The risk of peripheral vein phlebitis associated with chlorhexidine-coated catheters: a randomized, double-blind trial.

OBJECTIVE: To evaluate the risk of phlebitis associated with chlorhexidine-coated polyurethane catheters in peripheral veins. DESIGN: A randomized, double-blinded trial comparing chlorhexidine-coated polyurethane catheters with uncoated polyurethane catheters. SETTING: A university hospital. PATIENTS: Adult medicine and surgery patients. INTERVENTIONS: Certified registered nurse anesthetists or an infusion team consisting of nurses and physicians inserted the catheters. Catheter insertion sites were scored twice daily for evidence of phlebitis. At the time catheters were removed, a quantitative blood culture was performed, and catheters were sonicated for quantitative culture. RESULTS: Of 221 evaluable catheters, phlebitis developed in 18 (17%) of 105 coated catheters, compared to 27 (23%) of 116 uncoated catheters (relative risk [RR], 0.74; 95% confidence interval [CI95], 0.43-1.26; P = .32). By survival analysis, chlorhexidine-coated catheters had a lower risk of phlebitis during the first 3 days (P = .06), but not when all catheters were considered in both patient groups (P = .31). In the absence of catheter colonization, the incidence of phlebitis was 21% (16/76) and 24% (20/86) for coated and uncoated catheters, respectively (P = .85), whereas in the presence of catheter colonization, the incidence of phlebitis was 14% (1/7) and 80% (4/5) for coated and uncoated catheters, respectively (RR, 0.18; CI95, 0.03-1.15; P = .07). CONCLUSION: The risk of phlebitis in the presence of catheter colonization was 82% lower for chlorhexidine-coated polyurethane catheters compared to otherwise identical uncoated catheters.

Osteopenia induced by long-term, low- and high-level exposure of the adult rat to lead.

The skeleton, the major site for Pb accumulation, is responsible for the largest fraction of the total body burden, but long-term effects of low-level exposure in adults remain unclear. In this study rats were exposed to low (0.01%; 100 ppm, LoPb) or high (0.5%, 5,000 ppm, HiPb) Pb, low calcium, feeding regimes for 1-12 months. Both LoPb and HiPb animals showed significant 12-month blood Pb levels [LoPb 21 +/- 3 micrograms/dl; HiPb 59 +/- 18; controls 3 +/- 1 (mean +/- SEM), p = 0.001]. Dual energy X-ray densitometry of the femur detected a significant decrease in bone density in HiPb animals by 3 months which remained significantly lowered through 12 months [3 months: HiPb: 0.498 +/- 0.011 (6) vs. control: 0.546 +/- 0.012 (6), p < 0.003]. By 12 months' density was also significantly lowered in LoPb animals (p = 0.001). Mineral analyses of ashed femurs showed a significant lead content after 1, 3, 9 and 12 months' exposure [1 month: LoPb, 0.020 +/- 0.002 (4) (% ash weight) vs control 0.008 +/- 0.0004 (4); HiPb 0.016 +/- 0.001 (8); control 0.007 +/- 0.0004 (6) (p < or = 0.002)]. Ca levels (% ash weight) were significantly lowered at 9 months in HiPb and 12 months in both groups (p < or = 0.04). Quantitative histomorphometry documented significantly elevated osteoid and resorptive trabecular surface features in both Pb groups. The LoPb design produced no overt renal functional abnormalities and resulted in blood Pb values comparable to those in man with modest environmental Pb exposure. The HiPb design resulted in development of lead nephropathy (more severe from months 6-12) and produced blood lead levels comparable to those seen in past industrial exposure. Findings show that Pb is incorporated into bone mineral after only 1 month's exposure to LoPb with significant osteopenia after 12 months' exposure; HiPb caused osteopenia by 3 months. No normal compensatory mechanism was elicited to maintain bone mass. Results stress renewed concern about the effects of cumulative, low-level lead exposure in our elderly population.

Infected radial artery pseudoaneurysms occurring after percutaneous cannulation.

During a ten-month period in 1988 at our institution, we identified three infected radial artery pseudoaneurysms (RAPAs) associated with arterial lines. A retrospective chart review to 1983 identified three additional cases, all occurring in 1986. In the six-year period of 1983 through 1988, during which approximately 12,500 radial artery catheters were placed, the incidence of RAPA formation was 6/12,500 (0.048 percent). Five of the six cases were associated with Staphylococcus aureus infection. The duration of radial artery cannulation was significantly longer in patients who developed a pseudoaneurysm (12.5 days) than in those patients who did not suffer this complication (4.3 days). Patients in whom infected RAPAs occurred also tended to be older (mean, 71.6 years) than the average age (54 years) for all patients admitted to the intensive care unit (ICU). They also tended to have long stays in the ICU prior to development of RAPA, the shortest stay being 11 days and the average being 51 days. Risk factors for the development of this complication may include advanced age, longer duration of catheterization and hospitalization, and infection with S aureus.

Placement of a porous membrane underneath the mucoperiosteal flap and its effect on periodontal wound healing in dogs.

This study was designed to investigate the healing of surgically induced, horizontal periodontal defects in dogs following placement of a biocompatible, porous polytetrafluorethylene membrane around the roots of the treated teeth and to compare the healing to that of control teeth without membrane. Mandibular premolar teeth of 5 beagle dogs were used for experimentation. Specimen blocks were removed 3 months postoperatively for histological evaluation of contralateral experimental and control teeth. Mean apical migration of junctional epithelium among the experimental surfaces amounted to 0.1 mm as compared to 1.3 mm for the control surfaces. Accordingly, the amount of connective tissue attachment, defined by the distance from the base of the junctional epithelium to the apical termination of root planing, was greater for experimental than for control surfaces. As this increased amount of connective tissue attachment was associated with more coronal bone apposition, a periodontal ligament space was more prevalent in experimental than in control surfaces. A limited amount of ankylosis was observed for both experimental and control surfaces. Root resorption was more prevalent in control than in experimental surfaces. Conceivable reasons for the differences in healing between experimental and control teeth are discussed.