Closed Blood Conservation Device for Reducing Catheter-Related Infections in Children After Cardiac Surgery

2014 ◽  
Vol 34 (5) ◽  
pp. 53-60 ◽  
Author(s):  
Menglin Tang ◽  
Mei Feng ◽  
Lijun Chen ◽  
Jinmei Zhang ◽  
Peng Ji ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Bloodstream Infections ◽  
Control Group ◽  
Microbiological Analysis ◽  
Blood Conservation ◽  
Blood Samples ◽  
Potential Sources ◽  
Catheter System ◽  
Group 3 ◽  
Interventional Group

Background Arterial catheters are potential sources of nosocomial infection. Objective To investigate use of a closed blood conservation device in preventing catheter-related bloodstream infections in children after cardiac surgery. Methods Children with an indwelling arterial catheter after cardiac surgery were randomly assigned to 2 groups: a control group with a conventional 3-way stopcock in the catheter system and an interventional group with the conservation device in the catheter system. Catheter tips, catheter intraluminal fluid, and blood samples obtained from the catheter and peripherally were cultured for microbiological analysis. RESULTS Intraluminal fluid contamination was significantly lower (P = .03) in the interventional group (3 of 147 catheters) than in the control group (10 of 137 catheters). The 2 groups did not differ significantly in the rate of tip colonization (9 of 147 vs 12 of 137; P = .40) or in the number of catheter-related bloodstream infections (0 of 147 vs 2 of 137; P = .21). Conclusion Use of a closed blood conservation device could decrease the incidence of catheter-related contamination of intraluminal fluid.

scholarly journals Hemodilution in High Risk Cardiac Surgery: Laboratory Values, Physiological Parameters and Outcomes

2021 ◽  
Author(s):  
Domagoj Mladinov ◽  
Luz A Padilla ◽  
Benjamin Leahy ◽  
Joseph B Norman ◽  
Jacob Enslin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
High Risk ◽  
Bypass Graft ◽  
Physiological Parameters ◽  
Cerebral Oximetry ◽  
Organ Injury ◽  
Conservation Strategy ◽  
Control Group ◽  
Blood Conservation ◽  
Allogenic Blood

Background: Acute normovolemic hemodilution (ANH) is a blood conservation strategy in cardiac surgery, predominantly used in coronary artery bypass graft (CABG) and/or valve procedures. Although higher complexity cardiac procedures may benefit from ANH, concerns for hemodynamic instability and organ injury during hemodilution hinder its wider acceptance. Laboratory and physiological parameters during hemodilution in complex cardiac surgeries have not been described. Study Design and Methods: This observational cohort (2019-2021) study included 169 patients who underwent thoracic aortic repair, multiple valve procedure, concomitant CABG with the aforementioned procedure, and/or redo sternotomies. Patients who received allogeneic blood were excluded. Statistical comparisons were performed between ANH (N=66) and non ANH controls (N=103). ANH consisted of removal of blood at the beginning of surgery and its return after cardiopulmonary bypass (CPB). Results: Intraoperatively, the ANH group received more albumin (p=0.04) and vasopressor medications (p=0.01); while urine output was no different between ANH and controls. Bilateral cerebral oximetry (rSO2) values were similar before and after hemodilution. During bypass rSO2 were discretely lower in the ANH vs. control group (right rSO2 p=0.03, left rSO2 (p=0.05). No differences in lactic acid values were detected across the procedural continuum. Postoperatively, no differences in extubation times, ICU length of stay, kidney injury, stroke or infection were demonstrated. Discussion: This study suggests hemodilution to be a safe and comparable blood conservation technique, even without accounting for potential benefits of reduced allogenic blood administration. The study may contribute to better understanding and wider acceptance of ANH protocols in high risk cardiac surgeries.

scholarly journals Multiplex Polymerase chain reaction to diagnose bloodstream infections in patients after cardiothoracic surgery

2018 ◽  
Author(s):  
Kevin Pilarczyk ◽  
Peter-Michael Rath ◽  
Jörg Steinmann ◽  
Matthias Thielmann ◽  
Maximillian Dürbeck ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Cardiac Surgery ◽  
Blood Culture ◽  
Real Time ◽  
Multiplex Polymerase Chain Reaction ◽  
Bloodstream Infections ◽  
Chain Reaction ◽  
Blood Samples ◽  
Gram Negative ◽  
Polymerase Chain

Abstract Background: Sepsis and other infectious complications are major causes of mortality and morbidity in patients after cardiac surgery. Whereas blood culture (BC) as the current diagnostic gold standard suffers from low sensitivity as well as a reporting delay of approximately 48–72 h, polymerase chain reaction (PCR) based technologies might offer a fast and reliable alternative for detection of bloodstream infections (BSI). The aim of this study was to compare the performance of real time multiplex-PCR “SeptiFast” (SF), a real-time multiplex PCR assay, with conventional BC testing in patients after cardiac surgery. Methods: 279 blood samples from 168 individuals with suspected BSI were analyzed by SF and BC. Receiver operating characteristic (ROC) curves were generated to determine the accuracy of clinical and laboratory information for the prediction of positive SF results. Results: Excluding results attributable to contaminants, 14.7% (n = 41) of blood samples were positive using SF and 17.2% (n=49) using conventional BC (p= n.s.). In six samples, SF detected more than one pathogen. Among the 47 microorganisms identified by SF, only 11 (23.4%) could be confirmed by BC. SF identified a significantly higher number of Gram-negative bacteria than BC (28 vs. 12, χ2=7.97, p=0.005). The combination of BC and SF significantly increased the number of detected microorganism, including fungi, when compared to BC alone (86 vs. 49, χ2=13.51, p<0.001). C-reactive protein (CRP) (21.7±11.41 vs. 16.0±16.9 mg/dl, p=0.009), procalcitonin (PCT) (28.7±70.9 vs. 11.5±30.4 ng/dl, p=0.015) as well as interleukin 6 (IL 6) (932.3±1306.7 vs. 313.3±686.6 pg/ml, p=0.010) was significantly higher in patients with a positive SF result. In addition, incidence of severe acute kidney injury (AKI) was higher in SF positive than in SF negative patients (31/42 [76%] vs. 125/237 [53%], p=0.01). Using ROC analysis, IL-6 (AUC 0.836) as well as CRP (AUC 0.804), but not PCT showed the best predictive values for positive SF results. Microbiological diagnostic information gained through SF led to 8 therapy adaptations. Conclusion: The real time PCR-based SF test might represent a valuable addition to the traditional BC method for rapid etiologic diagnosis of BSI in patients after cardiothoracic surgery. This powerful method furthermore applies in particular for individuals with fungal infections, Gram-negative bacteremia, AKI and/or elevated CRP and IL-6-concentration. However, due to the low performance in detecting Gram-positive pathogens and the inability to determine antibiotic susceptibility, it should always be used in combination with BC. [1] Key words: Blood stream infection, blood culture, real time multiplex Polymerase Chain Reaction

Antioxidant Effect of α-Tocopherol on Fracture Haematoma in Rabbits

1996 ◽  
Vol 24 (5) ◽  
pp. 419-424 ◽  
Author(s):  
K DUrak ◽  
Ö F Bilgen ◽  
T Kaleli ◽  
P Tuncel ◽  
R Özbek ◽  
...  
Keyword(s):  
Oxygen Radicals ◽  
Venous Blood ◽  
Conjugated Dienes ◽  
Control Group ◽  
Free Oxygen Radicals ◽  
Free Oxygen ◽  
Blood Samples ◽  
Group I ◽  
Group 3 ◽  
Group 2

In this study, the effect of free oxygen radicals on lipid peroxidation and the antioxidant role of α-tocopherol (vitamin E) in these reactions were investigated in haematoma fluid and venous blood samples in rabbits with femoral fracture. There were 21 male rabbits, divided into 3 groups. Conjugated dienes values (as optical density) were compared in venous blood of the rabbits in Group I taken preanaesthesia and after the onset of anaesthesia and the difference between these values proved to be insignificant ( P > 0.05). A control group (Group 2) was given saline before fracture occurrence and the other group (Group 3) was injected with α-tocopherol 20 mg/kg intramuscularly. Venous blood samples and fracture haematoma fluids in both Group 2 and Group 3 were assayed biochemically. It was established that conjugated dienes values in fracture haematoma fluid in rabbits in the control group were higher than the values in the venous blood of the rabbits in the same group (P < 0.05). However, conjugated dienes values in the a-tocopherol injected group both in the haematoma fluid and in venous blood were reduced compared with those in the control group ( P < 0.5). In view of the fact that ischaemia and reperfusion develop in fractured regions and that general body ischaemia develops following serious fractures of the extremities, we consider that prophylactic administration of antioxidants such as α-tocopherol may be beneficial in suppressing the destructive effects of free oxygen radicals in cells.

scholarly journals A Cardiopulmonary Bypass Based Blood Management Strategy in Adult Cardiac Surgery

2017 ◽  
Vol 20 (5) ◽  
pp. 195 ◽  
Author(s):  
Ali Baran Budak ◽  
Kevin McCusker ◽  
Serdar Gunaydin
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Transfusion ◽  
Artery Bypass ◽  
Postoperative Hemorrhage ◽  
Control Group ◽  
Transfusion Rate ◽  
Blood Conservation ◽  
Transfusion Guidelines ◽  
Adult Cardiac Surgery

Background: Despite the recent introduction of a number of technical and pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open-heart surgical procedures. Efforts should be made to decrease or completely avoid transfusions to avoid these negative reactions.Methods: Our coronary artery bypass grafting database was reviewed retrospectively and a total of 243 patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) were studied in a 12-month period (January-December 2016) after the implementation of the new program, and compared with 275 patients of the previous 12-month period.All the staff involved in the care of the patients were educated about the risks and benefits of blood transfusions and the new transfusion guidelines in a 45-min training. We revised our guidelines for transfusions based on the STS. A transfusion log was created. Reduction in IV fluid volume was targeted. CPB circuitry was redesigned to achieve significantly less prime volume. Results: The proportion of patients transfused with red blood cells was 56% (n =154) in the control group and reduced by 26.8% in the study group (29.2%; 71 patients; P < .01). Blood transfusion rate (1.7 ± 1/3.05 ± 1 units), postoperative hemorrhage (545 ± 50/ 775 ± 55 mL), respiratory support duration (12.4 ± 7/16.8 ± 8 h) and ICU stay (2.2±1.1/ 3.5±1.2 days) were significantly better in the blood conservation group.  Conclusion: These findings, in addition to risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in adult cardiac operations. 

Efficacy of Near-Infrared Spectrometry for Monitoring the Cerebral Effects of Severe Dilutional Anemia

2014 ◽  
Vol 17 (3) ◽  
pp. 154 ◽  
Author(s):  
Arıtürk Cem ◽  
Ustalar Serpil ◽  
Toraman Fevzi ◽  
Ökten Murat ◽  
Güllü Ümit ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Surgery ◽  
Blood Lactate ◽  
Near Infrared ◽  
Bypass Graft ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Infrared Spectrometry ◽  
Control Group ◽  
Near Infrared Spectrometry

<p><strong>Introduction:</strong> Clear guidelines for red cell transfusion during cardiac surgery have not yet been established. The current focus on blood conservation during cardiac surgery has increased the urgency to determine the minimum safe hematocrit for these patients. The aim of this study was to determine whether monitoring of cerebral regional oxygen saturation (rSO<sub>2</sub>) via near-infrared spectrometry (NIRS) is effective for assessing the cerebral effects of severe dilutional anemia during elective coronary arterial bypass graft surgery (CABG).</p><p><strong>Methods:</strong> The prospective observational study involved patients who underwent cerebral rSO<sub>2</sub> monitoring by NIRS during elective isolated first-time CABG: an anemic group (<em>N</em>=15) (minimum Hemoglobin (Hb) N=15) (Hb &gt;8 g/dL during CPB). Mean arterial pressure (MAP), pump blood flow, blood lactate level, pCO<sub>2</sub>, pO<sub>2</sub> at five time points and cross-clamp time, extracorporeal circulation time were recorded for each patient. Group results statistically were compared.</p><p><strong>Results:</strong> The anemic group had significantly lower mean preoperative Hb than the control group (10.3 mg/dL versus 14.2 mg/dL; <em>P</em> = .001). The lowest Hb levels were observed in the hypothermic period of CPB in the anemic group. None of the controls exhibited a &gt;20% decrease in cerebral rSO<sub>2</sub>. Eleven (73.3%) of the anemic patients required an increase in pump blood flow to raise their cerebral rSO<sub>2</sub>.</p><p><strong>Conclusions:</strong> In this study, the changes in cerebral rSO<sub>2</sub> in the patients with low Hb were within acceptable limits, and this was in concordance with the blood lactate levels and blood-gas analysis. It can be suggested that NIRS monitoring of cerebral rSO<sub>2</sub> can assist in decision making related to blood transfusion and dilutional anemia during CPB.</p>

The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

2012 ◽  
Vol 15 (2) ◽  
pp. 84 ◽  
Author(s):  
Canturk Cakalagaoglu ◽  
Cengiz Koksal ◽  
Ayse Baysal ◽  
Gokhan Alici ◽  
Birol Ozkan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Pericardial Tamponade ◽  
Anxiety Level ◽  
Control Group ◽  
Echocardiographic Study ◽  
Number Of Patients ◽  
Hospital Stays

<p><b>Aim:</b> The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).</p><p><b>Materials and Methods:</b> We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.</p><p><b>Results:</b> The 2 groups were not significantly different with respect to demographic and operative data (<i>P</i> > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (<i>P</i> < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (<i>P</i> < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (<i>P</i> = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.</p><p><b>Conclusion:</b> Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.</p>

Management of Intraoperative Fluid Balance and Blood Conservation Techniques in Adult Cardiac Surgery

2011 ◽  
Vol 14 (1) ◽  
pp. 28 ◽  
Author(s):  
George Vretzakis ◽  
Athina Kleitsaki ◽  
Diamanto Aretha ◽  
Menelaos Karanikolas
Keyword(s):  
Cardiac Surgery ◽  
Blood Cell ◽  
Fluid Balance ◽  
Blood Product ◽  
Blood Donation ◽  
Autologous Blood ◽  
Small Body ◽  
Risk Indicators ◽  
Blood Transfusions ◽  
Blood Conservation

Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, especially when cardiopulmonary bypass (CPB) is used, because hematocrit drops precipitously during CPB due to blood loss and blood cell dilution. Advanced age, low preoperative red blood cell volume (preoperative anemia or small body size), preoperative antiplatelet or antithrombotic drugs, complex or re-operative procedures or emergency operations, and patient comorbidities were identified as important transfusion risk indicators in a report recently published by the Society of Cardiovascular Anesthesiologists. This report also identified several pre- and intraoperative interventions that may help reduce blood transfusions, including off-pump procedures, preoperative autologous blood donation, normovolemic hemodilution, and routine cell saver use.A multimodal approach to blood conservation, with highrisk patients receiving all available interventions, may help preserve vital organ perfusion and reduce blood product utilization. In addition, because positive intravenous fluid balance is a significant factor affecting hemodilution during cardiac surgery, especially when CPB is used, strategies aimed at limiting intraoperative fluid balance positiveness may also lead to reduced blood product utilization.This review discusses currently available techniques that can be used intraoperatively in an attempt to avoid or minimize fluid balance positiveness, to preserve the patient's own red blood cells, and to decrease blood product utilization during cardiac surgery.

Isolation of Stenotrophomonas maltophilia from Clinical Samples in Some Hospitals in Shiraz, Iran

2020 ◽  
pp. 1-3
Author(s):  
Majid Baserisalehi ◽  
Samira Zarezadeh ◽  
Majid Baserisalehi ◽  
Saeed Shoa
Keyword(s):  
Stenotrophomonas Maltophilia ◽  
Enterobacter Aerogenes ◽  
Late Summer ◽  
Early Spring ◽  
Clinical Samples ◽  
Bacillus Species ◽  
Microbiological Analysis ◽  
Blood Samples ◽  
Healthcare Facilities ◽  
Phenotypic Methods

Stenotrophomonas maltophilia is an emerging pathogenic non-fermentative Gram-negative Bacillus species. It has caused many nosocomial infections and can be isolated from various hospital wards and healthcare facilities. Research has shown that most of its strains are inherently resistant to many antibiotics and have multidrug resistance. This research intended to determine its occurrence frequency at some Hospitals in shiraz, Iran. The present study was conducted in six months (from early spring to late summer 2019). Clinical samples (Blood, Urine and cerebrospinal fluid (CSF)) collected from 120 patients afflicted with various infections. The samples were transferred to the Laboratory and subjected to microbiological analysis. Identification of the isolates was carried out by phenotypic methods and Stenotrophomonas maltophilia isolates verified using molecular methods. In total, various bacteria were isolated from 84 clinical samples. The isolates were Escherichia coli, Enterobacter aerogenes, Klebsiella pneumoniae, Stenotrophomonas maltophilia, Staphylococcus aureus and Pseudomonas aeruginosa. Stenotrophomonas maltophilia was isolated from 17 (20.2%) positive samples and most of them were isolated from blood samples. Our finding indicated that Stenotrophomonas maltophilia isolated more from blood samples follow by CSF sample. In addition, our finding illustrated that Stenotrophomonas maltophilia can be considered as the common nosocomial agent at hospitals in Shiraz, Iran.

Sign in / Sign up

Export Citation Format

Share Document