ABSTRACT
Abstract Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT) is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT) started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42). Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies in other regions of Brazil and Latin America.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Young Adult , Osteomyelitis/therapy , beta-Lactams/therapeutic use , Infusions, Parenteral/methods , Minocycline/analogs & derivatives , Anti-Bacterial Agents/administration & dosage , Outpatients , Bone Diseases, Infectious/classification , Bone Diseases, Infectious/drug therapy , Brazil , Ertapenem , Tigecycline , Anti-Infective Agents , Minocycline/therapeutic use , Anti-Bacterial Agents/classificationABSTRACT
A fifty-seven year old female patient visited the emergency department with tachypnea and a decreased mental status. The patient had been receiving fluid therapy at home and a bolus of air was injected into the fluid bottle in order to increase the infusion speed. Chest computed tomography revealed air in the left brachiocephalic vein that was accompanied with pulmonary edema the diagnosis of venous air embolism was made. Venous air embolism can result from various procedures that are performed in almost all clinical specialties and they can be fatal in cases of massive air embolism. Therefore, it is important for all clinicians to be aware of this problem.
Subject(s)
Female , Humans , Brachiocephalic Veins , Embolism, Air , Emergencies , Fluid Therapy , Home Infusion Therapy , Pulmonary Edema , Pulmonary Embolism , Tachypnea , ThoraxABSTRACT
La práctica de la medicina actual está relacionada con la administración frecuente de medicamentos y líquidos por vía parenteral, por lo cual se requiere una vía intravascular permeable. Desde hace algunos años se ha observado la tendencia al manejo extrahospitalario de pacientes con problemas crónicos que necesitan tratamiento farmacológico intravenoso. Estos procedimientos con mucha frecuencia son prolongados, y en algunas ocasiones por el resto de la vida del paciente, lo cual implica el riesgo de complicaciones, entre las que sobresalen las de origen infeccioso. El objetivo de esta comunicación es proponer una guía general para la creación y desarrollo de un servicio especializado en el manejo de dispositivos intravasculares, con la finalidad de brindar una atención de calidad. La integración de un servicio con estas características requiere de un equipo multidisciplinario en el que participe el médico, la enfermera y el químico clínico, previa elaboración de los criterios y rutinas que integrarán los procedimientos de manejo. Un manual de procedimientos señalará las técnicas de aplicación y retiro de dispositivos intravasculares, los cuidados de enfermería, estrategias de permeabilización de catéteres y toma de muestras, administración de líquidos y medicamentos. Es importante que queden señalados los criterios para definir la presencia de una complicación, ya sea infecciosa o de otra índole, y establecer los principios generales de su manejo. El cumplimiento de los procedimientos establecidos permitirá garantizar una atención médica de calidad a los pacientes que en su domicilio reciben los servicios y requieren de la aplicación parenteral de medicamentos por tiempo prolongado.
The contemporary practice of medicine is related with the parenteral administration of many drugs. It is necessary to maintain a patent vascular line that permissive the drugs and fluids administration in therapeutics for many diseases. Since many years ago, there is a tendentious to the extrahospitalary management to the patients with chronic diseases and whose need intravenous drugs administration. The treatments are the most of the times for longer periods and many times for ever. There is a risk for complications in this situation, and one of the most important is infection. The purpose of this paper is to show a general guide from a specialized service in the management of intravascular devices to patients who need the parenteral administration of drugs with the fewer risk of complications. The specialized service needs a physician, a nurse and a clinical chemistry, all of them working around de same purpose: a medical service with quality. They need to establish the proceedings of general management and the specials protocols that are require on a specific situation like the infectious or the obstruction complication. The strategies for the vascular cannulation, cure, technics for flu ids and drugs administration are very important. The accomplish of the proceedings will let the evaluation and backwards to obtain and guarantee a medical service with quality to the chronic patients the needs service at home.