ObjectiveThe goal of this prospective observational study was to identify adverse events (AEs) related to the use of intravenous access sites used for infective endocarditis (IE) treatment in a tertiary care hospital.DesignThis is an observational, analytical and prospective study on AEs resulting from the use of intravenous access sites in patients under antimicrobial treatment for IE. Patients enrolled in the International Collaboration on Endocarditis (ICE) study had their peripheral, short-term central catheters (CVC) and peripherally inserted central catheters (PICC) monitored for AEs.SettingTertiary care hospital for cardiac surgery in Rio de Janeiro, Brazil.PatientsPatients over 14 years of age, hospitalised in 2009 and 2010 with possible or definite criteria for IE by the modified Duke criteria were included.Main outcome measuresAEs related to intravenous catheters: erythema and infiltration, fever, obstruction, externalisation and blood stream infection.ResultsThirty-seven episodes of IE in 35 patients were studied. Mean patient age was 44.32±15.2 years; 22 (63%) were men. The number of vascular catheters studied were 253, 148 of which were peripheral, 85 CVC (21 of which for haemodialysis) and 20 PICC. The most frequent AEs were ‘erythema’ and ‘infiltration’ for peripheral catheters, ‘fever’ for CVCs and ‘obstruction’ and ‘externalisation’ for PICCs. The number of catheter-days was 360 for peripheral catheters, 1.156 for CVC and 420 for PICC. Kaplan-Meier curves for CVC and PICC showed statistical difference for obstruction (p<0.001) in PICCs. More bacteraemia occurred in CVC compared with PICC.ConclusionsThe choice of intravenous access sites is critical in the treatment of IE. Close observation for AEs and stricter implementation of infection control measures and better manipulation of catheters are suggested.
ObjectiveTranscatheter aortic valve replacement has been an alternative to invasive
treatment for symptomatic severe aortic stenosis in high risk patients. The
primary endpoint was 30-day and 1-year mortality from any cause. Secondary
endpoints were to compare the clinical and echocardiographic variation
pre-and post- transcatheter aortic valve replacement, and the occurrence of
complications throughout a 4-year follow-up period.MethodsThis prospective cohort, nestled to a multicenter study (Registro Brasileiro
de Implante de Bioprótese por Cateter), describes the experience of a
public tertiary center in transcatheter aortic valve replacement. All
patients who underwent this procedure between October 2011 and February 2016
were included.ResultsFifty-eight patients underwent transcatheter aortic valve replacement. The
30-day all-cause mortality was 5.2% (n=3) and after 1 year was 17.2% (n=10).
A significant improvement in New York Heart Association functional
classification was observed when comparing pre-and post- transcatheter
aortic valve replacement (III or IV 84.4% versus 5.8%;
P<0.001). A decline in peak was observed
(P<0.001) and mean (P<0.001)
systolic transaortic gradient. The results of peak and mean post-implant
transaortic gradient were sustained after one year (P=0.29
and P=0.36, respectively). Left ventricular ejection
fraction did not change significantly during follow-up
(P=0.41). The most frequent complications were bleeding
(28.9%), the need for permanent pacemaker (27.6%) and acute renal injury
(20.6%).ConclusionMortality and complications in this study were consistent with worldwide
experience. Transcatheter aortic valve replacement had positive clinical and
hemodynamic results, when comparing pre-and post-procedure, and the
hemodynamic profile of the prosthesis was sustained throughout
follow-up.
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