Repair of Central Venous Catheter in a Single-Center Adult Home Parenteral Nutrition Cohort.

BACKGROUND: Patients with chronic intestinal failure who require long-term parenteral nutrition rely on central venous catheters (CVCs) for access to nutrition and hydration. With prolonged use, complications such as central line-associated bloodstream infection (CLABSI), damage to CVC, and central venous thrombosis (CVT) can threaten the availability of life-preserving access. Because of this, all efforts should be made to preserve CVCs with techniques such as catheter salvage in case of CLABSI and catheter repair when damaged. The present study was conducted to evaluate the effectiveness and safety of catheter repair in our patient population. METHODS: Retrospective review in 1253 adult patients who received home parenteral nutrition at the Mayo Clinic between September 1, 1997, and April 30, 2018, was conducted to determine the incidence of CLABSI and CVT in patients who underwent CVC repair. RESULTS: Fifty-five CVC repairs were performed in 36 patients (n = 23 female) with mean age of 57.05 ± 16.96 years. A total of 14 catheters (25.45%) were complicated with 24 episodes of CLABSI. CLABSI rate before and after repair was 0.23/1000 catheter days and 0.21/1000 catheter days, respectively. Most common indications for eventual catheter replacement were mechanical damage (32%), infection (32%), and switching to alternate mode of nutrition (24%). We had a 100% success rate of catheter repair procedure, and no post-procedural complications were present. CONCLUSION: Catheter repair can increase the catheter survival without increasing the risk of CLABSI, providing not only socioeconomic benefit but also decreasing risk of compromising future vascular access.

Intranasal Dexmedetomidine as a Sedative for Pediatric Procedural Sedation.

OBJECTIVE: This study seeks to evaluate the efficacy and safety of intranasal (IN) dexmedetomidine as a sedative medication for non-invasive procedural sedation. METHODS: Subjects 6 months to 18 years of age undergoing non-invasive elective procedures were included. Dexmedetomidine (3 mcg/kg) was administered IN 40 minutes before the scheduled procedure time. The IN dexmedetomidine cohort was matched and compared to a cohort of 690 subjects who underwent sedation for similar procedures without the use of dexmedetomidine to evaluate for observed events/interventions and procedural times. RESULTS: One hundred (92%) of the 109 included subjects were successfully sedated with IN dexmedetomidine. There were no significant differences in the rate of observed events/interventions in comparison to the non-dexmedetomidine cohort. However, the IN dexmedetomidine group had a longer postprocedure sleep time when compared to the non-dexmedetomidine cohort (p < 0.001), which had a significant effect on recovery time (p = 0.024). Also, the dexmedetomidine cohort had longer procedure time and total admit time (p < 0.001 and p = 0.037, respectively). CONCLUSIONS: IN dexmedetomidine may be used for non-invasive pediatric procedural sedation. Subjects receiving IN dexmedetomidine had a similar rate of observed events/interventions as the subjects receiving non-dexmedetomidine sedation, with the exception of sleeping time. Also, patients sedated with IN dexmedetomidine had longer time to discharge, procedure time, and total admit time in comparison to other forms of sedation.

Pain and mild traumatic brain injury: the implications of pain severity on emotional and cognitive functioning.

PRIMARY OBJECTIVE: The aim of this study was to examine the effect of high chronic pain on (a) neuropsychological test performance and (b) self-reported emotional complaints in persons suffering from Postconcussional Disorders (PCD) after a mild traumatic brain injury (TBI). RESEARCH DESIGN: A two-group comparative research design was employed. METHODS AND PROCEDURE: An outpatient sample of 66 patients with mild TBI and PCD using the Ruff Neurobehavioural Inventory (RNBI) and a neuropsychological test battery. MAIN OUTCOMES AND RESULTS: According to ANOVAs, no significant between-group differences were found on neuropsychological test performances; however, the high pain group had significantly more emotional residuals; particularly elevated on the RNBI were the Anger and Aggression, Anxiety, Depression and Paranoia and Suspicion sub-scales. Furthermore, an ANOVA found participants of the high pain group reporting significantly higher impairments on the RNBI Cognitive, Physical and Quality-of-Life composite scores and several RNBI sub-scales compared to their pre-morbid functioning. CONCLUSIONS: High chronic pain exacerbates the emotional aspect of PCD and, therefore, should be given special observance in treatment settings.

Infusing learner-centered strategies into the classroom.

As an instructor, how do you engage the learners? This paper illustrates the value of using learner-centered teaching strategies to accomplish this goal in your classroom. Learner-centered teaching utilizes the instructor as a facilitator and creates an active learning environment in which the student takes responsibility of learning. Various techniques will be described as well as the practical application of leaner-centered teaching in the classroom.