PubMed · 12218677
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Lynn C Hadaway. 2002. What you can do to decrease catheter-related infections.. https://doi.org/10.1097/00152193-200209000-00034
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OBJECTIVE: Hand-held flushing of radial arterial lines at 0.5 ml/s in neonates can result in retrograde embolization of flush solution into the central arterial circulation. We studied flush flow velocities during intermittent arterial line purging using a flow regulating device with an infusion bag pump and a syringe pump system. MEASUREMENTS AND INTERVENTIONS: In this in vitro experiment we simulated flushing of a 24- and a 22-G cannula against a mean arterial pressure of 45 mmHg. Fluid flow velocities were gravimetrically measured during flushing from an infusion bag system pressurized to 100, 200, and 300 mmHg and from a syringe pump flush system after initialization of boluses of 0.5, 1.0, 1.5, 2.0, and 2.5 ml. The flow regulating device was opened for 1, 2, and 5 s. RESULTS: Both flush systems tested allowed delivery of flush flow velocities exceeding 0.5 ml/s (e.g., 22-G cannula; bag system, pressure 300 mmHg up to 0.64+/-0.08 ml/s; syringe pump, 2 ml bolus up to 0.74+/-0.05 ml/s). In syringe pump systems the main determinant of flow velocity was bolus size, in bag pump systems flushing time and bag pressure. CONCLUSIONS: Based on data about critical flow velocities through an radial arterial cannula in neonates, both tested flushing systems carry the risk of exceeding the critical value of 0.5 ml/s. They are likely to cause retrograde embolization of flushing solution into the central arterial circulation with the associated risk of clot and air embolization. In vivo studies should identify margins of safety to minimize the risk of retrograde flushing into the central arterial circulation.
INTRODUCTION: The authors classify infantile subdural fluid collection (SFC) into four chronological stages: (I) SFC with arachnoid tear, (II) SFC with inner membrane, (III) SFC with inner and outer membrane, and (IV) subdural hematoma, and discuss the appropriate treatment for each stage. CONCLUSIONS: Fontanel tapping can be used for every stage of SFC, but it is best indicated for stage II. Massive bleeding seldom occurs with punctures made with a small needle. Continuous external drainage is indicated for stages II and III. Although the risk of bleeding decreases even in stage III, this method involves a risk of infection. Burr hole irrigation is usually indicated for stage IV. Implantation of an Ommaya reservoir and endoscopic observation of the SFC cavity along with burr hole irrigation are very useful. A subduroperitoneal shunt cannot be recommended for the treatment of SFC in most cases.
We observed infection rates associated with the LifeSite Hemodialysis Access System, a novel dialysis device consisting of 2 subcutaneously implanted valves accessed by repeated use of fibrous tissue tracts, of 4.8 total infections and 8.1 first episodes per 1000 patient-days. These rates are higher than those observed elsewhere, which may be related to use of the device in a population of chronically ill patients, to the learning curve associated with use of the device, or to inherent qualities of the device.