Routine Changing of Intravenous Administration Sets Does Not Reduce Colonization or Infection in Central Venous Catheters

Objective: To determine the effect of routine intravascular administration-set changes on central venous catheter (CVC) colonization and catheter related bacteremia (CRB). Design: Prospective, randomised controlled trial Setting: 18-bed ICU in a University-affiliated, tertiary referral hospital. Participants: 404 chlorhexidine and silver sulfadiazine coated multi-lumen CVCs from 251 intensive care unit (ICU) patients. Interventions: After ethical approval, CVCs inserted in ICU and in situ on Day 4 were randomised to have their administration-sets changed on Day 4 (n = 203) or not at all (n = 201). Fluid container and blood product administration-set use was limited to 24 hours. CVCs were removed (Day 7, not required or suspected infection), and cultured for colonization ( 15 cfu). Medical and laboratory staff were blinded. CRB was diagnosed by a blinded intensivist using strict definitions. Data was collected on; catheter life, CVC site, APACHE II score, patient age, diagnosis, hyperglycemia, hypoalbuminemia, immune status, number of fluid containers and intravenous injections, propofol, blood, TPN or lipid infusion. Results: There were 10 colonized CVCs in the set change group and 19 in the no change group. This was not a statistically significant difference on Kaplan Meier survival analysis (Effect Size = 0.09, Log Rank = 0.87, df = 1, p = 0.35). There were 3 cases of CRB per group. Logistic regression found that burns diagnosis and increased ICU stay were the only factors that significantly predicted colonization (p < 0.001). Conclusions: Intravenous administration-sets can be used for 7-days. Routine administration-set changes are unnecessary before this time

Measurement of tissue cortisol levels in patients with severe burns: a preliminary investigation

Introduction The assessment of adrenal function in critically ill patients is problematic, and there is evidence to suggest that measurement of tissue glucocorticoid activity may be more useful than estimation of plasma cortisol concentrations. Interstitial cortisol concentrations of cortisol represent the available pool of glucocorticoids able to enter the cell and bind to the glucocorticoid receptor. However the concentrations of plasma cortisol may not accurately reflect interstitial concentrations. We elected to perform a preliminary study into the feasibility of measuring interstitial cortisol by microdialysis, and to investigate the relationship between total plasma cortisol, free plasma cortisol and interstitial cortisol in patients with severe burns

Is inhaled prophylactic heparin useful for prevention and management of pneumonia in ventilated ICU patients?

Purpose: The purpose was to determine the efficacy of prophylactic inhaled heparin for the prevention and treatment of pneumonia in patients receiving mechanical ventilation (MV)

Deliver us from Evil: The Effects of Mortality Salience and Reminders of 9/11 on Support for President George W. Bush

According to terror management theory, heightened concerns about mortality should intensify the appeal of charismatic leaders. To assess this idea, we investigated how thoughts about death and the 9/11 terrorist attacks influence Americans’ attitudes toward current U.S. President George W. Bush. Study 1 found that reminding people of their own mortality (mortality salience) increased support for Bush and his counterterrorism policies. Study 2 demonstrated that subliminal exposure to 9/11-related stimuli brought death-related thoughts closer to consciousness. Study 3 showed that reminders of both mortality and 9/11 increased support for Bush. In Study 4, mortality salience led participants to become more favorable toward Bush and voting for him in the upcoming election but less favorable toward Presidential candidate John Kerry and voting for him. Discussion focused on the role of terror management processes in allegiance to charismatic leaders and political decision making.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Intravascular Administration Sets are Accurate and in Appropriate Condition after 7 Days of Continuous Use: an in vitro Study

Background. The ideal duration of intravascular administration set use is unknown. Studies have compared the infective implications of one to seven days of use. The Centers for Disease Control recommend at least three days usage. No previous study has evaluated the accuracy of volume delivery or integrity of administration sets after prolonged use. Aim. To evaluate the accuracy and condition of intravascular administration sets used continuously for 7 days. Design. Prospective, randomised, experimental study in the laboratory setting. Methods. Four administration sets were randomly assigned to deliver 2 mL/h (IMED syringe set 2280-0000), 20, 50 or 100 mL/h (IMED infusion sets 2210-0500) of crystalloid solution continuously for 7 days through an IMED Gemini four channel infusion pump (PC4). At study commencement and daily for 7 days, a 4 hour volume measurement and an inspection for leaks/erosion of administration sets occurred for each administration set (total measurements = 32). Results. Mean volume outputs over four hours were 7.84mL (2mL/h), 80.66 mL (20mL/h), 205.35 (50 mL/h) and 406.37 (100 mL/h). These differed significantly from the programmed volumes (p = 0.00 – 0.01). Usage duration did not influence performance (F = 0.866, p = 0.55). Accuracy of volume delivery differed significantly with pump speed (F = 106.933, p < 0.001) exhibiting increased volume to 50 mL/h then a reduction at 100 mL/h. Differences were within manufacturer specifications (+/- 5%) and were clinically acceptable. All administration sets remained in appropriate condition displaying no leakage or erosion. Conclusion. There were small inaccuracies found between programmed and delivered volumes however there was no deterioration in performance over time. This suggests that inaccuracies were due to normal pump performance rather than the administration sets. Administration sets retain acceptable accuracy and condition after 7 days continuous use. Further research should assess the infective and other impacts of prolonged usage

Management of invasive candidiasis in the intensive care unit

Invasive candidiasis (IC) is an important infection in the intensive care unit (ICU) setting given its association with poor clinical outcomes. The epidemiology of IC is complex and, although incompletely elucidated, is characterized by considerable regional and temporal variability. Overall, there appears to be an increase in the incidence of IC and a change in distribution of the causative Candida spp. Of particular concern is an increase in the proportion of episodes caused by Candida glabrata, which is associated with reduced susceptibility to azole antifungal agents

A randomised controlled study of the efficacy of hypromellose and Lacri-Lube combination versus polyethylene/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient

Objective. To compare the efficacy of two forms of eye care (hypromellose and Lacri-Lube combination vs polyethylene/Cling wrap covers) for intensive care patients. Design. Randomised-controlled trial. Setting. University affiliated, tertiary referral hospital. Patients and participants. One hundred ten patients with a reduced or absent blink reflex were followed through until they regained consciousness, were discharged from the facility during study enrolment, died or developed a positive corneal ulcer or eye infection. Interventions. All patients received standard eye cleansing every 2 h. In addition to this, group one (n=60) received a treatment combining hypromellose drops and Lacri-Lube (HL) to each eye every 2 h. Group two (n=50) had polyethylene covers only placed over the eye to create a moisture chamber. Measurements and results. Corneal ulceration was determined using corneal fluorescein stains and mobile slit lamp evaluation, performed daily. No patients had corneal ulceration in the polyethylene cover group, but 4 patients had corneal ulceration in the HL group. Conclusions. Polyethylene covers are as effective as HL in reducing the incidence of corneal damage in intensive care patients

Routine changing of intravascular administration sets does not reduce colonisation or infection in central venous catheters

Objective: To determine the effect of routine intravascular administration-set changes on central venous catheter (CVC) colonization and catheter related bacteremia (CRB).\ud \ud Design: Prospective, randomised controlled trial\ud \ud Setting: 18-bed ICU in a University-affiliated, tertiary referral hospital.\ud \ud Participants: 404 chlorhexidine and silver sulfadiazine coated multi-lumen CVCs from 251 intensive care unit (ICU) patients.\ud \ud Interventions: After ethical approval, CVCs inserted in ICU and in situ on Day 4 were randomised to have their administration-sets changed on Day 4 (n = 203) or not at all (n = 201). Fluid container and blood product administration-set use was limited to 24 hours. CVCs were removed (Day 7, not required or suspected infection), and cultured for colonization ( 15 cfu). Medical and laboratory staff were blinded. CRB was diagnosed by a blinded intensivist using strict definitions. Data was collected on; catheter life, CVC site, APACHE II score, patient age, diagnosis, hyperglycemia, hypoalbuminemia, immune status, number of fluid containers and intravenous injections, propofol, blood, TPN or lipid infusion.\ud \ud Results: There were 10 colonized CVCs in the set change group and 19 in the no change group. This was not a statistically significant difference on Kaplan Meier survival analysis (Effect Size = 0.09, Log Rank = 0.87, df = 1, p = 0.35). There were 3 cases of CRB per group. Logistic regression found that burns diagnosis and increased ICU stay were the only factors that significantly predicted colonization (p < 0.001).\ud \ud Conclusions: Intravenous administration-sets can be used for 7-days. Routine administration-set changes are unnecessary before this time