Ethanol‐Lock Therapy for the Prevention of Central Venous Access Device Infections in Pediatric Patients With Intestinal Failure

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141158/1/jpen0067.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141158/2/jpen0067-sup-0001.pd

Peripherally Inserted Central Catheter Experience in Long-Term Home Parenteral Nutrition Patients

Abstract Parenteral nutrition is administered through a central venous catheter(CVC). Peripherally inserted central catheters (PICC) are appropriate for home parenteral nutrition (HPN). The objective of this study was to examine a group of HPN patients with a PICC in place for more than six months, and the complications associated with PICC removal. Medical records from one home infusion pharmacy were retrospectively reviewed for PICC characteristics and complications leading to removal. Nineteen adult HPN patients had 26 PICC placements. Total PICC days were 22,262 with a mean of 856 (265–2500) days. Seven PICCs were in place for 3 to greater than 5 years. The overall complication rate was 0.58/1000 CVC days. Catheter related bloodstream infection (CRBSI) was the main cause of PICC removal. There was no evidence of symptomatic thrombosis. Patients experienced no infusion related complications. The PICCs were 88% polyurethane, 65% double lumen, and 54% were 5 Fr. No patient received alcohol or antibiotic lock therapy, and 8 patients had successful alteplase administered at least one time. All patients needed caregiver assistance for site care and dressing changes, but were independent in HPN infusion and flushing. This group of patients demonstrated that PICCs are a viable option HPN administration. The PICC overall complication rate was very low, and the most frequent complication leading to removal was CRBSI. The infection rate of 0.36/1000 CVC days is considered very low in an HPN population. This is the only HPN infusion study to date reporting 7 PICCs lasting 3 or more years, with 2 lasting greater than 5 years without complications resulting in removal. Patients received their prescribed therapy reliably and without interruption with this device. Larger studies are needed to confirm the efficacy of maintaining a PICC for very long-term HPN administration.</jats:p

Alcohol production from agricultural and forestry residues

Technologies available for the production of ethanol from whole corn are reviewed. Particular emphasis is placed on the environmental aspects of the process, including land utilization and possible air and water pollutants. Suggestions are made for technological changes intended to improve the economics of the process as well as to reduce some of the pollution from by-product disposal. Ethanol may be derived from renewable cellulosic substances by either enzymatic or acid hydrolysis of cellulose to sugar, followed by conventional fermentation and distillation. The use of two agricultural residues - corn stover (field stalks remaining after harvest) and straw from wheat crops - is reviewed as a cellulosic feedstock. Two processes have been evaluated with regard to environmental impact - a two-stage acid process developed by G.T. Tsao of Purdue University and an enzymatic process based on the laboratory findings of C.R. Wilke of the University of California, Berkeley. The environmental residuals expected from the manufacture of methyl and ethyl alcohols from woody biomass are covered. The methanol is produced in a gasification process, whereas ethanol is produced by hydrolysis and fermentation processes similar to those used to derive ethanol from cellulosic materials

Epidemiology of bloodstream infections in patients receiving long-term total parenteral nutrition

Goals: To describe the epidemiology and microbiologic characteristics of bloodstream infections (BSIs) in patients receiving long-term total parenteral nutrition (TPN).Background: Home TPN therapy has been reported as a risk factor for BSI. However, little knowledge exists regarding the epidemiology of BSIs in this patient group.Study: A descriptive, observational epidemiologic study of patients receiving long-term TPN from January 1981 to July 2005 was performed. Variables analyzed include age, gender, time of follow-up, number of BSIs, microbiologic characteristics, underlying disease necessitating long-term TPN, catheter type, complications related to TPN, and clinical outcome.Results: Forty-seven patients receiving long-term TPN were evaluated. the most frequent indication for long-term TPN was ischemic bowel disease (25.5%). the mean duration of follow-up was 4.5 years. Thirty-eight patients (80.9%) developed 248 BSls while receiving TPN. More than 1 BSI episode occurred in 78.9% of these patients, and 23.8% of BSI episodes were polymicrobial. the most prevalent pathogen was coagulase negative staphylococci (33.5%). the most frequent complication among patients with BSI was central venous thrombosis (44.7%). Five patients were intravenous drug users. There were 11 deaths among the patients on long-term TPN, 4 of these were related to infection and 4 were related to intravenous drug use.Conclusions: the incidence of BSI is high, and a significant proportion of BSIs in long-term TPN patients are polymicrobial and due to multidrug-resistant bacteria and fungi. Careful management of the infusion line is required and interventions are needed to reduce the risk of catheter-related infections in this population.Virginia Commonwealth Univ, Med Coll Virginia, Dept Internal Med, Richmond, VA 23298 USAUNIFESP, EPM, Div Infect Dis, São Paulo, BrazilVirginia Commonwealth Univ, Ctr Med, Dept Surg Nursing, Richmond, VA 23298 USAUNIFESP, EPM, Div Infect Dis, São Paulo, BrazilWeb of Scienc