Made available in DSpace on 2014-08-13T14:50:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-10Bitstream added on 2014-08-13T18:00:54Z : No. of bitstreams: 1 000750720.pdf: 1924735 bytes, checksum: 19212f3bbe0c1eba4272b5f12ecc5764 (MD5) / A trombose do cateter de longa permanência (CVCp) em pacientes em hemodiálise (HD) é complicação mecânica comum e pode ocasionar mudanças freqüentes dos locais de cateter, que levam à eliminação de sítios vasculares. Avaliar a incidência da obstrução trombótica dos CVCp nos pacientes em HD e a eficácia do tratamento da oclusão com o uso da alteplase, além de identificar os fatores associados à oclusão trombótica. Estudo tipo coorte prospectivo realizado em dois centros que avaliou o diagnóstico e tratamento da oclusão trombótica de CVCp de pacientes em HD durante 24 meses consecutivos. A oclusão do cateter foi definida como a dificuldade de infundir ou retirar líquido das suas vias e assim que diagnosticada a dose de alteplase foi infundida conforme o volume da luz do cateter, permanecendo por 50 minutos. Não havendo a desobstrução do cateter, o procedimento foi repetido. A criopreservação da alteplase foi realizada, sendo o frasco de 50mg diluído em 50ml de água estéril e posteriormente dividido em doses individuais e armazenadas a -20°C. Estatística: Inicialmente foi realizada análise descritiva da população estudada e estabelecido como variável dependente a ocorrência de oclusão trombótica do cateter, utilizando para as variáveis categóricas, o teste Qui-quadrado e, para as variáveis contínuas, o teste t quando dados paramétricos e o teste de Mann- Whitney quando não-paramétricos. Posteriormente, foi realizada análise multivariada utilizando-se modelo de regressão logística. Foi considerada diferença estatística quando p <0,05. Foram avaliados e seguidos 339 CVCp em 247 pacientes totalizando 67.244 CVCp/dia. A mediana de idade foi de 58(47-66) anos, predomínio de sexo masculino (54%), nefropatia diabética como a principal causa de doença renal crônica terminal (44%), veia jugular interna como principal sítio de implante (82%), tempo em tratamento dialítico até o implante do CVCp ... / Thrombosis of tunneled central venous catheters (CVC) in hemodialysis (HD) patients is common and it can lead to elimination of vascular sites. This study aimed to evaluate the incidence of thrombotic obstruction of CVC in HD patients and the efficacy of occlusion treatment with alteplase use, and identify factors associated with thrombotic occlusion. It was a prospective cohort study performed in two centers which evaluated the diagnosis and treatment of thrombotic occlusion of CVC in HD patients for 24 consecutive months. The catheter occlusion was defined as the difficulty to infuse or withdraw fluid from their paths. Alteplase dose was infused to fill the lumen of occluded catheter and remained for 50 minutes. Since there was no obstruction of the catheter, the procedure was repeated. Alteplase cryopreservation was performed (50mg dissolved in 50ml of sterile water and subsequently divided into individual portions and stored at -20 ° C). Statistical analysis: Initially descriptive analysis of the population was performed and the occurrence of catheter thrombotic occlusion was established as dependent variable. For categorical variables, the Chisquare Test was used and for continuous variables, t Test or Mann - Whitney test. Subsequently, multivariate analysis was performed using logistic regression model. Difference was considered when p < 0.05. Three hundred thirty nine CVC in 247 patients were evaluated and followed totaling 67,244 CVC/ day. The median age was 58 (47-66) years , predominantly male (54 %) , diabetic nephropathy as the main cause of chronic kidney disease ( 44 % ) , internal jugular vein as the main site of implantation (82 %) , dialysis duration before CVC implantation of 119 (41.5 to 585.5) days . Eight hundred fifteen occlusion episodes were diagnosed (12 episodes per 1000 CVCP - day), with primary success with alteplase in 596 episodes (77 %) and secondary in 81 cases (10 %). In 99 episodes (13%) success was not ...

Orientador: Daniela Ponce / Banca: Etienne Maria Vasconcellos de Macedo / Banca: Paula Schmidt Azevedo Gaiolla / Resumo: A trombose do cateter de longa permanência (CVCp) em pacientes em hemodiálise (HD) é complicação mecânica comum e pode ocasionar mudanças freqüentes dos locais de cateter, que levam à eliminação de sítios vasculares. Avaliar a incidência da obstrução trombótica dos CVCp nos pacientes em HD e a eficácia do tratamento da oclusão com o uso da alteplase, além de identificar os fatores associados à oclusão trombótica. Estudo tipo coorte prospectivo realizado em dois centros que avaliou o diagnóstico e tratamento da oclusão trombótica de CVCp de pacientes em HD durante 24 meses consecutivos. A oclusão do cateter foi definida como a dificuldade de infundir ou retirar líquido das suas vias e assim que diagnosticada a dose de alteplase foi infundida conforme o volume da luz do cateter, permanecendo por 50 minutos. Não havendo a desobstrução do cateter, o procedimento foi repetido. A criopreservação da alteplase foi realizada, sendo o frasco de 50mg diluído em 50ml de água estéril e posteriormente dividido em doses individuais e armazenadas a -20°C. Estatística: Inicialmente foi realizada análise descritiva da população estudada e estabelecido como variável dependente a ocorrência de oclusão trombótica do cateter, utilizando para as variáveis categóricas, o teste Qui-quadrado e, para as variáveis contínuas, o teste t quando dados paramétricos e o teste de Mann- Whitney quando não-paramétricos. Posteriormente, foi realizada análise multivariada utilizando-se modelo de regressão logística. Foi considerada diferença estatística quando p <0,05. Foram avaliados e seguidos 339 CVCp em 247 pacientes totalizando 67.244 CVCp/dia. A mediana de idade foi de 58(47-66) anos, predomínio de sexo masculino (54%), nefropatia diabética como a principal causa de doença renal crônica terminal (44%), veia jugular interna como principal sítio de implante (82%), tempo em tratamento dialítico até o implante do CVCp ... / Abstract: Thrombosis of tunneled central venous catheters (CVC) in hemodialysis (HD) patients is common and it can lead to elimination of vascular sites. This study aimed to evaluate the incidence of thrombotic obstruction of CVC in HD patients and the efficacy of occlusion treatment with alteplase use, and identify factors associated with thrombotic occlusion. It was a prospective cohort study performed in two centers which evaluated the diagnosis and treatment of thrombotic occlusion of CVC in HD patients for 24 consecutive months. The catheter occlusion was defined as the difficulty to infuse or withdraw fluid from their paths. Alteplase dose was infused to fill the lumen of occluded catheter and remained for 50 minutes. Since there was no obstruction of the catheter, the procedure was repeated. Alteplase cryopreservation was performed (50mg dissolved in 50ml of sterile water and subsequently divided into individual portions and stored at -20 ° C). Statistical analysis: Initially descriptive analysis of the population was performed and the occurrence of catheter thrombotic occlusion was established as dependent variable. For categorical variables, the Chisquare Test was used and for continuous variables, t Test or Mann - Whitney test. Subsequently, multivariate analysis was performed using logistic regression model. Difference was considered when p < 0.05. Three hundred thirty nine CVC in 247 patients were evaluated and followed totaling 67,244 CVC/ day. The median age was 58 (47-66) years , predominantly male (54 %) , diabetic nephropathy as the main cause of chronic kidney disease ( 44 % ) , internal jugular vein as the main site of implantation (82 %) , dialysis duration before CVC implantation of 119 (41.5 to 585.5) days . Eight hundred fifteen occlusion episodes were diagnosed (12 episodes per 1000 CVCP - day), with primary success with alteplase in 596 episodes (77 %) and secondary in 81 cases (10 %). In 99 episodes (13%) success was not ... / Mestre

No description available.

Introduction and Background: Central venous catheters (CVCs) are extensively used worldwide. Mechanical, infectious and thrombotic complications are well described with their use and may be associated with prolonged hospitalisation, increased medical costs and mortality. CVCs account for an estimated 90% of all catheter-related bloodstream infections (CRBSI) and a host of risk factors for CVC-related infections have been documented. These include, most importantly, the duration of catheterisation. The duration of use of CVCs remains controversial and the length of time such devices can safely be left in place has not been fully and objectively addressed in the critically ill patient. Over the past few years, antimicrobial impregnated catheters have been introduced in an attempt to limit catheter-related infection (CRI) and increase the time that CVCs can safely be left in situ. Recent meta-analyses concluded that antimicrobial-impregnated CVCs appear to be effective in reducing CRI. Materials and Methods: This was a prospective randomised double-blind study performed in the adult multidisciplinary Intensive Care Unit (ICU) at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) over a four year period. The study entailed a comparison of standard triple-lumen versus antimicrobial impregnated CVCs on the rate of CRI. The aim was to determine whether the duration of catheter insertion time could safely be increased from the standard practice of seven days at the CMJAH adult multidisciplinary ICU to 14 days, to assess the influence of the antimicrobial impregnated catheter on the incidence of CRI, and to elucidate the epidemiology and risks of CRI. Results: One hundred and eighteen critically ill patients were included in the study which spanned 34 951.5 catheter hours (3.99 catheter years). Sixty-two patients received a standard triple-lumen catheter and 56, a chlorhexidine-silver sulfadiazine (CSS) impregnated triple-lumen catheter. The mean duration of placement for the full sample of 118 CVCs was 12.3 days (range, 1-14). No statistically significant difference in CRI rates between the two types of catheters could be demonstrated. The most common source of primary CRBSI was skin, followed by hub and infusate. The site of CVC insertion (internal jugular versus subclavian vein) and the use of parenteral nutrition were not noted to be risk factors for catheter infection. There was no clinical evidence of catheter-related thrombosis in either of the study groups. Conclusion: This study was unable to demonstrate that antimicrobial catheters provided any significant benefit over standard catheters, which it is felt, can safely be left in place for up to 14 days with appropriate infection control measures. The most common source of CRI was the skin. The administration of parenteral nutrition and the site of catheter insertion (internal jugular vein versus subclavian vein) were not noted to be risk factors for CRI. There was no clinical evidence of thrombotic complications in either of the study groups. This study offers direction for the use of CVCs in critically ill patients and addresses many of the controversies that exist.

One concern for medical professionals and women experiencing cesarean deliveries is the use of indwelling urinary catheters, which is associated with a delay in first void time, slower ambulation time, increased discomfort, longer hospital stays, and an increased risk for urinary tract infections. The purpose of this project was to determine if a practice change regarding the use of urinary catheters among pregnant women decreases the number of women receiving a catheter prior to having a cesarean section in a small community hospital. The knowledge to action and Rosswurm and Larabee's models were used to guide this project, which was comprised of 2 phases. Phase 1 included a team of 10 experts that created the needs assessment that would establish hemodynamic stability using a 4-point scale. The items for inclusion in the needs assessment included primary cesarean, repeat cesarean, no urinary tract infection present, no fetal distress present, no systemic disorders present, no hypertensive disorders present, and no contraindications for anesthesia. Phase 2 was the implementation and evaluation of the needs assessment and new practice guidelines. Statistical analysis was performed using the Mann Whitney U test. There was 98% compliance (p < 0.001.) with the use of the assessment in women undergoing a cesarean delivery and a 64% reduction in the length of time an indwelling catheter was left in place. However, there was no significant change in the number of women receiving a catheter prior to cesarean delivery after a needs assessment was performed (p = 0.805). This project has potential implications that would support social change by reducing the use of indwelling catheters among hemodynamically stable women undergoing cesarean deliveries.

No description available.

No description available.

Thesis (M.S.)--Florida State University, 2004. / Advisor: Dr. Jeanne Flannery, Florida State University, School of Nursing, Dept. of Graduate Studies. Title and description from dissertation home page (viewed Sept. 22, 2004). Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 1978.

Thesis (M.S.)--University of Michigan, 1978.