Jpen Parenter Enter
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Jpen Parenter Enter · Jul 1984
Case ReportsFatal cardiac tamponade in a patient receiving total parenteral nutrition via a silastic central venous catheter.
This is the first reported case of cardiac tamponade secondary to ventricular perforation involving a silastic catheter. The catheter had advanced into the right ventricle and become enmeshed in the trabeculae carnae. At autopsy there was an area of necrosis which we presumed was caused by the continuous direct contact of a small area of endocardium and subadjacent myocardium with the hypertonic infusate used for parenteral nutrition.
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Jpen Parenter Enter · Mar 1984
Comparative StudyPlasma ammonia levels in preterm infants receiving parenteral nutrition with crystalline L-amino acids.
In order to investigate the severity and incidence of hyperammonemia in preterm infants receiving total parenteral nutrition (TPN) with crystalline L-amino acids having high arginine content (Travasol), we determined the plasma ammonia (PA) levels in a group of 29 preterm infants on TPN, weekly and 1 wk posttherapy. Their mean gestational age was 29.9 +/- 2.6 wk and mean birth weight 1208 +/- 262 g. Thirty five blood samples obtained from 15 preterm infants not on TPN with mean gestational age 32.2 +/- 1.9 wk and a birth weight of 1495 +/- 161 g served as a control. ⋯ The incidence of hyperammonemia (greater than 160 micrograms/100 ml) was 30% in the TPN group versus 3% in the controls (p less than 0.01). Maximal PA level during that treatment was 405 versus 216 micrograms/100 ml 1 wk post-TPN versus 163 micrograms/100 ml in the controls. The data show a significant increase in PA levels in preterm infants receiving TPN with Travasol, possibly because of its high glycine content.
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Jpen Parenter Enter · Mar 1984
Care of the central venous catheterization site: the use of a transparent polyurethane film.
Studies of care of patients with central venous catheters report a 3-7% incidence of catheter-induced sepsis when sterile gauze and tape are used as an occlusive dressing. The technique requires that the dressing be changed three times each week for catheterization site inspection. From June 1979 to September 1980, a noncomparative evaluation of a transparent, self-adhesive, polyurethane dressing which is permeable to water vapor but not bacteria was performed. ⋯ Dressing life averaged 5.3 days with silicone rubber catheters and 4.3 days for polyvinyl chloride catheters. One patient developed catheter induced sepsis (incidence 1%). This dressing material: (1) is acceptable for use as a dressing of central venous catheters; (2) continuously permits inspection of the insertion sites; (3) decreases nursing hours; (4) provides a comfortable dressing which secures the catheter to the patient; and (5) is durable even when exposed to high humidity therapy devices, or when possible permits the patient to take showers.
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Jpen Parenter Enter · Mar 1984
Comparative StudyComparison of the elimination and metabolism of 10% Travamulsion and 10% Intralipid lipid emulsion in the dog.
A study was performed comparing the elimination kinetics of two soybean oil/egg phosphatide lipid emulsions (10% Travamulsion vs 10% Intralipid) from the vascular compartment of the dog. Elimination kinetics were evaluated after bolus injection and after continuous infusion studies. ⋯ Phospholipid and cholesterol data indicate a possible difference in remnant particle removal. At the higher lipid dosages, remnant particles from Travamulsion injection were removed at a faster rate than those from Intralipid.
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Jpen Parenter Enter · Jan 1984
Deep brachial vein catheterization for total parenteral nutrition--an alternate approach: review of 154 cases.
The relative safety of silicon rubber catheters allows us to use deep brachial vein catheterization when other vascular accesses are hazardous or impossible. The vein is isolated from nerve and artery after a small incision is made across the inner edge of the brachial biceps. From January 1980 until April 1982, 154 catheters were inserted and remained in place from 14-167 days. ⋯ Twice bleeding had to be controlled with an occlusive bandage. We had no incidence of clinical thrombosis. The surgical access to the deep brachial vein provides a simple and safe method for difficult and even long-term vascular access.