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Abstract Introduction Physicians frequently use point-of-care ultrasound for intravenous access and bloodwork in the ED. Recently, AIUM and ACEP released recommendations on ultrasound-guided peripheral intravenous lines (USPIVs), but there are no agreed upon standardized policies. We sought to determine whether the use of sterile-covered transducers (SCT) decreases the rate of contamination when compared to uncovered transducers (UCT) after standard low-level disinfection (LLD). Methods This is a randomized control trial comparing contamination rates of US transducers between SCT and UCT after their use for USPIV by the vascular access team, also known as the “PICC” team, over a 3-month period. A sample of admitted patient with an USPIV order were included and randomized to SCT (experimental) or UCT (control) arms. Transducers were swabbed and inserted into the SystemSURE Plus Adenosine Triphosphate (ATP) Luminometer to calculate Relative Light Units (RLU). We performed a cost analysis of requiring sterile covers for USPIVs. Results The UCT and SCT arms contained 35 and 38 patients, respectively. The SCT group had a mean of 0.34 compared to the UCT group mean of 2.29. Each sterile cover costs $8.49, and over 3000 USPIVs are placed annually by the “PICC” team. Conclusion Contamination rates were similar among the UCT and SCT groups after LLD. 254 inpatient USPIVs are performed monthly, not including failed attempts or covers used in the ED where USPIV placement is an essential part of ED workflow. This study suggests that the use of SCT does not significantly affect transducer contamination rates. These findings question burdensome regulatory hospital policies that are not evidence-based.

Introduction: Physicians frequently use point-of-care ultrasound for intravenous access and bloodwork in the ED. Recently, AIUM and ACEP released recommendations on ultrasound-guided peripheral intravenous lines (USPIVs), but there are no agreed upon standardized policies. We sought to determine whether the use of sterile-covered transducers (SCT) decreases the rate of contamination when compared to uncovered transducers (UCT) after standard low-level disinfection (LLD). Methods: This is a randomized control trial comparing contamination rates of US transducers between SCT and UCT after their use for USPIV by the vascular access team, also known as the "PICC" team, over a 3-month period. A sample of admitted patient with an USPIV order were included and randomized to SCT (experimental) or UCT (control) arms. Transducers were swabbed and inserted into the SystemSURE Plus Adenosine Triphosphate (ATP) Luminometer to calculate Relative Light Units (RLU). We performed a cost analysis of requiring sterile covers for USPIVs. Results: The UCT and SCT arms contained 35 and 38 patients, respectively. The SCT group had a mean of 0.34 compared to the UCT group mean of 2.29. Each sterile cover costs $8.49, and over 3000 USPIVs are placed annually by the "PICC" team. Conclusion: Contamination rates were similar among the UCT and SCT groups after LLD. 254 inpatient USPIVs are performed monthly, not including failed attempts or covers used in the ED where USPIV placement is an essential part of ED workflow. This study suggests that the use of SCT does not significantly affect transducer contamination rates. These findings question burdensome regulatory hospital policies that are not evidence-based. [ABSTRACT FROM AUTHOR]

Background: Rapid infusion of warmed blood products is the cornerstone of trauma resuscitation and treatment of surgical and obstetric massive hemorrhage. Integral to optimizing this delivery is selection of an intravenous (IV) catheter and use of a rapid infusion device (RID). We investigated which IV catheter and RID system enabled the greatest infusion rate of blood products and the governing catheter characteristics. Study Design and Methods: The maximum flow rates of nine IV catheters were measured while infusing a mixture of packed red blood cells and fresh frozen plasma at a 1:1 ratio using a RID with and without a patient line extension. To account for IV catheters that achieved the RID's maximum 1000 ml/min, the conductance of each infusion circuit configuration was calculated. Results: IV catheters of 7‐Fr caliber or higher reached the maximum pressurized flow rate. The 9‐Fr multi‐lumen access catheter (MAC) achieved the greatest conductance, over sevenfold greater than the 18 g peripheral catheter (4.6 vs. 0.6 ml/min/mmHg, p <.001). Conductance was positively correlated with internal radius (β = 1.098, 95% CI 4.286–5.025, p <.001) and negatively correlated with length (β= − 0.495, 95% CI −0.007 to 0.005, p <.001). Use of an extension line (β= − 0.094, 95% CI −0.505 to −0.095, p =.005) was independently associated with reduced conductance in large caliber catheters. Conclusion: Short, large‐diameter catheters provided the greatest infusion rates of massive transfusion blood products for the least pressure. For patients requiring the highest transfusion flow rates, extension tubing should be avoided when possible. [ABSTRACT FROM AUTHOR]

Abstract The circulating tumor cell (CTC) count is closely related to cancer recurrence and metastasis. The technology that can in vivo destroy CTCs may bring great benefits to patients, which is an urgent clinical demand. Here, a minimally invasive therapeutic intravenous catheter for in vivo enriching and photothermal killing of CTCs is developed. The surface of catheter is modified with anti‐EpCAM antibody and the interior is filled with black phosphorus nanosheets (BPNSs). CTCs in the peripheral blood are captured by the catheter continually with the aid of circulation. The captured CTCs are used for downstream analyses or in vivo eliminated by the near‐infrared (NIR) photothermal effect of BPNSs. A capture efficiency of 2.1% is obtained during the 5 min of treatment, and 100% of the captured CTCs are killed by following NIR light irradiation in both an in vitro closed‐loop circulation system and an in vivo rabbit model. This cost‐effective modality for lowering the CTCs burden can be a good supplement to traditional therapies, which holds great promise as an effective clinical intervention for cancer patients.

The circulating tumor cell (CTC) count is closely related to cancer recurrence and metastasis. The technology that can in vivo destroy CTCs may bring great benefits to patients, which is an urgent clinical demand. Here, a minimally invasive therapeutic intravenous catheter for in vivo enriching and photothermal killing of CTCs is developed. The surface of catheter is modified with anti‐EpCAM antibody and the interior is filled with black phosphorus nanosheets (BPNSs). CTCs in the peripheral blood are captured by the catheter continually with the aid of circulation. The captured CTCs are used for downstream analyses or in vivo eliminated by the near‐infrared (NIR) photothermal effect of BPNSs. A capture efficiency of 2.1% is obtained during the 5 min of treatment, and 100% of the captured CTCs are killed by following NIR light irradiation in both an in vitro closed‐loop circulation system and an in vivo rabbit model. This cost‐effective modality for lowering the CTCs burden can be a good supplement to traditional therapies, which holds great promise as an effective clinical intervention for cancer patients. [ABSTRACT FROM AUTHOR]

Background: Reducing or preventing bloodstream infection caused by invasive intravenous catheterization, emphasizes the use of an effective topical antiseptics agent; however, because of the flaw in the evidence available regarding the choice of safe antiseptic to use on infants' skin under 2 months this issue remains controversial. The aim of this study was to investigate the types of antiseptics commonly used in neonatal intensive care units, consumption criteria and side effects of consumption and the effects of using antiseptics in premature infants. Methods: In this review, the total number of articles in PubMed, Scopus and ScienceDirect databases since 2010 were searched; titles and abstracts to identify relevant articles have been identified and 14 of the 48 searched articles were finally reviewed. Results: The review articles showed that different antiseptic-including chlorhexidine (CHG) 2% with alcohol base, pure CHG (in different density - 0.05%–2%), povidone-iodine 10%, isopropyl alcohol, 70% alcohol are used when inserting intravenous catheters in premature infants. Cutaneous side effect, systemic absorption and transient hyperthyroidism were reported as common side effects. Weight or age was criteria reported for antiseptic use. Various studies have been conducted to compare the effects of antiseptic with each other and different results have been reported. Conclusion: There is a paucity of evidence-based consensus guidelines for the use of appropriate antiseptic for preparing the skin before placing the intravenous catheter in preterm babies. Further research and publications are required, which will help reduce the risk of line related hospital-acquired infections. [ABSTRACT FROM AUTHOR]

• Increased NO fluxes from electrochemical IV-catheters in O 2 -rich environments. • O 2 -tolerant copper(II)-ligand complex. • Mitigated O 2 diffusion into the catheter material via immobilized oxidase enzyme. • Highest NO fluxes reported thus far in >3% O 2 saturated solutions. Electrocatalytic nitric oxide (NO) generation from nitrite (NO 2 –) within a single lumen of a dual-lumen catheter using CuII-ligand (CuII-L) mediators have been successful at demonstrating NO's potent antimicrobial and antithrombotic properties to reduce bacterial counts and mitigate clotting under low oxygen conditions (e.g., venous blood). Under more aerobic conditions, the O 2 sensitivity of the Cu(II)-ligand catalysts and the reaction of O 2 (highly soluble in the catheter material) with the NO diffusing through the outer walls of the catheters results in a large decreases in NO fluxes from the surfaces of the catheters, reducing the utility of this approach. Herein, we describe a new more O 2 -tolerant CuII-L catalyst, [Cu(BEPA-EtSO 3)(OTf)], as well as a potentially useful immobilized glucose oxidase enzyme-coating approach that greatly reduces the NO reactivity with oxygen as the NO partitions and diffuses through the catheter material. Results from this work demonstrate that very effective NO fluxes (>1*10−10 mol min−1 cm−2) from a single-lumen silicone rubber catheter can be achieved in the presence of up to 10% O 2 saturated solutions. [ABSTRACT FROM AUTHOR]

Peripheral intravenous catheters are administered for various purposes, such as blood sampling or the infusion of contrast agents and drugs. Extravasation happens when the catheter is unintentionally directed outside of the vein due to movement of the intravascular catheter, enhanced vascular permeability, or occlusion of the upstream vein. In this article, extravasation and its mechanism are discussed. Subsequently, the sensorized devices (e.g., single sensor and multimodal detection) to identify the extravasation phenomena are highlighted. In this review article, we have shed light on both physiological and engineering points of view of extravasation and its detection approaches. This review provides an overview on the most recent and relevant technologies that can help in the early detection of extravasation.

Objectives: To report our success and complication rates with emergency department (ED) technician–performed ultrasound (US)‐guided peripheral intravenous (IV) catheter placement and to compare our results to similar studies in the literature. Methods: We conducted a retrospective review of a prospective database of patients who underwent US‐guided peripheral IV catheter placement attempts for clinical care in the ED. All patients meeting difficult IV access criteria who had a US‐guided peripheral IV catheter placement attempted by a trained ED technician were included. Average attempts per success and overall success rates were compared to similar published studies. Results: There were 830 participants, with an overall success rate of ED technician– performed US‐guided peripheral IV catheter placement of 97.5%. Clinicians categorized 82.6% of participants as having difficult IV access and reported that in 46.5%, a central venous catheter would have been necessary if the US‐guided peripheral IV catheter failed. Of successful catheter attempts, 86.8% were placed on the first attempt; 11.6% were placed on the second attempt; and 1.6% were placed on the third attempt. For this study, the average number of attempts per success was 1.15 (95% confidence interval, 1.12–1.18), which was lower than in 6 other published studies, ranging from 1.27 to 1.70. The overall success rate of our ED technician‐performed attempts was 0.970 (95% confidence interval, 0.956–0.983), which was higher than that reported in previous ED technician studies (0.79–0.80), and closer to that reported for physicians or nurses (0.87–0.97). The arterial puncture complication rate was 0.8%, which was also lower than in other published studies (1.25%–9.80%). Conclusions: With brief but comprehensive training, ED technicians can successfully obtain US‐guided peripheral IV catheter access in patients with difficult IV access. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to investigate whether scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec could reduce the incidence of neonatal sepsis in a level-three neonatal intensive care unit. Methods We studied the incidence of neonatal sepsis caused by coagulase-negative staphylococci ( Co NS) for 16.5 months before the initiative was launched on May 15, 2012 and then for a further 8.5 months after it was introduced. The hub routine was applied to all intravenous catheters. Results During the control period before the initiative was launched, there were nine cases of Co NS sepsis compared with no cases after it was introduced, resulting in a decrease in sepsis incidence from 1.5% to 0% with a risk reduction of 1.5% (0.53-2.58%) (p = 0.06). In the preterm infant population, the incidence of sepsis decreased from 3.6% to 0% (1.1-6.0%) (p = 0.11). Conclusion Scrubbing the hub of intravenous catheters with an alcohol wipe for 15 sec seemed to be an efficient way of preventing sepsis caused by Co NS in newborn infants. However, the evidence for the benefits will remain weak until a large randomised trial has been completed. [ABSTRACT FROM AUTHOR]

Objectives: The Mycoses Forum in Japan has developed management bundles for candidaemia to incorporate into bedside practice. The aim of this study was to investigate nationwide compliance with the bundles and their impact on clinical outcomes. Methods: Non-neutropenic patients treated with antifungals for candidaemia were surveyed. Bundles consist of nine items to complete. Data were sent to the central office between July 2011 and April 2012. Results: Six hundred and eight patientswere analysed. The compliance rate for achieving all elements was 6.9%, and it increased to 21.4% when compliance was analysed by the bundle except for oral switch. There was a significant difference in clinical success between patients with and without compliance [92.9% versus 75.8% (P¼0.011)]. Compliance with the bundles, however, failed to be an independent factor associated with favourable outcomes. When step-down oral therapy was excluded from the elements of compliance, compliance with the bundles was revealed to be an independent predictor of clinical success (OR 4.42, 95% CI 2.05–9.52) and mortality (OR 0.27, 95% CI 0.13–0.57). Independent individual elements contributing to clinical success were removal of central venous catheters within 24 h, assessment of clinical efficacy on the third to the fifth day and at least 2 weeks of therapy after clearance of candidaemia. Conclusions: Compliance with the bundles for candidaemia had a beneficial effect on clinical outcomes. Promotion of the bundles approach may have the potential to narrow the gap between clinical evidence and bedside practice. [ABSTRACT FROM AUTHOR]

The article explores the risk factors associated with the development of phlebitis in patients with peripheral intravenous catheters (PIVC). A inflammation of a vein, with multiple cases, phlebitis is the main local complication of the insertion of PIVC. In the authors' study, they discovered that patients who were inserted PIVC in the upper extremities had less than 72 percent chance of developing phlebitis while those receiving KCl or antibiotics have the most significant risk factors.

Aims. To design clinical guidelines on timing for replacing peripheral intravenous catheters, in an attempt to decrease complications and lower related expenditures. Background. Intravenous therapy is a common intervention for patients in hospitals and some other clinical settings. However, the currently available international and local guidelines have come under criticism. There is a need to develop evidence-based guidelines to benefit patients as well as to save on the resources of healthcare systems. Design. A discursive paper. Methods. The evidence-based health care of Dawes et al. ( BioMed Central Medical Education 5, 2005, 1) was adopted to guide the development of this guideline. Cochrane Library Database was searched with four keywords: (1) Intravenous, (2) Infusion, (3) Infection, and (4) Timing, which identified one systematic review. Guideline on timing for replacing peripheral intravenous catheters was proposed based on the systematic review. Further recommendation for application in clinical settings and quality management are given. An algorithm on the replacement of peripheral intravenous catheters was included. Conclusion. Clinically indicated replacement was suggested over routine replacement because the former results in lower healthcare expenditures without involving any extra risks of complications. Relevance to clinical practice. These guidelines are simple and easy to follow in a clinical environment. An algorithm is given to enhance the usage of these guidelines by clinicians. [ABSTRACT FROM AUTHOR]

To determine the equivalency of pressure measurements from peripherally inserted central catheters (PICCs) versus centrally inserted central venous catheters (CVCs) in vitro as well as in vivo. The in vitro study was performed in a clinical laboratory. Static pressure measurements from PICCs and CVCs were obtained in vitro over a physiologic range of 5-25 mmHg. Triple and dual lumen PICCs were directly compared to CVC controls. Dynamic pressure waveforms were recorded to simulate physiologic intravascular pressure variation. The in vivo study was executed in the medical intensive care unit (MICU) of a tertiary-level academic medical center. Data was collected from ten adult patients with both a PICC and a CVC in place for on-going clinical care. Measurements of central venous pressure (CVP) were recorded simultaneously from PICCs and CVCs. Duplicate measurements were taken after a stable waveform was recorded. For the in vitro study, a total of 540 pressure measurements were recorded. The average bias determined by Bland-Altman plot was 0 mmHg for the 5Fr PICC and 0.071 mmHg for the 6Fr PICC. The correlation coefficient for both catheters was 1.0 ( P < 0.001). Dynamic pressure waveforms revealed equivalent amplitude. During the in vivo trial, 70 CVP measurements were collected. The paired CVP measurements were found to be highly reliable across subjects ( r = 0.99, P < 0.0001). No significance in the average difference in CVP measurement (PICC-CVC) was determined by the Wilcoxon Signed Rank test ( S = 1, P = 0.93). In conclusion, PICCs are equivalent to CVCs when measuring static and dynamic pressure in vitro and CVP in ICU patients. [ABSTRACT FROM AUTHOR]

An important goal of clinical electrophysiological studies is estimation of the source of rhythm disturbances (arrhythmia) in the heart. 15% of ventricular arrhythmias are known to originate from the outer surface of the heart (epicardium). One localization approach targeting the epicardium uses multielectrode catheters placed in the coronary veins. However, epicardial measurement sites from these catheters are limited to locations reached via the coronary veins. This study investigates the feasibility of several pattern classification and neural network approaches for localization of the source of ventricular arrhythmias from sparse measurements acquired from within coronary veins. Specifically, we studied Kohonen self-organizing maps and fuzzy C-means clustering methods for the construction of the target vector in neural networks from experimental high-resolution activation-time patterns. We also studied two neural network techniques, probabilistic neural networks and backpropagation networks, for the training and test procedures. The results of this study showed that it was possible to localize the arrhythmia source in a relatively small region for approximately 70% of cases. This study, in general, showed that the combination of probabilistic neural networks, Kohonen self-organizing maps and fuzzy C-means clustering approaches is feasible in catheter-based epicardial arrhythmia source localization. [ABSTRACT FROM AUTHOR]

Background: Peripheral intravenous catheters are among the most widely used medical devices in the world. European patients are increasingly aware of the risk of health care associated infections and the role catheters play in their facilitation. Aims: We intend to show that European health care providers are increasingly aware of the occupational risks of bloodborne infections such as HIV and hepatitis which can be transmitted by the needles from catheters and that the political will is building to take action to ensure safer devices are provided. Methods: We review the wide variety of peripheral intravenous catheters which are specially engineered to reduce these risks. Results: Available safety devices include spring-loaded retractable needles, guards that shield the dangerous tips and closed, needle-free access valves for intravenous sets. Conlusions: It is no longer necessary for patients and professionals to take risks to health and life when solutions which minimize these risks are at hand. [ABSTRACT FROM AUTHOR]

Abstract: Supportive care issues play a very prominent role in the management of malignant disease. In this context, “supportive care” includes the prevention and treatment of both the complications of anti-neoplastic therapy and of the cancer itself. It is recognized that many of the increasingly effective intensive management strategies now used in oncologic practice could not be employed in the absence of a thorough understanding of these processes, and the development of helpful therapeutic approaches. In this chapter a number of supportive care topics, recently highlighted in the published peer-reviewed literature, are discussed. These include: (a) factors which predict for the development of various types of infectious events (bacterial, viral, fungal) in specific malignancies; (b) the clinical utility of oral versus intravenous antibiotics; (c) the benefits of prophylactic antibiotic therapy (d) outpatient management of neutropenic fever; (e) strategies to optimally manage bacterial, viral and fungal infections in cancer patients; (f) complications associated with the use of indwelling intravenous catheter systems in the oncology patient population and methods to both manage and prevent such events; (g) new developments in anti-emetic therapy; and (h) and a novel strategy to prevent treatment-associated mucositis. [Copyright &y& Elsevier]

The results of bacteriologic cultures of blood and heparin-lock fluid, both drawn from the central venous catheters of 54 consecutive oncohematologic patients, have been used to determine their value for the diagnosis of systemic and catheter-associated infection. In 30 patients with clinical signs of infection (bacteremia or septicemia), 74 of 1000 (7.4%) heparin-lock fluid cultures, 114 of 542 (21%) catheter-drawn blood cultures, and 36 of 134 (26%) venipuncture blood cultures became positive, whereas in 24 patients without clinical signs of infection the respective values were 5 of 700 (0.7%), one of 220 (0.4%), and none of ten cultures. Comparison of the results of cultures sampled on the same day reveals that the positive and negative predictive values for catheter-drawn blood cultures, with the venipuncture blood cultures taken as the standard for bacteremia, are 82% and 95% respectively. The results of heparin-lock fluid are indicative for clinically relevant colonization of the catheter. Three or more positive heparin-lock fluid cultures, sampled on subsequent days, were correlated with the occurrence of bacteremia or septicemia with a positive predictive value of 100%. The conclusions are supported by the results of scanning electron microscopy. [ABSTRACT FROM AUTHOR]

The Royal College Of Nursing (RCN) have evidence-based guidelines with regard to optimal time for changing peripheral intravenous cannulae (PIC) and documentation rest-insertion (patient and nursing notes). This clinical audit assesses the compliance with respect to the RCN and Eastbourne District General Hospital guidelines of documenting the date post-insertion of PIC, optimal time for changing cannulae and rates of superficial phlebitis on the surgical wards All PIC, their dressings, sites and intravenous infusions were examined on all inpatients on the surgical wards on three random days. Staff awareness with regard to RCN and local guidelines for optimal time to change peripheral venous cannulae and documentation post-insertion was assessed. The majority of staff nurses correctly stated that the optimal time for changing an uncomplicated PIC was 72 hours, despite this 13.8% had a cannulae which had been inserted for more than 72 hours. Our study has found that despite medical and nursing staff being aware of RCN and local guidelines, there is still poor compliance with regards to documentation, optimal time for changing and thus increased levels of superficial phlebitis post insertion of PIC. [ABSTRACT FROM AUTHOR]

The introduction of intravenous (IV) line access into hospitalized patients has become a common procedure. Over the past decades increasing numbers of patients have required an IV line for longer periods of time. This has exposed the patients to potential complications such as a local external infection at the IV site. So far, no consensus regarding the optimal preventive measures has been reached. The Micromat pad is a newly developed device consisting of a double-sided wound contact layer absorbent laminate with chlorhexidine gluconate (CHG) 2% solution, which is placed on the skin below the IV line. To evaluate the efficacy and safety of the Micromat pad, we performed a double-blind controlled prospective trial. All admitted patients who needed peripheral or central venous catheterization entered the study; 129 patients were enrolled in the study and 130 were evaluable. Thirty of 71 patients (42%) in the control group had positive cultures compared with only 12 of 59 patients (20%) in the study group ( p <0.05). There was no difference between the groups in patients with diabetes mellitus (but we cannot discuss its significance because of the small numbers in the subgroups). Cost-effectiveness analysis was also in favour of the Micromat pad. Prophylactic disinfection treatment of the local IV site by the use of external Micromat pads for intravenous devices is probably effective as well as cost-effective. However, large-scale studies are required in order to confirm these results. [ABSTRACT FROM AUTHOR]

Intravascular (IV) catheters are essential devices in the hospital that are used to monitor a patient's blood and for administering drugs or nutrients. However, IV catheters are also prone to blood clotting at the point of insertion and infection by formation of robust bacterial biofilms on their surface. Nitric oxide (NO) is ideally suited to counteract both of these problems, due to its antimicrobial properties and its ability to inhibit platelet activation/aggregation. One way to equip catheters with NO releasing properties is by electrocatalytic nitrite reduction to NO by copper complexes in a multi-lumen configuration. In this work, we systematically investigate six closely related Cu(II) BMPA- and BEPA-carboxylate complexes (BMPA = bis-(2-methylpyridyl)amine); BEPA = bis-(2-ethylpyridyl)amine), using carboxylate groups of different chain lengths. The corresponding Cu(II) complexes were characterized using UV-Vis, EPR spectroscopy, and X-ray crystallography. Using detailed cyclic voltammetry (CV) and bulk electrocatalyic studies (with real-time NO quantification), in aqueous buffer, pH 7.4, we are able to derive clear reactivity relations between the ligand structures of the complexes, their Faradaic efficiencies for NO generation, their turnover frequencies (TOFs), and their redox potentials. Our results show that the complex [Cu(BEPA-Bu)](OAc) is the best catalyst with a high Faradaic efficiency over large nitrite concentration ranges and the expected best tolerance to oxygen levels. For this species, the more positive redox potential suppresses NO disproportionation, which is a major Achilles heel of the (faster) catalysts with the more negative reduction potentials.

Further studies aimed at examining the activity of different Cu(II)-ligand complexes to serve as electron-transfer mediators to prepare novel antimicrobial/thromboresistant nitric oxide (NO)-releasing intravenous catheters are reported. In these devices, the NO release can be modulated by applying different potentials or currents to reduce the Cu(II)-complexes to Cu(I) species which then reduce nitrite ions into NO (g) within a lumen of the catheter. Four different ligands are compared with respect to NO generation efficiency and stability over time using both single- and dual-lumen silicone rubber catheters: N-propanoate- N, N-bis(2-pyridylethyl)amine (BEPA-Pr), N-propanoate- N, N-bis(2-pyridylmethyl)amine (BMPA-Pr), 1,4,7-trimethyl-1,4,7-triazacyclononane (Me 3 TACN), and tris(2-pyridylmethyl)amine (TPMA). Of these, the Cu(II)BEPA-Pr and Cu(II)Me 3 TACN complexes provide biomedically useful NO fluxes from the surface of the catheters, >2 × 10 -10 mol·min -1 ·cm -2 , under conditions mimicking the bloodstream environment. Cu(II)Me 3 TACN exhibits the best stability over time with a steady and continuous NO release observed for 8 d under a nitrogen atmosphere. Antimicrobial experiments conducted over 5 d with NO-releasing catheters turned "on" electrochemically for only 3 or 6 h each day revealed >2 logarithmic units in reduction of bacterial biofilm attached to the catheter surfaces. The use of optimal Cu(II)-ligand complexes within a lumen reservoir along with high levels of nitrite ions can potentially provide an effective method of preventing/decreasing the rate of infections caused by intravascular catheters.

Introduction: Blood reflux is caused by changes in pressure within intravascular catheters upon connection or disconnection of a syringe or intravenous tubing from a needle-free connector (NFC). Changes in pressure, differing with each brand of NFC, may result in fluid movement and blood reflux that can contribute to intraluminal catheter occlusions and increase the potential for central-line associated bloodstream infections (CLABSI)., Methods: In this study, 14 NFC brands representing each of the four market-categories of NFCs were selected for evaluation of fluid movement occurring during connection and disconnection of a syringe. Study objectives were to 1) theoretically estimate amount of blood reflux volume in microliters (μL) permitted by each NFC based on exact component measurements, and 2) experimentally measure NFC volume of fluid movement for disconnection reflux of negative, neutral and anti-reflux NFC and fluid movement for connection reflux of positive displacement NFC., Results: The results demonstrated fluid movement/reflux volumes of 9.73 μL to 50.34 μL for negative displacement, 3.60 μL to 10.80 μL for neutral displacement, and 0.02 μL to 1.73 μL for pressure-activated anti-reflux NFC. Separate experiment was performed measuring connection reflux of 18.23 μL to 38.83 μL for positive displacement NFC connectors., Conclusions: This study revealed significant differences in reflux volumes for fluid displacement based on NFC design. While more research is needed on effects of blood reflux in catheters and NFCs, results highlight the need to consider NFCs based on performance of individual connector designs, rather than manufacturer designation of positive, negative and neutral marketing categories for NFCs without anti-reflux mechanisms.

Objectives: The Mycoses Forum in Japan has developed management bundles for candidaemia to incorporate into bedside practice. The aim of this study was to investigate nationwide compliance with the bundles and their impact on clinical outcomes., Methods: Non-neutropenic patients treated with antifungals for candidaemia were surveyed. Bundles consist of nine items to complete. Data were sent to the central office between July 2011 and April 2012., Results: Six hundred and eight patients were analysed. The compliance rate for achieving all elements was 6.9%, and it increased to 21.4% when compliance was analysed by the bundle except for oral switch. There was a significant difference in clinical success between patients with and without compliance [92.9% versus 75.8% (P=0.011)]. Compliance with the bundles, however, failed to be an independent factor associated with favourable outcomes. When step-down oral therapy was excluded from the elements of compliance, compliance with the bundles was revealed to be an independent predictor of clinical success (OR 4.42, 95% CI 2.05-9.52) and mortality (OR 0.27, 95% CI 0.13-0.57). Independent individual elements contributing to clinical success were removal of central venous catheters within 24 h, assessment of clinical efficacy on the third to the fifth day and at least 2 weeks of therapy after clearance of candidaemia., Conclusions: Compliance with the bundles for candidaemia had a beneficial effect on clinical outcomes. Promotion of the bundles approach may have the potential to narrow the gap between clinical evidence and bedside practice., (© The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.)