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Intrapleural chest drainage
Published in Philip Woodrow, Nursing Acutely Ill Adults, 2015
Clamping can convert an open pneumothorax into a life-threatening tension pneumothorax. Drains should only be clamped if disconnectedwhen changing collection chamberif there is excessive drainage (see above)moving the chamber above the patient is unavoidablebriefly, following any drug instillation (e.g. 1 hour for sclerosants (Roberts et al., 2010)).
Complications of Intravesical Therapy
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
Michael A. O’Donnell, José L. Maymí
Because of their larger molecular weights, systemic absorption of the anthracycline drugs is very low and systemic side effects very rare (60,61). Indeed, myelosuppression occurs in <1% of patients (17). Allergic reactions, primarily skin rash, have been reported in 2% of patients treated with Adriamycin® but have also been documented with epirubicin and valrubicin (62–64). These allergic reactions are usually treated according to their symptoms, mainly by using antihistaminic drugs and supportive measures. Fever (4%) and nausea/vomiting (1–2%) have also been reported (17). As with all intravesical drugs, integrity of the bladder wall is important in limiting absorption with lower levels of absorption found during later instillations. One severe local reaction with adriamycin and three with epirubicin (and one death) from bladder perforations have been reported (65,66). Yoshimura et al. described chemical pericystitis in a patient who underwent transurethral resection of the bladder tumor, with a subsequent instillation of Adriamycin (65). The patient had fever lasting more than 2 weeks, lower abdominal pain, and mild hydronephrosis of the left kidney. A computed tomography (CT) showed an irregular thickening of his left bladder wall. Due to symptom persistence, an exploratory laparotomy was performed. The left perivesical space was found replaced by a scar and edematous tissue. Yoshimura et al. presumed that extravasation of doxorubicin was responsible. Because classic signs of peritonitis may not always be present, a CT scan (preferably CT cystogram) should be performed in all suspected perforations after TURB and perioperative drug instillation. In one documented case of valrubicin leakage, no accompanying local untoward effects were observed (64). Valrubicin has also been used for intraperitoneal chemotherapy of ovarian disease (67).
Intravesical radiofrequency induced hyperthermia enhances mitomycin C accumulation in tumour tissue
Published in International Journal of Hyperthermia, 2018
F. Johannes P. van Valenberg, Antoine G. van der Heijden, Rianne J. M. Lammers, Johannes Falke, Tom J. H. Arends, Egbert Oosterwijk, J. Alfred Witjes
The median intravesical MMC dwell time was substantially longer for cold MMC instillation (94 min) compared to RF-CHT (50 min). This likely resulted in a higher total exposure to MMC in the cold MMC group. Assuming an average urine production of 50 mL/30 min, this implies that after 90 min and a starting dose of 40 mg MMC in 50 mL, the intravesical MMC concentration still is 0.2 mg/mL, being higher than the threshold of 0.12 mg/mL for effective MMC exposure [13]. In comparison, the MMC concentration after 30 min of RF-CHT using the lower dose of 20 mg MMC – as was done in our study – is 0.13 mg/mL [26]. Using hyperthermia, the MMC concentration is known to decrease much faster compared to cold MMC instillation due to additional dilution, absorption and degradation of the drug [26]. Thus, the longer intravesical dwell time for cold MMC merely underlines the observed advantage of RF-CHT over cold MMC in reaching higher MMC accumulation in tumour tissue. Additionally, optimalisation of the intravesical drug instillation by increasing dwell time, reducing drug dilution, inducing urine alkalinisation, and increasing dose to 2 mg MMC/mL is known to enhance efficacy [27].
Retrospective review of intrapleural therapy for pleural infections: “Real life” outcomes and challenges
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2018
Catherine Robitaille, Céline Dupont, David Valenti, Jonathan Spicer, Christian Sirois, Anne V. Gonzalez, Stephane Beaudoin
Our results highlight several metrics that have thus far received a minimal amount of attention in the literature. For example, the time from detection of pleural effusion to chest drain insertion and the time from chest drain insertion to the first dose of tPA or DNase were longer than anticipated and reported. Although a good success rate has been reported in other settings where intrapleural therapy was not started upfront,11 we suspect that a long delay may actually render this intervention less effective. We had a high rate of drain blockage and a higher re-intervention rate than previously reported. We think that this could be improved by adopting regular saline flushing protocols for chest drains, as has been previously recommended.2,13 The rate of incomplete therapy was surprisingly high compared to other studies. One of the presumed issues is that intrapleural drug instillation remains a physician-restricted activity at our center, which impeded strict adherence to the protocol.
A Randomized Controlled Clinical Trial to Compare Conventional Drug Instillation to A Device Dropper Method in Medical Treatment of Glaucoma
Published in Ophthalmic Epidemiology, 2022
Sharmila Rajendrababu, Shalini Kannan, Shilpa More, Mohammed Uduman S Sithiq, Subbaiah Ramasamy Krishnadas
In a study in South India, 42% of patients reported one or more problems in using their glaucoma medications, and around 6% reported less than 100% adherence or compliance to their medications.6 A patient’s inability to successfully instill an eye drop can have multiple consequences like inadequate IOP control that may have a major impact on vision.4 Improper drug instillation techniques may lead to drug spillage, increased drug reactions, dropper tip contamination, and significantly enhances cost of therapy.7 A device that could simplify drug instillation and address these difficulties can improve adherence to topical medical therapy while eliminating drug wastage, spillage, and contamination of dropper tips.8,9