pharmacy department decided to focus efforts on this population. Pharmacists and pharmacy technicians received training on how to properly prime tubing, document when a patient received a new central line, document if a central line was removed, and record when new tubing was due based on a department policy. This novel, pharmacy-led priming procedure resulted in a low CLABSI incidence, offering a promising strategy to reduce CLABSIs in a NICU.

The Environmental Impact of Gastrointestinal Procedures: A Prospective Study of Waste Generation, Energy Consumption, and Auditing in an Endoscopy Unit

Gastrointestinal (GI) endoscopy procedures are critical for screening, diagnosis, and treatment of a variety of GI disorders. However, like the procedures in other medical disciplines, they are a source of environmental waste generation and energy consumption. We prospectively collected data on total waste generation, energy consumption, and the role of intraprocedural inventory audit of a single tertiary care academic endoscopy unit over a 2-month period (May-June 2022). Detailed data on items used were collected, including procedure type (esophagogastroduodenoscopy or colonoscopy), accessories, intravenous tubing, biopsy jars, linen, and personal protective equipment use. Data on endoscope reprocessing-related waste generation and energy use in the endoscopy unit (equipment, lights, and computers) were also collected. We used an endoscopy staff-guided auditing and review of the items used during procedures to determine potentially recyclable items going to landfill waste. The waste generated was stratified into biohazardous, nonbiohazardous, or potentially recyclable items. A total of 450 consecutive procedures were analyzed for total waste management (generation and reprocessing) and energy consumption. The total waste generated during the study period was 1398.6 kg (61.6% directly going to landfill, 33.3% biohazard waste, and 5.1% sharps), averaging 3.03 kg/procedure. The average waste directly going to landfill was 219 kg per 100 procedures. The estimated total annual waste generation approximated the size of 2 football fields (1-foot-high layered waste). Endoscope reprocessing generated 194 gallons of liquid waste per day, averaging 13.85 gallons per procedure. Total energy consumption in the endoscopy unit was 277.1 kW·h energy per day; for every 100 procedures, amounting to 1200 miles of distance traveled by an average fuel efficiency car. The estimated carbon footprint for every 100 GI procedures was 1501 kg carbon dioxide (CO2) equivalent (= 1680 lbs of coal burned), which would require 1.8 acres of forests to sequester. The recyclable waste audit and review demonstrated that 20% of total waste consisted of potentially recyclable items (8.6 kg/d) that could be avoided by appropriate waste segregation of these items. On average, every 100 GI endoscopy procedures (esophagogastroduodenoscopy/colonoscopy) are associated with 303 kg of solid waste and 1385 gallons of liquid waste generation, and 1980 kW·h energy consumption. Potentially recyclable materials account for 20% of the total waste. These data could serve as an actionable model for health systems to reduce total waste generation and decrease landfill waste and water waste toward environmentally sustainable endoscopy units.

Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units

The establishment of an epidemiological overview provides valuable insights needed for the (future) dissemination of infection-prevention initiatives. To describe the nationwide epidemiology of central-line-associated bloodstream infections (CLABSI) among Dutch Neonatal Intensive Care Units (NICUs). Data from 2935 neonates born at <32 weeks' gestation and/or with a birth weight <1500g admitted to all nine Dutch NICUs over a two-year surveillance period (2019-2020) were analysed. Variations in baseline characteristics, CLABSI incidence per 1000 central-line days, pathogen distribution and CLABSI care bundles were evaluated. Multi-variable logistic mixed-modelling was used to identify significant predictors for CLABSI. A total of 1699 (58%) neonates received a central line, in which 160 CLABSI episodes were recorded. Coagulase-negative staphylococci were the most common infecting organisms of all CLABSI episodes (N=100, 63%). An almost six-fold difference in the CLABSI incidence between participating units was found (2.91-16.14 per 1000 line-days). Logistic mixed-modelling revealed longer central line dwell-time (adjusted odds ratio (aOR):1.08, P<0.001), umbilical lines (aOR:1.85, P=0.03) and single rooms (aOR:3.63, P=0.02) to be significant predictors of CLABSI. Variations in bundle elements included intravenous tubing care and antibiotic prophylaxis. CLABSI remains a common problem in preterm infants in The Netherlands, with substantial variation in incidence between centres. Being the largest collection of data on the burden of neonatal CLABSI in The Netherlands, this epidemiological overview provides a solid foundation for the development of a collaborative platform for continuous surveillance, ideally leading to refinement of national evidence-based guidelines. Future efforts should focus on ensuring availability and extraction of routine patient data in aggregated formats.

A Clinical Data Warehouse Analysis of Risk Factors for Inpatient Falls in a Tertiary Hospital: A Case-Control Study.

The aims of the study are to identify fall risk factors and to establish automatic risk assessments based on clinical data from electronic medical records of hospitalized patients. In this retrospective case-control study, we reviewed the electronic medical records of 1454 patients (292 and 1162 patients in the fall and nonfall groups, respectively) who were hospitalized at a 1800-bed tertiary hospital in South Korea between January 1, 2017, and December 31, 2017. Patients' age, sex, and clinical department were matched, and all laboratory reports, clinical flow sheets, and nursing initial assessment records of case from the Clinical Data Warehouse system were analyzed. The collated patient records data were analyzed using SAS (version 9.4) and logistic regression. Overall, 65 risk factors, including low body mass index, low blood pressure, low albumin levels, high fasting blood sugar level, low red blood cell counts, and high potassium levels, that significantly increased the incidence of falls were identified. Falls were also associated with 21 items from the clinical flow sheet and nursing initial assessment, including frequent bowel movements, 24-hour urine tests, imaging tests, biopsy, pain, intravenous tubes, unclear consciousness, and taking medication. Fall risk factors identified via the Clinical Data Warehouse can be used to build an automated detection system to detect fall risk in electronic medical records, enabling nurses to assess the fall risk in addition to using the fall scale.

An Experimental Model Exhibiting Anterograde and Retrograde Vascular Occlusion of Facial Fillers to Avoid Vision Loss.

Facial filler injection techniques that help decrease the risk of vascular occlusion are an important growing area of study. This study demonstrates a model of injecting fillers into a simulated bifurcated arterial system, using different sized needle gauges at a constant injection pressure. Three facial fillers were injected into a bifurcated intravenous tubing with continuous irrigation at a constant pressure to simulate a vascular system. Videography was used to observe for retrograde flow through the simulated supratrochlear artery to the bifurcation point, where the filler was redirected by anterograde flow into the branch representing the ophthalmic artery. Filler injection with retrograde flow to the bifurcation occurred with all the 27G needle trials. In comparison, the 30G needle trials were only able to reach the bifurcation point in three of the nine trials. The average time to the bifurcation point with subsequent ophthalmic artery anterograde flow with the 27G and 30G needles were 8.44 (95% confidence interval ±2.06) and 33.33 (95% confidence interval ±16.56) seconds, respectively. Larger 27G needles consistently reached retrograde flow and the bifurcation point faster than 30G needles. This study suggests thinner needles may be less likely to cause retrograde occlusion.

Device profile of the Orchid safety release valve for the prevention of accidental catheter dislodgement

ABSTRACT Introduction More than 4 out of 5 patients in acute care require intravenous catheters. Complications of catheter dislodgement and failure are commonly reported at rates of 15–69% causing interrupted treatment and greater resource consumption when catheter replacement is required. Areas covered This manuscript outlines unmet needs in the prevention of catheter dislodgement and how a novel safety release device (Orchid SRV™, Linear Health Sciences) might address these gaps based on available evidence. Expert opinion Healthcare initiatives focus on reducing complications and associated costs with the delivery of intravenous treatments. Tension-activated safety release valve devices, attached to intravenous tubing, are a new feature that adds a level of safety to intravenous catheters to reduce mechanical catheter dislodgement when a pull force of greater than 3 pounds is applied. Incorporating a tension-activated accessory into and between existing intravenous tubing and the catheter and extension set protects the catheter from dislodgement. Flow continues until excessive pull force separates and closes the flow pathway in both directions, while the SRV provides a quick replacement to reestablish flow. The safety release valve is used to prevent accidental catheter dislodgement, limit tubing contamination, and avoid more serious complications while maintaining a functional catheter.

Construction of Soft Prep Cadaver Pericardiocentesis Training Model and Implementation Among Emergency Medicine Residents.

This procedure training model is designed for all levels of emergency medicine residents. Pericardiocentesis is a relatively uncommon but potentially life-saving procedure within the scope of Emergency Medicine practice. As such, the Accreditation Council for Graduate Medical Education (ACGME) designates its competency as a requirement within emergency medicine residency programs. Because of its relative rarity, simulation-based training is often utilized to fill the gaps in clinical experience during emergency medicine residency training. There have been several models of pericardiocentesis training, including gel-based models that can be purchased or constructed,1-3 non-gel models,4 and cadaveric models.5 In this paper, we describe the fabrication of a high-fidelity cadaveric model and report emergency medicine resident experience with this model. Training programs can use this model to increase trainee competence and confidence with this high-acuity, low-frequency procedure. By the end of this session, residents will gain increased procedural competence and confidence with pericardiocentesis. Residents will be able to identify necessary supplies for the procedure, identify relevant surface anatomy and ultrasound views, and successfully aspirate fluid from model effusion. We created a pericardial effusion in a soft prep cadaver by placing a catheter into the pericardial sac and then infusing normal saline via intravenous fluid tubing. Learners were then able to practice aspiration of pericardial fluid via landmark and ultrasound-guided approaches under observation by facilitators able to offer real-time feedback. Learners were asked to complete a survey assessing pre-intervention and post-intervention subjective confidence in their ability to perform pericardiocentesis and were asked for qualitative feedback on the experience of using the training model. All residents were able to successfully visualize the pericardial effusion and perform needle aspiration via parasternal and subxiphoid approaches under dynamic ultrasound guidance, allowing needle visualization. All residents reported a subjective increase in procedural confidence and competence after practicing with this training model. Overall, the primary benefit of this training model cited by emergency medicine residents was that it closely approximates reality. This model is re-usable, relatively durable, and reproducible. Emergency medicine residencies associated with academic medical centers that already utilize cadavers for education may relatively easily incorporate this training model into their procedure training curriculum. Pericardiocentesis, simulation, task trainer.

The versatility of the transnasal sphenopalatine ganglion block.

Dear Editor, We read with great interest the article by Ferjani et al.1 on how a patient’s headache from a postoperative spinal dural tear was successfully relieved with a bilateral transnasal sphenopalatine ganglion block. This is a simple and valuable technique that was discovered in 1908, but few anesthesiology or pain physicians are familiar with the block and its versatility. Intranasal devices for the administration of the transnasal sphenopalatine ganglion block are available but are expensive and might not be readily available at all institutions. To safely and inexpensively perform the transnasal sphenopalatine ganglion block to treat headaches and also extend the treatment to other types of pain, we have created our own device from supplies that are readily accessible in most medical facilities. For our transnasal sphenopalatine ganglion block applicator, we attached a 3-mL syringe (filled with 4% lidocaine hydrochloride solution) to one side of intravenous extension tubing with a stopcock, and we attached a hollow cotton swab dipped into 5% lidocaine ointment to the other side of the tubing. The patients position themselves supine with neck extension and hemodynamic monitoring. The applicator is gently advanced perpendicular to the patient’s nostril until the tip reaches the back of the nasal pharynx and gentle resistance is met. Lidocaine 4% is administered slowly under low pressure through the cotton-tipped applicator until the medication is felt in the back of the throat. A second applicator is then inserted into the opposite nostril, and the medication is administered as before. Symptoms are evaluated 15 minutes after insertion. If the symptoms are not sufficiently relieved, this procedure is repeated up to 2 more times. In our experience, this transnasal sphenopalatine ganglion block has successfully relieved the pain amenable to sphenopalatine ganglion blockade; importantly, this approach has not had a technical failure.

Design and development of IV fluid warming system using TRIZ methodology

In intravenous (IV) tube infusion therapy, various fluids, such as saline, glucose, blood, and others, are infused into the body via the veins leading to the heart, causing the fluids to circulate throughout the body. The IV fluid is packaged in a flexible plastic-based container, and during therapy, the container is kept in an open environment that could either cool or warm the fluid. The body’s core temperature, which is usually 37 °C, catastrophic drops when this cool intravenous fluid is combined with blood, resulting in hypothermia and other health complications. It can be life-threatening for young newborns, severe patients, and elderly individuals. Nearly 14% of hospitalized patients are hypothermic upon arrival. In this study, a portable IV fluid warming system was made that warms the intravenous fluids before they reach the human body, preventing hypothermia by maintaining the required temperature. The solution was formulated using the TRIZ contradiction matrix. Various processes involved in resolving the conflict via the TRIZ matrix were investigated in depth, and the device was subsequently made employing the ideas. The device consists of an encased heating jacket that can be wrapped all around the IV fluid container to heat the fluid without direct contact, thereby eliminating the risk of contamination. It works on a feedback control system & simplifies temperature regulation desired by the physician. The design was validated via thermal analysis in software, and via experimentation, both the results were within a close tolerance of each other, which proves the design successful. Later, the equipment was certified by an ISO 13485-accredited facility, and currently, testing is ongoing in hospitals under supervision. The developed IV fluid warmer is cost-effective, recyclable, and ergonomically designed for user comfort compared to conventional commercial warmers.

Preterm Babies: At the Hospital

Preterm Babies: At the Hospital

Synthesis and Characterization of Banana Peel Starch-based Bioplastic for Intravenous Tubes Preparation

The work undertaken in this paper intends to reduce the negative environmental effects of single-use plastics especially to trim down the medical waste generated post-utilization of plastic intravenous tubes. The present study emphasises on the production, characterization of banana peel starch-based bioplastic with Glycerin as bioplastic adhesive or plasticizer. Single-use plastic medical wastes derived from petroleum-based sources continue to accumulate in landfills and leach into the environment. Managing plastics and medical wastes tends to be an urgent environmental crisis and poses a serious threat to the same, and switching to biodegradable plastics can help to alleviate the problem. Three assorted banana peel starch-based bioplastic samples were fabricated using assorted mixtures of Banana peel starch, Corn starch, Vinegar, Glycerin and distilled water. All the three samples were subjected to evaluation tests such as moisture content, water absorption, water solubility, alcohol solubility, Soil degradation, tensile strength study and FTIR analysis. In addition, the intravenous tube was simulated using ANSYS software, and its flow and velocity profiles were studied and tested. Obtained results evince that banana peel starch-based bioplastic sample-II has the necessary physiochemical and mechanical properties, which may be printed and moulded as intravenous tube in future, for infusion and transfusion applications.

S68 Concurrent Esophageal Crohn’s Disease and Superior Mesenteric Artery Syndrome in a Pediatric Patient

Case: A previously healthy 12-year-old female with 4-month history of malaise, dizziness, headaches, anorexia (20-pound weight loss). A month prior, she developed daily non-bilious, non-bloody emesis and early satiety. Denied abdominal pain, diarrhea, hematochezia, constipation, oral ulcers, rash or fever. Family history was negative for gastrointestinal illness. Physical exam showed thin stature, epigastric tenderness, weight 37.7 kg (27th percentile) and BMI 14.36 kg/m2 (2nd percentile). Initial labs: Hgb 13 g/dL, MCV 74.4 fL, albumin 2.5 g/dL, platelet 497,000/uL, CRP 16.6 mg/L, ESR 24 mm/hr and fecal calprotectin 2500 mcg/g with remainder unremarkable. Upper GI demonstrated mucosal irregularity/fold thickening and narrowing at the third portion of the duodenum. Superior mesenteric artery (SMA) ultrasound showed aortomesenteric angle EGD revealed esophagitis, gastritis and bulbar duodenitis. She received intravenous pantoprazole and NJ tube placed for enteral nutrition. Biopsy with chronic lymphocytic esophagitis, chronic active gastritis negative for Helicobacter Pylori or CMV, and chronic peptic duodenitis. MRE demonstrated a 1-2 cm segment of bowel wall thickening and hyperenhancement 10-20 cm proximal to the terminal ileum. Colonoscopy found terminal ileitis, unremarkable colon, and perianal disease consisting of a skin tag with small fissure. Biopsies revealed mixed inflammatory infiltrate consistent with chronic active ileitis. Discharged with NJ feeds for 4-6 weeks, and pantoprazole. Given first dose of adalimumab prior to discharge. Introduction: SMA syndrome is characterized by compression of the third portion of the duodenum between the SMA and the aorta. In pediatrics, the major cause is rapid weight loss leading to loss of the intervening mesenteric fat pad. Symptoms include postprandial epigastric pain and early satiety. Those with advanced obstructions may have severe nausea, bilious emesis and weight loss. The incidence ranges between 0.013 and 0.3%. Treatment is typically successful with enteral nutrition, with surgical intervention reserved for patient’s refractory to refeeding. Crohn’s disease (CD) is a chronic inflammatory disease that can affect any part of the GI tract. CD of the esophagus is less common, affecting 7.6-17.6% of pediatric patients. Most cases of esophageal CD present with symptoms similar to gastroesophageal reflux disease (GERD) with chest pain, heartburn and regurgitation and more advanced cases with odynophagia, vomiting, and weight loss. The mean time to diagnosis of CD and esophageal involvement is up to 3 years. Upper GI involvement of CD is more common in pediatric than adult population, but still less prevalent than lower GI involvement. Discussion: This is an atypical case of CD primarily involving the esophagus that led to the development of SMA syndrome. Though weight loss due to CD is common (57%) there is limited literature describing CD associated with SMA syndrome and only a few reported cases of SMA syndrome as the presenting sign of CD with nonspecific symptoms (vomiting, abdominal pain). There is an even smaller number of cases reported in the pediatric literature. Thus, it is important to highlight that esophageal CD, often presenting with nonspecific symptoms (vomiting, weight loss), is severe and can lead to SMA syndrome.

A Novel Ocular Tonometry Task Trainer.

The measurement of intraocular pressure via ocular tonometry is a skill necessary for the evaluation of emergency department patients with ocular complaints. Accurate results inform the use of time-sensitive medications or invasive procedures. We sought to develop and evaluate an affordable, realistic, and reproducible task trainer to allow Emergency Medicine residents and medical students to practice tonometry. We placed an angiocatheter into the vitreous chamber of a swine eye through the optic nerve stump and sealed it with a purse string suture and cyanoacrylate glue. This allowed us to connect intravenous extension tubing and use a saline-filled syringe to repeatedly adjust intraocular pressure in real time. Optionally, this model can be mounted in a polystyrene foam mannequin head to enhance realism and facilitate practice. The task trainer was implemented in medical student and Emergency Medicine resident education at Vanderbilt University Medical Center. Thirty-six learners participated in the study, all of whom completed pre-course and post-course surveys. Among all learners, the mean comfort with performing tonometry improved significantly (3.26 to 7.64 {Z = -4.95, p < 0.005}). The mean confidence in the accuracy of measurements also increased (3.11 to 7.56 {Z = -4.8, p < 0.005}). On a 10-point scale, learners felt this task trainer was highly helpful in increasing their comfort with and the ability to perform tonometry (mean 9.19 {SD 1.19}). We have developed a low-cost and easily constructed ocular tonometry task trainer that resulted in significant improvement in learner comfort and confidence.

Study on the method to avoid infusion-site adverse events following chemotherapeutic treatment with epirubicin and fosaprepitant using immortalized human umbilical vein endothelial cells.

The combination of intravenous Proemend® containing fosaprepitant meglumine, a prodrug for fosaprepitant (FAP), and Tween 80 and chemotherapy with anthracyclines, such as epirubicin (EPI), can cause infusion-site adverse events in clinical practice. In immortalized human umbilical vein endothelial (HUEhT-1) cells, the cytotoxic effects of FAP, EPI, diluted Proemend with culture medium and Tween 80 alone, and a combination of FAP and EPI, were evaluated using the WST-1 cell viability assay. FAP, EPI and diluted Proemend exhibited cytotoxicity in a concentration-dependent manner and marked synergic cytotoxicity was observed between FAP and EPI. The washing of the cell surface following incubation with diluted Proemend containing FAP and Tween-80 eliminated the synergic cytotoxicity of EPI applied thereafter. These results indicated that washing of the infusion-site vascular tissue following intravenous Proemend administration via intravenous tube flushing with an efficient amount of saline may reduce the infusion-site adverse events, which are caused by the combined use of FAP and EPI.

Air bubbles removal technique from intravenous tubing

Background: The air bubbles in the intravenous tubing can be fatal if it enters the body. It can result in an air embolism. Air embolism is a condition in which air bubbles enter the blood vessels. Several methods can be used to remove air bubbles in the intravenous tubing. One is replacing it with new intravenous tubing, but this method is considered less efficient. This article describes effective and efficient ways to remove air bubbles from intravenous tubing and tests them for effectiveness.Technique: Four techniques can be applied when the intravenous tubing is filled with air, namely the roll-up technique, flick technique, combination roll-up and flick technique, and push-pull technique.Conclusion: From the test, the push-pull technique is the most effective and efficient in removing air from intravenous tubing compared to the others.

Critical vitamin deficiencies in autism spectrum disorder: Reversible and irreversible outcomes.

Vitamin deficiencies are an emerging concern in the management of children with autism spectrum disorder (ASD). Particular attention is required for recognizing the variable signs caused by unbalanced food intakes. We herein report two patients with multiple vitamin deficiencies who needed critical care showing different prognoses. Patient 1 with 'Shoshin' beriberi presenting with cardiac arrest had thiamine deficiency developed severe neurological sequelae despite rapid vitamin supplementation. Patient 2, who had leg pain and a limping gait, showed a rapid recovery with intravenous infusion and tube feeding after being diagnosed with scurvy. A literature search revealed several children with ASD with critically ill thiamine deficiency, but few reports documented a life-threatening condition in the form of cardiac arrest at the onset. Considering the high observation rate of food selectivity in children with ASD, early intervention is required to prevent the exacerbation of vitamin deficiencies to severe neurological disabilities.

A Survey of Sustainability Efforts in Healthcare Simulation and Clinical Learning

BackgroundHealthcare contributes to sustainability challenges. Students learning new skills must use plastic supplies like the clinical setting, however, the accumulation of plastic waste in the simulated learning environment is extensive. In one semester, approximately 300 pounds of plastic intravenous tubing waste was accumulated in one nursing simulation education center. This project identified current sustainability practices of clinical simulation education centers in the United States. MethodsAn electronic survey was distributed to simulation-focused groups and associations from October 2020 to January 2021, resulting in 77 responses from 75 institutions. ResultsPolicies regarding reuse and recycling of supplies were identified. Other aspects of sustainability such as supply procurement, supply disposal, and student education/involvement were lacking. Few simulation centers have formal plans for sustainability or carbon neutrality. ConclusionSimulation waste reduction will improve downstream population and planetary health but must be balanced with student learning needs. Given reduced infection concern compared to medical centers, simulation could provide an arena to pilot new sustainable procurement, reuse, and waste management policies before implementation in high stakes patient care settings.

Burden of catheter associated urinary tract infection by candida Albicans and non Albicans with emphasis on biofilm formation and antifungal sensitivity pattern

Candida spp. is generally found in humans; however, when the host's immune system is compromised, the pathogen infects the host, earning it the name opportunistic pathogen. It can also be found on the surfaces of biomaterials such as catheters, Venflon, intravenous tubes, dentures, and blood bags in a medical setting. It infects people who have been admitted to the hospital. This causes major health problems for the patients and raises morbidity and mortality rates over time. Those who take antifungal medications for this infection on a regular basis acquire resistant to the drugs. Candida albicans and non-Candida albicans were found to predominate in distinct clinical samples in this investigation. The goal of this cross-sectional study, which took place at the Index Medical College Hospital and Research Centre, Indore, was to determine the burden of catheter associated urinary tract infection by candida albicans and non albicans with emphasis on biofilm formation. CAUTI is a prevalent complication in critically ill individuals. In order to reduce the incidence of catheter-related UTI, the focus should be on appropriate catheter maintenance and lowering catheterization length rather than prophylactic. In the treatment of CAUTI, culture and susceptibility testing are crucial.

Synthesis and Characterization of Banana Peel Starch-Based Bioplastic for Making Intra Venous Tubes

Synthesis and Characterization of Banana Peel Starch-Based Bioplastic for Making Intra Venous Tubes

Multi-infusion with integrated multiple pressure sensing allows earlier detection of line occlusions

BackgroundOcclusions of intravenous (IV) tubing can prevent vital and time-critical medication or solutions from being delivered into the bloodstream of patients receiving IV therapy. At low flow rates (≤ 1 ml/h) the alarm delay (time to an alert to the user) can be up to 2 h using conventional pressure threshold algorithms. In order to reduce alarm delays we developed and evaluated the performance of two new real-time occlusion detection algorithms and one co-occlusion detector that determines the correlation in trends in pressure changes for multiple pumps.MethodsBench-tested experimental runs were recorded in triplicate at rates of 1, 2, 4, 8, 16, and 32 ml/h. Each run consisted of 10 min of non-occluded infusion followed by a period of occluded infusion of 10 min or until a conventional occlusion alarm at 400 mmHg occurred. The first algorithm based on binary logistic regression attempts to detect occlusions based on the pump’s administration rate Q(t) and pressure sensor readings P(t). The second algorithm continuously monitored whether the actual variation in the pressure exceeded a threshold of 2 standard deviations (SD) above the baseline pressure. When a pump detected an occlusion using the SD algorithm, a third algorithm correlated the pressures of multiple pumps to detect the presence of a shared occlusion. The algorithms were evaluated using 6 bench-tested baseline single-pump occlusion scenarios, 9 single-pump validation scenarios and 7 multi-pump co-occlusion scenarios (i.e. with flow rates of 1 + 1, 1 + 2, 1 + 4, 1 + 8, 1 + 16, and 1 + 32 ml/h respectively). Alarm delay was the primary performance measure.ResultsIn the baseline single-pump occlusion scenarios, the overall mean ± SD alarm delay of the regression and SD algorithms were 1.8 ± 0.8 min and 0.4 ± 0.2 min, respectively. Compared to the delay of the conventional alarm this corresponds to a mean time reduction of 76% (P = 0.003) and 95% (P = 0.001), respectively. In the validation scenarios the overall mean ± SD alarm delay of the regression and SD algorithms were respectively 1.8 ± 1.6 min and 0.3 ± 0.2 min, corresponding to a mean time reduction of 77% and 95%. In the multi-pump scenarios a correlation > 0.8 between multiple pump pressures after initial occlusion detection by the SD algorithm had a mean ± SD alarm delay of 0.4 ± 0.2 min. In 2 out of the 9 validation scenarios an occlusion was not detected by the regression algorithm before a conventional occlusion alarm occurred. Otherwise no occlusions were missed.ConclusionsIn single pumps, both the regression and SD algorithm considerably reduced alarm delay compared to conventional pressure limit-based detection. The SD algorithm appeared to be more robust than the regression algorithm. For multiple pumps the correlation algorithm reliably detected co-occlusions. The latter may be used to localize the segment of tubing in which the occlusion occurs.Trial registration Not applicable.