Specificity and sensitivity of the SeLECT score in predicting late seizures in patients undergoing intravenous thrombolytic treatment and the effect of diabetes mellitus and leukoaraiosis / Especificidade e sensibilidade do escore SeLECT na predição de convulsões tardias em pacientes submetidos a tratamento trombolítico intravenoso e o efeito do diabetes mellitus e leucoaraiose

Abstract Background Seizures after stroke can negatively affect the prognosis of ischemic stroke and cause a decrease in quality of life. The efficacy of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment in acute ischemic stroke has been demonstrated in many studies, and IV rt-PA treatment has been increasingly used around the world. The SeLECT score is a useful score for the prediction of late seizures after stroke and includes the severity of stroke (Se), large artery atherosclerosis (L), early seizure (E), cortical involvement (C), and the territory of the middle cerebral artery (T). However, the specificity and sensitivity of the SeLECTscore have not been studied in acute ischemic stroke patients that received IV rt-PA treatment. Objective In the present study, we aimed to validate and develop the SeLECT score in acute ischemic stroke patients receiving IV rt-PA treatment. Methods The present study included 157 patients who received IV thrombolytic treatment in our third-stage hospital. The 1-year seizure rates of the patients were detected. SeLECT scores were calculated. Results In our study, we found that the SeLECT score had low sensitivity but high specificity for predicting the likelihood of late seizure after stroke in patients administered IV rt-PA therapy. In addition to the SeLECT score, we found that the specificity and sensitivity were higher when we evaluated diabetes mellitus (DM) and leukoaraiosis. Conclusion We found that DM was an independent risk factor for late seizures after stroke in a patient group receiving thrombolytic therapy, and late seizures after stroke were less frequent in patients with leukoaraiosis.

Resumo Antecedentes As convulsões após o AVC podem afetar negativamente o prognóstico do AVC isquêmico e causar uma diminuição na qualidade de vida. A eficácia do tratamento com ativador do plasminogênio tecidual recombinante (rt-PA) intravenoso (IV) no AVC isquêmico agudo foi demonstrada em muitos estudos, e o tratamento com rt-PA IV tem sido cada vez mais usado em todo o mundo. A pontuação SeLECT é uma pontuação útil para a previsão de convulsões tardias após AVC e inclui a gravidade do AVC (Se), aterosclerose de grandes artérias (L), convulsão precoce (E), envolvimento cortical (C) e o território do meio artéria cerebral (T). No entanto, a especificidade e a sensibilidade do escore SeLECT não foram estudadas em pacientes com AVC isquêmico agudo que receberam tratamento IV com rt-PA. Objetivo No presente estudo, objetivamos validar e desenvolver o escore SeLECT em pacientes com AVC isquêmico agudo recebendo tratamento IV com rt-PA. Métodos O presente estudo incluiu 157 pacientes que receberam tratamento trombolítico IV em nosso hospital de terceiro estágio. As taxas de convulsão de 1 ano dos pacientes foram detectadas. Os escores SeLECT foram calculados. Resultados Em nosso estudo, descobrimos que o escore SeLECT apresentou baixa sensibilidade, mas alta especificidade para prever a probabilidade de convulsão tardia após AVC em pacientes que receberam terapia IV com rt-PA. Além do escore SeLECT, descobrimos que a especificidade e a sensibilidade foram maiores quando avaliamos diabetes mellitus (DM) e leucoaraiose. Conclusão Descobrimos que DM foi um fator de risco independente para convulsões tardias após AVC em um grupo de pacientes recebendo terapia trombolítica, e convulsões tardias após AVC foram menos frequentes em pacientes com leucoaraiose.

Construção e validação de ferramenta preventiva sobre incompatibilidade medicamentosa em via Y / Construction and validation of a preventive tool on drug incompatibility in the Y-route / Construcción y validación de una herramienta preventiva de incompatibilidad de medicamentos en la ruta Y

Introdução: A terapia com medicamentos endovenosos é muito utilizada nas unidades hospitalares, porém, possui uma elevada chance de incidentes, principalmente quando os medicamentos são administrados simultaneamente em via Y. Essa prática pode resultar em incompatibilidades medicamentosas classificadas em reações físicas e químicas. Objetivo: Construir e validar uma ferramenta preventiva de incompatibilidade medicamentosa em via Y. Método: Estudo metodológico com abordagem quantitativa. Foi desenvolvido em três etapas: Levantamento bibliográfico, construção e diagramação do material e por fim, a validação da ferramenta preventiva. Para validação, a ferramenta preventiva foi submetida ao processo de validação de face e conteúdo por juízes com expertise na temática. Resultados: Construiu-se e validou-se uma ferramenta preventiva através da busca de dados na literatura com a participação de sete juízes especialistas na temática. Os itens avaliativos referentes a tabela de incompatibilidade medicamentosa quanto aos objetivos, estrutura, apresentação e relevância da ferramenta preventiva foi considerada válida, pois foram julgados como adequado pelos especialistas. Conclusão: A validação de conteúdo, foi considerada válida pelos juízes, portanto, espera-se que o material alcance o seu objetivo ao ser aplicado durante a prática clínica. Dessa forma, será disponibilizado à instituição para que seja utilizado, favorecendo a prevenção de danos e contribuindo para a segurança dos pacientes, bem como melhorando a qualidade da assistência e educação em saúde.

Introduction: Intravenous drug therapy is widely used in hospital units, however, it has a high chance of incidents, especially when drugs are administered simultaneously in a Y route. This practice can result in drug incompatibilities classified into physical and chemical reactions. Objective: To build and validate a preventive tool for drug incompatibility in the Y pathway. Method: Methodological study with a quantitative approach. It was developed in three stages: bibliographic survey, construction and layout of the material and finally, the validation of the preventive tool. For validation, the preventive tool was submitted to the face and content validation process by judges with expertise in the subject. Results: A preventive tool was built and validated through the search for data in the literature with the participation of seven expert judges on the subject. The evaluative items referring to the medication incompatibility table regarding the objectives, structure, presentation and relevance of the preventive tool were considered valid, as they were judged as adequate by the specialists. Conclusion: The content validation was considered valid by the judges, therefore, it is expected that the material reaches its objective when applied during clinical practice. In this way, it will be made available to the institution for use, favoring the prevention of damage and contributing to patient safety, as well as improving the quality of health care and education.

Introducción: La farmacoterapia intravenosa es ampliamente utilizada en las unidades hospitalarias, sin embargo, tiene una alta probabilidad de incidencias, especialmente cuando los fármacos se administran simultáneamente en una vía Y. Esta práctica puede dar lugar a incompatibilidades medicamentosas clasificadas en reacciones físicas y químicas. Objetivo: Construir y validar una herramienta preventiva de incompatibilidad de medicamentos en la vía Y. Método: Estudio metodológico con enfoque cuantitativo. Se desarrolló en tres etapas: relevamiento bibliográfico, construcción y diagramación del material y finalmente, la validación de la herramienta preventiva. Para la validación, la herramienta preventiva fue sometida al proceso de validación facial y de contenido por jueces expertos en el tema. Resultados: Se construyó y validó una herramienta preventiva a través de la búsqueda de datos en la literatura con la participación de siete jueces expertos en el tema. Los ítems evaluativos referentes a la tabla de incompatibilidad de medicamentos en relación a los objetivos, estructura, presentación y relevancia de la herramienta preventiva fueron considerados válidos, pues fueron juzgados como adecuados por los especialistas. Conclusiones: La validación del contenido fue considerada válida por los jueces, por lo tanto, se espera que el material alcance su objetivo al ser aplicado durante la práctica clínica. De esta forma, se pondrá a disposición de la institución para su uso, favoreciendo la prevención de daños y contribuyendo a la seguridad del paciente, además de mejorar la calidad de la atención y educación en salud.

Estrategias para la prevención de errores en la administración de medicamentos intravenosos / Strategies for the Prevention of Errors in the Administration of Intravenous Medication / Estratégias para a prevenção de erros na administração de medicamentos intravenosos

Los medicamentos que son administrados erróneamente pueden producir efectos adversos, los cuales pueden causar afectaciones en el paciente y gastos adicionales en las instituciones. Los cuatro errores más comunes en la administración de medicamentos por vía intravenosa son dosis incorrectas del medicamento, volumen incorrecto, mezclas incorrectas e incompatibilidad farmacológica. El nivel de conocimiento farmacológico en el profesional de enfermería cobra especial importancia. Objetivo: analizar la literatura disponible sobre estrategias utilizadas para prevenir la ocurrencia de estos errores en la administración de medicamentos intravenosos por parte del personal enfermería desde el año 2010 al 2019. Método: se realizó una revisión integrativa (RI) para dar respuesta a la pregunta: ¿cuál es la evidencia disponible sobre estrategias para la prevención de errores en la administración de medicamentos por vía intravenosa? Se utilizaron bases datos entre las que se encuentran OVID, ScienceDirect, SciELO, Medline Complete, Academic Search Complete, PubMed y Guías de Prácticas Clínicas, con límite de tiempo entre 2010 y 2019. Resultado: se identificaron 17 publicaciones sobre estrategias de prevención de errores en la administración de medicamentos por vía Intravenosa, se clasificaron los resultados en 3 grupos relacionados con dosis, volumen, mezclas e incompatibilidades y con factores extrínsecos del paciente. Conclusiones: el número de estudios en cuanto a la prevención de errores en la administración de los medicamentos intravenosos es reducido al igual que el rigor metodológico; respecto a las estrategias de minimización de errores, prevalece la utilización de dispositivos electrónicos (bombas inteligentes, códigos electrónicos, etiquetado), comunicación asertiva, creación y adherencia a las guías y protocolos (principalmente en fármacos analgésicos y antibióticos) , fortalecimiento de los conocimientos individuales (educación continua, temas farmacológicos y capacitación en habilidades técnicas) y la generación de una estandarización en la preparación y administración de medicamentos intravenosos.

Erroneous intravenous medication administration can produce adverse effects, which can cause affectations in the patient and additional expenses for the institutions. The four most common errors in intravenous medication administration are wrong doses, wrong volume, wrong mixes, and pharmacological incompatibility. The level of pharmacological knowledge in nursing professionals is essential. Objective: to analyze the available literature on strategies used to prevent these errors in the administration of intravenous medications by nursing staff from 2010 to 2019. Method: an integrative review (IR) was carried out to answer the question: what is the available evidence on strategies for preventing errors in the administration of intravenous medication? Databases were used, including OVID, ScienceDirect, SciELO, Medline Complete, Academic Search Complete, PubMed, and Clinical Practice Guidelines, with a period limit between 2010 and 2019. Results: 17 publications were identified on strategies for preventing errors in the administration of intravenous medication. The results were classified into 3 groups related to dose, volume, mixtures,and incompatibilitiesand with factorsextrinsicto the patient. Conclusions: the number of studiesregarding the prevention oferrorsissmall,asisthemethodologicalrigor.Regarding thestrategiestominimizeerrors,the use ofelectronic devices prevails (smart pumps, electronic codes, labeling); assertive communication, creation, and adherence to guidelines and protocols (mainly in analgesic drugs and antibiotics); strengthening of individual knowledge (continuing education in pharmacological issues and training in technical skills) and the generation of standardization in the preparation and administration of intravenous medication.

Os medicamentos administrados de forma incorreta podem produzir efeitos adversos, que podem causar afetações no paciente e gastos adicionais nas instituições. Os quatro erros mais comuns na administração intravenosa de medicamentos são doses erradas, volume errado, misturas erradas e incompatibilidade farmacológica. O nível de conhecimento farmacológico do professional de enfermagem é especialmente importante. Objetivo: analisar a literatura disponível sobre as estratégias utilizadas para prevenir a ocorrência desses erros na administração de medicamentos intravenosos por professionais de enfermagem no período de 2010 a 2019. Método: foirealizada umarevisão integrativa(RI) pararesponderà questão:Quaisasevidências disponíveissobreestratégias de prevenção deerros naadministração de medicamentos intravenosos? Foram utilizadas bases de dados,entreas queestao OVID, ScienceDirect, SciELO, Medline Complete, Academic Search Complete, PubMed e Guías de Práticas Clínicas, com limite de tempo entre 2010 e 2019. Resultado: foram identificadas 17 publicações sobre estratégias de prevenção de erros na administração de medicamentos por via intravenosa, os resultados foram classificados em três grupos relacionados a dose, volume, misturas e incompatibilidadeseafatoresextrínsecosao paciente. Conclusões: o número deestudos sobre prevenção deerros naadministração de medicamentos intravenosos é pequeno, assim como o rigor metodológico. Em relação às estratégias para minimizar erros, prevalece o uso de dispositivos eletrônicos (bombas inteligentes, códigos eletrônicos, rotulagem), comunicação assertiva, criação e adesão a diretrizes e protocolos (principalmente em fármacos analgésicos e antibióticos), fortalecimento dos conhecimentos individuais(educação continuada, questõesfarmacológicasetreinamento emhabilidadestécnicas)ea geração de uma padronização no preparo e administração de medicamentos intravenosos.

In(compatibility) of intravenous drugs in critical units: adult cohort / In(compatibilidad) de medicamentos intravenosos en unidades críticas: cohorte de adultos / In(compatibilidade) de medicamentos intravenosos em unidades críticas: coorte de adultos

ABSTRACT Objectives: To analyze potential (in)compatibilities of intravenous drugs based on the scheduling prepared by the nursing team. Methods: historic cohort (retrospective) with 110 adults in critical units. Intravenous medications were identified concomitantly, whose pairs were analyzed for (in) compatibility using the screening system Trissel's™ 2 Compatibility IV-Micromedex 2.0. Parametric and non-parametric statistic were used according to the nature of the variable. Results: 565 pairs of drugs were identified. Of these, 44.9% were compatible; and 8.8%, potentially incompatible. Most potentially incompatible pairs involved substances with alkaline pH such as phenytoin (32%) and sodium bicarbonate (8%) and weak acids such as midazolam (12%) and dobutamine (6%), which could result in precipitate formation. Conclusions: almost half of the mixtures simultaneously administrated was compatible, which indirectly reflects in the organized work between the nursing team and the clinical pharmaceutic in the discussions and decisions related to time scheduling.

RESUMEN Objetivos: analizar las (in)compatibilidades potenciales de medicamentos intravenosos basado en el aplazamiento de horarios realizado por equipo de enfermería. Métodos: cohorte histórica (retrospectiva) con 110 adultos de unidades críticas. Identificaron medicamentos intravenosos aplazados de modo concomitante, cuyas duplas han analizadas cuanto a la (in)compatibilidad por medio del sistema de screening Trissel's™ 2 Compatibility IV-Micromedex 2.0. Utilizó estadística paramétrica y no paramétrica segundo naturaleza de la variable. Resultados: identificaron 565 duplas de medicamentos. De estas, 44,9% compatibles; y 8,8%, potencialmente incompatibles. Mayoría de las duplas potencialmente incompatibles envolvió substancias con pH alcalino como fenitoína (32%) y bicarbonato de sodio (8%) y ácidos débiles como midazolam (12%) y dobutamina (6%), las cuales podrían resultar en precipitación. Conclusiones: casi mitad de las misturas aplazadas simultáneamente fue compatible, aspecto que, indirectamente, refleja el trabajo orquestado entre el equipo de enfermería y el farmacéutico clínico en las discusiones y decisiones acerca del aplazamiento de horarios.

RESUMO Objetivos: analisar as (in)compatibilidades potenciais de medicamentos intravenosos com base no aprazamento de horários realizado pela equipe de enfermagem. Métodos: coorte histórica (retrospectiva) com 110 adultos de unidades críticas. Identificaram-se medicamentos intravenosos aprazados de modo concomitante, cujas duplas foram analisadas quanto à (in)compatibilidade por meio do sistema de screening Trissel's™ 2 Compatibility IV-Micromedex 2.0. Utilizou-se estatística paramétrica e não paramétrica segundo natureza da variável. Resultados: identificaram-se 565 duplas de medicamentos. Destas, 44,9% foram compatíveis; e 8,8%, potencialmente incompatíveis. A maioria das duplas potencialmente incompatíveis envolveu substâncias com pH alcalino como fenitoína (32%) e bicarbonato de sódio (8%) e ácidos fracos como midazolam (12%) e dobutamina (6%), as quais poderiam resultar em precipitação. Conclusões: quase metade das misturas aprazadas simultaneamente foi compatível, aspecto que, indiretamente, reflete o trabalho orquestrado entre a equipe de enfermagem e o farmacêutico clínico nas discussões e decisões acerca do aprazamento de horários.

Custo-minimização da troca entre imunoglobulinas de diferentes vias e marcas: sustentabilidade relacionada ao tratamento na saúde suplementar / Cost minimizing the switching between immunoglobulin of different routes and brands: of treatment-related in the supplementary health

Objetivo: Avaliar custo-minimização da troca entre as versões intravenosa (IVIg) e subcutânea (SCIg) das imunoglobulinas (Ig) em operadora de saúde com mais de 500.000 vidas. Métodos: Estudo retrospectivo, transversal, descritivo, seguido de custo-minimização entre os pacientes que utilizaram IVIg, de 1º de outubro de 2018 a 30 de setembro de 2019. Simulou-se a troca entre as IVIg e SCIg, objetivando descrever a economia de uma hipotética substituição. Estabeleceram-se como critérios de exclusão: o não pagamento e a liberação com dose acima de 60.000 mg. Após exclusão, calcularam-se as despesas totais, somando-se os custos do produto e taxas de infusão. Resultados: Evidenciou-se que 133 pacientes, totalizando 1.175 liberações, utilizaram IVIg no período avaliado. Identificou-se a utilização de 34.797.500 mg de IVIg, por 10 especialidades, totalizando R$ 12.408.192,50 de despesas. Quando aplicada simulação, há uma potencial economia de recursos de até 29,83%, dependendo da SCIg escolhida. Conclusão: A análise econômica no tratamento com imunoglobulinas evidenciou significativa relevância, pois contribui com o uso adequado da terapêutica garantindo a sustentabilidade do sistema de saúde. Medicamentos subcutâneos apresentam-se como uma opção custo-minimizatória em comparação ao tratamento intravenoso para saúde suplementar brasileira.

Objective: Cost-minimization evaluation of the switch from intravenous (IVIg) to subcutaneous (SCIg) immunoglobulin (Ig) in a Brazilian Health Maintenance Organization (HMO), with more than 500.000 lives. Methods: This is a retrospective, transversal and descriptive study, followed by a cost-minimization analysis among patients using IVIg between 2018, October, 1st and 2019, September, 30th. The simulation was performed supposing the exchange from IVIg to SCIg, in order to calculate possible savings. Exclusion criteria: non-payment (gloss), and infusions with doses above 60.000 miligrams. After exclusion, total expenditures were calculated by summing product and infusion costs. Results: There were133 patients, with1,175 IVIg infusion events in the period evaluated. It was identified the use of 34,797,500 milligrams of IVIg, for 10 specialties, with R$ 12,408,192.50 of final expenditure. The simulation previews hypothetical reduction in the final cost of up to 29.83%, depending on the SCIg brand chosen. Conclusion: The economic analysis in the treatment with immunoglobulins showed significant relevance, as it contributes to the appropriate use of therapy ensuring the sustainability of the health system. Subcutaneous drugs are a cost-minimizing option compared to intravenous treatment for Brazilian HMOs.

Adherencia y potenciales eventos adversos prevenidos durante la administración de medicamentos endovenosos empleando bombas de infusión inteligentes en cuatro unidades de cuidados intensivos en Colombia / Adherence and potential adverse events prevented during the administration of intravenous medications using Smart infusion pump in four intensive care units in Colombia

Resumen Introducción: Las bombas de infusión inteligentes, constituyen una herramienta útil para la administración segura de medicamentos endovenosos dado que permiten prevenir potenciales eventos adversos. Objetivo: Evaluar la adherencia y los potenciales eventos adversos prevenidos, durante la administración de medicamentos endovenosos empleando bombas de infusión inteligentes. Metodología: Estudio observacional, realizado en cuatro unidades de cuidados intensivos usando datos del software Hospira MedNetTM. Un análisis descriptivo fue llevado a cabo junto con un análisis bivariado empleando una prueba U de Mann-Whitney, una prueba de Kruskal-Wallis y un test de Bonferroni para evaluar la adherencia y los potenciales eventos adversos prevenidos por año y servicio. Resultados: La adherencia fue del 74,0%, se presentaron 78.299 alertas de seguridad y se previnieron 4,54% (n=16.288) potenciales eventos adversos. Se encontraron diferencias entre el primer y segundo año en la adherencia [Mediana: 69,15 (Q1:64,2-Q3:75,5) Vs Mediana: 84,2(Q1:72,15-Q3:89,05), p<0.001], adherencia a la seguridad [Mediana: 87,1% (Q1:83,05-Q3:91,2) Vs Mediana: 94,05 (Q1:89,95-Q3:96,2), p<0.001] y las ediciones de alertas de limite relativo [Mediana:17,0 (Q1:8,5-Q3:24,5) Vs Mediana: 12,0 (Q1:7,0-Q3:17,5), p=0.013]. La solución salina, la norepinefrina, el lactato de ringer, la piperacilina-tazobactam, la nitroglicerina y la heparina presentaron el mayor número de alertas de seguridad. Conclusión: Se encontró una buena adherencia (uso de la farmacoteca) y adherencia a la seguridad (indicador de uso de la bomba), con una reducción de los potenciales eventos adversos; así el uso de bombas inteligentes podría contribuir en la prevención de potenciales errores durante la administración de medicamentos endovenosos en la unidad de cuidados intensivos.

Abstract Introduction: Smart infusion pumps have become a useful tool for the safe administration of intravenous medications, since they allow the prevention of potential adverse events. Objetive: To assess adherence and potential adverse events prevented during intravenous medication administration using smart infusion pumps. Methods: Observational study, conducted in four intensive care units using data from Hospira MedNetTM software. A descriptive analysis was carried out together with a bivariate analysis using a Mann-Whitney U test, a KruskalWallis test and a Bonferroni test to assess adherence and potential adverse events prevented by year and service. Results: Adherence was 74.0%, 78,299 safety alerts were presented and 4.54% (n = 16,288) potential adverse events were prevented. Differences were found between the first and second year in adherence [Median: 69.15 (Q1: 64.2-Q3:75.5) versus Median: 84.2 (Q1: 72.15-Q3: 89.05), p<0.001]. Likewise safety adherence [Median: 87.1% (Q1: 83.05-Q3: 91.2) versus Median: 94.05 (Q1: 89.95-Q3: 96.2), p<0.001] and the relative limit alert editions [Median: 17.0 (Q1: 8.5-Q3: 24.5) versus Median: 12.0 (Q1: 7.0-Q3: 17.5), p=0.013]. The saline solution, norepinephrine, ringer's lactate, piperacillin-tazobactam, nitroglycerin and heparin presented the highest number of safety alerts. Conclusions: Adequate adherence (use of the drug library) and safety adherence (indicator of pump use) were found, with a reduction in potential adverse events; thus, the use of smart pumps could contribute to the prevention of potential errors during the administration of intravenous medications in the intensive care unit.

Acute Toxicity Study of Intravenous Administration of Thymoquinone-Loaded Nanostructured Lipid Carrier (TQ-NLC) in Sprague Dawley Rats

@#Introduction: Thymoquinone (TQ), a bioactive compound from Nigella sativa is known for its various medicinal properties. Due to the low solubility of TQ, nanostructured lipid carrier (NLC) has been used as a delivery system to improve its efficacy. Nevertheless, the effect of TQ-NLC when administered intravenously is unclear. This study investigated the acute toxicity profile of intravenous administration of TQ-NLC in an in vivo model. Methods: Twelve female Sprague dawley rats were assigned randomly into two groups (n=6); a control and a treatment group that received normal saline and 25 mg/kg TQ-NLC, respectively, via intravenous injection. The rats were observed for 14 days for any alterations to their usual physical conditions such as behaviour and mortality, body weight, food intake, organ-to-body weight ratio, and haematological, biochemical and histopathological profile. Results: There were no significant changes (p>0.05) in the body weight, food intake, organ-to-body weight ratio, and haematological, biochemical and histopathological profile between TQ-NLC treatment and the control group. However, inflammation was observed at the site of injection on the rat’s tail. Conclusion: Intravenous administration of TQ-NLC (25 mg/kg) did not exert acute toxic effect in female Sprague dawley rats. The data can be used as a basis to further develop TQNLC as a potential therapeutic drug.

Comparison of patient-controlled epidural analgesia with patient-controlled intravenous analgesia for laparoscopic radical prostatectomy

BACKGROUND: Patient-controlled epidural analgesia (PCEA) is known to provide good postoperative analgesia in many types of surgery including laparoscopic surgery. However, no study has compared PCEA with patient-controlled intravascular analgesia (PCIA) in laparoscopic radical prostatectomy (LARP). In this study, the efficacy and side effects of PCEA and PCIA after LARP were compared. METHODS: Forty patients undergoing LARP were randomly divided into two groups: 1) a PCEA group, treated with 0.2% ropivacaine 3 ml and 0.1 mg morphine in the bolus; and 2) a PCIA group, treated with oxycodone 1 mg and nefopam 1 mg in the bolus. After the operation, a blinded observer assessed estimated blood loss (EBL), added a dose of rocuronium, performed transfusion, and added analgesics. The numeric rating scale (NRS), infused PCA dose, and side effects were assessed at 1, 6, 24, and 48 h. RESULTS: EBL, added rocuronium, and added analgesics in the PCEA group were less than those in the PCIA group. There were no significant differences in side-effects after the operation between the two groups. Patients were more satisfied with PCEA than with PCIA. The NRS and accumulated PCA count were lower in PCEA group. CONCLUSIONS: Combined thoracic epidural anesthesia could induce less blood loss during operations. PCEA showed better postoperative analgesia and greater patient satisfaction than PCIA. Thus, PCEA may be a more useful analgesic method than PICA after LARP.

Utilização de barreiras de segurança no preparo de drogas vasoativas e sedativos/analgésicos em terapia intensiva pediátrica / Utilización de barreras de seguridaden la preparación de drogas vasoactivas y sedantes/analgésicos en terapia intensiva pediátrica / Use of safety barriers in the preparation of vasoactive drugs and sedatives/analgesics in pediatric intensive care

RESUMO: Objetivo: analisar a utilização de barreiras de segurança no preparo de drogas vasoativas e sedativos/analgésicos. Método: estudo quantitativo, com 204 observações durante o preparo de medicamentos em uma Unidade de Terapia Intensiva Pediátrica no Hospital Pediátrico do Estado de Santa Catarina, de março de 2016 a maio de 2017. As barreiras analisadas foram: tipo de prescrição; transcrição da medicação, identificação do paciente e dados no rótulo; local de fixação; dupla checagem; preparo de infusões contínuas; interrupções. Os dados foram analisados por estatística descritiva. Resultados: as barreiras de segurança foram relacionadas à prescrição escrita (93,6%); transcrição da medicação em rótulo (87,7%); identificação do primeiro nome do paciente no rótulo (96%); dados da medicação no rótulo sem a transcrição da via de administração (99,4%); dupla checagem (34,6%); interrupções durante o preparo (52,9%). Conclusão: este estudo alerta a área sobre a necessidade da implementação de barreiras no intuito de uma prática clínica segura.

RESUMEN: Objetivo: analizar el uso de barreras de seguridaden la preparación de drogas vasoactivas y sedantes/analgésicos. Método: estudio cuantitativo, con 204 observaciones durante la preparación de medicamentos en una Unidad de Terapia Intensiva Pediátrica en el Hospital Pediátrico del Estado de Santa Catarina, de marzo de 2016 a mayo de 2017. Las barreras analizadas fueron: tipo de prescripción; transcripción de la medicación, identificación del paciente y datos en el rótulo; local de fijación; doble verificación; preparación de infusiones continuas; interrupciones. Se hizo el análisis dedatos por medio de estadística descriptiva. Resultados: se asociaronlas barreras de seguridad a la prescripción escrita (93,6%); transcripción de la medicación en rótulo (87,7%); identificación del primer nombre del paciente en el rótulo (96%); datos de la medicaciónen el rótulo sinla transcripción de la vía de administración (99,4%); doble verificación (34,6%); interrupciones durante lapreparación (52,9%). Conclusión: este estudio hace un alerta sobre la necesidad de la implementación de barreras con el objetivo de llegar a una práctica clínica segura.

ABSTRACT: Objective: to analyze the use of safety barriers in the preparation of vasoactive drugs and sedatives/analgesics. Method: quantitative study, with 204 observations during the preparation of medications in a Pediatric Intensive Care Unit in the Pediatric Hospital of the State of Santa Catarina, between March 2016 and May 2017. The barriers analyzed were: type of prescription; transcription of the medication, identification of the patient and data on the label; label attachment; double checking; preparation of continuous infusions; and interruptions. The data were analyzed using descriptive statistics. Results: the safety barriers were related to written prescription (93.6%); transcription of the medication on the label (87.7%); patient identification on the label only by the first name (96%); data relating to the medication on the label failing to include the transcription of the route of administration (99.4%); double checking (34.6%); and interruptions during the preparation (52.9%). Conclusion: this study alerts the area to the need to implement barriers so as to promote safe clinical practice.

Conhecimento de técnicos e auxiliares de enfermagem sobre cuidados com cateteres centrais em um hospital pediátrico / Conocimiento de técnicos y auxiliares de enfermería acerca de la atención con cateteres centrales en un hospital pediátrico / Knowledge of nursing technicians and aides about central venous catheter care in a pediatric hospital

Objetivo identificar os conhecimentos de técnicos e auxiliares de enfermagem acerca dos cuidados com a manutenção de cateteres venosos centrais de longa, média e curta permanência em crianças. Método estudo exploratório-descritivo com abordagem quantitativa, realizado de setembro a novembro de 2017, com amostra de 157 técnicos e auxiliares de enfermagem das unidades de internação de uma instituição exclusivamente pediátrica do estado do Paraná, Brasil. Resultados responderam que já haviam recebido orientações sobre cuidados de enfermagem com cateteres centrais 134 (85,3%) participantes, entretanto 92 (58%) colaboradores pontuaram que a seringa de 1 ml não deve ser utilizada no manuseio desses dispositivos, evidenciando que ainda ocorriam erros nos apontamentos quanto aos cuidados adequados com esses acessos. Conclusão apesar de a equipe de enfermagem conhecer os cuidados com a manutenção de cateteres centrais, percebeu-se que ainda existiam dificuldades quanto aos cuidados primordiais com esses dispositivos intravenosos de grande relevância para a eficácia da terapia medicamentosa em pediatria.

Objetivo identificar conocimientos de técnicos y auxiliares de enfermería acerca de la atención con el mantenimiento de catéteres venosos centrales de larga, media y corta permanencia en niños. Método estudio exploratorio-descriptivo, cuantitativo, de septiembre a noviembre de 2017, con muestra de 157 técnicos y auxiliares de enfermería de las unidades de internación de una institución exclusivamente pediátrica del Paraná, Brasil. Resultados respondieron que ya habían recibido orientaciones sobre cuidados de enfermería con catéteres centrales 134 (85,3%) participantes, sin embargo 92 (58%) puntuaron que la jeringa de 1 ml no debe ser utilizada en el manejo de esos dispositivos, evidenciándose que se produjeron errores en los apuntes en cuanto a los cuidados adecuados con esos accesos. Conclusión a pesar del equipo de enfermería conocer la atención con el mantenimiento de catéteres centrales, se percibieron dificultades en cuanto a los cuidados primordiales con esos dispositivos intravenosos de gran relevancia para eficacia de la terapia medicamentosa en pediatría.

Objective identify the knowledge of nursing technicians and aides about maintenance practices of long-, medium- and short-term central venous catheters in children. Method a descriptive exploratory study of a quantitative approach was conducted from September to November 2017, with 157 nursing technicians and aides from the hospitalization units of an exclusively pediatric institution in the state of Paraná, Brazil. Results this study found that 134 (85.3%) participants answered they had received guidance on nursing practices with central venous catheters, but 92 (58%) participants highlighted that 1 ml syringe should not be used when handling these devices, showing improper practices regarding these catheters. Conclusion although the nursing team was aware of the maintenance of central venous catheters, improper practices were still observed regarding basic actions with these intravenous devices of great relevance for an effective pediatric drug therapy.

Incompatibilidad de medicamentos intravenosos: revisión estructurada / Incompatibility of intravenous drugs: Structured review

Resumen Introducción: Las incompatibilidades físicas o químicas presentadas entre las mezclas de medicamentos de uso intravenosos pueden comprometer la eficacia y seguridad del tratamiento y del paciente. La disponibilidad de la información relacionada con este aspecto es limitada o fraccionada, lo que restringe su uso. El objetivo del presente trabajo fue sistematizar la información disponible en las bases de datos sobre compatibilidad/incompatibilidad entre medicamentos intravenosos, que favorezca los procesos de prescripción, preparación y administración. Métodos: Revisión estructurada de incompatibilidades de medicamentos intravenosos en PubMed/MedLine utilizando los términos MeSH: Drug Incompatibility, Administration Intravenous, and Infusions Intravenous. Se buscaron artículos en inglés o español, con acceso a texto completo hasta febrero 29 del 2016. Se identificaron 121 artículos, de los cuales se seleccionaron 58; además se incluyeron 18 manuscritos de las referencias considerados como importantes. Resultados: Se estructuró un cuadro sobre compatibilidad/incompatibilidad de 100 medicamentos intravenosos, el tiempo de estabilidad, condiciones de almacenamiento, tipo de compatibilidad/incompatibilidad presentada y tipo de administración recomendada. Conclusión: Se presenta información sobre compatibilidad / incompatibilidad de medicamentos, la cual podría favorecer los procesos de prescripción, preparación y administración por el personal asistencial y con ello contribuir a la efectividad y seguridad de estos medicamentos.

Abstract Introduction: The physical or chemical incompatibilities between mixtures of intravenous drugs may compromise the efficacy and safety of treatment and the patient. The availability of information related to this aspect is limited or fractionated, which restricts its use; in this context. The objective of the present study was to compile in a table the available information in the databases on the compatibility/incompatibility between intravenous drugs, which favors the processes of prescription, preparation and administration of these products. Methods: We completed a structured review of incompatibilities of intravenous drugs in PubMed/Medline using the MeSH terms: Drug Incompatibility, Administration Intravenous, and Infusions Intravenous, we collected articles in English or Spanish, with access to full text until February 29, 2016. We identified 121 articles, from which we selected 58; additionally we included 18 manuscripts of the references considered as important. Results: With the information obtained was structured a table on compatibility/incompatibility of 100 intravenous drugs, the time of stability, conditions of storage, type of compatibility/incompatibility presented and the type of management recommended. Conclusion: We arranged information on compatibility/incompatibility of drugs, which may improve the processes of prescription, preparation and administration by the health care professionals, so it could contribute to the effectiveness and safety of these drugs.

Brinquedo terapêutico na administração de medicação endovenosa em crianças: estudo exploratório / Use of therapeutic play during intravenous drug administration in children: exploratory study / Juguete terapéutico en la administración de medicamentos intravenoso en niños: estudio exploratorio

OBJETIVO: Identificar reações de crianças na administração de medicação endovenosa, realizada anterior e posteriormente à técnica do Brinquedo Terapêutico, e analisar percepção dos acompanhantes em relação à influência da técnica no preparo para administração da medicação endovenosa. MÉTODO: Estudo exploratório, com abordagem qualitativa, realizado por meio de observações de administração medicamentosa endovenosa e das sessões de Brinquedo Terapêutico com crianças, e entrevista semiestruturada com acompanhantes. Os dados foram submetidos à análise temática. RESULTADOS: Crianças com dificuldade em aceitar a medicação endovenosa apresentaram mudanças positivas no comportamento após realização Brinquedo Terapêutico, principalmente aquelas entre 4 e 6 anos. Acompanhantes recomendam a realização dessa prática para melhoria do cuidado e redução do estresse durante a administração. CONCLUSÃO: Brinquedo terapêutico é uma relevante intervenção de enfermagem para minimizar as reações da criança durante o uso de medicações endovenosas, sendo importante a capacitação dos enfermeiros e o fomento da técnica para qualificação da assistência.

AIM: To identify the reactions of children during intravenous drug administration before and after the use of therapeutic play technique and to analyse their companions' perceptions regarding the technique's effects on the child's preparation for intravenous drug administration. METHOD: An exploratory study with a qualitative approach conducted through observations of intravenous drug administration and therapeutic play sessions with children and semi-structured interviews with their companions. The data were subjected to thematic analysis. RESULTS: Children who had difficulty accepting intravenous medication, especially those between 4 and 6 years, presented positive behavioural changes after the use of therapeutic play. The children's companions recommended the use of this technique to improve care and reduce stress during drug administration. CONCLUSION: Therapeutic play is a relevant nursing intervention for minimizing children's reactions during intravenous drug administration, and the training of nurses and the promotion of technique are important for improving care.

OBJETIVO: Identificar reacciones de niños en la administración de medicamentos intravenoso, realizada anterior y posteriormente a la técnica del Juguete Terapéutico, y analizar percepción de los acompañantes en relación a la influencia de la técnica en el preparo para la administración del medicamento intravenoso. MÉTODO: Estudio exploratorio, con enfoque cualitativo, realizado por medio de observaciones de administración medicamentosa intravenosa y de las sesiones de Juguete Terapéutico con niños, y entrevista semiestructurada con acompañantes. Los datos fueron sometidos al análisis temático. RESULTADOS: Niños con dificultad en aceptar el medicamento intravenoso presentaron cambios positivos en el comportamiento después la realización Juguete Terapéutico, principalmente aquellas entre 4 y 6 años. Acompañantes recomiendan la realización de esa práctica para mejora del cuidado y reducción del estrés durante la administración. CONCLUSIÓN: Juguete terapéutico es una relevante intervención de enfermería para minimizar las reacciones del niño durante el uso de medicamentos intravenosa, siendo importante la capacitación de los enfermeros y el fomento de la técnica para cualificación de la asistencia.

Assessment of an intervention aimed at early discontinuation of intravenous antimicrobial therapy in a Brazilian University hospital

Abstract Many interventions demonstrate success in adapting the duration of intravenous antibiotic therapy, but few studies have been conducted in developing countries. The aim of this study was to evaluate the effectiveness of an intervention in the induction of early discontinuation of intravenous antimicrobial therapy and/or its switch to oral therapy. The study employed a before–after intervention design that consisted of displaying a message in the computerized prescription on the third day and suspension of the prescription on the fifth day of intravenous antimicrobial therapy. A total of 465 patients were followed during the control period (CP) and 440 in the intervention period (IP). The intravenous therapy was switched to oral therapy for 11 (2.4%) patients during the CP and 25 (5.7%) in the IP (p = 0.011), and was discontinued for 82 (17.6%) patients during the CP and 106 (24.1%) in the IP (p = 0.017). During the IP there was a significant increase of patients who had their antimicrobial treatment discontinued before the seventh day of intravenous treatment, 37.40% (49/131) in the IP and 16.13% (15/93) in the CP (p = 0.0005). The duration of intravenous antimicrobial therapy decreased by one day, but it was not significant (p = 0.136). It is concluded that the proposed intervention is effective in promoting the early discontinuation of antimicrobial treatment and/or switch to oral therapy. As long as a computerized system for prescription already exists, it is easy and inexpensive to be implemented, especially in hospitals in developing countries.

Investigation on the Intravenous Use of Antibiotics in Outpatients and Emergency Department Patients in a Tertiary First-class Hospital / 医药导报

Objective To investigate status of the intravenous use of antibiotics in outpatients and emergency patients of a tertiary first-class hospital, and provide a reference for developing management measures in next step. Methods By a retrospective method,all the prescriptions using antibiotics by intravenous administration in outpatients and emergency department patients from a tertiary first-class hospital in 2013 were extracted from the hospital information system. The categories of antimicrobial agents,proportion of intravenous use of antimicrobial drugs,ranking of the antibiotic consumption sum and defined daily dose,and the top 10 clinical departments or wards intravenously using antimicrobial drugs were chosen to analyze. The data in 2014 were extracted as a comparison. Results Outpatients and emergency department patients respectively used 8 categories 31 kinds and 8 categories 30 kinds of intravenous antimicrobial drugs, with high consumption of cephalosporins and restricted antimicrobials such as sodium cefoxitin.Intravenous use of antimicrobial drug prescription proportion in emergency department is higher than that in outpatient department. Conclusion After intervention in 2014, antibiotic consumption is effectively controlled as compared that in 2013. But management should be strengthened and appropriate interventions should be taken to ensure the use of intravenous antibiotics in a safe,effective and economical manner.

Práctica segura en el cuidado del paciente oncológico con dispositivos vasculares / Safe practice in the care of cancer patients with vascular devices

Resumen:

Las infecciones asociadas a la atención de la salud son un problema importante en la seguridad del paciente por su impacto en la morbilidad y mortalidad. Una de las tres primeras causas es la infección relacionada con líneas vasculares; si bien su uso es indispensable en servicios de urgencia, cuidados intensivos y servicios de hospitalización, esto conlleva el riesgo de bacteriemia relacionada a catéter (BRC). Respecto a esto existen referentes de normas, protocolos, programas, guías de práctica clínica y manuales, así como las recomendaciones que emiten organismos internacionales como la Sociedad de Enfermeras de Infusión (INS) y el Centro para la Prevención y Control de Enfermedades (CDC). Con dichos referentes, la integración de equipos de terapia intravenosa (ETI), la implementación de estrategias de mejora e intervenciones operativamente prácticas, así como la colaboración de los profesionales involucrados en el proceso, permiten resultados favorables en beneficio de los pacientes oncológicos con dispositivos vasculares.

Abstract:

Infections associated with healthcare are a major patient safety problem due to its impact on morbidity and mortality. One of the top three causes of infection is related to vascular lines. Although its use is essential in emergency services, intensive care, and inpatient services, it carries the risk of catheter-related bacteremia (CRB). In this regard, there are standards, protocols, programs, clinical practice guidelines and manuals; as well as the recommendations issued by international organizations like the Infusion Nurses Society (INS) and the Center for Disease Control and Prevention (CDC). With these references, the integration of Intravenous Therapy Equipment (ITE), implementing improvement strategies and operationally practical interventions, as well as the collaboration of professionals involved in the process, makes for favorable results to benefit cancer patients with vascular devices.

A Case of Acute Hepatitis Associated with Intravenous Infusion Amiodarone in Patient with Atrial Fibrillation

We report a case of intravenous infusion amiodarone induced acute hepatitis, occurs within 1 day after initiation of drug in a 72-year-old woman with paroxysmal atrial fibrillation. Liver function test before intravenous infusion amiodarone treatment was normal. She was treated with intravenous infusion amiodarone, and then developed acute hepatitis next day. We suspected drug induced hepatitis due to intravenous infusion amiodarone. The liver function test returned to normal after the amiodarone was stopped. We described an unusual case which intravenous infusion amiodarone induced acute hepatitis within.

Tissue distribution on a novel derivate of all-trans-retinoic acid,ATPR / 中国药理学通报

Aim To develop a sensitive,specific and accurate method for quantifying a novel derivate of all-trans-retinoic acid, 4-amino-2-trifluoromethyl-phenyl retinate (ATPR)in rat tissues to investigate the tissue distribution of ATPR in rats.Methods Sprague-Daw-ley (SD)rats were killed by exsanguination at 2,4,7 h after a single intragastric administration with one dose of ATPR (20 mg·kg-1 )or at 5 min,1 h,5 h after a single intravenous administration with one dose of AT-PR (7 mg·kg-1 ).The concentration of ATPR in the tissues was determined by high performance liquid chromatography (HPLC)method.Results After the rats were administrated intragastrically, the highest concentration of ATPR was observed in intestine,fol-lowed by liver,spleen and lung,while the distribution in heart,kidney,fat and brain was very little.Howev-er,the highest concentration of ATPR was in liver after given intravenously,followed by spleen and lung,and very low in heart,kidney,intestines,fat and brain. Conclusion The distribution of ATPR is higher in liv-er after administrated both intragastrically and intrave-nously,suggesting the potential anti-proliferation and differentiation inducing effects of ATPR targeting at liv-er cancer.

Infusão venosa acidental de clister glicerinado em adulto: relato de caso / Accidental intravenous infusion of rectal glycerol preparation in an adult: case report

JUSTIFICATIVA E OBJETIVOS: Relatar um caso clínico de erro de administração de solução de clister glicerinado por via venosa. RELATO DO CASO: Paciente do sexo masculino, 56 anos, procurou hospital por queixa de dor abdominal e constipação há 5 dias. Possuía antecedente de hipertensão mal controlada sem outras alterações de exame físico. Foi prescrito clister glicerinado (500 mL a 12%) que, erroneamente, foi administrado por via venosa (T0). O erro quando detectado, foi comunicado ao Centro de Controle de Intoxicações de Campinas, que orientou iniciari nvestigação laboratorial, revelando inicialmente hematúria microscópica discreta, elevação de CK (401 U/L; VR= 26-189),e níveis aumentados de ureia (66 mg/dL; VR = 15-40) e creatinina (2,4 mg/dL; VR = 0,7-1,4). A dosagem de bilirrubina total encontrava-se elevada (1,8 mg/dL; VR até 1,2) às custas de BI =1,7 mg/dL (VR = 0,1-0,8). Durante a evolução, o eritrograma mostrou discreta redução dos níveis de hemoglobina (Hb) (14,6 g/dL [T2] e 13,8 g/dL [T5:30]) e paciente apresentou leucocitose (18.200) sem desvio. Transferido ao hospital de referênciano T15:30, onde os exames laboratoriais demonstravam dosagem sérica de bilirrubina total dentro do VR (0,75 mg/dL), Hb = 14 g/dL e CK mantinham-se elevadas (625 U/L). Durante toda a internação o paciente permaneceu assintomático. CONCLUSÃO: Apesar da escassez de informações sobre o glicerol administrado por via venosa ter suscitado preocupação com relação a possíveis efeitos tóxicos, o desfecho favorável deste caso, em concordância com a literatura, sugeriu que a infusão de solução de clister glicerinado disponível comercialmente (12%), até a dose de 0,65 g/kg, não parece implicar em riscos elevados de efeitos adversos.

BACKGROUND AND OBJECTIVES: To report a clinical case of iatrogenic administration of glycerol rectal preparation intravenously (IV). CASE REPORT : Male patient, 56 years, searched for hospital complaining of abdominal pain and constipation for 5 days. Hehad a history of arterial hypertension poorly controlled. For the constipation, glycerin (500 mL to 12%) was prescribed, which mistakenly was given IV (T0). The error was reported to the Campinas Poison Control Center, which advised to monitor electrolyte and metabolic changes. Patient presented mild microscopic hematuria, elevated CK (401 U/L; RV = 26-189), and increased levels of urea (66 mg/dL; VR = 15-40) and creatinine (2.4 mg /dL, RV = 0.7-1.4). The level of total bilirubin was elevated (1.8mg / dL, RV = up to 1.2) due to unconjugated =1.7 mg/dL (RV = 0.1-0.8). During evolution, showed the erythrocyte slight reductionof Hb levels (14.6 g/dL [T2] and 13.8 g/dL [T5: 30]) and patient showed leukocytosis (18,200) (T5:30). Transferred to reference hospital at T15: 30, where tests showed serum total bilirubin within the VR (0.75 mg/dL), Hb = 14 g/dL and CK remained high (625 U/L). During hospitalization the patient remained asymptomatic. CONCLUSION : Despite the paucity of information about effects of glycerol IV, this case has raised concern about possible toxic effects, due to volume and concentration of glycerol administered.The favorable outcome, rather in agreement with thel iterature, has suggested that the IV infusion of commercially available glycerin enema solution (12%) does not seem to beof significant risk to the patient.

Intravenously Administered Anti-recoverin Antibody Alone Does Not Pass through the Blood-Retinal Barrier

PURPOSE: Cancer-associated retinopathy is a paraneoplastic retinal degeneration which may primarily result from auto-immune mediated apoptosis. It has been hypothesized that high titer of auto-antibodies are able to cross the blood-retinal barrier (BRB) and to enter retinal cells to activate apoptotic pathway which has been already well-established. However, it still remains to be elucidated whether auto-antibodies could cross BRB in the retina. Herein, we demonstrated that intravenously administrated anti-recoverin antibodies could not pass through BRB and not lead to retinal cell death. METHODS: Anti-recoverin antibody was intravenously injected to C57BL/6 mice, which were sacrificed 1 and 7 days to obtain eye. Vascular endothelial growth factor was intravitreally injected to induce BRB breakdown, which was confirmed by fluorescein angiography and western blotting for zonula occludens (ZO)-1, ZO-2 and occludin. To investigate the location of anti-recoverin antibody in the retina, immunofluorescein was performed. The retinal toxicity of intravenous anti-recoverin antibody was evaluated by histological examination and transferase-mediated dUTP nick-end labeling. Immunofluorescein staining for glial fibrillary acidic protein was done to address glial activation as well. RESULTS: Intravenously administrated anti-recoverin antibodies were exclusively distributed on retinal vessels which were co-localized with CD31, and led to neither increase of glial fibrillary acidic protein expression, as an indicator of retinal stress, nor apoptotic retinal cell death. Moreover, even in the condition of vascular endothelial growth factor-induced BRB breakdown, anti-recoverin antibodies could not migrate across BRB and still remained on retinal vessels without retinal cytotoxicity. CONCLUSIONS: Our results suggest that high titer of intravascular anti-recoverin antibodies could not penetrate into the retina by themselves, and BRB breakdown mediated by dysregulation of tight junction might not be sufficient to allow anti-recoverin antibodies to pass through BRB.

Efficacy and safety of intravenous combined with intracoronary administration of tirofiban bolus in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention / 第二军医大学学报

Objective: To assess the safety and efficacy of simultaneous intravenous plus intracoronary administration of tirofiban bolus for patients with acute ST-elevation myocardial infarction(STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: Forty-three patients with acute STEMI ready to receive primary PCI were randomly divided into tirofiban IV group (intravenous tirofiban bolus only before stent deployment, n = 22) or tirofiban IV&IC group (intravenous plus intracoronary administration of tirofiban bolos simultaneously, n = 21). The thrombolysis in myocardial infarction trial and perfusion of the myocardium were observed before and after PCI. Major adverse cardiovascular event (MACE), hemorrhage event,and thrombocytopenia were observed during hospital stay; MACE was also observed 30 days after PCI. Results: The clinical characteristics and baseline angiographic findings were similar in the two groups. After PCI, no difference was observed in the final TIMI flow grade 3,CTFC≤27, sumSTR≥70% between the two groups (P=0.951,0.933,0.666, respectively). There was no significant difference in the frequencies of MACE (P=0.101) and the left ventricular ejection fraction between the two groups (P=0.694). No major hemorrhage or severe thrombocytopenia were found in the two groups during hospital stay. The total rate of bleeding was also similar in the two groups (P = 0.558). The frequencies of MACE were similar in the two groups 30 days after operation. Conclusion: Simultaneous intravenous and intracoronary administration of tirofiban bolus is safe for STEMI patients undergoing primary PCI; the short-term efficacy is similar to that of intravenous administration only.