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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred patients receiving parenteral nutrition with lipids and hypertonic amino acids and glucose were divided into five groups of 20, depending on the type of intravenous catheter used for the infusion. Least satisfactory were the short Butterfly needles (average 3.3 days in place) and the long peripherally inserted polyvinyl central venous catheters (average 6.2 days in place). Subclavian catheters of polyvinyl (average 15.3 days) or silicone elastomer (average 17.5 days) were equally efficacious. A new long silicone elastomer catheter inserted peripherally was most satisfactory (average 29.5 days). Problems common with polyvinyl catheters (phlebitis, thrombosis, and sepsis) rarely occurred with either the long or short silicone elastomer catheter.
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PMID:A comparative study of peripherally inserted silicone catheters for parenteral nutrition. 40 92

During a 1 yr period, 19 infants less than 2 mo of age were fed intravenously with an infusate composed of glucose, amino acids, electrolytes, and vitamins. The solution was infused at a rate of 200 ml/kg/day or more for periods ranging from 5-247 days. No central venous catheters were utilized; the solutions were always administered through a needle in a peripheral vein. Weight gains similar to those seen with other techniques of intravenous nutrition were observed in all of the patients studied. No instance of fluid overload in the form of pulmonary edema, peripheral edema, or congestive heart failure was seen, and osmotic diuresis was not observed because of the lower tonicity of the infusate. Phlebitis was seen in 1/5 of the infusions, but was reversed by stopping the infusion and applying warm soaks. Three cases of skin slough were observed and two of these healed spontaneously without the need of skin grafting. The advantages of this technique over central venous nutrition are the elimination of the complications related to the central venous catheter, namely, sepsis and superior vena cava thrombosis.
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PMID:Peripheral intravenous nutrition without fat in neonatal surgery. 40 75

Three hundred fifty-seven groin hernia repairs were performed under local anesthesia using a long-lasting local anesthetic agent. An ilioinguinal, iliohypogastric, and twelfth intercostal nerve block was carried out initially, followed by regional infiltration of the agent, using a technic first described by Ponka [8] with several modifications. This technic can be employed suffessfully in the majority of groin hernia repairs. It requires careful attention to detail in the administration of preoperative sedation and analgesia and the use of sharp dissection only and greater gentleness in the handling of tissue. We have observed a significant reduction in postoperative discomfort and the virtual elimination of urinary retention, urinary sepsis, atelectasis, and phlebitis in these cases. All patients are fully ambulatory, without assistance immediately after surgery and the majority are discharged the same day or the following morning. This results in a marked reduction in the total cost of repairing a groin hernia.
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PMID:Change in the management of adult groin hernia. 41 25

A review of 100 patients with peripheral septic phlebitis revealed that 54 per cent of the cases were due to intravenous catheters and 46 per cent were secondary to drug abuse. Eighty per cent of the involved veins were in the arm or neck. Pain was the most common symptom (83 per cent), with erythema and edema the most common physical signs (63 per cent). Eighty per cent of the causative organisms were gram-positive bacteria, usually Staphylococcus aureus (41 per cent) or Group A streptococcus (20 per cent). Complications were more common if septic phlebitis was due to intravenous therapy than drug abuse. No deaths were directly attributed to septic phlebitis. However, hospital stay after development of septic phlebitis was 14 days with a 56 per cent complication rate. The initial treatment of septic phlebitis should include prompt removal of the intravenous device, antibiotics, heat, and elevation. Because serious complications occur in a significant number of patients, operative excision of the involved vein should be performed if clinical deterioration occurs or if septicemia persists after 24 hours despite conservative therapy.
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PMID:Septic phlebitis: a neglected disease. 46 15

Particulate and bacterial contamination of IV fluids and drugs have been implicated in venous thrombosis, infusion phlebitis, suppurative thrombophlebitis, pyrogenic reactions, and systemic sepsis. In a study of the inflammatory potential of the filterable residue of sodium cephalothin, we have found a tissue-specific reaction with venous endothelium but not with cutaneous or subcutaneous tissues. In a controlled animal model, removal of particulates from an infusion by use of a 0.45 micron in-line membrane filter reduces the incidence and severity of infusion phlebitis.
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PMID:Inflammatory potential of foreign particulates in parenteral drugs. 55 45

Forty-two patients were treated with intravenous cefoxitin, a new cephamycin antibiotic. These patients had postoperative abdominal sepsis (26), intrathoracic infections (6), urinary tract infections (5), gram-negative bacterial meningitis (2), septic arthritis (1), epidural abscess (1) and isolated septicemia (1). The antibacterial spectrum of cefoxitin was found to be one which included all gram-positive organisms except enterococci, most gram-negative organisms except Pseudomonas aeruginosa, and almost all of the important anaerobic organisms. The only five treatment failures included one patient with empyema and one with septic arthritis, both caused by Serratia marcescens, initially only moderately susceptible to cefoxitin, which subsequently developed increased resistance, two patients with contaminated intravenous catheters, and one patient with epidural abscess and cerebritis, who was treated late in the course. There was one serious clinical superinfection with P. aeruginosa. The drug levels noted in the pus and joint fluid were half to two-thirds of the simultaneous serum level. In inflamed meninges, up to 30% of the serum level was noted in the cerebrospinal fluid, and as the process resolved, 10 to 15% was noted. Toxicity of cefoxitin was mild and constituted skin rash in three patients (7%) and phlebitis in eight (19%).
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PMID:Use of cefoxitin, new cephalosporin-like antibiotic, in the treatment of aerobic and anaerobic infections. 74 74

Ticarcillin, a semisynthetic penicillin, was evaluated in the treatment of 75 serious gram-negative infections, 50 of which were caused by Pseudomonas aeruginosa. The overall rate of response was 81%. Septicemia and urinary tract infections responded more frequently (93%) than infections of the lower respiratory tract (71%). Response to therapy was comparable to results achieved previously with larger doses of carbenicillin. Response was not correlated with levels of drug in serum. Patients with nonfatal underlying disease were the most likely to respond to treatment. Ticarcillin-resistant organisms were isolated during therapy in 39% of the cases, and superinfection occurred in 12%. Colonization with resistant organisms did nto correlate with success or failure of therapy, severity of underlying disease, or levels of ticarcillin in serum. The clinical response and incidence of colonization were not altered by concurrent use of gentamicin, nor was the development of superinfection affected. Combination of ticarcillin and gentamicin in treatment of 19 patients did not produce toxicity. Eosinophilia, phlebitis, and hypokalemia occurred, as seen with carbenicillin, but major toxicity was not encountered.
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PMID:Ticarcillin for treatment of serious infections with gram-negative bacteria. 82 82

Nonsuppurative peripheral thrombophlebitis is a frequently recognized source of sepsis. Eleven patients cared for on general medical and surgical services had Gram-negative bacillary sepsis on this basis. Ten had isolation of organisms of the Klebsiella-Enterobacter group from the involved peripheral vein. All failed to respond to organism-sensitive antibiotics until the involved vein was excised. After local vein excision, all patients were afebrile within 48 hours and recovered. In seven of the 11 patients, the septic phlebitis source was associated with a standard intravenous needle, and none had cutdown procedures. It is strongly emphasized that this condition is a source of life-threatening sepsis that can be treated by vein excision at the bedside. The treatment in our patients resulted in no morbidity. A high index of suspicion is necessary to diagnose this occult source of sepsis because of the minimal local physical signs.
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PMID:Septic nonsuppurative thrombophlebitis. 125 17

We present a descriptive study of 229 consecutive inpatients requiring intravenous nutrition. These patients received either complete peripheral intravenous nutrition via a fine-bore silicone catheter (n = 80) or short Teflon catheter (n = 15) or received conventional central intravenous nutrition (n = 134). Nutrient delivery was similar for both systems, providing 0.2-0.4 g N.kg-1 x day-1 and 0.13-0.15 mJ.kg-1 x day-1 from preparations containing 4.3 MJ/L total energy (65-75% lipid: 25-35% glucose for peripheral support and 100% glucose for central delivery) with 6 g N/L. We compared the incidence of catheter complication and the probability of catheter function over time for the peripheral and conventional central systems. Venous access complications were seen only with central venous catheterization (10.4%). Chemical phlebitis occurred in 17% of fine-bore catheters and 91.4% of Teflon catheters. The infective phlebitis rate of fine-bore silicone catheters was 1.02% and daily risk of phlebitis 0.016%, with no instance of device-related bacteremia or sepsis. Central-line microbial contamination (21.7%) and catheter-related sepsis (3%) were significantly greater (p < 0.0005, chi 2 goodness-of-fit test) than with fine-bore silicone and Teflon catheters. The probability of complication-free function against time was similar (0.75 < p < 0.90, log-rank test) in fine-bore silicone catheters and central venous catheters. We conclude that fine-bore silicone catheters provide long-term phlebitis-free delivery of complete peripheral intravenous nutrition.
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PMID:Fine-bore peripheral catheters versus central venous catheters for delivery of intravenous nutrition. 148 53

Six hundred fifty-four peripheral Teflon catheters in 303 pediatric intensive care unit patients were examined to determine complication rates and associated risk factors. Phlebitis, extravasation, and bacterial colonization occurred at rates of 13%, 28%, and 11%, respectively. Logistic regression of factors that increased phlebitis risk revealed infusion of hyperalimentation (odds ratio 2.9) or lorazepam (odds ratio 2.2) and catheter location (odds ratio 2.9) as the most important determinants of phlebitis risk. Age (less than or equal to 1 year, odds ratio 2.0), catheter time in situ (less than or equal to 72 hours, odds ratio 2.1), and infusion of antiepileptics (odds ratio 2.1) were the most important determinants of extravasation. Catheters were colonized most frequently with coagulase-negative Staphylococcus (51/54). Sepsis attributable to catheter colonization occurred in 1 patient. Duration of catheter placement (greater than or equal to 144 hours, odds ratio 5.8) was an important determinant of catheter colonization. Colonization risk increased from 11% in catheters that were in situ for 48 to 144 hours to 34% for catheters that were in for longer than 144 hours. Infusion of diazepam (odds ratio 11.0) or lipid emulsions (odds ratio 2.5) and age (less than or equal to 1 year, odds ratio 2.2) were also important determinants of colonization risk. Replacing catheters in critically ill children every 72 hours would not decrease phlebitis, bacterial colonization, or catheter-induced sepsis and could increase extravasation risk. Catheters can be safely maintained with adequate monitoring for up to 144 hours in critically ill children.
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PMID:Peripheral intravenous catheter complications in critically ill children: a prospective study. 159 67


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