A administração de catecolaminas por via intravenosa é uma prática comum no ambiente hospitalar, principalmente em Unidade de Terapia Intensiva (UTI), Hemodiálise e Pronto Socorro (PS). Apesar de se tratar de um procedimento que demanda cuidados de enfermagem bastante específicos, este pode ser realizado por qualquer membro da equipe de enfermagem, até mesmo sem supervisão direta de um enfermeiro. Para prestar cuidados de enfermagem adequados aos pacientes que recebem catecolaminas por via intravenosa é necessário que o profissional que realiza o procedimento disponha de conhecimento específico acerca da prática realizada. Em unidades como UTI, PS e Hemodiálise, espera-se que o enfermeiro exerça supervisão direta desses cuidados, já que são unidades em que os pacientes apresentam condições mais críticas e geralmente instáveis. Desta forma, é esperado que o enfermeiro detenha todo o conhecimento necessário para administrar as catecolaminas com segurança, minimizando assim os riscos para o paciente. Estes conhecimentos devem ser aprofundados englobando desde ciências básicas como anatomia e fisiologia, até aspectos mais específicos como a escolha do cateter, recomendações de uso dos materiais disponíveis, conhecimentos farmacológicos direcionados e recomendações e cuidados durante a infusão desse tipo de medicamento. Este estudo avaliou o grau de conhecimento dos enfermeiros do Hospital Universitário (HU) da Universidade de São Paulo (USP) quanto à administração de catecolaminas de infusão contínua por via intravenosa. Foram sujeitos deste estudo somente os enfermeiros que atuam em unidades onde a administração de catecolaminas é prática comum. A pesquisa limitou-se aos enfermeiros que atuam em unidades de cuidados de adultos por considerar que há peculiaridades existentes no cuidado do paciente adulto e pediátrico no que diz respeito à administração de drogas vasoativas e à necessidade de atualização e vivência prática da situação. Assim, através de questionário estruturado, procedeu-se a avaliação do conhecimento dos enfermeiros atuantes nas unidades de Hemodiálise, PS de adultos e UTI de adultos com relação à administração de catecolaminas por via intravenosa. Os dados obtidos com a aplicação dos questionários foram submetidos a análises estatísticas para definir se o conhecimento apresentado pelos enfermeiros avaliados é condizente com o preconizado pela literatura para realização segura de tal procedimento / Catecholamine management through intravenous route is a common practice in the hospital setting, mainly at the Intensive Care Unit (ICU), Hemodialysis and Emergency Room (ER). Although it\'s a procedure that demands very specific nursing care, this can be made by any member of the nursing staff, even without direct supervision of a nurse. For delivering optimal nursing care to patients who receive catecholamine through intravenous route, it\'s necessary the provider who makes the procedure to have specific knowledge on this practice. In settings like ICU, ER and Hemodialysis, the nurse is expected to have direct supervision in these procedures, once they are units where patients present more critical and generally unstable conditions. This way, the nurse is supposed to have all the knowledge necessary to manage catecholamine safely, thus minimizing the risks for the patient. This knowledge must be deepen involving from basic sciences such as anatomy and physiology, to more specific aspects, such as the catheter chosen, recommendations for use of available material, specified pharmacological knowledge and recommendations and care during infusion of this type of medication. This study evaluated the knowledge level of nurses from University Hospital (HU) of University of Sao Paulo (USP) regarding to catecholamine management of continuous infusion through intravenous route. Subjects of the study were only the nurses who work in setting where catecholamine management is a common practice. The research limited to nurses who work in adult care, considering that there are peculiarities in adult and pediatric care related to vasoactive medication management and the need of upgrade and practical experience of the situation. Thus, through a structured questionnaire, it was made an evaluation of knowledge of nurses who work in Hemodialysis units, adult ER and adult ICU regarding to catecholamine management through intravenous route. The data obtained through the questionnaires were submitted to statistic analyses to define if the knowledge presented by the evaluated nurses is according to what is advised by literature to make safely such procedure

Made available in DSpace on 2014-06-11T19:29:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-12-18Bitstream added on 2014-06-13T20:18:51Z : No. of bitstreams: 1 simoni_rf_me_botfm.pdf: 286447 bytes, checksum: 285c09bd4daeaa3c8d21ed54be946f3b (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A constante de equilíbrio entre o plasma e o sítio efetor (ke0) é utilizada pelos modelos farmacocinéticos para prever a concentração do fármaco em seu local de ação (Ce). Seria interessante que a Ce de propofol fosse semelhante na perda e na recuperação da consciência. O objetivo desse estudo foi avaliar o desempenho clínico de duas diferentes ke0 (rápida = 1,21 min-1 e lenta = 0,26 min-1) com relação à concentração de propofol prevista em seu local de ação durante a perda e a recuperação da consciência usando o modelo farmacocinético de Marsh. Material e Método – Participaram desse estudo 20 voluntários adultos, sadios e do sexo masculino. Em todos os voluntários foi administrado propofol em regime de infusão alvo-controlada modelo farmacocinético de Marsh ke0 rápida e em outra oportunidade foi usado, o mesmo modelo farmacocinético com a ke0 lenta. Inicialmente, o propofol foi infundido em concentração-alvo plasmática de 3,0 μg.mL-1. A perda da consciência e recuperação da consciência foi baseada na resposta ao estímulo verbal. A concentração de propofol prevista em seu local de ação foi anotada no momento da perda e recuperação da consciência. Resultados - Na perda e recuperação da consciência, a concentração média de propofol prevista em seu local de ação pela ke0 rápida foi diferente (3,64 ± 0,78 e 1,47 ± 0,29 μg.mL-1, respectivamente, p < 0,0001), enquanto que com a ke0 lenta a concentração média de propofol prevista em seu local de ação foi semelhante (2,20 ± 0,70 e 2,13 ± 0,43 μg.mL-1, respectivamente, p = 0,5425). Conclusão - Do ponto de vista clínico, a ke0 lenta (0,26 min-1) incorporada ao modelo farmacocinético de Marsh apresentou melhor desempenho que a ke0 rápida (1,21 min-1), uma vez que a concentração de propofol prevista em seu local de ação na perda e recuperação da consciência foi... / The ke0 can be defined as the proportional variation of the gradient of concentration between the plasma and the effect-site in relation to the unit of time. Theoretically, the higher the value of the ke0, the faster the drug enters the effectsite. Therefore, drugs with short T½ke0 have high ke0s and fast onset of action. The aim of this study was to assess the clinical performance of two different ke0s (fast and slow) in terms of propofol effect-site concentration (Ce) during the loss and recovery of consciousness, using Marsh's pharmacokinetic model. Method: Twenty healthy male adult volunteers participated in this study. Propofol was first administered to the individual volunteer using Marsh's pharmacokinetic targetcontrolled infusion model with ke0 of 1.21 min-1 and, on another opportunity, with the same pharmacokinetic model but ke0 of 0.26 min-1. Propofol was infused in plasma target-concentration of 3.0 μg.mL-1. Loss and recovery of consciousness was defined as response of the volunteer to verbal stimulus. The Ce was registered at the moments of loss and recovery of consciousness. Results: At loss and recovery of consciousness, propofol Ce means predicted by the fast ke0 were different (3.64 ± 0.78 and 1.47 ± 0.29 μg.mL-1, respectively, p < 0.0001), whereas with the slow ke0 the predicted Ce means were similar (2.20 ± 0.70 and 2.13 ± 0.43 μg.mL-1, respectively, p = 0.5425). Conclusion: It can be concluded that slow ke0 (0.26 min-1) incorporated into Marsh's pharmacokinetic model showed better clinical performance than fast ke0 (1.21 min-1), since the predicted effect-site concentrations of propofol at loss and recovery of consciousness were similar. Key words: Intravenous anesthesia: propofol, pharmacokinetic model; Monitoring: bispectral index.

Orientador: Pedro Thadeu Galvão Vianna / Banca: Eliana Marisa Ganem / Banca: Gilberto Denucci / Resumo: A constante de equilíbrio entre o plasma e o sítio efetor (ke0) é utilizada pelos modelos farmacocinéticos para prever a concentração do fármaco em seu local de ação (Ce). Seria interessante que a Ce de propofol fosse semelhante na perda e na recuperação da consciência. O objetivo desse estudo foi avaliar o desempenho clínico de duas diferentes ke0 (rápida = 1,21 min-1 e lenta = 0,26 min-1) com relação à concentração de propofol prevista em seu local de ação durante a perda e a recuperação da consciência usando o modelo farmacocinético de Marsh. Material e Método - Participaram desse estudo 20 voluntários adultos, sadios e do sexo masculino. Em todos os voluntários foi administrado propofol em regime de infusão alvo-controlada modelo farmacocinético de Marsh ke0 rápida e em outra oportunidade foi usado, o mesmo modelo farmacocinético com a ke0 lenta. Inicialmente, o propofol foi infundido em concentração-alvo plasmática de 3,0 μg.mL-1. A perda da consciência e recuperação da consciência foi baseada na resposta ao estímulo verbal. A concentração de propofol prevista em seu local de ação foi anotada no momento da perda e recuperação da consciência. Resultados - Na perda e recuperação da consciência, a concentração média de propofol prevista em seu local de ação pela ke0 rápida foi diferente (3,64 ± 0,78 e 1,47 ± 0,29 μg.mL-1, respectivamente, p < 0,0001), enquanto que com a ke0 lenta a concentração média de propofol prevista em seu local de ação foi semelhante (2,20 ± 0,70 e 2,13 ± 0,43 μg.mL-1, respectivamente, p = 0,5425). Conclusão - Do ponto de vista clínico, a ke0 lenta (0,26 min-1) incorporada ao modelo farmacocinético de Marsh apresentou melhor desempenho que a ke0 rápida (1,21 min-1), uma vez que a concentração de propofol prevista em seu local de ação na perda e recuperação da consciência foi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The ke0 can be defined as the proportional variation of the gradient of concentration between the plasma and the effect-site in relation to the unit of time. Theoretically, the higher the value of the ke0, the faster the drug enters the effectsite. Therefore, drugs with short T½ke0 have high ke0s and fast onset of action. The aim of this study was to assess the clinical performance of two different ke0s (fast and slow) in terms of propofol effect-site concentration (Ce) during the loss and recovery of consciousness, using Marsh's pharmacokinetic model. Method: Twenty healthy male adult volunteers participated in this study. Propofol was first administered to the individual volunteer using Marsh's pharmacokinetic targetcontrolled infusion model with ke0 of 1.21 min-1 and, on another opportunity, with the same pharmacokinetic model but ke0 of 0.26 min-1. Propofol was infused in plasma target-concentration of 3.0 μg.mL-1. Loss and recovery of consciousness was defined as response of the volunteer to verbal stimulus. The Ce was registered at the moments of loss and recovery of consciousness. Results: At loss and recovery of consciousness, propofol Ce means predicted by the fast ke0 were different (3.64 ± 0.78 and 1.47 ± 0.29 μg.mL-1, respectively, p < 0.0001), whereas with the slow ke0 the predicted Ce means were similar (2.20 ± 0.70 and 2.13 ± 0.43 μg.mL-1, respectively, p = 0.5425). Conclusion: It can be concluded that slow ke0 (0.26 min-1) incorporated into Marsh's pharmacokinetic model showed better clinical performance than fast ke0 (1.21 min-1), since the predicted effect-site concentrations of propofol at loss and recovery of consciousness were similar. Key words: Intravenous anesthesia: propofol, pharmacokinetic model; Monitoring: bispectral index. / Mestre

Class of 2012 Abstract / Specific Aims: To assess the chemical stability of ampicillin for injection in normal saline at pH values ranging from 5 to 6. Methods: A stability-indicating high performance liquid chromatography (HPLC) method was developed and used to determine the stability of ampicillin for injection in normal saline following buffering with sodium acetate and acid adjustment with HCl at pH values of 5, 5.5, and 6. To confirm that the assay was stability-indicating, ampicillin trihydrate reference standard (1 mg/mL) was exposed to alkali, acid, and oxidative stress conditions and analyzed by HPLC for the presence of degradation products. Analysis was performed on a reverse-phase (C-18) column with a mobile phase consisting of water, acetonitrile, 1 M monobasic potassium phosphate, and 1 N acetic acid (909:80:10:1). Other HPLC parameters were: flow rate 1 mL/min; detection wavelength 254 nm; injection volume 20 µL; column temperature 30˚C. The method was evaluated for linearity, precision, and accuracy. The chemical stability of ampicillin for injection (18 mg/mL) in normal saline and sodium acetate (pH adjusted at values of 5, 5.5, and 6) was assessed at baseline (t=0), 7, 11, 17, 31, and 44 hours and compared to a control solution (no pH adjustment). Measurements at each time interval were performed in triplicate. Main Results: Ampicillin trihydrate reference standard (1 mg/mL) was adequately separated from degradation products following exposure to alkali, acid, and oxidative stress conditions. After 16 hours, a precipitate was observed in the solution at pH 6, and therefore stability is not reported. All other solutions (pH 5, pH 5.5, and control) were stable for at least 24 hours at room temperature and yielded t90 values of 110, 64.2, and 27.5 hours, respectively. Conclusions: Adjustment of intravenous ampicillin solutions to pH values of 5 or 5.5 significantly increased stability. Ampicillin appears to be most stable at a pH near its isoelectric point (pH 5).

Class of 2014 Abstract / Specific Aims: To evaluate the association of weight-based insulin dose with hypoglycemia in critically ill patients receiving continuous intravenous insulin infuions. To determine whether higher weight-based doses of insulin were associated with a higher incidence of hypoglycemia Methods: This was a retrospective, case-control study conducted at a tertiary care, academic medical center. Adult (>18 years) patients admitted to the intensive care unit (ICU) receiving intravenous (IV) regular insulin infusions for the management of hyperglycemia between 1 January 2008 and 30 March 2013 were included. Medical records were retrospectively reviewed. Each patient with hypoglycemia was matched with a non-hypoglycemic control subject, based on age range and sex. Laboratory data, patient demographics, hypoglycemic events, insulin infusion data, SOFA scores, length of hospital and ICU stay, and patient outcomes were collected and evaluated. Main Results: Sixty-one patients experienced a hypoglycemic event and were matched with 61 non-hypoglycemic control subjects for statistical analysis. With the exception of ethnicity (p = 0.041) as a demographic predictor of hypoglycemia; age, sex, weight, height, and BMI were not significant. The starting insulin infusion rate and the total number of insulin units per day administered were not found to be associated with hypoglycemia, p=0.107 and p=0.357, respectively. Conclusion: This study failed to show significance in the total units per day of insulin and the incidence of hypoglycemia. There was no statistical significance in BMI between case and control groups, thus no clear conclusion can be made associating hypoglycemia with weight-based insulin dosing.

Pulmonary embolism (PE) is a common clinical problem affecting 600,000 patients per year in the United States. Although the diagnosis can be easily confirmed by imaging techniques, such as computed tomographic angiography of the chest, the identification of underlying mechanism leading to PE is important for appropriate duration of anticoagulation, and prevention of subsequent episodes. The differential diagnosis of underlying mechanism is broad and must include careful review of medication history. Drug-related thromboembolic disease can be easily missed and may have catastrophic consequences. The identification of the culprit drug is important for prevention of subsequent episodes and choosing appropriate duration of anticoagulation. We report a case of a middle-aged man who developed PE after administration of intravenous immunoglobulin.

Hepatitis C infection (HCV) continues to disproportionately affect Hispanics/Latinos in the United States. Hispanic/Latino intravenous drug users (IDUs), because of their risky injection and sexual behaviors, are prone to HCV infection and rapid transmission of the virus to others via several routes. With a prevalence rate of approximately 75% among IDUs, it is imperative that transmission of HCV be prevented in this population. This study aims to examine the associations between demographic, injection and sexual risk factors to HCV infection in a group Hispanic/Latino IDUs in Miami-Dade County, Florida. Preliminary unadjusted results in this sample reveal that age (OR=4.592, p=0.004), weekly injection (OR=5.171, p=0.000), daily injection frequency (OR=3.856, p=0.000) and use of a dirty needle (OR=2.320, p= 0.006) were all significantly associated with HCV infection. Being born outside the U.S. was significantly negatively associated with HCV infection (OR=0.349, p=0.004). Additionally, having two or more sex partners in the past three months (OR=0.472, p=0.014) was negatively associated with HCV infection. After adjusting for all other variables, older age (AOR=7.470, p=0.006), weekly injection (AOR=3.238, p=0.007) and daily injection frequency (AOR=2.625, p=0.010) were all significantly associated with HCV infection. Being born outside the U.S. (AOR=0.369, p=0.019) was a significant protective factor for HCV infection, along with having two or more sex partners in the past three months (AOR=0.481, p=0.037). When analyzing the significant variables in a backward regression model, having 2 or more sex partners in the past three months was not significant at the p

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.

Urticaria can be a chronic and debilitating affliction and is a relatively common disorder affecting between 10- 20% of the population. Common causes include reactions to medication, food allergen, physical stimuli and venoms. Urticaria can be acute or chronic. Chronic urticaria lasts for more than 6 weeks and is commonly difficult to treat. The use of immunosuppressive agents for this disorder when antihistamines fail can result in significant morbidity. Recent advances in the pathogenesis, etiology, diagnosis and management of chronic urticaria have led to new paradigms in treatment of this disorder. Cyclosporine is often the most effective but has some unique adverse effects that may prevent it from being used in some patients. The use of intravenous immunoglobulin (IVIG) has proven effective in a variety of reports and we will review the mechanisms likely involved in the successful control of urticarial symptoms by immunomodulating therapy using IVIG. In this review, we will discuss mechanisms and pathogenesis of urticaria and the specific role of intravenous immunoglobulin (IVIG) in this disorder, especially in refractory or steroid-dependent cases.

Background: Patients who have suffered an acute ischemic stroke (AIS) and are smokers may have a better outcome following thrombolytic therapy when compared with non-smokers. While this finding is controversial, data on baseline clinical risk factors to predict treatment efficacy of thrombolytic therapy using ambulatory status in patients who suffered AIS and are smokers is not common. Methods: Between 2010 and 2016, retrospective data on patients who have suffered an AIS and received recombinant tissue plasminogen activator (rtPA) were obtained from Greenville health system registry. Assessment of clinical risk factors and the likelihood of an improvement in post-stroke ambulation among smokers and non-smokers was carried out using multivariate logistic regression. Results: Of 1001 patients, 70.8% were smokers and 29.2% non-smokers. Among the smokers and non-smokers, 74.6% and 84.6% improvement in ambulation respectively at discharge. The odds of improved ambulation decrease among smokers as age group increases compared to those below 50 [(60–69 years, aOR, 0.30, 95% C.I, 0.108–0.850, p < 0.05), (70–79 years aOR, 0.27, 95% C.I, 0.096–0.734, p < 0.05), (80+ years aOR, 0.16, 95% C.I, 0.057–0.430, P < 0.01). Patients with National Institute of Health Stroke Scale Score (NIHSS) score > 7 (reference <7) were 91% less likely to have improved ambulation among smokers and non-smokers (aOR, 0.09, 95% C.I, 0.055–0.155, P = 0.01), and (aOR, 0.08, 95% C.I, 0.027–0.214, P = 0.01) respectively. Atrial fibrillation was an independent predictor of decreased improvement in ambulation only among smokers (aOR, 0.58, 95% C.I, 0.356–0.928 P < 0.05). Conclusion: Our findings suggest that elderly smokers with atrial fibrillation would benefit more from aggressive management of atrial fibrillation than non-smokers.