This study was performed to investigate whether an intravenous (IV) strategy based on newgeneration midline catheters is an efficacious alternative to a conventional IV strategy consisting of peripheral venous catheters and central venous catheters, for patients needing IV therapy exceeding 5 days. Methods: This was a prospective, randomized, controlled study. Patients requiring more than 5 days of IV treatment were randomized to either a midline catheter-based IV strategy or a conventional strategy. The primary endpoint was the composite of the insertion of a central venous catheter (CVC) or the need for four or more peripheral venous catheter (PVC) insertions. The secondary outcomes included catheter dwell times and reasons for premature removal. Results: One hundred and twenty patients were included. The fraction of patients receiving four or more PVCs or having a CVC inserted was 12/58 (21%) in the midline group versus 38/58 (66%) in the conventional group (p < 0.001); the number needed to treat was 2.2. The median overall catheter dwell time was 7 days (range 0-60 days) in the midline group and 4 days (range 0-84 days) in the conventional group (p = 0.002). Conclusion:In patients requiring more than 5 days of IV therapy, a midline catheter strategy reduced the need for insertion of a CVC or four or more PVCs.
mediate macrophage migration, neovascularization, collagen synthesis, fibroblast proliferation and epithelization, while leucocytes fight infection and thrombocytes are blood-clotting agents. After the centrifuging, the bloodpatch is placed directly into the wound bed and fastened by appropriate bandages. Methods: The treatment is implemented in a multidisciplinary outpatient clinic specialized in advanced wound treatment, as a supplement to standard care (off-loading, compression, debridement, infection control etc.). Only patients with hardto-heal wounds (wound duration>6 weeks) are included. The indication for blood patch treatment is set after clinical assessment by a consultant wound specialist. We administer the autologous blood patch [1] weekly, and measure the wound size at the beginning and at the end of treatment. Furthermore, we register time to healing and potential adverse events. Results: From June 2016 to October 2018, 26 patients were included. Wound-categories were: diabetic foot ulcer(n¼4), pressure ulcer(n¼7), related to surgical incision(n¼9) venous(n¼3) and other(n¼3). The mean age was 65 years (SD 13.6), 58%(n¼15) were males. Median pre-treatment time before inclusion was 21.5 weeks (IQR 28). The median number of blood patch[1] treatments were three ranging from 1-19 treatments per patient. The median time to healing was 73 days (IQR 156). 54 %(14/26) healed < 20 weeks, 27%(7/26) healed >20 weeks, and 19%(5/32) did not heal. A reduction in mean wound size was seen, from 2.75 cm 2 (SD 3.55) at the start of treatment versus 1.62 cm 2 (SD 2.48) after completion of treatment, (95%CI 1.29;4.22) versus (95%CI 0.59;2.64) p¼0.0058. In all cases with pain prior to treatment, the patients reported less pain after treatment start. All patients had weekly controls and treatment was stopped ahead of time for 3/26 patients: one because of difficulties obtaining the blood sample, one had an infection and one was amputated. Conclusion:
Purpose We aimed to evaluate the diagnostic and logistical consequences of routine preoperative focused cardiac ultrasound (FOCUS) in patients scheduled for elective vascular surgery. Methods In a prospective, observational study, FOCUS was performed in all patients seen in the vascular surgery outpatient clinic from January 14 to May1, 2019, unless a full echocardiography had been conducted in the preceding 12 months or the patient was already referred to an echocardiography by the vascular surgeons. FOCUS followed a stringent protocol and referrals for a full echocardiography followed predefined criteria. Results Preoperative FOCUS was performed in 55 (60%) patients. Of these, 12 patients (22%) revealed cardiac pathology and were referred to a full echocardiography. Coronary angiography was subsequently performed in one of these patients but was without a further consequence. All patients underwent surgery. Conclusion FOCUS disclosed cardiac pathology in the outpatient clinic but with little clinical consequence. This study does not support routine FOCUS as a part of the preoperative patient cardiovascular assessment before vascular surgery. However, larger studies are warranted to further evaluate the relevance of preoperative FOCUS in a larger sample size.
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