Peripheral Venous Line Research Articles

Educational Program on Nurses Knowledge about Blood Exchange Transfusion in Neonatal Care Units

Background: Exchange transfusion entails the sequential drawing and injecting of blood aliquots via peripheral or central venous and arterial lines. Notably, arterial lines—either peripheral or umbilical—should not be used for donor blood injections; rather, they should only be used for baby blood withdrawal. To ascertain the Nurses' Knowledge of Blood Exchange Transfusion in Neonatal Intensive Care Units Educational Program. Methods: Designing a quasi-experimental using (non-probability) To ascertain the impact of a training program on nurses' performance with regard to blood exchange transfusion, purposeful sampling was used. The "Statistical Package for Social Science (SPSS) software for Windows (Version 26)" is used to analyze data. Results: This result showed that 33.3%(10) of the study's nurses and 33.3%(10) of the control group's nurses were between the ages of 31 and 35.The study's findings regarding the gender of the nursing staff showed that 53.3% of the participants (19) were female. and of the fifteen participants, 63.3% were men. 50% of the participants are nurses.had a Nursing Institute (15) In terms of general years of experience, 33.3% (10) of the sample had six to ten years of experience, and 3.0% worked in the pediatric department. Conclusion: The study concluded that the nurses’ knowledge about the blood transfusion process before giving the educational program to the patients was poor, and through the intervention and giving the nursing program, their knowledge became good. The reason is due to the effectiveness of the effective programs.

Nosocomial Infection in MICU: An Observational Study

Introduction: Nosocomial infections are infections; patients acquire while admitted to a health-care facility and generally develop 48 h or later after admission. These infections can lead to serious problems such as sepsis and even death. Materials and Methods: A prospective observational study was conducted for 6 months to estimate the incidence of nosocomial infections acquired in the medical intensive care unit (MICU), their risk factors, the causative pathogens, and the outcome. The patients admitted for more than 48 h to the MICU and willing to give consent were included in the study. Of 496 patients in MICU, 216 patients stayed 48 h and Acute Physiology and Chronic Health Evaluation II (APACHE II) score during the first 24 h of admission to the MICU. Results: The incidence of nosocomial infections in MICU was 14.9% (32 out of 216). Age, APACHE II score >13, MICU stay >7 days, and comorbidities such as peripheral venous line, central venous catheter, duration of urinary catheterization, duration of endotracheal intubation, nasogastric tube, and mechanical ventilator of >7 days were found to be independent risk factors of acquiring nosocomial infections (P < 0.05). Important causative organisms for nosocomial infections were Pseudomonas aeruginosa in 18 patients (32.72%), Escherichia coli in 11 (20.0%), Acinetobacter species in 8 (14.54%), and Klebsiella pneumoniae in seven patients (12.72%). Mortality among patients with nosocomial infections was 25% (8/32) and among those without nosocomial infections was 6.5% (12/184), P = 0.002. The length of ICU stay was higher in patients with nosocomial infections (15.42 ± 6.93 days) than in those without nosocomial infections (6.7 ± 5.14 days), P < 0.001. Conclusion: Nosocomial infections are common in ICU settings and contribute to significant mortality and morbidity. Infection control strategies are necessary to reduce nosocomial infection rates as well as ICU mortality and morbidity.

Evaluation of Upper Extremity Venous Thrombosis with Doppler Ultrasonography in Peripheral Venous Line Applied Patients

Objectives: Peripherally inserted venous lines (PVL) may increase the risk of venous thrombosis due to vessel wall disarrangement. Aim of this study is to identify the cases of upper extremity venous thrombosis (UEVT) related to PVL since most of the PVLs applied to upper extremities.
 Methods: Sixty-nine hospitalized patients with previous or present PVL insertions were included in this prospective study. Upper extremity Doppler compression ultrasonography (USG) examination were performed to on all patients. The cases with detected UEVTs were evaluated as group 1 and the remaining cases were evaluated as group 2. Demographic parameters, PVL applications, intravenous treatments were compared between the groups.
 Results: UEVT was diagnosed by Doppler USG in 26 (37.7%) patients out of 69 patients. Lower extremity thrombosis was found in 10 (14.49%) patients. UEVT was observed in cephalic vein in 14 (53.8%) and in basilic vein in four (15.4%) out of 26 (37.7%) patients. Axillary and brachial deep UEVT was located in two (2.9%) cases. Superficial UEVT was found in 24 (34.8%) cases. Ceftriaxone, cefoperazone/sulbactam and esomeprazole were the mostly associated treatments with UEVT. UEVT was detected in five patients with PVL that were inserted only for drawing blood.
 Conclusion: PVL is a risk factor for UEVT since almost 1/3 of the patients revealed UEVT. When PVL is no longer needed or the need for intravenous therapy decreases, oral therapy should be planned and PVL should be removed. Removal of PVL appears to be necessary to avoid UEVT.

Extravasation: Surgical Management and Prevention

Extravasation is defined as the leakage of fluid from a blood vessel into the surrounding area at the injection site. These accidents occur during injection for diagnostic or therapeutic purposes, carried out through the peripheral or central venous lines (Chemotherapy, metabolites, or contrast agent for radiographic examination). They can be the cause of skin necrosis able to progress to significant functional, cosmetic, and psychological sequelae. The saline washout technique is the emergency surgical treatment of choice for extravasations of certain products, allowing the elimination of the toxicant and the preservation of the skin. In the event of skin necrosis, covering techniques such as directed healing, grafts and flaps allow healing. The difficulty of the therapeutic management of these lesions and their unpredictable evolution, require prevention, by the development of protocols for the installation and monitoring of the venous catheters, and by the continuous training of the nursing staff to know the symptoms of extravasation, and their immediate management. The aim of this work is to present a review of the existing literature, allowing to know the diagnostic criteria, insist on the means of prevention, and propose a protocol of management.

Phlebitis associated with peripheral venous catheter placement: systematic review

Peripheral venous catheter (PVC) is often a common application we use for patient care worldwide for intravenous (IV) fluid administration. Objective: to examine the scientific literature on phlebitis associated with peripheral venous catheter placement through systematic review. Methodology: it is a literature review for the realization of this process, the recommendations of the PRISMA method will be followed. Main results: the worldwide prevalence of phlebitis was Australia 12%, Portugal 11.5%, Germany 7.6%, Spain 5.6%, Portugal 36.7%. Risk factors: age, venipuncture site, venous catheter size, failed attempts, and HIV drugs, diabetic patients, immunosuppressive drugs, venipuncture site, cathlon number 18. Risk factors for phlebitis: age, sex, venipuncture site, large venous catheters, failed attempts, hypertonic fluids, antibiotics. Conclusion: the staff should know the symptoms of phlebitis, monitor the site where the peripheral venous line was placed, the anatomical part should focus on the caliber of the venous catheter, the care should be comfortable and safe, thus increasing the quality of care and avoiding complications such as inflammation,

Change of Anesthetic Management From Open to Laparoscopic Living Donor Right Hepatectomy After Learning Curve

In our hospital, open living donor hepatectomy (OLDH) began in 1996 and laparoscopic living donor hepatectomy (LLDH) began in 2013. In this study, we focus on the change of anesthetic management from OLDH to LLDH. Under the approval of the Institutional Review Board of our hospital, medical records of the last 2 years (2011 and 2012 vs 2019 and 2020) of each OLDH and LLDH era were collected. Left hepatectomy in any period and OLDH during the LLDH era were excluded. There were 175 OLDHs and 213 LLDHs. We performed 836 cases of OLDH before 2011 and 206 cases of LLDH before 2019. Laryngeal mask airway replaced intubation in half of LLDH cases. Erector spinae plane block was performed in a quarter of LLDH cases. Lung-protective ventilation with low tidal volume and positive end-expiratory pressure were applied for LLDH. Additional peripheral venous line was decreased, and there was no central venous catheterization. Anesthesia duration time was reduced and crystalloid infusion per hour was also decreased. There was no intraoperative transfusion and there was no difference in postoperative transfusion incidence. Reoperation rate was not different. Only 1 donor in OLDH transferred to the intensive care unit after the operation because of uncontrolled hypertension. Length of hospital stay was decreased. As the surgical tactics for living liver donors become less invasive, the anesthetic strategy also becomes less invasive. In addition, new types of airway management, ventilation method, and analgesic technique have been introduced.

Comparison of the Efficacy of Simple, Partial Manual and Automated Exchange Transfusions in the Management of Sickle Cell Disease in Pediatric Patients

Background: Chronic transfusion therapy in sickle cell disease is used to prevent complications of sickle cell disease by reducing hemoglobin S levels, most commonly used for primary or secondary stroke prophylaxis, amongst other indications. Transfusions can be completed as simple, partial manual exchange or automated exchange.Comparative evidence on the long term efficacy of simple, partial manual or automated exchange in the management of children with sickle cell disease is lacking.Methods: A retrospective study of patients aged less than 18 years with a diagnosis of sickle cell disease on a chronic transfusion program (simple top-up transfusion, partial manual exchange or automated exchange transfusion), followed at the Hospital for Sick Children, Toronto, Ontario from January 2003- July 2020.We excluded patients who received transfusions for acute complications. Data collected included: demographics, indication for transfusion, type of transfusion (simple, partial manual exchange or automated exchange), access for transfusion (peripheral intravenous (PIV), central venous line (CVL)), pre-transfusion hemoglobin and hemoglobin S values.Analysis: Exploratory data analysis was conducted where descriptive statistics were used to summarize data for both continuous and categorical variables. Continuous variables were summarized using measures of central tendency and dispersion where mean and standard deviations for normally distributed data and medians and interquartile ranges were used where the data was skewed. Chi-squared tests were employed when demonstrating relationships between two categorical variables. All statistical analyses were two-sided tests with 0.05 as the critical level of significance.Ethics: This study was approved by The Hospital of Sick Children Research Ethics Board(REB).Results: Sixty-one participants were observed between January 2003 and July 2020. Majority 38 out of (62.3%) of the participants were male. The most common indication for transfusion was primary stroke prevention (following abnormal transcranial doppler (TCD) 36 %) followed by vasculopathy 11 (%, stroke 9 % , abnormal TCD & silent infarct 8 %, and splenic sequestration 2 %) There were 744 total transfusions. 491/744 (66%) transfusions were simple transfusions, 168/744 (22.6%) were PMEs while 85/744 (11.4%) were apheresis transfusions. Average pre-transfusion hemoglobin S (HbS) was similar between the two types of access (p=0.416) and also across the three types of transfusion (p=0.158).The type of access did not appear to have an effect on the changes in HbS per transfusion(p=0.561.)The trends of pre-transfusion HbS %were similar over time between participants whose access was PIV and those whose access was CVL/ PORT.(Figure 1 below).Achievement of target HbS was similar between peripheral intravenous and central venous line access (p=0.337) and across the three types of transfusion (p=0.086).See Table 1 below.The type of transfusion had an effect on the reduction in HBS with simple transfusion having the highest percentage change of HbSS(-3.69%) followed by Apheresis (-1.32%) and PME (-0.75%), p=0.018., that is per every transfusion. The reason for this is that is the values being compared are quite different. The automated exchange values are on established patients (pre transfusion hemoglobin S had already been lowered), while the simple transfusion values are on new to transfusion patients (pre transfusion S high), the patients on partial manual exchange started off with lower HbS levels, so consequently their change was less.Conclusion: All three types of transfusion had equal efficiency in reducing HbS over time. Apheresis showed a quicker reduction in the hemoglobin S level in the initial transfusions. Simple transfusions and PME are as efficient as apheresis in achieving target HbS levels to prevent complications associated with SCD. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Options to Minimize the Use of Central Lines: Midodrine, Peripheral Venous Lines, and Midline Catheters.

Options to Minimize the Use of Central Lines: Midodrine, Peripheral Venous Lines, and Midline Catheters.

Can the CT by-product Time to threshold be a prognostic factor in patients with acute pulmonary embolism?

Bolus tracking is applied in computed tomography pulmonary angiography. The time that it takes for contrast to reach a predefined threshold in the pulmonary artery is called time to threshold (TTT). Our purpose was to analyse possible associations between TTT and circulatory state and prognosis in patients with acute pulmonary embolism (PE). In a single-centre, retrospective study 138 patients with PE and contrast administration via peripheral venous line were included. Clinical parameters of circulatory state were arterial pH, systolic blood pressure, heart rate, sPESI score, Wells score and GENEVA score. Survival was defined as surviving the following 30 days after the PE diagnosis. Time to threshold was only weakly correlated with Fi02 (r = 0.26, P = 0.04), pH (r = -0.22, P = 0.009), venous base excess (r = -0.18, P = 0.04) and venous lactate (r = 0.21, P = 0.01). TTT did not correlate with clinical parameters/scores and mortality. There were weak associations between TTT and blood gas analysis parameters. There were no associations with clinically relevant prognosis scores and overall survival. Therefore, albeit TTT is an easily assessable parameter of CTPA, the potential use in clinical routine is limited for prognosis stratification in patients with PE.

Ambulatory cataract surgery centre without perioperative anaesthesia care: a prospective cohort study

This study aims to evaluate the safety and patient satisfaction of a fast-track procedure for cataract surgery under topical anaesthesia without perioperative anaesthesia care. This is a prospective single-centre study including all cataract procedures in the Centre Ambulatoire de la Chirurgie de la Cataracte at the Hospital of Bourges between May and August 2018. Procedures were performed under topical anaesthesia without the presence of a nurse anaesthesiologist or anaesthesiologist, the patient had not fasted, and no peripheral venous line was placed. Only heart rate and oxygen saturation were monitored intraoperatively with pulse oximetry. Incidence and nature of intraoperative adverse events and surgical complications were recorded. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Scale (ISAS). In total, 651 cataract surgeries were performed among which 614 (94.3%) were uneventful. Thirty (4.6%) intraoperative adverse events and 8 (1.2%) surgical complications were recorded. All surgeries were successfully completed. No medical emergency team intervention or hospital admittance was encountered. The mean ISAS score was 5.7/6, indicating high patient satisfaction. Cataract surgery in an ambulatory cataract surgery centre without perioperative anaesthesia care is a safe procedure with high patient satisfaction for screened patients. Anaesthesia ressources are scarce and may be more beneficial to more complex ophthalmic or non-ophthalmic surgeries.

Factors that Affecting the Skin Necrotic due to Extravasation Injury and Modality Theraphy at Pediatric Inpatient Ward dr. Soetomo Hospital Surabaya (Januari - Desember 2019)

Background: Extravasation injury is the most common complication of intravenous therapy in children. Research in the NICU at UK, found extravasation injury caused skin necrotic 38/1000 neonates, 70% of preterm neonates. Extravasation injuries and their sequels can be more serious morbidity than the underlying disease, potentially for amputation. The research objective was to determine the factors that influence the incidence of skin necrotic due to extravasation injury and the types of treatment modalities in the pediatric hospital Dr. Soetomo Hospital Surabaya for the period January - September 2019.Methods: This research is descriptive analytic with cross sectional approach with collected data from medical records. The medical records of 44 pediatric patients undergoing treatment at the pediatric inpatient ward of Dr. Soetomo Hospital Surabaya with skin necrotic due to extravasation injury which was brought to the Reconstructive and Aesthetic Plastic Surgery Dr. Soetomo Hospital Surabaya for the January - December 2019 period was reviewed retrospectively. We analyzed patient characteristics, risk factors, types of wound care therapy modalities, and case outcomes.Results: There were 44 cases of skin necrotic injury due to extravasation injury, with the largest percentage of neonates group (34%), male gender (66%), hypertonic fluids / drugs (73%), most regions of dorsum and wrist dextra (17%) and the most used therapeutic modality was autolytic debridement (45%).Conclusions: From this study, several conclusions can be drawn regarding the prevalence of skin necrotic due to extravasation injury, there was a relationship between the incidence of skin necrotic injury due to extravasation injury with age, types of fluid/drug given, and the location of the peripheral venous line, whereas the incidence was not related to gender. The initial treatment modality that is still frequently used today is autolytic debridement.

Prehospitalno prepoznavanje životno ugrožavajuće torakalne traume prikaz slučaja

Introduction: Severe thoracic trauma is a potentially lifethreatening injury, leading to immediate impairment of cardiorespiratory functions or bleeding; but also consequential fatal infections, damage of: heart, large blood vessels, mediastinal organs or pleura with pneumothorax/hematothorax. Objective: To present a case of penetrating chest injuries with forks, caused by traffic. Methodology: Case report from medical documentation. Case report: The EMS team was called for a car accident including vehicle and a tractor. At the passenger seat of the car, a female person was found stabbed with a pitchfork through the torso and fixed to the seat. Firefighters cut a part of the metal forks, while medics stabilized foreign body and made emporary hemostasis. The entrance and exit wounds were verified. Vitals were: TA: 130/60mmHg, heart rate 100/min, SaO2 90%. The peripheral venous line was opened and O2 10L/min was applied through an oxygen mask. The patient was transported in a sitting position, with medical manual stabilization, to the ER. The surgeon was immediately consulted and the patient, due to vital indications, was urgently admitted to the operating room. In the abdomen, 8 cm laceration of the III segment of the liver, cleft omentum and deserosion of the small curve of the stomach were verified. A foreign body passed between the aorta and the esophagus, without injuring them. Conclusion: Thanks to the prompt EMS reaction and the proper pre-hospital care, as well as early inpatient surgical treatment, the patient's outcome was good.

Optimizing Contrast-Enhanced Thoracoabdominal CT in Patients During Extracorporeal Membrane Oxygenation

To evaluate the quality and value of contrast-enhanced (CE) chest- and abdominal computed tomography (CT) and CT angiography in neonates, children, and adults undergoing extracorporeal membrane oxygenation (ECMO) using a customized protocol for contrast delivery. All patients admitted for CE thoracic- and/or abdominal CT while on ECMO were prospectively included in the study. A protocol for contrast delivery adapted for the type of ECMO circulation, cannulation sites, anatomy of interest, and desired contrast phase was applied. Clinical information, ECMO and CT technique, including contrast administration strategy, was noted for each patient. Two radiologists separately evaluated the quality of the scan. The value of the examination was decided in consensus with the referring ECMO physician. One hundred thirty CE thoracoabdominal scans were performed at 103 different occasions during the study time. Eighty-nine scans were performed during veno-arterial ECMO and 41 during veno-venous ECMO. In the majority, contrast was delivered to the oxygenator with preserved ECMO flow. A peripheral or central venous line with reduced flow was utilized in the remaining cases. Mean scan quality was graded 4.2 on a five-grade scale. In 56% of the examinations, the findings affected the immediate treatment of the patient. High-quality CT and CT angiography can be achieved in ECMO patients of different ages and clinical issues considering the type of ECMO circulation, ECMO cannulation sites, preferred contrast phase and anatomy of interest. CT diagnoses affect the treatment of the patient.

Extravasation of Noncytotoxic Drugs.

Objective: Commonly used drugs may be dangerous in case of extravasation. The lack of information from health care teams can lead to delays in both diagnosis and treatments. This review aims at alerting health care professionals about drugs and risk factors for extravasation and outlines recommendations for the diagnosis and treatment of extravasation. Data Source: A literature search of MEDLINE/PubMed, Scopus, the Cochrane Library, and Google Scholar was performed from 2000 to December 2019 using the following terms: extravasation, central venous line, peripheral venous line, irritant, and vesicant. Study Selection and Data Extraction: Overall, 140 articles dealing with drug extravasation were considered potentially relevant. Each article was critically appraised independently by 2 authors, leading to the inclusion of 80 relevant studies, guidelines, and reviews. Articles discussing incidents of extravasation in the neonatal and pediatric population of patients were excluded. Data Synthesis: Training of health care teams and writing care protocols are important for an optimal management of extravasations. A prompt consultation should be achieved by a specialist surgeon. The surgical procedure, if necessary, will consist of wound debridement followed by an abundant lavage. Relevance to Patient Care and Clinical Practice: This review discusses the management of drug extravasations according to their mechanism(s) of toxicity on tissues. It highlights the importance of a close monitoring of patients and the training of health care teams likely to face this type of adverse event. Conclusions: Extravasations still contribute to significant morbidity and mortality. A good knowledge of risk factors and the implementation of easily and quickly accessible standardized care protocols are 2 key elements in both prevention and treatment of extravasations.

A STROBE cohort study of 755 deep and superficial upper-extremity vein thrombosis.

Upper extremity vein thrombosis (UE-VT) are more and more frequent pathologies and yet little studied. The aim is to describe the clinical and ultrasound features, UE-VT-related diseases, and the prevalence of pulmonary embolism (PE) and associated deaths.All UE-VT patients diagnosed by Doppler-ultrasound in Nantes University Hospital, from January 2015 to December 2017, were included retrospectively. UE-VT suspicion patterns, clinical features, UE-VT topography, and prevalence of PE and death were analyzed.Seven hundred and fifty-five UE-VT were analyzed, including 427 deep thrombosis (UE-DVT) and 328 superficial thrombosis (UE-SVT). In 86.2% (n = 651) UE-VT were related to endovascular devices. Among these thrombosis, one third is in connection with a PICC LINE and one quarter with a peripheral venous line. Forty nine percent (n = 370) of the patients had solid neoplasia or hematological malignancies. An inflammatory or systemic infectious context was found in 40.8% (n = 308) of the cases. The most frequently observed clinical sign at the UE-VT diagnosis was edema (28.6%). Among the UE-SVT it was the presence of an indurated cord (33.2%) and among the UE-DVT the indication of the Doppler-ultrasound was mainly a suspicion of infection on endovascular device (35.1%). In 10.6% (n = 80) of the cases the UE-VT were asymptomatic. The most frequently thrombosed veins were brachial basilic veins (16.7% of all thrombosed segments) followed by jugular (13%) and subclavian (12.3%) veins; 61.3% (n = 463) of UE-VT were in the right upper extremity; 63.3% (n = 478) UE-VT were occlusive. The occurrence of PE is 4% and the death rate is 10.2%, mainly related to the severe comorbidities of patients with UE-VT.UE-VT occurs in particular clinical contexts (hematological malignancies, solid cancers, systemic infections) and in the majority of endovascular devices (86.2%). The occurrence of PE is low.

International survey of neurosurgical anesthesia (iSonata) : An international survey of current practices in neurosurgical anesthesia.

No standardized recommendations have been currently defined for anesthesia management of patients undergoing elective intracranial surgery. It can therefore be assumed that international clinical institutions have diverging approaches or standard operating procedures (SOP) which determine the type of general anesthesia, hemodynamic management, neuromuscular blockade, implementation of hypothermia and postoperative patient care. This international survey aimed to assess perioperative patient management during elective intracranial procedures. This survey was performed from February to October 2018 and 311 neurosurgical, maximum care centers across 19European countries were contacted. The aim was to evaluate the anesthesia management to provide relevant data of neuroanesthesia practices across European centers. The survey differentiated between vascular and non-vascular as well as supratentorial and infratentorial procedures. Atotal of 109 (35.0%) completed questionnaires from 15European countries were analyzed. The results illustrated that total intravenous anesthesia was most commonly implemented during elective intracranial procedures (83.8%). All centers performed endotracheal intubation prior to major intracranial surgery (100%). Central venous lines were placed in 63.3% of cases. Moderate intraoperative hypothermia was carried out in 12.8% of the procedures, especially during vascular supratentorial and infratentorial surgery. Aneuromuscular blockade during surgery was implemented in 74.1% of patients. Assessment of the neuromuscular junction was performed in 59.2% of cases, 76.7% of patients were immediately extubated in the operating room. 84.7% of these patients were directly transferred to amonitoring ward or an intensive care unit (ICU) and 55.1% of ventilated patients were transferred directly to an ICU. The data demonstrate that many aspects of anesthesia management during elective intracranial surgery vary between European institutions. The data also suggest that abroad consensus exists regarding the implementation of total intravenous anesthesia, airway management (endotracheal intubation), the implementation of urinary catheters, large bore peripheral venous lines and the broad availability of cross-matched red blood cell concentrates. Nevertheless, anesthesia management (e.g. central venous catheterization, moderate hypothermia, neuromuscular monitoring) is still handled differently across many European institutions. Alack of standardized guidelines defining anesthetic management in patients undergoing intracranial procedures could explain this variability. Further studies could help establish optimal anesthesia management for these patients. This in turn could help in the development of national and international guidelines and SOPs which could define optimal management strategies for intracranial procedures.

Modified Epirubicin, cisplatin, and 5-FU regimen as first-line chemotherapy in metastatic gastric or gastroesophageal junction adenocarcinoma: A Phase II study.

Background:Epirubicin, cisplatin, and 5-FU (ECF) is one of the most commonly used first-line chemotherapy regimens in metastatic gastric cancer. However, due to protracted infusion schedule, need for special infusion pumps, and catheter-related complications, the practical utility and acceptability of standard ECF regimen are limited, particularly in resource-constrained settings including India.Materials and Methods:In the present study, we have used a more convenient modification of the standard ECF protocol (using 5 days intravenous infusion of 5-FU at a dose of 750 mg/m2/day, given over 6 h through a peripheral venous line), in Indian patients with metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma. The primary endpoint was overall survival (OS). The secondary endpoints were overall response rate (ORR), progression-free survival (PFS), and toxicity profile.Results:Between January 2014 and December 2017, 107 patients were assigned and treated with this modified ECF regimen. The median age was 52 years (range, 34–62); 66.3% were males and 36.5% of the patients had ≥ 3 metastatic disease site involvement at baseline. Dose reductions due to toxicity were required in 14.9% of the patients. The ORR was 32.7%; median PFS and OS were 5.9 months (95% confidence interval [CI]: 4.7–6.9) and 10.4 months (95% CI: 8.4–11.8), respectively. Both the hematological and nonhematological toxicities were manageable, and there was no toxicity-related death. The most frequent Grade 3–4 adverse events were neutropenia (18.7%), febrile neutropenia (13.1%), mucositis (5.6%), and diarrhea (5.6%).Conclusions:In the present study, the modified ECF regimen demonstrated significant efficacy with an acceptable toxicity profile in Indian patients with metastatic gastric and GEJ adenocarcinoma. The survival outcomes of this modified schedule were comparable with those of the standard ECF regimen, as reported earlier. Clearly, this modified and more convenient ECF protocol should be explored and validated through large prospective randomized trials.

Dose determination of sufentanil for intravenous patient-controlled analgesia with background infusion in abdominal surgeries: A random study.

ObjectivesSufentanil has been widely used in epidural PCA, while its use in intravenous PCA has rarely been reported. Based on its use in target controlled infusion, we reckoned that the effect-site concentration of sufentanil would be steady if background infusion is given in intravenous PCA. This prospective, single center, randomized study with a three arm parallel group design aims to find out the appropriate dose of sufentanil when used in intravenous PCA with background infusion in abdominal surgeries.MethodsPatients diagnosed with gastrointestinal cancer and consented to the study were recruited. The analgesia pump with one of three different doses of sufentanil (1.5, 2.0 or 2.5 μg/kg) was attached to the patient through peripheral venous line right after surgery. The primary endpoint was pain scale VAS up to 48 hours postoperatively.ResultsIn our study 90 patients were analyzed. In group B (SF 2.0) and C (SF2.5), patients had better pain relief than in group A (SF 1.5). There was no difference between group B and C in pain intensity at rest. While in group C more patients got pain relived at activity than in group B. All three groups had low and similar incidence of adverse effects of sufentanil.ConclusionThe dose 2.5 μg/kg of sufentanil with background infusion is preferred because of better pain alleviation at activity without increase of adverse effects up to 48 hours after surgery.

A Retrospective Study of Catheter-Related Thrombosis Using the Central Vein Catheters for the Ulcerative Colitis Patients

Leukocyte apheresis is a therapeutic option for moderate-to-severe active ulcerative colitis in Japan. It causes fewer complications, however, leukocyte apheresis requires the use of a relatively large caliber of peripheral venous line for hemodialysis. We reluctantly used a large caliber catheter with a double-lumen into the central vein.

L-carnitine on myocardial function after coronary artery bypass grafting.

This study aims to evaluate the effect of L-carnitine on postoperative cardiac performance and morbidity and complications in patients undergoing coronary artery bypass grafting. Between April 2005 and June 2008, a total of 60 patients (36 males, 24 females; mean age 60.6 years; range 57 to 65) who were scheduled for coronary artery bypass grafting were prospectively randomized to receive one of three different strategies of myocardial preservation. Group A (n=20) received antegrade crystalloid cardioplegia, Group B (n=20) received antegrade blood cardioplegia, and Group C (n=20) received antegrade blood cardioplegia with carnitine. Samples for lactate dehydrogenase (LDH), creatinine phosphokinase (CPK), creatinine phosphokinasemyocardial band (CK-MB), and Troponin-I were taken from coronary sinus during the operation and from peripheral venous line postoperatively. Blood samples were obtained before CPB, just after CPB and postoperative 1, 6, 12, 24 and 48 hours. Levels of CPK, CK-MB and Troponin-T levels were studied by immunoassay method. The patients who received carnitine had significantly improved cardiac output, cardiac index, and right and left ventricular stroke work immediately after cardiopulmonary bypass and at the first postoperative hour (p=0.01). Troponin-T levels decreased in all patients after 12 hours postoperatively, and this change was most prominent in Group C (p=0.001). Intravenous supplementation of carnitine during cardioplegia provides better results on the recovery of cardiac function and metabolic parameters after coronary artery bypass grafting.