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Biomedical subjects

C Powell

Publications and source records attributed to C Powell.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

Clinical effect of nonthrombotic total parenteral nutrition catheters.

Radiographic evidence of subclavian vein thrombosis has been shown to occur in 33% of total parenteral nutrition patients. This incidence can be significantly reduced to 8% when heparin is administered concomitantly in total parenteral nutrition solutions. To evaluate the thrombotic risk of a newly developed polyurethane catheter, 20 concurrent patient pairs were prospectively cannulated with either a standard polyethylene catheter plus heparin or a polyurethane catheter without heparin in a sequential statistical study. Radionuclide venograms (Tc99m) were performed within 72 hr of catheterization, at biweeky intervals, and at termination of total parenteral nutrition administration. No patient in either group developed clinical (pain, arm swelling, collateral veins) or venogram evidence of thrombosis after catheterization during an overall cannulation period of 820 days. Use of polyurethane catheters and elimination of heparin in total parenteral solutions may be particularly important since contraindications to heparin use are common. Additionally, heparin elimination can decrease admixture work and confusion (ie, subcutaneous heparin double dosing) without increasing the risk of subclavian vein thrombosis.

Adult↗
PubMedDate not supplied

Heparin does not reduce catheter sepsis during total parenteral nutrition.

Although it is recognized that the addition of heparin to total parenteral nutrition solutions reduces subclavian vein thrombosis from percutaneous polyethylene catheters, it does not affect the low thrombosis rate associated with polyurethane catheters. It has been suggested that heparin also reduces catheter sepsis during total parenteral nutrition. We reviewed the sepsis rate in 86 patients randomized to receive iv nutrition with or without heparin through polyethylene, polyvinyl, and polyurethane catheters. Blood was drawn from febrile patients for culture; if positive, catheters were removed and the tips cultured. Catheters were considered infected if blood and catheter tips were positive, or if fever disappeared within 48 hr after catheter removal, even if cultures were negative. Catheter sepsis occurred in two patients in both groups. It appears that heparin does not reduce sepsis from percutaneous subclavian vein catheters. Although its use may be indicated to reduce thrombosis associated with polyethylene catheters, there is no indication for its use to reduce sepsis with either type of catheter.

Bacterial Infections↗
PubMedDate not supplied

Risk of infection accompanying the use of single-lumen vs double-lumen subclavian catheters: a prospective randomized study.

A prospective study was undertaken to compare the risks of a multiple-lumen catheter to bilateral subclavian catheters in patients receiving total parenteral nutrition (TPN). All patients had one preexisting subclavian catheter. Patients were randomized into two groups: one group received a double-lumen catheter via a guidewire change of the preexisting single-lumen subclavian catheter. In the second group, a second single-lumen subclavian catheter was inserted and the preexisting single-lumen catheter was changed over a guidewire. Patients were followed by the Nutrition Support Service and were managed identically with regard to solutions given, catheter care, dressing changes, monitoring of mechanical complications, and evaluation of fever. Total infection rates in both groups were identical (22.7%). The difference in mechanical complication rates in the double-lumen catheter group (9%) and the group with bilateral single-lumen catheters (22.7%) was not significant by Fischer's exact test. The multiple-lumen catheter is superior in convenience and as safe as bilateral single-lumen catheters.

Catheters, Indwelling↗
PubMedDate not supplied

Effect of frequent guidewire changes on triple-lumen catheter sepsis.

Frequent guidewire changes of single-lumen (SLC) and triple-lumen (TLC) catheters have been proposed to decrease catheter sepsis. We placed TLC in 126 patients needing total parenteral nutrition (TPN) and multiple venous access, prospectively randomizing them to two groups: group I received a guidewire change every 3 days, and group II received guidewire changes for mechanical or septic complications only. Tips were cultured at each line change and tips and blood for each septic episode. Catheter sepsis was defined by the criteria of the Association for Practitioners in Infection Control (APIC). There were 67 positive cultures in 52 patients, but most produced very few colonies or grew the same organisms in other infection sites. Forty-seven% of all cultures grew Staphylococci, and 23% grew Candida. APIC-defined catheter sepsis was detected in 12.7% of group I and 15.9% of group II. Although we observed no statistically significant difference in the two techniques, if we assume that a 20% difference in the incidence of catheter-induced sepsis would be important to detect, the probability of failing to detect such a difference is 0.24 with an 0.05 level of significance (two-sided). Prophylactic guidewire changes did not alter the incidence of catheter sepsis in patients with TLC who required TPN. The high rate of sepsis and Candida infection may be due to the critical illness of the immunocompromised population studied.

Adult↗
PubMedDate not supplied

The challenge of the Children's Charter: rhetoric vs reality.

The rights of children are not enshrined in statute. However, over recent years, a number of organizations such as Action for Sick Children and The Children's Trust, Tadworth, have produced guidelines related to the rights of children and their families in hospital. The voluntary sector has led the way in influencing policy makers. This is exemplified in the publication of the Department of Health's draft Children's Charter. This article explores the strengths, weaknesses, opportunities and threats of this recent innovation.

Child↗
PubMedDate not supplied

Development of an introductory course in child protection.

The maltreatment of children is a significant public health and social problem. Healthcare professionals have a crucial role to play working with other agencies to protect children from abuse and neglect. The need for training, support and clinical supervision in this work has been identified. This article discusses the collaborative work that led to the establishment of an introductory course in child protection (English National Board 970) at one school of nursing and midwifery and outlines the benefits of undertaking such a course. The course has attracted participants from a range of healthcare settings and has proved to be well evaluated and oversubscribed. Practitioners have returned to their work setting with increased awareness of child maltreatment and an understanding of the need for a proactive approach to child protection.

Child↗