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Critical Care
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Jaimie Maines, Lauren A. Plante
Central venous catheters can be used to administer medications, fluids, and monitor changes to central venous pressure in response to interventions. Arterial catheters allow for instantaneous and continuous blood pressure monitoring and arterial blood gas analysis. Due to the gravid uterus and proximity of the femoral vessels to the areas involved in vaginal and cesarean delivery, access via the femoral artery and vein should generally be avoided. Some critical care techniques (e.g., the pulmonary artery or Swan-Ganz catheter) have largely disappeared from critical care practice [63]. Noninvasive or minimally invasive hemodynamic monitors have become more common.
Nursing Considerations in Necrotizing Enterocolitis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
Margaret Birdsong, Michelle Felix
Central venous catheters (CVC) are essential for the safe delivery of electrolytes, nutrition, and medications in patients with necrotizing enterocolitis (NEC) and who are critically ill, cannot receive nutrition or medication by mouth, or need secure emergent or long-term venous access (2, 3, 8, 16, 19). The typically used catheters are made from silicone or polyurethane with indications for short- and long-term use and can be inserted in a peripheral (peripherally inserted central catheter [PICC]) or central vein (nontunneled, tunneled, or implantable port also known as an infusaport) with a single lumen or multiple lumens (3). The type of line placed in the patient will be determined by patient stability and comorbidities, purpose of the line, history of previous CVCs, patient size, therapy, and the practitioner's skills/training (16). This chapter will assess the use and care of central venous catheters from the perspective of the bedside nurse.
Duodenal atresia and stenosis
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Afif N. Kulaylat, Colin G. DeLong, Simon Clarke, Robert E. Cilley
Postoperative care consists primarily of supportive measures to provide nutrition while awaiting the return of intestinal function. Immediate enteral feeding can be started if a transanastomotic tube is placed at the time of the initial operation. Transanastomotic feeding may reduce parenteral nutrition use and improve the time to oral feeding. The disadvantages of transanastomotic feeding include tube dislodgment and intestinal injury. Parenteral nutrition may be used to provide nutritional support postoperatively. To minimize the risks of parenteral nutrition (especially hepatotoxicity), total calories, protein, and fat intake should be kept at the lowest levels possible to allow growth. Peripherally inserted central venous catheters are used commonly.
SARS-CoV-2-infection in the setting of autotransplants for multiple sclerosis
Published in Hematology, 2023
Juan Carlos Olivares-Gazca, Robert Peter Gale, Daniela Sánchez-Bonilla, Moisés Manuel Gallardo-Pérez, Silvia Soto-Olvera, Guillermo J. Ruiz-Delgado, Guillermo José Ruiz-Argüelles
Clinical and laboratory co-variates are displayed in the Table 1. Subjects were previously treated for multiple sclerosis. 2 were vaccinated against SARS-CoV-2 163 and 58 days pretransplant. Real time quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) testing for SARS-CoV-2 on day-12 in the 3 subjects pretransplant was negative (TaqPath™ 1-Step Multiplex Master Mix. Thermo Fisher, Frederick MD, U.S.A.). SARS-CoV-2 antigen and antibodies testing were not done. Subjects were likely infected on day-3 when a central venous catheter in hospital. On day +7 SARS-CoV-2-infection was detected by qRT-PCR TaqPath™ 1-Step Multiplex Master Mix. Thermo Fisher, Frederick MD, U.S.A.); threshold cycle levels indicated a high viral burden. At this time the subjects had low blood concentrations of granulocytes and lymphocytes but remained asymptomatic and received no anti-viral therapy. SARS-CoV-2 antigen tests done by means of Panbio Abbott Covid-19 Ag rapid tests device (Abbott, Jena, Germany) were negative on days +14, +14 and +16, but qRT-PCR tests remained positive. Subjects were instructed to postpone rituximab therapy until they became SARS-CoV-2 qRT-PCR test negative [5]. Sequencing studies revealed that the same virus infected the patients.
Chlorhexidine gluconate (CHG) foam improves adherence, satisfaction, and maintains central line associated infection rates compared to CHG wipes in pediatric hematology-oncology and bone marrow transplant patients
Published in Pediatric Hematology and Oncology, 2023
Zachary D. Prudowsky, Kandice Bledsaw, Sharon Staton, Mark Zobeck, Janet DeJean, Lindsay Johnson-Bishop, Anil George, David Steffin, Alexandra Stevens
Pediatric patients with cancer or undergoing hematopoietic stem cell transplantation (HSCT) typically receive intensive chemotherapy regimens, leading to immune compromise. Additionally, patients are given central venous catheters (CVCs) to maintain long-term trustworthy intravenous (IV) access for chemotherapy and supportive medications. These factors render such patients vulnerable to central line-associated blood stream infections (CLABSIs), a relatively common life-threatening complication where bacteria gain access to the bloodstream. Primary CLABSIs are blood stream infections not linked to an already known infection source and are often due to direct entry into the bloodstream from central line site contamination and can consist of native skin bacteria such as coagulase-negative staphylococcus (CoNS). Mucosal barrier injury-associated blood stream infections (MBI-CLABSIs) are due to enteric pathogens that gain access to the bloodstream through co-morbidities such as mucositis, typhlitis, and graph-versus-host disease (GVHD).1,2 A recent multi-institutional study reported that primary CLABSIs and MBI-CLABSIs had 5% and 7% 30-day mortality rates in pediatric Hematology-Oncology patients, respectively; additionally, children undergoing HSCT had 30-day mortality rates of 6%.3 CLABSIs also prolong hospitalizations and accrue significant healthcare-associated costs.4 Preventative measures are necessary to provide optimal care and better overall outcomes for these vulnerable patients.
Comparison of intermittent versus continuous infusion of 3% hypertonic saline on intracranial pressure in traumatic brain injury using ultrasound assessment of optic nerve sheath
Published in Egyptian Journal of Anaesthesia, 2022
Amr Samir Wahdan, Ahmed Abdallah Al-Madawi, Khaled Abdelrahman El-Shafey, Safinaz Hassan Othman
On admission to N-ICU, the baseline characteristic data of patients were collected from the medical records of the local trauma database (e.g., age, sex, weight, body mass index [BMI], comorbidity, Injury Severity Score, AIS, and injury diagnosis). Hemodynamics (mean heart rate [HR], MAP, temperature, and oxygen saturation [SpO2]) were then evaluated, and routine laboratory tests (complete blood count, Na, potassium [K], serum urea, serum creatinine, alanine transaminase, aspartate transaminase, international normalized ratio, prothrombin concentration, lactate, bilirubin, plasma osmolarity, and blood gases) were performed. A central venous catheter was inserted. Additionally, at this time, the GCS scores, Simplified Acute Physiology Score (SAPS II), and Acute Physiology and Chronic Health Evaluation (APACHE II) scores were measured.