[Phlebitis due to intravenous administration of macrolide antibiotics. A comparative study of erythromycin versus clarithromycin]

Flebite no pré e pós-operatório de pacientes neurocirúrgicos

OBJETIVOS: Verificar a incidência de flebite em pacientes internados em uma unidade de neurocirurgia, o tempo de permanência de cateteres intravenosos periféricos e os possíveis fatores de risco para o desenvolvimento de flebite. MÉTODOS: Estudo do tipo coorte prospectivo, com uma amostra 60 pacientes, nos quais foram inseridos 152 cateteres intravenosos periféricos do tipo sobre agulha. RESULTADOS: Os resultados evidenciaram incidência de flebite de 10,5%, em relação à proporcionalidade de cateteres. O tempo de permanência dos cateteres variou de 2 a 216 horas, sendo que os cateteres com permanência inferior a 72 horas tiveram menor incidência de flebite. CONCLUSÕES: Esta incidência encontra-se acima da aceita em padrões de prática internacionais. Os fatores de risco para flebite identificados neste estudo foram: tempo de permanência maior que 72 horas, manutenção intermitente dos cateteres e inserção no período de pós-operatório.

Effect of quinupristin/dalfopristin on 3T3 and Eahy926 cells in vitro in comparison to other antimicrobial agents with the potential to induce infusion phlebitis

Infusion phlebitis is a common clinical problem that is observed with some antimicrobial agents, when being administered intravenously. In this study, cultured murine fibroblasts and immortalised human endothelial cells were exposed to three antibiotics at clinically relevant concentrations to assess their toxic potential in two established cytotoxicity assays. BALB/c 3T3 fibroblasts and Eahy926 endothelial cells were exposed to quinupristin/dalfopristin (QD), erythromycin and levofloxacin at increasing concentrations. For assessment of cytotoxicity the cells were incubated with neutral red (NR) or stained with crystal violet (CV). Measurements were done by photometry. At the concentration range tested QD and erythromycin showed a concentration-dependent cytotoxic effect in both cell cultures. In 3T3 cells the half-maximal effect concentration (EC50) was 20 mg/l for QD and 340 mg/l for erythromycin in the NR uptake test and 12 and 200 mg/l, respectively, in the CV assay. In Eahy926 cells the EC50 was 50 mg/l for QD and 880 mg/l for erythromycin in the NR uptake test and 40 and 750 mg/l, respectively, in the CV assay. No EC50 could be established in both cell types for levofloxacin. Eahy926 cells were less sensitive to cytotoxic stimuli than 3T3 fibroblasts. Cytotoxic effects in both cell cultures occurred in the following order: QD > erythromycin >> levofloxacin. This ranking correlates well with the frequency of local adverse effects observed with the infusion of these antibiotics in patients. Thus, these in vitro assays may serve as an estimate for the prediction of local tolerability of antibiotics when administered parenterally.

Contamination Control in Nursing With Filtration

Filters often are viewed as screens with openings smaller than the particles intended to be removed by a process technically known as direct interception. However, filter manufacturing embraces far more advanced technological approaches, with an evolution toward selective removal of cells or soluble constituents from complex physiologic solutions. An appreciation of filtration development makes it easy to understand how differently manufactured filters with the same claims may not perform identically. This article focuses on the filtration of intravenous solutions and point-of-use hospital water.