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Biomedical subjects

S Curtas

Publications and source records attributed to S Curtas.

23 records · Page 2Linked to original sources
PubMedDate not supplied

Intestinal obstruction from cecal bezoar; a complication of fiber-containing tube feedings.

Dietary fiber increases stool bulk, regulates bowel transit time, and decreases intraluminal pressure. Because these actions constitute a natural way to stop diarrhea, a frequent problem with tube feedings, enteral tube feeding manufacturers have marketed several fiber-containing formulae. While bulk-forming agents such as fiber may not be appropriate for every tube-fed patient, we were unable to find any published contraindications to the use of fiber-containing enteral products. We present the case of a seriously ill man who received a fiber-containing tube feeding while also getting intestinal motility-suppressing medications. A large fiber bezoar developed, with resultant mesenteric hemorrhage. We conclude that fiber-containing tube feedings are contraindicated in certain types of patients.

Bezoars↗
PubMedDate not supplied

Standardized TPN order form reduces staff time and potential for error.

The Nutrition Support Team developed a standardized parenteral nutrition (PN) order form for the newly introduced total nutritional admixture (TNA) system. The new order form (TNA-Form) is oriented toward the physician, providing prescription guidelines and standing orders for the initiation and discontinuation of PN. The form replaced an older one (TPN-Form) originally designed for pharmacy use. Over two 4-month periods, the usefulness of the new TNA-Form was compared with that of the old TPN-Form, with reviews of the completeness and safety of all PN prescriptions. When prescription errors, errors of dosage, or errors of omission occurred, the pharmacist queried the physician. The number and the nature of the prescription errors per PN order were recorded daily for each patient. With the old TPN-Form, there were 634 prescription errors in 682 patients (93% total error rate). This rate decreased to 116 prescription errors in 1017 patients (11% total error rate) with the new TNA-Form. There were fewer errors in all categories concerning glucose and lipid concentrations, trace elements and vitamins, the use of heparin, infusion rate, and electrolyte concentrations. It was concluded that the new TNA-Form led to a substantial decrease in overall PN prescription errors, particularly errors of omission, resulting in safer, more efficacious, and more uniform provision of PN. The new TNA-Form provided the secondary benefit of an educational tool for housestaff. Because of its broad-based benefits, it was subsequently adopted by two other hospitals in the community.

Drug Prescriptions↗
PubMedDate not supplied

[The bacteriological diagnosis of catheter-related sepsis. The advantages of quantitative blood cultures].

If sepsis due to a catheter is suspected in a patient receiving parenteral nutrition, the doctor responsible for the patient usually withdraws the catheter and sends the point to the bacteriological laboratory for examination. This operation is usually accompanied by the extraction of several blood samples for haemoculture. With this attitude, it has been observed that most of the catheters withdrawn are sterile or if they are contaminated, they are not the cause of the sepsis. This leads to a series of unnecessary expenses and risks. This problem has prompted us to design a clinical study for the prospective investigation of the efficiency of quantitative haemocultures in the diagnosis of sepsis due to the catheter. During an 8-month period, all the patients who received parenteral nutrition in our centre were followed up by members of the nutritional support unit and participated in the study. In the face of the clinical suspicion of sepsis due to the catheter, blood was obtained for haemoculture, both through the catheter and from the peripheral veins. However, the catheters were not withdrawn until after the results of the cultures, between 16 and 24 hours following the extraction. A count of colonies in blood proceeding from the catheter which was five times or more greater than the count in the peripheral blood was interpreted as sepsis due to the catheter and the catheter was withdrawn. Differences between both counts (central and peripheral) which were less were interpreted as sepsis with a different origin to the catheter and in this case, the catheter was not withdrawn. A total of 26 catheters were evaluated using this method.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Refinement of central venous cannulation technique.

A further refinement of the improved Seldinger technique of central venous cannulation is described. The method entails inserting the guidewire through a previously created side hole in a standard 5ml plastic syringe. The problems of needle dislodgement, air embolism and blood loss are virtually eliminated with this technique.

Catheterization, Central Venous↗