Lancet
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Randomized Controlled Trial Clinical Trial
Effect of catheter tunnelling and a nutrition nurse on catheter sepsis during parenteral nutrition. A controlled trial.
In a three-year controlled trial of subcutaneous catheter tunnelling as a method of reducing total parenteral nutrition (TPN) catheter sepsis 99 silicone catheters (52 tunnelled, 47 untunnelled) were inserted into the subclavian (94%) or jugular (6%) veins under aseptic conditions. The influence of a nutrition nurse, who joined the nutrition team after 18 months, on catheter sepsis rate was also documented. Catheter sepsis was confirmed in 13 of 47 (28%) untunnelled catheters and only 6 of 52 (11.5%) tunnelled catheters (p less than 0.05). ⋯ There was no significant difference between tunnelled and untunnelled catheters in sepsis rates after the arrival of the nutrition nurse. Although 85% patients had concurrent internal sepsis, the pathogens implicated in catheter sepsis came from superficial sites in 16 of 19 cases (p less than 0.01). Rigorous aseptic nursing care is thus the most significant factor in the reduction of TPN catheter sepsis, but tunnelling can reduce sepsis rate when nursing care is suboptimum.
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Comparative Study Clinical Trial
Effect of desferrioxamine on removal of aluminum and iron by coated charcoal haemoperfusion and haemodialysis.
An intravenous infusion of desferrioxamine (3 g) was given to 17 chronic renal failure patients stabilised on standard haemodialysis. Aluminium clearance 48 h after desferrioxamine was 65.3 +/- 11.0 ml/min for 'Dialaid 4000' with 70 g coated charcoal haemoperfusion system; 44.6 +/- 13.7 ml/min for 'Rhondial 75' with polyacrylonitrate membrane; 35.8 +/- 11.0 ml/min for 'Monitral' with polyacrylonitrate membrane; and 4.0 +/- 17.8 ml/min for haemodialysers with a 'Cupraphane' membrane. ⋯ CAC did not absorb ferric ions in vitro. But when 40 mg/dl of desferrioxamine was present CAC absorbed increasing concentrations of ferric ions in a linear fashion.