Inter-rater Reliability Testing of the Safety Protocol for Thirst Management.

PURPOSE: Thirst is one of the most common and yet undertreated symptoms in the postoperative period, mainly because of the lack of safety criteria to support indication for thirst management strategies. A Safety Protocol for Thirst Management was developed and validated, and the objective of this article was to evaluate the inter-rater reliability of the protocol. DESIGN: This is a methodological and applied study carried out in a teaching hospital in Brazil. METHODS: Safety criteria selected were the assessment of level of consciousness, presence of coughing and swallowing, and absence of nausea and vomiting. FINDINGS: Agreement between evaluators was almost perfect (Bachelors of Science in Nursing-Kappa of 0.968; nursing technicians-Kappa of 0.867). CONCLUSIONS: The protocol is presented as a viable and useful tool to evaluate safety criteria that allow administration of strategies to mitigate thirst of patients in the postoperative period.

Cyclosporine level: difference between blood samples collected through peripheral and central venous access.

AIMS AND OBJECTIVES: To identify differences in cyclosporine levels between blood samples collected from a peripheral venous access, catheter line used for drug infusion and catheter line not used for drug infusion in adult patients receiving allogeneic haematopoietic stem cell transplantation. Background. Cyclosporine is an immunosuppressant that prevents graft-versus-host disease, has a narrow therapeutic window and causes nephrotoxicity. For cyclosporine infusion, a tunnelled central venous access device is used; however, because of the lipophilic properties of the drug, it can adsorb to the catheter surface and falsely raise cyclosporine concentrations in blood specimens. DESIGN: Prospective observational study. METHODS: The study collected 135 blood samples from 16 patients. In 13 subjects, samples were obtained from the three lines at three time points (1, 7 and 14 days after the start of cyclosporine infusion), and for three subjects, samples were only obtained at 1 and 7 days after the start of infusion. The 5-ml blood discard method was used for samples collected from the catheter. Using this procedure, the catheter line was washed with saline solution, 5 ml of blood and saline solution were aspirated from the catheter line and discarded, and then sample blood used for the test was collected. The paired t-test with the Bonferroni correction was used to analyse the differences in cyclosporine serum levels. RESULTS: Significant differences were observed when the drug serum levels obtained in the line used for drug infusion were compared with the levels obtained in the line not used for infusion or the peripheral venous line. No differences in drug levels were identified in blood collected from the peripheral venous line and the line not used for drug infusion. CONCLUSION: Drug adsorption occurs in the line used for infusion. Therefore, the blood sample collected from the line not used for cyclosporine infusion can be considered reliable for drug concentration determination. RELEVANCE TO CLINICAL PRACTICE: Nurses should standardise one line of the tunnelled central venous access device for cyclosporine infusion, which avoids the need for evasive procedures and provides patients with more comfort.

[Nursing diagnosis in the perioperative period of cardiac surgery]. / Diagnósticos de enfermagem no perioperatório de cirurgia cardíaca.

This study identified the nursing diagnoses of patients in the perioperative period of cardiac surgeries and verified the existence or not of agreement between the first author and other nurses in the identification of these diagnoses. Seventeen patients admitted for cardiac surgery were submitted to evaluation using instruments for the perioperative period. In the preoperative, out of the 9 diagnosis categories identified by the first author, three agreed with the nurses (example: Activity intolerance). In the trans-operative, seven categories showed agreement among the nurses and the first author (example: Risk for infection). In the post-operative, 11 categories showed agreement among the nurses and the first author (example: Risk for peripheral neurovascular dysfunction).

First isolation and molecular characterization of Toxoplasma gondii from finishing pigs from São Paulo State, Brazil.

Toxoplasma gondii infection is widely prevalent in humans in Brazil. Among the food animals, pigs are considered the most important meat source of T. gondii for infection in humans. In the present study, we report the first isolation of viable T. gondii from finishing pigs in Brazil. Antibodies to T. gondii were found in 49 (17%) of 286 pigs prior slaughter using the modified agglutination test (MAT) at a serum dilution of 1:25. Attempts were made to isolate T. gondii from 28 seropositive pigs. Samples of heart, brain, and tongue from each pig were pooled, digested in acid pepsin, and bioassayed in five mice per pig. Viable T. gondii was isolated from seven pigs; all isolates were lethal for mice. Restriction fragment length polymorphism on products of SAG2 locus amplified by PCR revealed that two isolates were Type I and five were Type III. The results indicate that phenotypically and genetically T. gondii isolates from pigs from Brazil are distinct from isolates of T. gondii from pigs in the USA.