Cannula Research Articles

Evaluation of peripheral cannulation technique among nurses in maternity and Dr. Jamal Ahmad Rashid pediatric teaching hospitals in Sulaimaniyah, Iraq

BackgroundObedience to the excellent standards of nursing practice is the ultimate attitude to develop patient outcomes and avoid nursing process related-infections. Inserting the peripheral intravenous cannula is the utmost mutual aggressive technique achieved in nursing care for patients. Therefore, nurses must have adequate knowledge and practice to ensure the procedure’s success.ObjectivesTo determine the peripheral cannulation technique evaluation among nurses working in the emergency departments.MethodsThis descriptive-analytical study was conducted at Maternity and Pediatric Teaching Hospitals in Sulaimaniyah, Iraq on 101 randomly selected nurses, from 14th December 2021 to 16th March 2022. Data collection was carried out through a structured interview questionnaire aimed to gather the nurses’ general characteristics and an observational checklist to assess the nurses’ pre, during and post practices regarding peripheral cannulation technique.ResultsAccording to general practice, 43.6% of nurses had an average level, 29.7% had a good level, and 26.7% had a poor level of practice in the evaluation of the peripheral cannulation technique. Our study also showed a positive association between socio-demographic characteristics of the studied samples with the overall level of practice regarding peripheral cannulation technique.ConclusionsNurses were not practised peripheral cannulation technique appropriately; however, half of the nurses’ had an average level of practice, although their practices were not followed the standard protocols.

BIO23: Hyperthermic Extracorporeal Applied Tumor Therapy (HEATT®) for Treatment of Advanced, Unresponsive, Hospice Eligible Cancer Patients: Update

Purpose: HEATT® is veno-venous perfusion-induced systemic hyperthermia with a heart-lung pump, dialysis, blood sorbent, and CO2/pH control with flow at 20% of cardiac output to homogeneously increase core temperature to 42°C for 120 min while normalizing fluid and electrolyte changes. Two Phase 1 FDA trials (advanced lung, ovarian cancer), demonstrated safety and efficacy. We are reporting progress on an open label, non-randomized, early feasibility, single dose of HEATT® to treat select cancer patients with persistent or recurrent unresectable cancers unresponsive to chemo-, immuno-, and/or curative therapy. Method: Informed consent was obtained. Exclusion criteria: recent brain surgery, metastasis or stroke; organ failure; sepsis; or active bleeding. HEATT® uses 13-17 Fr Femoral-Jugular cannulas placed by image guidance in a veno-venous circuit. All individual components are FDA approved. Upon general anesthesia and systemic anticoagulation, Interventional Radiology placed a triple lumen central line, arterial line, and IVC/SVC venous cannula at L2 for drainage and at SVC/RA junction for infusion of heated blood for a targeted 20% cardiac output flow to increase core temperature to 42°C for 120 min. Patients are cooled to 38°C, then recovered. Results: All patients met criteria and were hospice eligible with a mean predicted survival of 90 days. Primary cancers included ovarian (5), colon (2), breast (2), lung (1), pancreatic (1), cholangiocarcinoma (1), and lipo-sarcoma (1). All achieved 42°C core temperature for 120 min with stable hemodynamics, heat transfer, and circuit dynamics. No complications were identified specific to HEATT®. Length of stay was 2-4 days including treatment, 12/13 survived to 30-day all-cause mortality, while 1/13 died of pulmonary hemorrhage from multiple metastasis. Eight of 13 exceeded expected median survival, 6/13 exceeded 180 day predicted maximum end-of-life. Four are alive and active at 500, 386, 360, and 288 days (Max 530). Twelve of 13 recovered to receive additional therapies. Frailty, age >80, and immobility negatively impact recovery. HEATT® does not predictably relieve tumor obstruction. Summary: We recommend HEATT® for treatment of advanced cancer patients unresponsive to conventional treatments.

P25: Assessment of VentriFlo True Pulse Pump in Cardiopulmonary Bypass Circuit In vivo

Objective: The objective of this study was to evaluate the hemodynamic and laboratory data during the post-cardiopulmonary bypass (CPB) phase in vivo in cardiovascular surgery utilizing the VentriFlo True Pulse Pump, a novel pulsatile extracorporeal blood pump capable of generating a natural-like pulse through standard oxygenators, cannulas, and tubing sets. Methods: The surgical procedure in porcine animal model (n=2, weight 26 and 23 kg) consisted of full median sternotomy access, central aortic cannulation, transatrial venous cannula insertion under general anesthesia. The intended duration of 3 hours has been maintained. In one case, a roller pump (RP) has been instituted. Second case has received the VentriFlo pulsatile pump (VentriFlo Inc., Pelham, NH). Hemodynamics were recorded during the CPB support period and for 3 hours post-CPB, and blood sampling was performed every hour. Results: The aortic pulse pressure was consistently higher with the VentriFlo pump compared to the RP (47 mm Hg vs. 25 mm Hg) (Figure 1). Although the pump flow during CPB was comparable (Both approximately 1.3 L/min), cardiac output was higher in the VentriFlo pig during the post-CPB period (1-3 hours) compared to the RP pig (2.2 L/min vs. 1.1 L/min). Regarding blood tests, the RP group exhibited a higher white blood cell count (21,800/uL vs. 13,150/uL in the VentriFlo pig). Conclusion: The VentriFlo pulsatile pump demonstrated the capability to deliver and maintain normal pulsatile flow and optimal cardiac output during and after CPB. More studies will be necessary to elucidate longer duration postoperative outcomes in cardiovascular surgical setup.Figure 1. Left – Aortic pulse pressure during the study. Middle – cardiac output post CPB. Right – WBC, white blood cell count. CPB, cardiopulmonary bypass.

P52: ECMO Circuit Exchange on a Single Pump Console: Maximizing Mechanical Circulatory Support Resources in the High Census Pediatric Environment

Background: Pediatric hospitals have faced an unprecedented period of high census due to a confluence of respiratory illnesses, resulting in increased use of ECMO for rescue and long-term therapy. Combined with equipment demands imposed by a cardiac surgical program, ECMO disposables and pump console inventories have been stretched to their limits in many centers. Circuit exchanges place additional burden on device numbers, as two pump consoles are typically used for the changeout procedure. We report the case of an infant cardiac surgical patient requiring ECMO circuit exchange while the remainder of appropriately sized systems were in use on other patients in the hospital. Methods: A 3kg infant with complex congenital heart disease on VA ECMO post repair required circuit exchange due to consumptive coagulopathy and significantly increased trans-oxygenator gradient after multiple weeks of support. Due to a concurrent period of high ECMO utilization, a size appropriate replacement system was unavailable. In our institution, cardiac patients under 20kg requiring mechanical circulatory assistance are supported on a roller system with multiple pump heads, allowing conversion from ECMO to cardiopulmonary bypass without exposing the patient to an additional circuit and associated sequalae. After careful planning, the decision was made to build and prime a replacement circuit on the currently used pump base, using one of the accessory roller heads to de-air and recirculate the system. The pump-mounted oxygen tank was used to oxygenate the blood-primed circuit, and an extra heater was used to bring the perfusate up patient temperature. Three-way stopcocks placed on the venous, pre-, and post-oxygenator transducers allowed simultaneous pressure monitoring of both circuits. After a period of recirculation, the new infusion and return lines were handed up to the field and marked with white tape to denote new versus old tubing. A brief period off support was well tolerated as the circuits were changed out at the arterial and venous cannula connections, and subsequently the old circuit was removed from the pump base and discarded. Sweep control was re-established by the on-board mixer and flow meters, and water lines were reconnected to the on-board heater.

Integrative respiratory support during thoracoabdominal aortic aneurysm repair in a patient with severe lung disease: a case report

BackgroundThoracoabdominal aneurysm repair is a highly complicated procedure, especially among patients with severe lung disease, resulting in respiratory problems during and after the surgery. Herein, we designed a novel intraoperative respiratory support to address this.Case presentationAn open thoracoabdominal aortic aneurysm repair was performed on a 65-year-old man who had severe chronic obstructive pulmonary disease with a giant right lung bulla. One-and-a-half lung ventilation by left lower lobe blockade was maintained during the operation to avoid right barotrauma. Cardiopulmonary bypass (CPB) was established with venous cannulas in the right internal jugular vein and left femoral vein for elective venovenous extracorporeal membrane oxygenation (VV-ECMO). After aortic repair and withdrawal from CPB, the VV-ECMO was consecutively initiated using the same circuit by connecting the arterial cannula to the right internal jugular venous cannula. The patient maintained adequate oxygenation during hemostasis under the support of VV-ECMO after protamine was administered. He was weaned from VV-ECMO in the operating room and discharged without any complications.ConclusionPartial bronchial blockage and intraoperative VV-ECMO using the same circuit of CPB were useful methods for severe lung disease during a thoracoabdominal aortic repair.

Comparison of Plasma Levels of Metanephrines Obtained by Direct Venipuncture vs Indwelling Intravenous Cannula in Hypertensive Patients

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Reducing blood sample hemolysis in the emergency department using S-Monovette® in aspiration mode

BackgroundBlood sample hemolysis continues to be a significant problem in clinical practice. In vitro hemolysis rates up to 77% have been reported in literature. The use of manual aspiration techniques for blood sampling has previously been shown to reduce the burden of erythrocyte injury in the pre-analytical phase compared to the vacuum collection technique. This study compares the hemolysis rates between two blood sampling methods: 5.0 ml BD Vacutainer® SST™ (BDV) and 4.9 ml S-Monovette® serum gel tubes in aspiration mode (SMA). MethodsThis was a prospective randomised controlled study conducted in an Emergency department (ED). A convenience sample of 191 adult patients, aged 18–90 years old, presenting at the ED and requiring blood samples for serum electrolyte was included in the study. Paired blood samples were obtained through an intravenous cannula from each patient with randomised order of blood draw using SMA or BDV. Patient data was obtained and hemolysis index (HI), serum lactate dehydrogenase (LDH), and serum potassium (K) levels measured. ResultsThe adjusted mean HI (35.2 vs 21.5 mg/dL, p < 0.001), serum K (4.38 vs 4.16 mmol/L, p < 0.001) and LDH levels (259.6 vs 228.4 U/L, p < 0.001) were significantly higher in blood samples taken using BDV compared to SMA. The frequency of severely hemolyzed (>150 mg/dL) samples was also higher in blood collected using BDV (16.2%) compared to SMA (0%). ConclusionsThe burden of hemolysis in blood samples taken from IV cannulae can be effectively reduced with the use of manual aspiration using the S-Monovette® blood collection system as compared to BD-Vacutainer.

Simulation-based perioperative anaesthesia information management practice: cross-sectional study.

Pre-interventional and post-interventional cross-sectional study was conducted from 21 June to 25 July 2022 on 164 anaesthesia record filled by 51 anaesthesia care provider in pre-interventional and post-interventional phase. Data were collected using a semi-structured questionnaire and the data entered by Epi-data software (version 4.6) and analyzed by using SPSS version 26. For all indicators, the projected completion rate was 100%. Indicators with completion rates of greater than 90% were classified as acceptable, while those with completion rates of 50% were seen as urgently needing improvement. Pre-interventional result: among all indicators, none of the indicators had 100%, completeness rate. Postoperative nausea and vomiting management orders, the names of the surgeon and anaesthetist, the location of the intravenous cannula, the maintenance of anaesthesia, the total amount of fluid supplied, the content of the consent discussion, and null per ose status, age, and weight of the patient were some of the markers that were identified below average (50%) and in need of significant improvement. Post-interventional result: when compared with the pre-interventional result, their documentation skills were improving after discussions with stakeholders and the relevant bodies; however, none of the indicators attained 100% completion rate. Even after the interventions, the desired completion rate was not attained. As a result, it requires ongoing instruction on perioperative anaesthesia information management according to the standard perspectives.

Establishing Pediatric Reference Ranges for Rotational Thromboelastometry.

The aim of our investigation was to establish normal pediatric reference intervals (PRIs) for rotational thromboelastometry (ROTEM) Delta assays in a representative group of healthy children, 0 to 18 years of age, at our institution. This was a prospective study of healthy pediatric patients undergoing elective minor surgery requiring placement of an intravenous cannula. The sample size for patients was 20 per age group of either sex from 5 different age groups based on coagulation system maturity: 0 to 6 or fewer months, more than 6 to 12 or fewer months, more than 1 year to 5 or fewer years, more than 5 to 11 or fewer years, and more than 11 to 18 or fewer years. ROTEM Delta assays assessed include the EXTEM, INTEM, and FIBTEM. We defined 2 sets of ROTEM PRIs for our patient population: one for patients 11 years or younger and one for children more than 11 years of age. For those 11 years or younger, the PRIs were derived from the 2.5th and 97.5th percentiles from the 0 to 11 age groups. For those older than 11 years, previously published adult reference intervals validated internally with adult normal samples were used. The 2 sets of PRIs were embedded into our electronic medical record, allowing clinicians to easily interpret their patient's ROTEM results against age-verified reference ranges, enabling them to make informed transfusion decisions.

Unrecognized Patent Foramen Ovale in Patient With Sinus Venosus-Type Atrial Septal Defect With Partial Anomalous Pulmonary Venous Return.

Unrecognized Patent Foramen Ovale in Patient With Sinus Venosus-Type Atrial Septal Defect With Partial Anomalous Pulmonary Venous Return.

Experience with percutaneous right ventricular support in the early post-left ventricular assist device implantation period (clinical case report and literature reviews)

Implantable left ventricular assist device (LVAD) is a state-of-the-art treatment for adults and children with end-stage heart failure. The early and late period after LVAD implantation can be severely complicated. Right ventricular failure (RVF) still remains a common complication after LVAD implantation. RVF is the cause of reduced post-implant survival. We suggest that an additional temporary or permanent right ventricular assist device (RVAD) is an effective treatment for LVAD-associated RVF. In this clinical case report, we describe the medical history of a pediatric patient (14 years old) with severe heart failure (PediMACS Level 1) against a background of dilated cardiomyopathy. The patient required peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) prior to urgent LVAD (HM3) implantation. In the early post-LVAD implantation (1 POD) period, the patient presented with hemodynamic and echocardiographic events of acute RVF that was resistant to drug therapy (inotropic/vasopressor support, iNO) and required mechanical circulatory support (MCS) with a preoperatively implanted VA-ECMO. In the LVAD-associated RVF scenario, VA-ECMO as a means of total cardiac bypass is a non-physiological MCS method and, therefore, undesirable. In this clinical situation, our solution was to use a paracorporeal centrifugal blood pump for temporary right heart support. A RVAD was assembled using percutaneous cannulation in two sites and a modification of the pre-existing VA-ECMO circuit. For RVAD, we used an ECMO cannula previously installed through the femoral vein (26 F) and added a reverse venous cannula (22 F) through the right internal jugular vein into the pulmonary trunk. To facilitate the passage of the return cannula into the pulmonary artery, we used a contralateral sheath (6 F, 40 cm) and an Amplatz Super Stiff guidewire under radiological control. The oxygenator was removed from the circuit on day 2 of RVAD. Central hemodynamics (reduction in right atrial pressure (RAP) to 10 mm Hg, increase in pulmonary capillary wedge pressure (PCWP) to 14 mm Hg), as well as right ventricular (RV) and left ventricular (LV) volume characteristics all improved. These observations allowed us to optimize the performance of the implantable LVAD (increase in flow rate to 4.2 l/min or 2.1 l/min/m2). The duration of paracorporeal RVAD after LVAD implantation was 7 days with an average flow rate of 2.3 ± 0.2 l/min. Postoperative treatment in the intensive care unit (ICU) lasted for 15 days. The patient was discharged from the hospital on postoperative day 34.

Combined Transarterial and Inferior Ophthalmic Vein Approach to a Direct Carotid-Cavernous Fistula: Technical Note

We describe our rescue technique for direct puncture of the inferior ophthalmic vein (IOV) for transvenous access of a direct, high-flow carotid-cavernous fistula (CCF). The CCF was caused by rupture of a large internal carotid artery aneurysm. Aneurysm and fistula embolization solely via the transarterial approach did not appear promising due to partial aneurysm thrombosis. Also, transvenous access via the facial vein failed due to extensive vessel tortuosity. Instead, the engorged and arterialized IOV was accessed by direct puncture with an 18-gauge venous cannula. After a small skin incision of the medial aspect of the lower eyelid and further transseptal puncture, the cannula was advanced stepwise between the maxillary bone and the bulbus oculi and below the medial rectus muscle to the IOV under repeated biplane roadmap guidance in 2 planes. Thereafter, the fistula and the aneurysm dome could be embolized with coils via a low-profile microcatheter. Hereby, a protective flow diverter was implanted via the arterial route into the internal carotid artery to seal the parent artery, prevent coil protrusion, and ensure permanent aneurysm occlusion. At 1-month follow-up, the aneurysm and CCF were completely occluded. Direct puncture of the IOV represents a feasible and minimally invasive approach for venous CCF access. The proposed method needs to be validated by further reports.

HDAC6 inhibition alleviates acute pulmonary embolism: a possible future therapeutic option.

Acute pulmonary embolism (APE) is a clinical syndrome of pulmonary circulation disorder caused by obstruction of the pulmonary artery or its branches. Histone deacetylase 6 (HDAC6) has been reported to play an important role in lung-related diseases. However, the functional role of HDAC6 in APE remains unclear. Male Sprague Dawley rats were used. The APE model was constructed by inserting an intravenous cannula into the right femoral vein and injecting Sephadex G-50 microspheres (12 mg/kg; 300 μm in diameter). After 1 h, the control and APE rats were intraperitoneally injected with tubastatin A (TubA) (40 mg/kg, an inhibitor of HDAC6) and sampled at 24 h after modeling. H&E staining, arterial blood gas analysis, and wet/dry (W/D) weight ratio were used to evaluate the histopathological changes and pulmonary function in APE rats. ELISA, Western blot, and immunohistochemistry were used to explore the potential mechanism of HDAC6-mediated inflammation in APE. The results indicated that HDAC6 expression was significantly increased in lungs of APE rats. TubA treatment in vivo decreased HDAC6 expression in lung tissues. HDAC6 inhibition alleviated histopathological damage and pulmonary dysfunction, as evidenced by decreased PaO2/FiO2 ratio and W/D weight ratio in APE rats. Furthermore, HDAC6 inhibition alleviated APE-induced inflammatory response. Specifically, APE rats exhibited increased production of pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6, and IL-18, however, this increase was reversed by HDAC6 inhibition. Meanwhile, the activation of the NLRP3 inflammasome was also observed in lungs of APE rats, while HDAC6 inhibition blocked this activation. Mechanically, we demonstrated that HDAC6 inhibition blocked the activation of the protein kinase B (AKT)/extracellular signal-regulated protein kinase (ERK) signaling pathway, a classic pathway promoting inflammation. These findings demonstrate that the inhibition of HDAC6 may alleviate lung dysfunction and pathological injury resulting from APE by blocking the AKT/ERK signaling pathway, providing new theoretical fundamentals for APE therapy.

The patients’ experience of neuroimaging of primary brain tumors: a cross-sectional survey study

PurposeTo gain insight into how patients with primary brain tumors experience MRI, follow-up protocols, and gadolinium-based contrast agent (GBCA) use.MethodsPrimary brain tumor patients answered a survey after their MRI exam. Questions were analyzed to determine trends in patients’ experience regarding the scan itself, follow-up frequency, and the use of GBCAs. Subgroup analysis was performed on sex, lesion grade, age, and the number of scans. Subgroup comparison was made using the Pearson chi-square test and the Mann–Whitney U-test for categorical and ordinal questions, respectively.ResultsOf the 100 patients, 93 had a histopathologically confirmed diagnosis, and seven were considered to have a slow-growing low-grade tumor after multidisciplinary assessment and follow-up. 61/100 patients were male, with a mean age ± standard deviation of 44 ± 14 years and 46 ± 13 years for the females. Fifty-nine patients had low-grade tumors. Patients consistently underestimated the number of their previous scans. 92% of primary brain tumor patients did not experience the MRI as bothering and 78% would not change the number of follow-up MRIs. 63% of the patients would prefer GBCA-free MRI scans if diagnostically equally accurate. Women found the MRI and receiving intravenous cannulas significantly more uncomfortable than men (p = 0.003). Age, diagnosis, and the number of previous scans had no relevant impact on the patient experience.ConclusionPatients with primary brain tumors experienced current neuro-oncological MRI practice as positive. Especially women would, however, prefer GBCA-free imaging if diagnostically equally accurate. Patient knowledge of GBCAs was limited, indicating improvable patient information.

Venoarterial extracorporeal membrane oxygenation in acute myocardial infarction

Venoarterial extracorporeal membrane oxygenation in acute myocardial infarction

Whole Body Retrograde Perfusion Combined With Central Aortic Perfusion Strategy in the Repair of Distal Arch Pathology Through a Lateral Thoracotomy

ObjectiveTo compare the results of the hypothermic circulatory arrest (HCA) + retrograde whole-body perfusion (RBP) technique with those of deep hypothermic circulatory arrest (DHCA-only) approach. MethodsLimited data are available on cerebral protection techniques when distal arch repairs are performed through a lateral thoracotomy. In 2012, the RBP technique was introduced as adjunct to HCA during open distal arch repair via thoracotomy. We reviewed the results of the HCA + RBP technique compared with those of the DHCA-only approach. From February 2000 to November 2019, 189 patients (median age, 59 [IQR, 46 to 71] years; 30.7% female) underwent open distal arch repair via lateral thoracotomy to treat aortic aneurysms. The DHCA technique was used in 117 patients (62%, median age 53 [IQR, 41 to 60] years), whereas HCA + RBP was used in 72 patients (38%, median age 65 [IQR, 51 to 74] years). In HCA + RBP patients, cardiopulmonary bypass was interrupted when systemic cooling achieved isoelectric electroencephalogram; once the distal arch had been opened, RBP was then initiated via the venous cannula (flow of 700 to 1000 mL/min, central venous pressure <15 to 20 mm Hg). ResultsThe stroke rate was significantly lower in the HCA + RBP group (3%, n=2) compared with the DHCA-only (12%, n=14) (P=.031), despite longer circulatory arrest times in HCA + RBP compared with the DHCA-only (31 [IQR, 25 to 40] minutes vs 22 [IQR, 17 to 30] minutes, respectively; P<.001). Operative mortality for patients undergoing HCA + RBP was 6.7% (n=4), whereas for those undergoing DHCA-only it was 10.4% (n=12) (P=.410). The 1-, 3-, and 5-year age-adjusted survival rates for the DHCA group are 86%, 81%, and 75%, respectively. The 1-, 3-, and 5-year age-adjusted survival rates for the HCA + RBP group are 88%, 88%, and 76%, respectively. ConclusionThe addition of RBP to HCA in the treatment of distal open arch repair via a lateral thoracotomy is safe and provides excellent neurological protection.

Sex Differences in Epidemiology, Care, and Outcomes in Patients With Acute Chest Pain

BackgroundDiscrepancies in cardiovascular care for women are well described, but few data assess the entire patient journey for chest pain care. ObjectivesThis study aimed to assess sex differences in epidemiology and care pathways from emergency medical services (EMS) contact through to clinical outcomes following discharge. MethodsThis is a state-wide population-based cohort study including consecutive adult patients attended by EMS for acute undifferentiated chest pain in Victoria, Australia (January 1, 2015, to June 30, 2019). EMS clinical data were individually linked to emergency and hospital administrative datasets, and mortality data and differences in care quality and outcomes were assessed using multivariable analyses. ResultsIn 256,901 EMS attendances for chest pain, 129,096 attendances (50.3%) were women, and mean age was 61.6 years. Age-standardized incidence rates were marginally higher for women compared with men (1,191 vs 1,135 per 100,000 person-years). In multivariable models, women were less likely to receive guideline-directed care across most care measures including transport to hospital, prehospital aspirin or analgesia administration, 12-lead electrocardiogram, intravenous cannula insertion, and off-load from EMS or review by emergency department clinicians within target times. Similarly, women with acute coronary syndrome were less likely to undergo angiography or be admitted to a cardiac or intensive care unit. Thirty-day and long-term mortality was higher for women diagnosed with ST-segment elevation myocardial infarction, but lower overall. ConclusionsSubstantial differences in care are present across the spectrum of acute chest pain management from first contact through to hospital discharge. Women have higher mortality for STEMI, but better outcomes for other etiologies of chest pain compared with men.

Effectiveness of Intermittent Normal Saline Flush to Maintain the Patency of Intravenous Cannula among Children Admitted in Pediatric Wards of Tertiary Center of Eastern Nepal

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Peripheral parenteral nutrition in surgery – a systematic review and meta-analysis

Peripheral parenteral nutrition (PPN) refers to the delivery of artificial nutrition via a peripheral intravenous cannula. As a nutritional intervention it remains under-utilised in peri-operative care. This is despite purported advantages which includes avoiding the risks associated with central venous lines and preventing potential delays to the initiation of nutrition support. This systematic review and meta-analysis will detail the available evidence for PPN use in surgery. A comprehensive search of the EMBASE and Medline databases was undertaken to identify randomised control trials (RCTs) involving PPN use in surgical patients published until July 30th 2022. Three domains of PPN use were reviewed including: PPN compared to crystalloid intravenous fluids on nutritional and clinical outcomes; PPN compared to Central PN (CPN) on nutritional outcomes and complications; and strategies to prevent thrombophlebitis associated with PPN. The meta-analysis included 8 studies which included 698 patients. Use of PPN led to reduced post-operative weight loss (% body weight change) with a mean difference of-1.45% (95% CI -2.9 to-0.01, p=0.05). There was no statistically significant difference in terms of length of stay, infectious/non-infectious complications, surgical site infections or phlebitis. 42 RCTs were included in the systematic review. 14 RCTs compared PPN to crystalloid infusion. There was significant heterogeneity in the trial populations, interventions and measured outcomes. Most trials found that PPN may improve nitrogen balance and positively impact nutritional markers. Quality of life and post-operative complications were either improved or no difference found in trials assessing these outcomes. Four RCTs showed that PPN is a safe and feasible alternative to CPN. 22 RCTs reported on measures that may impact on thrombophlebitis rates associated with PPN. These included lower osmolality of PPN solution, cyclical PPN delivery, use of a small gauge polyurethane cannula in an upper limb vein, addition of heparin/hydrocortisone to PPN solutions and placement of a GTN patch over infusion sites. PPN is a safe and effective mode of delivery of peri-operative nutrition. It is a feasible short-term alternative to central-line delivered PN. There are a number of strategies to reduce thrombophlebitis associated with PPN use. Further high-quality RCTs are required to assess the use of PPN in contemporary surgical practice.

Evaluation Nurses’ Practices During Intravenous Canulation for Children in the Emergency Units

Background: Increasing risks and complications with IV cannulation making this issue a research focus of several authors around the world. In addition, it was reported that emerged complications with IV cannulation could be phlebitis, infiltration, extravasation, infection, and pain. Aims of the study: This study aimed to evaluate nurses’ practices during intravenous canulation for children in the emergency units. Methodology: A mixed method research design was used in this study specifically (Convergent parallel: Quantitative and qualitative approach). The study was initiated from October 15th, 2021, through June 28th, 2022. A non-probability (Purposive) sample was selected of 25 nurses who work at Alzahraa teaching hospital. The data was collected using a previously prepared questionnaire and official agreement to use the study questionnaire was obtained from the original author. Descriptive statistics (frequencies, percentages, mean, and standard deviation) and inferential statistics (contingency coefficient) were used in the data analysis. Results: Findings declared by most of nurses that they have practice deficit about pediatric cannulation, especially at the first time of their work. Participant 7 said that “even though we got knowledge about IV cannulation during our education journey in nursing college, but it is not enough to be proficient to perform this procedure as an expert. We have limited knowledge and practices about performing procedures in pediatric patients who are different from adult patients”. Conclusion: The study concluded that Several themes were emerged from nurses’ responses to the main research question “What are the barriers that confronting nurses' practices during insertion of intravenous cannula to children in emergency room? The major themes were nurses’ related barriers; organization’s related barriers; patients’ related barriers; and opportunities and solutions for barriers. Recommendations: Efforts from the ministry of Health in Iraq should be targeted toward supplying pediatric emergency nurses with all facilities that assist their work focusing on availability of IV viewer.