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Rickard CM, Marsh NM, Larsen EN, McGrail MR, Graves N, Runnegar N, Webster J, Corley A, McMillan D, Gowardman JR, Long DA, Fraser JF, Gill FJ, Young J, Murgo M, Alexandrou E, Choudhury MA, Chan RJ, Gavin NC, Daud A, Palermo A, Regli A, Playford EG. Effect of infusion set replacement intervals on catheter-related bloodstream infections (RSVP): a randomised, controlled, equivalence (central venous access device)-non-inferiority (peripheral arterial catheter) trial. Lancet 2021; 397:1447-1458. [PMID: 33865494 DOI: 10.1016/s0140-6736(21)00351-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/11/2021] [Accepted: 02/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The optimal duration of infusion set use to prevent life-threatening catheter-related bloodstream infection (CRBSI) is unclear. We aimed to compare the effectiveness and costs of 7-day (intervention) versus 4-day (control) infusion set replacement to prevent CRBSI in patients with central venous access devices (tunnelled cuffed, non-tunnelled, peripherally inserted, and totally implanted) and peripheral arterial catheters. METHODS We did a randomised, controlled, assessor-masked trial at ten Australian hospitals. Our hypothesis was CRBSI equivalence for central venous access devices and non-inferiority for peripheral arterial catheters (both 2% margin). Adults and children with expected greater than 24 h central venous access device-peripheral arterial catheter use were randomly assigned (1:1; stratified by hospital, catheter type, and intensive care unit or ward) by a centralised, web-based service (concealed before allocation) to infusion set replacement every 7 days, or 4 days. This included crystalloids, non-lipid parenteral nutrition, and medication infusions. Patients and clinicians were not masked, but the primary outcome (CRBSI) was adjudicated by masked infectious diseases physicians. The analysis was modified intention to treat (mITT). This study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12610000505000 and is complete. FINDINGS Between May 30, 2011, and Dec, 9, 2016, from 6007 patients assessed, we assigned 2944 patients to 7-day (n=1463) or 4-day (n=1481) infusion set replacement, with 2941 in the mITT analysis. For central venous access devices, 20 (1·78%) of 1124 patients (7-day group) and 16 (1·46%) of 1097 patients (4-day group) had CRBSI (absolute risk difference [ARD] 0·32%, 95% CI -0·73 to 1·37). For peripheral arterial catheters, one (0·28%) of 357 patients in the 7-day group and none of 363 patients in the 4-day group had CRBSI (ARD 0·28%, -0·27% to 0·83%). There were no treatment-related adverse events. INTERPRETATION Infusion set use can be safely extended to 7 days with resultant cost and workload reductions. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Claire M Rickard
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Infection Management Services, Nursing Practice Development Unit, and Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia.
| | - Nicole M Marsh
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Emily N Larsen
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Matthew R McGrail
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia
| | - Nicholas Graves
- Health Services and Systems Research, Duke-National University of Singapore, Medical School, Singapore
| | - Naomi Runnegar
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; Infection Management Services, Nursing Practice Development Unit, and Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Joan Webster
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Amanda Corley
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
| | - David McMillan
- School of Health and Sports Sciences, School of Nursing, Midwifery and Paramedicine, and INFLAME Biomedical Research Cluster, The University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - John R Gowardman
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Debbie A Long
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; School of Nursing, and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, QLD, Australia; Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - John F Fraser
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Critical Care Research Group, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Fenella J Gill
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley, WA, Australia; Perth Children's Hospital, Child and Adolescent Health Service, Nedlands, WA, Australia
| | - Jeanine Young
- School of Health and Sports Sciences, School of Nursing, Midwifery and Paramedicine, and INFLAME Biomedical Research Cluster, The University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Marghie Murgo
- Partnering with Consumers, Australian Commission on Safety and Quality in Healthcare, Sydney, NSW, Australia
| | - Evan Alexandrou
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia; Centre for Applied Nursing Research and Ingham Institute for Applied Medical Research, South Western Sydney LHD, Liverpool, NSW, Australia; Department of Intensive Care, Liverpool Hospital, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
| | - Md Abu Choudhury
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Raymond J Chan
- School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Infection Management Services, Nursing Practice Development Unit, and Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia; School of Nursing, and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Nicole C Gavin
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; School of Nursing and Midwifery, and Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia; Herston Infectious Diseases Institute, Nursing and Midwifery Research Centre, Cancer Care Services, and Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia; School of Nursing, and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Azlina Daud
- Faculty of Nursing, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Kuantan Campus, Kuantan, Pahang, Malaysia
| | - Annamaria Palermo
- Intensive Care Unit, St John of God Murdoch Hospital, Murdoch, WA, Australia
| | - Adrian Regli
- Intensive Care Unit, St John of God Murdoch Hospital, Murdoch, WA, Australia; Medical School, The University of Western Australia, Sterling Highway, Crawley, WA, Australia; Medical School, The Notre Dame University, Henry Road, Fremantle, WA, Australia
| | - E Geoffrey Playford
- School of Nursing, Midwifery and Social Work, Rural Clinical School, UQ Centre for Clinical Research, School of Medicine, The University of Queensland, QLD, Australia; Infection Management Services, Nursing Practice Development Unit, and Division of Cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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Chaves F, Garnacho-Montero J, Del Pozo JL, Bouza E, Capdevila JA, de Cueto M, Domínguez MÁ, Esteban J, Fernández-Hidalgo N, Fernández Sampedro M, Fortún J, Guembe M, Lorente L, Paño JR, Ramírez P, Salavert M, Sánchez M, Vallés J. Executive summary: Diagnosis and Treatment of Catheter-Related Bloodstream Infection: Clinical Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) and the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). Enferm Infecc Microbiol Clin 2019; 36:112-119. [PMID: 29412895 DOI: 10.1016/j.eimc.2017.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/29/2017] [Accepted: 10/12/2017] [Indexed: 11/29/2022]
Abstract
Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Sthaphylococcus aureus, Enterococcus spp, Gram-negative bacilli, and Candida spp), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
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Affiliation(s)
- Fernando Chaves
- Servicio de Microbiología, Hospital Universitario 12 de Octubre, Madrid, España
| | - José Garnacho-Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, España
| | - José Luis Del Pozo
- Área de Enfermedades Infecciosas, Servicio de Microbiología, Clínica Universidad de Navarra, Pamplona, España.
| | - Emilio Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid; CIBER de Enfermedades Respiratorias, CibeRes, Instituto de Salud Carlos III, Madrid; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | | | - Marina de Cueto
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M Ángeles Domínguez
- Servicio de Microbiología, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
| | - Jaime Esteban
- Departamento de Microbiología Clínica, Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España
| | - Nuria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Marta Fernández Sampedro
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Jesús Fortún
- Unidad de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España
| | - María Guembe
- Unidad de Enfermedades Infecciosas y Microbiología Clínica, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Leonardo Lorente
- Unidad de Cuidados Intensivos, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - Jose Ramón Paño
- Unidad de Enfermedades Infecciosas, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España
| | - Paula Ramírez
- Unidad de Cuidados Intensivos, Hospital Universitari i Politècnic La Fe, Valencia; CIBER de Enfermedades Respiratorias (CibeRes), Instituto de Salud Carlos III, Madrid, España
| | - Miguel Salavert
- Unidad de Enfermedades Infecciosas, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - Miguel Sánchez
- Servicio de Medicina Intensiva, Hospital Clínico San Carlos, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Jordi Vallés
- Unidad de Cuidados Intensivos, Hospital Universitari Parc Taulí, Sabadell, Barcelona; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España
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Rickard CM, Marsh NM, Webster J, Gavin NC, McGrail MR, Larsen E, Corley A, Long D, Gowardman JR, Murgo M, Fraser JF, Chan RJ, Wallis MC, Young J, McMillan D, Zhang L, Choudhury MA, Graves N, Playford EG. Intravascular device administration sets: replacement after standard versus prolonged use in hospitalised patients-a study protocol for a randomised controlled trial (The RSVP Trial). BMJ Open 2015; 5:e007257. [PMID: 25649214 PMCID: PMC4322194 DOI: 10.1136/bmjopen-2014-007257] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Vascular access devices (VADs), such as peripheral or central venous catheters, are vital across all medical and surgical specialties. To allow therapy or haemodynamic monitoring, VADs frequently require administration sets (AS) composed of infusion tubing, fluid containers, pressure-monitoring transducers and/or burettes. While VADs are replaced only when necessary, AS are routinely replaced every 3-4 days in the belief that this reduces infectious complications. Strong evidence supports AS use up to 4 days, but there is less evidence for AS use beyond 4 days. AS replacement twice weekly increases hospital costs and workload. METHODS AND ANALYSIS This is a pragmatic, multicentre, randomised controlled trial (RCT) of equivalence design comparing AS replacement at 4 (control) versus 7 (experimental) days. Randomisation is stratified by site and device, centrally allocated and concealed until enrolment. 6554 adult/paediatric patients with a central venous catheter, peripherally inserted central catheter or peripheral arterial catheter will be enrolled over 4 years. The primary outcome is VAD-related bloodstream infection (BSI) and secondary outcomes are VAD colonisation, AS colonisation, all-cause BSI, all-cause mortality, number of AS per patient, VAD time in situ and costs. Relative incidence rates of VAD-BSI per 100 devices and hazard rates per 1000 device days (95% CIs) will summarise the impact of 7-day relative to 4-day AS use and test equivalence. Kaplan-Meier survival curves (with log rank Mantel-Cox test) will compare VAD-BSI over time. Appropriate parametric or non-parametric techniques will be used to compare secondary end points. p Values of <0.05 will be considered significant. ETHICS AND DISSEMINATION Relevant ethical approvals have been received. CONSORT Statement recommendations will be used to guide preparation of any publication. Results will be presented at relevant conferences and sent to the major organisations with clinical practice guidelines for VAD care. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN 12610000505000).
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Affiliation(s)
- Claire M Rickard
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Nicole M Marsh
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Joan Webster
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nicole C Gavin
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Emily Larsen
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Amanda Corley
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Debbie Long
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Lady Cilento Children's Hospital, Brisbane, Australia
| | - John R Gowardman
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Marghie Murgo
- Clinical Excellence Commission, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
| | - John F Fraser
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Brisbane, Australia
| | - Raymond J Chan
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Marianne C Wallis
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- School of Nursing and Midwifery, University of the Sunshine Coast, Maroochydore, Australia
| | - Jeanine Young
- Lady Cilento Children's Hospital, Brisbane, Australia
- School of Nursing and Midwifery, University of the Sunshine Coast, Maroochydore, Australia
| | - David McMillan
- Inflammation and Healing Research Cluster, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - Li Zhang
- Inflammation and Healing Research Cluster, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, Australia
| | - Md Abu Choudhury
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - E Geoffrey Playford
- NHMRC Centre of Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation—Griffith Health Institute, Griffith University, Brisbane, Australia
- Infection Management Services, Princess Alexandra Hospital, Brisbane, Australia
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