ABSTRACT
PURPOSE: To evaluate the clinical usefulness of an integrated closed intravenous catheter system (CICS) with a preattached stabilization platform and extension tube (BD Nexiva™; Becton, Dickinson and Company) in Japanese patients. METHODS: In this open, single-center study, patients who required peripheral intravenous (PIV) catheterization for ≥72 hours were quasi-randomized to receive a CICS or a conventional intravenous catheter. Study outcomes included adverse events during catheter insertion, catheter replacements during the initial 72 hours, catheter survival rate at 72 hours after insertion and costs of initial catheterization and catheter replacement. RESULTS: Of 359 patients enrolled, 194 received the CICS and 165 received the conventional catheter. The incidence rates of ≥1 failed insertion attempts, blood leakage and blood exposure were similar in both groups. The survival rate of the CICS group (83.7%) was significantly higher than that of the conventional catheter group (62.6%) in the intention-to-treat analysis (p=0.0085). There were significantly fewer catheter replacements due to catheter-related complications (e.g., catheter failure or extravasation) in the CICS group (p=0.0056). Although the initial cost per patient was greater for the CICS group (US$17.07 vs. US$13.26), the total cost per patient over 72 hours was similar (US$21.00 vs. US$20.30) because of the cost of unplanned replacements of conventional catheters. CONCLUSIONS: Although rates of adverse events at insertion were similar for both catheters, significantly fewer patients required unplanned reinsertion with the CICS. The results suggest that the longer survival rate for the CICS can offset the higher initial catheterization costs.
Subject(s)
Catheterization, Peripheral/instrumentation , Vascular Access Devices , Aged , Aged, 80 and over , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/economics , Device Removal , Equipment Design , Equipment Failure , Female , Hospital Costs , Humans , Japan , Male , Middle Aged , Polyurethanes , Time Factors , Vascular Access Devices/economicsABSTRACT
Chiral surfaces were prepared by L, D, and Meso-tartaric acids (TAs) adsorbed on gemini-structured self-assembled monolayers (SAMs) composed of ethylenebis [(12-mercaptododecyl) dimethyl ammonium bromide] (HS-gQA-SH). The formation and structure of the chiral surfaces were characterized by surface plasmon resonance spectroscopy (SPR) and Fourier transform infrared-reflection adsorption spectroscopy (FTIR-RAS). The thickness of enantiomeric TA layers on the HS-gQA-SH SAM was estimated to be c.a. 5-6 angstroms regardless of their chirality, in good agreement with the height of TA molecules anchoring on the surface with two COOH groups. All the TAs on the HS-gQA-SH SAM exhibit the same ionization state independent of their chirality in their vibration bands of carboxylic groups. We attempted a second-layer adsorption of the enantiomeric TAs on L-TA monomolecular layer (L-TA SAM) precomposed on the HS-gQA-SH. A strong affinity between first and second TA layers resulted in the film growth when their chirality is identical (i.e., L-TA on L-TA SAM). We found the structure of second L-TA layer was completely different from that of the first layer, where a crystalline-like L-TA phase was found as a predominant component. Our results imply a preferential crystalline growth of chiral molecules on the same chiral surface, which may lead to a work for optical resolution into two enantiomers at a solid-liquid interface.
