Thesis (M.S.)--University of Michigan, 1974.

Thesis (M.S.)--University of Michigan, 1974.

Thesis (M.S.)--University of Michigan, 1974.

Includes bibliographies. / The effect of a 0,2 μm air venting in-line filter on the incidence of post-infusion phlebitis was studied in a prospective, controlled, observer-blind investigation of 132 infusions. The filters were changed daily and the infusions were allowed to continue until no longer required, or until there was a reason for discontinuation. Microbiological evaluation of filters, skin at the site of cannulation immediately prior to removal of cannulae, and cannula tips was performed. Particle size analyses of the commonly used intravenous infusion fluids and medicines was also carried out. The incidence of phlebitis was significantly reduced by the inclusion of the filter in-line. The efficacy of the filter in reducing phlebitis was most pronounced when intravenous antimicrobial agents, especially the cephalosporins, were administered. Micro-organisms were isolated from 13% (28/209) of filters which originated from 31% (16/32) of infusions with filters in-line. A relationship could not be established between the number of filters used per infusion or the number of intravenous additives to the infusion system. Phlebitis was not associated with microbial contamination of cannula tips. Medicines for intravenous administration, especially the powders to be reconstituted prior to administration, were heavily contaminated with particulate matter prior to filtration.

published_or_final_version / Nursing Studies / Master / Master of Nursing

No description available.

Introdução: flebite é um dos eventos adversos presente em grande parte das instituições de saúde podendo comprometer a assistência ao paciente. A compreensão do tema faz-se importante para que melhor possam ser trabalhadas estratégias de prevenção e para tanto, é imprescindível conhecer suas características e eventuais associações relacionadas ao seu aparecimento. O estudo teve como objetivo geral avaliar as características dos pacientes com flebites notificadas e características desses eventos adversos em um hospital de médio porte em Ribeirão Preto, São Paulo. Material e Método: trata-se de um estudo quantitativo, descritivo, exploratório, retrospectivo e transversal, aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto/USP com coleta de dados das notificações realizadas entre 2012 a 2014. Na instituição hospitalar em que o estudo foi desenvolvido, 373 pacientes apresentaram 436 episódios de flebites. Os dados foram coletados por meio de um instrumento tendo como fonte de consulta as fichas de notificação e prontuários eletrônicos dos pacientes. Resultados: a média de flebite em 2012 foi de 2,13%(±0,009), em 2013 de 2,91%(±0,010) e em 2014 de 1,84%(±0,008), inferiores a 5%, que é o aceitável; a idade média dos pacientes foi de 59,3 anos sendo 50,7% do sexo feminino e 82,8% de cor branca. A Pneumonia foi o diagnóstico que mais levou à internação e 49,6% dos pacientes tinham hipertensão. Ocorreram 436 flebites com destaque a um paciente em que ocorreram cinco flebites no período de 30 dias; a classificação da flebite com maior ocorrência foi a de grau 2 (45,4%), o calibre do cateter mais utilizado foi o 22 G (29,7%); o local mais utilizado para punção dos acessos venosos foi o membro superior esquerdo (53,4%); os profissionais que mais realizaram as punções foram auxiliares/técnicos de enfermagem (62,6%). Quanto aos medicamentos utilizados na vigência das flebites, 96,2% eram antibióticos; o tempo de permanência do cateter desde sua inserção até o momento em a flebite apareceu foi de 48 horas (31,1); 20,9% das flebites notificadas eram de punções realizadas em outros serviços, que não a instituição onde o estudo foi realizado. Ocorreu variação nos resultados de exames coletados anterior e posteriormente à ocorrência da flebite como Hemoglobina, Glóbulos Brancos, Proteína C Reativa e Plaquetas; no entanto, apenas os dois últimos apresentaram resultados estatisticamente significantes (p=0,0095 e p=0,0001 respectivamente). Observa-se resultado estatisticamente significante (p=0,0172) na associação da flebite de grau 2 com o cateter de calibre n°22 G. Conclusão: o estudo agrega conhecimentos à área da enfermagem e é o primeiro abordando este tema realizado na instituição hospitalar. Apesar de o numero de flebite ser menor que o aceitável pela literatura, é preciso empenho e dedicação para que esse índice diminua ainda mais, pois isso influencia diretamente na qualidade da assistência e na segurança do paciente / Introduction: phlebitis is one of the adverse events presented in most part of health institutions that can put assistance to patients in danger. The comprehension of this theme made of great importance for a better worked prevention strategy and therefore, it is vital to know its characteristics and casual associations related to its appearance. The study has as general objective evaluate the phlebitis patients´characteristics notified and these adverse events characteristics in a medium-sized hospital in Ribeirão Preto, São Paulo. Material and Method: it is about a quantitative, descriptive, exploratory, retrospective and transversal study, approved by the Ethical Committee in Research from Nursing School in Ribeirão Preto/USP with the notification data collection applied out between 2012 to 2014. At the hospital institution which the study was developed, 373 patients presented 436 phlebitis episodes. The data were collected through an instrument having as source the notification records and patients electronical handbooks. Results: the phlebitis average in 2012 was 2,13%(±0,009), in 2013 2,91%(±0,010) and in 2014 1,84%(±0,008), inferior to 5%, which is acceptable; the mean age patients was 59,3 years old being 50,7 female and 82,8% white skin. Pneumonia was the diagnosis that took patients to hospital admission and 49,6% of the patients had hypertension. 436 phlebitis occurred with emphasis to one patient that had five phlebitis within 30 days; the phlebitis classification with higher occurrence was of degree 2 (45,4%), the most used caliber catheter was 22 G (29,7%); the most used for vein puncture access was the left upper limb (53,4%); the professional who most performed vein puncture were assistants/technical nursing (32,6%). According to the medications used during phlebitis moments, 96,2% were antibiotics; the time spent for the catheter since its insertion until the moment that the phlebitis appeared was 48 hours (31,1); 20,9% of notified phlebitis were from other punctures applied in other services, which were not in the institution that the study was conducted. It occurred variation in the collected exam results before and after the phlebitis occurrence like hemoglobin, white blood cells, Reactive Protein C; therefore, only the two last ones presented significant statistically results (p=0,0095 and p=0,0001 respectively). It is observed significant statistically results (p= 0,0172) in association with phlebitis of degree 2 with the catheter of caliber number 22 G. Conclusion: the study adds knowledge to the area of nursing and it is the first approaching theme that has happened in the hospital institution. Despite the number of phlebitis being smaller than the acceptable by the literature, it is necessary effort and dedication to this index diminish even more, because of that it directly influences in the patient´s assistance quality and the patient´s security

Introdução: flebite é um dos eventos adversos presente em grande parte das instituições de saúde podendo comprometer a assistência ao paciente. A compreensão do tema faz-se importante para que melhor possam ser trabalhadas estratégias de prevenção e para tanto, é imprescindível conhecer suas características e eventuais associações relacionadas ao seu aparecimento. O estudo teve como objetivo geral avaliar as características dos pacientes com flebites notificadas e características desses eventos adversos em um hospital de médio porte em Ribeirão Preto, São Paulo. Material e Método: trata-se de um estudo quantitativo, descritivo, exploratório, retrospectivo e transversal, aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto/USP com coleta de dados das notificações realizadas entre 2012 a 2014. Na instituição hospitalar em que o estudo foi desenvolvido, 373 pacientes apresentaram 436 episódios de flebites. Os dados foram coletados por meio de um instrumento tendo como fonte de consulta as fichas de notificação e prontuários eletrônicos dos pacientes. Resultados: a média de flebite em 2012 foi de 2,13%(±0,009), em 2013 de 2,91%(±0,010) e em 2014 de 1,84%(±0,008), inferiores a 5%, que é o aceitável; a idade média dos pacientes foi de 59,3 anos sendo 50,7% do sexo feminino e 82,8% de cor branca. A Pneumonia foi o diagnóstico que mais levou à internação e 49,6% dos pacientes tinham hipertensão. Ocorreram 436 flebites com destaque a um paciente em que ocorreram cinco flebites no período de 30 dias; a classificação da flebite com maior ocorrência foi a de grau 2 (45,4%), o calibre do cateter mais utilizado foi o 22 G (29,7%); o local mais utilizado para punção dos acessos venosos foi o membro superior esquerdo (53,4%); os profissionais que mais realizaram as punções foram auxiliares/técnicos de enfermagem (62,6%). Quanto aos medicamentos utilizados na vigência das flebites, 96,2% eram antibióticos; o tempo de permanência do cateter desde sua inserção até o momento em a flebite apareceu foi de 48 horas (31,1); 20,9% das flebites notificadas eram de punções realizadas em outros serviços, que não a instituição onde o estudo foi realizado. Ocorreu variação nos resultados de exames coletados anterior e posteriormente à ocorrência da flebite como Hemoglobina, Glóbulos Brancos, Proteína C Reativa e Plaquetas; no entanto, apenas os dois últimos apresentaram resultados estatisticamente significantes (p=0,0095 e p=0,0001 respectivamente). Observa-se resultado estatisticamente significante (p=0,0172) na associação da flebite de grau 2 com o cateter de calibre n°22 G. Conclusão: o estudo agrega conhecimentos à área da enfermagem e é o primeiro abordando este tema realizado na instituição hospitalar. Apesar de o numero de flebite ser menor que o aceitável pela literatura, é preciso empenho e dedicação para que esse índice diminua ainda mais, pois isso influencia diretamente na qualidade da assistência e na segurança do paciente / Introduction: phlebitis is one of the adverse events presented in most part of health institutions that can put assistance to patients in danger. The comprehension of this theme made of great importance for a better worked prevention strategy and therefore, it is vital to know its characteristics and casual associations related to its appearance. The study has as general objective evaluate the phlebitis patients´characteristics notified and these adverse events characteristics in a medium-sized hospital in Ribeirão Preto, São Paulo. Material and Method: it is about a quantitative, descriptive, exploratory, retrospective and transversal study, approved by the Ethical Committee in Research from Nursing School in Ribeirão Preto/USP with the notification data collection applied out between 2012 to 2014. At the hospital institution which the study was developed, 373 patients presented 436 phlebitis episodes. The data were collected through an instrument having as source the notification records and patients electronical handbooks. Results: the phlebitis average in 2012 was 2,13%(±0,009), in 2013 2,91%(±0,010) and in 2014 1,84%(±0,008), inferior to 5%, which is acceptable; the mean age patients was 59,3 years old being 50,7 female and 82,8% white skin. Pneumonia was the diagnosis that took patients to hospital admission and 49,6% of the patients had hypertension. 436 phlebitis occurred with emphasis to one patient that had five phlebitis within 30 days; the phlebitis classification with higher occurrence was of degree 2 (45,4%), the most used caliber catheter was 22 G (29,7%); the most used for vein puncture access was the left upper limb (53,4%); the professional who most performed vein puncture were assistants/technical nursing (32,6%). According to the medications used during phlebitis moments, 96,2% were antibiotics; the time spent for the catheter since its insertion until the moment that the phlebitis appeared was 48 hours (31,1); 20,9% of notified phlebitis were from other punctures applied in other services, which were not in the institution that the study was conducted. It occurred variation in the collected exam results before and after the phlebitis occurrence like hemoglobin, white blood cells, Reactive Protein C; therefore, only the two last ones presented significant statistically results (p=0,0095 and p=0,0001 respectively). It is observed significant statistically results (p= 0,0172) in association with phlebitis of degree 2 with the catheter of caliber number 22 G. Conclusion: the study adds knowledge to the area of nursing and it is the first approaching theme that has happened in the hospital institution. Despite the number of phlebitis being smaller than the acceptable by the literature, it is necessary effort and dedication to this index diminish even more, because of that it directly influences in the patient´s assistance quality and the patient´s security

Administering drug therapy through the intravenous route ensures rapid, and complete, bioavailability, which can be critical in an emergency situation. However, bypassing all of its protective barriers leaves the body vulnerable to harm if the parenteral formulation becomes unstable when mixed with the blood. An example of this formulation instability is the precipitation of poorly water-soluble drugs after mixing with the blood's aqueous environment. This happens when parenteral formulations rely too heavily upon the solution pH, and excipients, to increase the drug solubility. This precipitation in the blood can damage venous cell membranes producing symptoms ranging from mild skin irritation to death. To screen potential drug formulations for problems such as injection site drug precipitation, pharmaceutical companies have traditionally used costly and time consuming animal studies. To reduce the amount of pre-clinical animal studies necessary to find an optimal IV formulation, an in vitro device to detect injection site drug precipitation is introduced. In addition to the device, software that simulates the dilution of a parenteral drug formulation with blood upon administration has been developed and is introduced. Both the device and software were tested on commercially available formulations plus one formulation currently in clinical trials. The results and capabilities of the new device were compared to those obtained using an earlier in vitro device. Finally, a robust model for early screening of injection site precipitation is developed using both the in vitro device and software.

Ligia J. Zarate College of Nursing Master of Science Peripheral catheter-related phlebitis is the inflammation of a superficial vein that can lead to infection or thrombus formation if untreated. About 150 million peripheral intravenous catheters (PIVC) are inserted in the United States each year with phlebitis rates reported between 5% and 70%. Many PIVCs are started on trauma patients, but the rate of phlebitis in trauma patients whether the PIVC is started outside the emergency department (ED) or inside the ED is unknown. Therefore, the purpose of this pilot study was to determine phlebitis rates in trauma patients when PIVC's are started inside or outside the emergency department. Variables investigated, which may influence phlebitis rates were duration of time the catheter was in place, the anatomical placement site of the PIVC, the catheter gauge, where the PIVC initially was placed (inside or outside the ED), and the injury severity score (ISS). This was a prospective descriptive design. Results indicated 432 catheters were placed inside or outside the ED in trauma patients that met the inclusion criteria. The overall phlebitis rate was 5.79 %. The rate of phlebitis when the PIVC was started inside the ED was 2.92%. The rate of phlebitis when the PIVC was started outside the ED was 6.94%. If the PIVC was started outside the ED by EMTs the rate was 6.09%. When the PIVC was started outside the ED by paramedics the rate was 7.78%. There was no significant difference in rates of phlebitis according to where the PIVC was started when a Chi Square analysis was performed. No variables predicted phlebitis no matter where the PIVC was started when regression analyses were conducted. The rate of phlebitis in PIVCs started in the ED, or by EMTs or Paramedics outside the ED in this study was similar to and low according to the literature. The Center for Disease Control and Prevention (CDC) suggests removal of the PIVC within 48 hours if placed under emergency situations. However in this study, phlebitis rates of trauma patients meet the benchmark of best practice and perhaps removal of the PIVC within 48 hours should be reconsidered. Complete documentation of medical records was 87.4%. However, best practice of recording information and patient response to treatment should be higher.