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van de Pol I, Roescher N, Rigter S, Noordzij PG. Prolonged use of intravenous administration sets on central line associated bloodstream infection, nursing workload and material use: A before-after study. Intensive Crit Care Nurs 2023; 78:103446. [PMID: 37210225 DOI: 10.1016/j.iccn.2023.103446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES One of the interventions to reduce risk of central line associated bloodstream infection (CLABSI) is routine replacement of the intravenous administration sets. Guidelines advises a time interval that ranges between four and seven days. However many hospitals replace intravenous administration sets every four days to prevent CLABSI. RESEARCH METHODOLOGY In this single centre retrospective study we analysed whether the extension of the time interval from four to seven days for routine replacement of intravenous administration sets had impact on the incidence of CLABSI and colonization of the central venous catheter. Secondary outcomes were the effects on nursing workload, material use and costs. RESULTS In total, 1,409 patients with 1,679 central lines were included. During the pre-intervention period 2.8 CLABSI cases per 1,000 catheter days were found in comparison with 1.3 CLABSI cases per 1,000 catheter days during the post-intervention period. The rate difference between the groups was 1.52 CLABSI cases per 1,000 catheter days (95% CI: -0.50 to +4.13, p = 0.138). The intervention resulted in a saving of 345 intravenous single use plastic administration sets and 260 hours nursing time, and reduced cost with an estimate of at least 17.250 Euros. CONCLUSION Extension of the time interval from four to seven days for routine replacement of intravenous administration sets did not negatively affect the incidence of CLABSI. IMPLICATIONS FOR CLINICAL PRACTICE Additional benefits of the prolonged time interval were saving of nursing time by avoiding unnecessary routine procedures, the reducing of waste because of reducing the use of disposable materials and healthcare costs.
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Affiliation(s)
- Ineke van de Pol
- Intensive Care Unit, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Nienke Roescher
- Department of Clinical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Sander Rigter
- Departments of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Peter G Noordzij
- Departments of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Anesthesiology and Intensive Care, UMC Utrecht, The Netherlands
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Abstract
BACKGROUND Extra Corporeal Life Support (ECLS) may be a life-saving treatment for patients with reversible cardiac and/or respiratory failure. ECLS is associated with a high risk of complications and mortality. Because only a small number of studies have been conducted into the long-term effects of ECLS, we investigated the difference in quality of life, anxiety and depressive complaints and PTSD 3 months after ICU discharge. METHOD It is a retrospective case-control study covering the period January 2012 to December 2017. The ECLS patient group was compared to a matched similar patient group in the Intensive Care (IC) that did not have ECLS therapy. Quality of life was measured with the Short-Form-36 (SF-36) questionnaire, anxiety and depression was measured with the Hospital Anxiety and Depression Scale (HADS) questionnaire and for PTSD the Impact of Events Scale (IES) questionnaire was used, comparing sum scores and cut-off points of scores from both groups. RESULTS Included were 19 patients in the ECLS group and 38 in the control group. The mean sum scores on the sub scales of the SF36 questionnaire were the same for both groups. Only the mean score of 66.2 (scale 0-100) on the domain 'general health experience' was statistically significantly different in the ECLS group than in the control group (56.8, p = .02). There was no significant difference between the sum scores of both groups on anxiety and depressive complaints. In the ECLS group 32% of the patients may have a depressive disorder versus 18% from the control group (p = .32). And 26% of the patients from the ECLS group may have an anxiety disorder versus 7% from the control group (p = .51). The incidence of PTSD was 42% in the ECLS group and 24% in the control group (p = .22). CONCLUSION We found no statistically significant difference in quality of life, anxiety and depressive symptoms and PTSD symptoms between ECLS patients and the matched control group - 3 months after the ICU discharge. The incidence of anxiety and depressive symptoms and PTSD in the ECLS group is higher than in the control group, however, this difference is not significant.
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Affiliation(s)
- Roos de Vlugt
- Intensive Care, St. Antonius hospital, Nieuwegein, Netherlands
| | - Bea Spek
- Department Epidemiology and Data Science, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Sander Rigter
- Department of anesthesiology and ICU, St Antonius Ziekenhuis, Nieuwegein, Netherlands
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van Minnen O, Oude Lansink-Hartgring A, van den Boogaard B, van den Brule J, Bulpa P, Bunge JJH, Delnoij TSR, Elzo Kraemer CV, Kuijpers M, Lambermont B, Maas JJ, de Metz J, Michaux I, van de Pol I, van de Poll M, Raasveld SJ, Raes M, Dos Reis Miranda D, Scholten E, Simonet O, Taccone FS, Vallot F, Vlaar APJ, van den Bergh WM. Reduced anticoagulation targets in extracorporeal life support (RATE): study protocol for a randomized controlled trial. Trials 2022; 23:405. [PMID: 35578271 PMCID: PMC9108348 DOI: 10.1186/s13063-022-06367-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although life-saving in selected patients, ECMO treatment still has high mortality which for a large part is due to treatment-related complications. A feared complication is ischemic stroke for which heparin is routinely administered for which the dosage is usually guided by activated partial thromboplastin time (aPTT). However, there is no relation between aPTT and the rare occurrence of ischemic stroke (1.2%), but there is a relation with the much more frequent occurrence of bleeding complications (55%) and blood transfusion. Both are strongly related to outcome. METHODS We will conduct a three-arm non-inferiority randomized controlled trial, in adult patients treated with ECMO. Participants will be randomized between heparin administration with a target of 2-2.5 times baseline aPTT, 1.5-2 times baseline aPTT, or low molecular weight heparin guided by weight and renal function. Apart from anticoagulation targets, treatment will be according to standard care. The primary outcome parameter is a combined endpoint consisting of major bleeding including hemorrhagic stroke, severe thromboembolic complications including ischemic stroke, and mortality at 6 months. DISCUSSION We hypothesize that with lower anticoagulation targets or anticoagulation with LMWH during ECMO therapy, patients will have fewer hemorrhagic complications without an increase in thromboembolic complication or a negative effect on their outcome. If our hypothesis is confirmed, this study could lead to a change in anticoagulation protocols and a better outcome for patients treated with ECMO. TRIAL REGISTRATION ClinicalTrials.gov NCT04536272 . Registered on 2 September 2020. Netherlands Trial Register NL7969.
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Affiliation(s)
- Olivier van Minnen
- Department of Critical Care, University Medical Center Groningen, Room R3.904, PO BOX 30001, 9700, RB, Groningen, The Netherlands.
| | - Annemieke Oude Lansink-Hartgring
- Department of Critical Care, University Medical Center Groningen, Room R3.904, PO BOX 30001, 9700, RB, Groningen, The Netherlands
| | | | - Judith van den Brule
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pierre Bulpa
- Department of Intensive Care, CHU UCL Namur site Mont-Godinne, Yvoir, Belgium
| | - Jeroen J H Bunge
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Thijs S R Delnoij
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Carlos V Elzo Kraemer
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Marijn Kuijpers
- Department of Intensive Care Medicine, Isala Clinics, Zwolle, The Netherlands
| | | | - Jacinta J Maas
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jesse de Metz
- Department of Intensive Care, OLVG, Amsterdam, The Netherlands
| | - Isabelle Michaux
- Department of Intensive Care, CHU UCL Namur site Mont-Godinne, Yvoir, Belgium
| | - Ineke van de Pol
- Department of Intensive Care Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marcel van de Poll
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Jorinde Raasveld
- Department of Intensive Care Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Matthias Raes
- Department of Intensive Care, University Hospital Brussels, Brussels, Belgium
| | - Dinis Dos Reis Miranda
- Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Erik Scholten
- Department of Intensive Care Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Olivier Simonet
- Department of Intensive Care, Centre Hospitalier de Wallonie Picarde (CHwapi), Tournai, Belgium
| | - Fabio S Taccone
- Department of Intensive Care, Hôpital Erasme Bruxelles, Brussels, Belgium
| | - Frederic Vallot
- Department of Intensive Care, Centre Hospitalier de Wallonie Picarde (CHwapi), Tournai, Belgium
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Walter M van den Bergh
- Department of Critical Care, University Medical Center Groningen, Room R3.904, PO BOX 30001, 9700, RB, Groningen, The Netherlands
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