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A pulmonary sequestration is an unusual disorder in which a portion of the lung develops independently, deriving its blood supply from a systemic artery. Scleroderma and numerous other chronic lung conditions can cause hypertrophy of systemic collaterals, bronchial, intercostal, phrenic arteries which then communicate with the pulmonary arteries. Scimitar syndrome is characterized by an abnormal vascular communication between the lung parenchyma and the systemic circulation. But the abnormal communication is aberrant venous drainage to the inferior cava, not an aberrant arterial blood supply as depicted here. Regarding patients with portal hypertension, which of the following might be an indication for a transjugular intrahepatic portosystemic shunt? Refractory ascites Hepatic encephalopathy Biliary obstruction Hepatocellular carcinoma Key: A Rationale: A: Correct. Infection Dissection Penetrating ulcer Inflammatory aneurysm Key: A Rationale: A: Correct. Imaging manifestations of infectious aortitis include aortic wall thickening, periaortic fluid, saccular aneurysm or pseudoaneurysm, and occasionally intramural gas. In addition to the ulcer, the thickened wall, as seen in this case, is caused by the associated hematoma. Penetrating Atherosclerotic Ulcer of the Aorta: Imaging Features and Disease Concept. Infection Dissection Penetrating ulcer Inflammatory aneurysm Key: C Rationale: A: Incorrect. Imaging manifestations of infectious aortitis include aortic wall thickening, periaortic fluid, and the development of a saccular aneurysm or pseudoaneurysm. Penetrating atherosclerotic ulcer of the aorta is a distinct pathological entity and represents an ulcerated, atheromatous lesion with the ulcer penetrating deeply into the wall of the aorta. If communication between the newly formed hematoma and the aortic lumen develops, a classic double barrel aortic dissection with an intimal flap may be produced. Aortitis: imaging spectrum of the infectious and inflammatory conditions of the aorta. Hypothenar hammer syndrome Systemic lupus erythematosis Thromboemboli Arteriovenous malformation Key: D Rationale: A: Incorrect. Characteristic for hypothenar hammer syndrome is damage to the ulnar artery resulting more commonly in occlusion. Occasionally, repetitive trauma to the ulnar artery may result in aneurysm formation with distal emboli to the small arteries of the hand. Lupus, in common with the other collagen vascular diseases, may manifest as an arteritis causing stenoses and occlusions of the small arteries in the hand. Congenital arteriovenous malformations are characterized by enlarged feeding arteries, a dense tumor stain and early draining veins Reference: Greenspan, et al. Choice of femoral rather than subclavian vein insertion sites Credentialing personnel responsible for the insertion and maintenance of the lines Administering systemic antibiotics routinely before insertion of the line Routinely administering anticoagulant therapy after placing the line Key: B Rationale: A: Incorrect. The Society of Interventional Radiology recommends subclavian in preference to femoral insertion sites. Based on the best scientific evidence, the Society of Interventional Radiology recommends that: 1. Designate only trained personnel who demonstrate competence for the insertion and maintenance of peripheral and central intravascular catheters. The Society of Interventional Radiology recommends specifically against the use of antibiotics. The Society of Interventional Radiology recommends specifically against the use of anticoagulant prophylaxis. Guidelines for the Prevention of Intravascular Catheter-related Infections: Recommendations Relevant to Interventional Radiology for Venous Catheter Placement and Maintenance Donald L. Catheter-based arterial sympathectomy is a therapeutic modality with application for: A.

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Hand Hygiene Hand hygiene has been shown to significantly decrease the risk of contamination and cross-contamination. Its function is to reduce water loss, provide protection against abrasive action and microorganisms, and act as a barrier to the environment. The barrier function results from the dying, degeneration, and compaction of underlying epidermis and from the process of synthesis of the stratum corneum occurring at the same rate as loss. When using specific products for hand hygiene, it is important to maintain normal barrier function. Resident flora reside under the superficial cells of the stratum corneum and on the skin surface. Areas of skin that tend to be highly colonized include the perineum and inguinal area, but also the axillae, trunk, and upper extremities. These organisms must be capable of surviving for at least several minutes on the hands of personnel. Hand hygiene by the worker is inadequate or omitted entirely, or the agent used for hand hygiene is inappropriate. Alcohols are not appropriate for use when hands are visibly dirty or contaminated and in the case of suspected or known spore-forming pathogens as discussed below. Although there is no residual activity, regrowth of bacteria occurs more slowly after use. Alcohol-based hand rubs that contain humectants cause less drying and irritation than soaps. Critically important to reducing transmission of these pathogens are hand hygiene and attention to surface cleaning and disinfection (Weber et al. It is recommended that health-care agencies provide personnel with efficacious hand hygiene products that have a low irritancy potential, particularly when these products are used multiple times per shift. The use of gloves does not replace hand hygiene and does not provide complete protection. For insertion of peripheral catheters, good hand hygiene and wearing of gloves during catheter insertion, combined with proper aseptic technique during catheter manipulation, reduce infection risk. Additional recommendations include: Do not wear artificial fingernails or extenders when having direct contact with patients at high risk. Aseptic Technique Aseptic technique must be followed for all clinical procedures associated with risk for infections. It is important to understand the difference between the terms sterile, aseptic, and clean technique. Skin antisepsis also must be performed to minimize the presence of microbes on the skin prior to insertion, thus reducing risk for infection. Once a package is opened and sterile supplies are exposed to the air, the term aseptic technique is used, in preference to sterile technique. As defined earlier in this chapter, aseptic technique is defined as a set of specific practices and procedures performed in a manner that minimizes risk of transmission of pathogenic microorganisms to patients. Based on a theoretical and practice framework, hand hygiene and presence of an aseptic field promote aseptic technique, but effective "no-touch" technique ensures it. The tip of the flush syringe is protected by a cap that is not to be removed until it is ready for use. The syringe tip must not be touched prior to insertion into the needleless connector. Any breaks in asepsis should result in prompt disposal and replacement of the product. For patients who are sensitive or allergic to chlorhexidine or alcohol and for children younger than 2 months, povidone-iodine is considered an acceptable disinfectant. For patients with compromised skin integrity or infants younger than 2 months, the povidone-iodine can be removed with sterile normal saline or sterile water to prevent absorption of the product through the skin (Pedivan, 2010). Additional important aspects of skin preparation include the following: Antimicrobial solutions in a single-unit use configuration should be used. Alcohol should not be applied after the application of povidoneiodine preparation because alcohol negates the effect of povidone-iodine. It is never acceptable to speed up the drying process of skin antisepsis by "blowing" on or fanning the area!

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The intercurrent mortality data of all four groups and the results of the tests for dose response relationship and homogeneity of survivals for Groups 2, 3, and 4 are given in Tables 1A and 1B in the appendix for male and female rats, respectively. Tumor data analysis the tumor data were analyzed for dose response relationships across Groups 1, 2, 3, and 4, and pairwise comparisons of each of the three treated groups (Groups 2, 3, and 4) against the vehicle control group (Group 1), using the Poly-k method described in the paper of Bailer and Portier (1988) and Bieler and Williams (1993). In the ploy-k method, the adjustment for differences in mortality among treatment groups is made by modifying the number of animals at risk in the denominators in the calculations of overall tumor rates in the Cochran-Armitage test to reflect less-than-whole-animal contributions for animals that die without tumor before the end of the study (Bailer and Portier 1988). The modification is made by defining a new number of animals at risk for each treatment group. Certain treatment groups of a study or the entire study may be terminated earlier than the planned (or intended) time of terminal sacrifice due to excessive mortalities. The tsacr should always be equal to the planned (or intended) time of terminal sacrifice. For those animals that were sacrificed later than tsacr, regardless their actual terminal sacrifice time, tsacr was used as their time of terminal sacrifice in the analysis. One critical point for Poly-k test is the choice of the appropriate value of k, which depends on the tumor incidence pattern with the increased dose. For multiple pairwise comparisons of treated group with control group, however, the guidance indicated that the corresponding multiple testing adjustment is still under development and not yet available. However, in a later work Rahman and Lin (2008) showed that this rule for multiple testing for dose response relationship is also suitable for Poly-k tests. However, if the background information for the common or rare tumor is not available, the number of animals bearing tumors in the vehicle control group in the present study was used to determine the common or rare tumor status in the review report. No other statistically significant findings were noted in tumor data for both male and female rats. Mouse Study Two separate experiments, one in male mice and one in female mice were conducted. As indicated in Table 3, in each of these two experiments there were three treated groups, one positive control group, and one vehicle control group. The animals were removed from the cage and a detailed clinical observation was performed at least once weekly, beginning Week -1. For carcinogenicity group animals that died on study, a macroscopic examination was conducted and specified tissues were saved. Carcinogenicity group animals surviving until scheduled euthanasia were weighed and the animals were euthanized by isoflurane inhalation, followed by exsanguination. The generalized Wilcoxon test for survival was used to compare the homogeneity of survival rates across the vehicle control and test article groups at the 0. If the survival rates were significantly different, the generalized Wilcoxon test was used to make pairwise comparisons of each test article group with the vehicle control group. Additionally, the positive control group was compared to the vehicle control group using the generalized Wilcoxon test. There were no deaths in the vehicle control group prior to study day 100 and there were no tumors in the test article animals that died prior to day 100. Therefore, the following fixed intervals were used for incidental tumor analyses: Days 1 through 100, and Days 101 through and including terminal sacrifice. A minimum exposure of 100 days was considered sufficient to be included with animals surviving through scheduled termination. All metastases and invasive tumors were considered secondary and not statistically analyzed. A 1-sided comparison of each test article group with the vehicle control was performed. For the analysis of both the survival data and the tumor data in mice, this reviewer used similar methodologies that were used for the analyses of the rat survival and tumor data. Survival analysis the Kaplan-Meier curves for survival rates of all treatment groups are given in Figures 2A and 2B in the appendix for male and female mice, respectively. The intercurrent mortality data, and the results of the tests for dose response relationship and homogeneity of survivals for the vehicle control, low, mid, and high dose groups were given in Tables 3A and 3B in the appendix for male and female mice, respectively.

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Rajasekharan, Prevention of 1,2-dimethylhydrazine-induced circulatory oxidative stress by bis-1,7-(2-hydroxyphenyl)-hepta-1,6-diene-3,5dione during colon carcinogenesis, Pharmacol. Otani, Inhibition of farnesyl protein transferase by monoterpene, curcumin derivatives and gallotannin, Anticancer Res. Macdonald, Phytoestrogens in common herbs regulate prostate cancer cell growth in vitro, Nutr. Ghosh, Inhibition of arachidonate 5-lipoxygenase triggers prostate cancer cell death through rapid activation of c-Jun N-terminal kinase, Biochem. Carmena, Vasoactive intestinal peptide induces cyclooxygenase-2 expression through nuclear factor-kappaB in human prostate cell lines differential time-dependent responses in cancer progression, Mol. Design and synthesis of new curcumin analogues as potential antiprostate cancer agents, J. New 4-ethoxycarbonylethyl curcumin analogs as potential antiandrogenic agents, Bioorg. Curcumin analogues as novel androgen receptor antagonists with potential as anti-prostate cancer agents, J. Skrzypczak-Jankun, Synthetic curcuminoids modulate the arachidonic acid metabolism of human platelet 12-lipoxygenase and reduce sprout formation of human endothelial cells, Mol. Choi, the effects of curcumin on the invasiveness of prostate cancer in vitro and in vivo, Prostate Cancer Prostatic Dis. Bhattacharya, Induction of apoptosis in tumor cells by natural phenolic compounds, Asian Pac. Sun, Cytotoxicity of curcuminoids and some novel compounds from Curcuma zedoaria, J. Wu, Growth inhibition and apoptosis inducing mechanisms of curcumin on human ovarian cancer cell line A2780, Chin. Wu, Growth-inhibitory effects of curcumin on ovary cancer cells and its mechanisms, J. Ouyang, Antiproliferation and apoptosis induced by curcumin in human ovarian cancer cells, Cell Biol. Sood, Curcumin inhibits tumor growth and angiogenesis in ovarian carcinoma by targeting the nuclear factor-kappaB pathway, Clin. McCaughan, Quality of life and survival in the 2 years after surgery for non small-cell lung cancer, J. Hill, Screening of potential cancer-preventing chemicals for inhibition of induction of ornithine decarboxylase in epithelial cells from rat trachea, Oncol. Saiki, Regulation of activator protein-1 activity in the mediastinal lymph node metastasis of lung cancer, Clin. Carrier, Induction of apoptosis in human lung cancer cells by curcumin, Cancer Lett. Steele, Differential response of normal, premalignant and malignant human oral epithelial cells to growth inhibition by chemopreventive agents, Anticancer Res. Medina, Curcumin: a new radio-sensitizer of squamous cell carcinoma cells, Otolaryngol. Fujisawa, Induction of cytotoxicity and apoptosis and inhibition of cyclooxygenase-2 gene expression, by curcumin and its analog, alpha-diisoeugenol, Anticancer Res. Miyazawa, Multidisciplinary treatment for advanced invasive thymoma with cisplatin, doxorubicin, and methylprednisolone, J. Sa, Tumor-induced oxidative stress perturbs nuclear factorkappaB activity-augmenting tumor necrosis factor-alphamediated T-cell death: protection by curcumin, Cancer Res. Chen, the experimental and clinical study on the effect of curcumin on cell cycle proteins and regulating proteins of apoptosis in acute myelogenous leukemia, J. Roy, Inhibition of telomerase activity and induction of apoptosis by curcumin in K-562 cells, Mutat. Awasthi, the effect of curcumin on glutathione-linked enzymes in K562 human leukemia cells, Toxicol. Diederich, Induction of apoptosis by curcumin: mediation by glutathione S-transferase P1-1 inhibition, Biochem.

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If you look to vale or hill, If you listen, all is still, Save a little neighboring Rill, That from out the rocky ground Strikes a solitary sound. Down he came with a crack, Tumbling flat on his back, To the stones at the foot of the tree. Some time after this, when my sores were all healed, As I lay in the sun, sound asleep in a field, Miss Fanny crept slyly, and, grasping me fast, Declared she had caught the sweet creature at lust. I shall never forget him, How many"s the time master Jacky would set him, And while I stood terrified, all of a quake, Cried, "Hey, cat! Be this as it may, with the noise of its squeaking, Miss Fanny came in while my whis kers were reeking, And on my poor back with the hot poker flying, She gave me those bruises of which I am dying. But I feel that my breathing grows shorter apace, And cold clammy sweats trickle down from my face: I forgive little Fanny this bruise on my side. However, time gave me a little re lief, And mousing diverted the thoughts of my grief, And at last I began to be gay and contented, Till one dreadful morning, for ever repented. The simple thing, that cannot sew, Now tell me, my friends, was the like And mend her clothes when they are ever heard, torn, That a cat should be killed just for Or run away when thus forlorn. The suggestion was applauded Loudly, by one and all, Till somebody squeaked, " That trap "We all have our inspirations-" this produced a general smirk- would be " But we are not all at liberty About ninety-five times too small! I ask you, then, to trust me: Then a medical mouse suggested- You need have no further fears- A little under his breath- Consider our enemy done for! Arose with a solemn air, And, by way of increasing his stature, the mice had faith-of course they Rubbed up his whiskers and hair. This story has a moral- It is very short, you see, So no one, of course, will skip it, For fear of offending me. Kitten, kitten, two months old, Woolly snowball, lying snug, Curled up in the warmest fold Of the warm hearth-rug! Suppose a child may now and then Give to a cat a little pain, May not a poor cat scratch again? By my mother I must keep: I am safe enough from cold At her side within the fold. I creep in every bud I see, " Little sparrow, come here and say And all the honey is for me. I go where I like, and I stay where I How glad they all are when they see please, In the heat of the sun or the shade me come home! Once a trap was baited With a piece of cheese: It tickled so a little mouse It almost made him sneeze. Once there was a robin Lived outside the door, Who wanted to go inside And hop upon the floor. How pleasant the life of a bird must be, Flitting about in each leafy tree- In the leafy trees, so broad and tall, Like a green and beautiful palacehall, With its airy chambers, light and boon, That open to sun, and stars, and moon- That open unto the bright blue sky, And the froliesome winds as they wan der by! And away through the air what joy to go, And to look on the bright green earth below! How pleasant the life of a bird must be, Skimming about on the breezy sea, Cresting the billows like silvery foam, j And then wheeling away to its cliffbuilt home! What joy it must be to sail, upborne By a strong free wing, through the rosy morn, They have left their nests in the forest To meet the young sun face to face. Lightly to soar, and to see beneath the wastes of the blossoming purple heath, And the yellow furze like fields of gold That gladden some fairy regions old! On mountain-tops, on the billowy sea, On the leafy stems of the forest tree, How pleasant the life of a bird must be! Every change of song or voice Plainly proveth to my mind They can suffer and rejoice. The cuckoo makes no nest at all, But through the wood she strays Until she finds one snug and warm, And there her eggs she lays. The habits of each little bird, And all its patient skill, Are surely taught by God Himself, And ordered by His will. Day after day, and hour by hour, To feed her young she sped, Placed every sunny morn by me Beneath an arbory shed. All feel that crawl, or walk, or swim, Or poise the busy wing: Then seek not pleasure in the pain Of any living thing. But green leaves and blossoms and sunny warm weather, And singing and loving, all come back together. But the lark is so brimful of gladness and love, the green fields below him, the blue sky above, That he sings and he sings, and for ever sings he, " I love my love, and my love loves me.

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Distribution of the lactase phenotypes in the population of the Democratic Republic of the Sudan. Lactose intolerance and self-reported milk intolerance: relationship with lactose maldigestion and nutrient intake. All lactase preparations are not the same: results of a prospective, randomized, placebo-controlled trial. The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. Lactase deficiency: not more common in pediatric patients with inflammatory bowel disease than in patients with chronic abdominal pain. Calcium supply, bone mineral density and genetically defined lactose maldigestion in a cohort of elderly men. Dietary modification with dairy products for preventing vertebral bone loss in premenopausal women: a three-year prospective study. Molecularly-defined lactose malabsorption, milk consumption and anthropometric differences in adult males. Genetic predisposition for adult lactose intolerance and relation to diet, bone density, and bone fractures. Genetic lactase non-persistence, consumption of milk products and intakes of milk nutrients in Finns from childhood to young adulthood. Calcium and dairy intake: Longitudinal trends during the transition to young adulthood and correlates of calcium intake. The effect of a lactoserestricted diet in patients with a positive lactose tolerance test, earlier diagnosed as irritable bowel syndrome: a 5 year follow-up study. Children who avoid drinking cow milk have low dietary calcium intakes and poor bone health. A case-control study of hip fracture: evaluation of selected dietary variables and teenage physical activity. Two-year changes in bone and body composition in young children with a history of prolonged milk avoidance. Perceived milk intolerance is related to bone mineral content in 10- to 13 year-old female adolescents. The effects of a high calcium dairy food on bone health in pre pubertal children in New Zealand. Milk intake and bone mineral acquisition in adolescent girls: randomised, controlled intervention trial. Calcium-enriched foods and bone mass growth in prepubertal girls: a randomized, double-blind, placebo-controlled trial. Skeletal site selectivity in the effects of calcium supplementation on areal bone mineral density gain: a randomized, doubleblind, placebo-controlled trial in prepubertal boys. Effects of calcium, dairy product, and vitamin D supplementation on bone mass accrual and body composition in 10-12-y-old girls: a 2-y randomized trial. Abdominal pain associated with lactose ingestion in children with lactose intolerance. Lactose maldigestion is not an impediment to the intake of 1500 mg calcium daily as dairy products. A comparison of symptoms after the consumption of milk or lactose hydrolyzed milk by people with self-reported severe lactose intolerance. Relative effectiveness of milks with reduced amounts of lactose in alleviating milk intolerance. Comparative tolerance of elderly from differing ethnic backgrounds to lactosecontaining and lactose-free dairy drinks: a double-blind study. Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. Treatment of lactose intolerance with exogenous beta-D-galactosidase in pellet form. Double-blind study on the tolerance of four types of milk in lactose malabsorbers and absorbers. Calcium absorption and acceptance of low-lactose milk among children with primary lactase deficiency. Comparative tolerance of adolescents of differing ethnic backgrounds to lactose-containing and lactose-free dairy drinks. Effective reduction of lactose malabsorption and milk intolerance by direct addition of beta-galactosidase to milk at mealtime.

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Constitute by slowly adding 46 mL Purified Water and shaking vigorously for 5-10 seconds. Elimination halflife is dependent on renal function, and decreases with age from 11 hours (range 5 to 22) in neonates to 8 hours (range 4 to 12) by 3 months of age. The minimum dose should be used in infants with severe hyperbilirubinemia, sepsis, or severe pulmonary dysfunction. There are no specific data regarding the compatibility of dobutamine or dopamine and fat emulsions. Terminal Injection Site Incompatibility Acyclovir, amikacin, amphotericin B, ganciclovir, lorazepam, magnesium chloride, midazolam, octreotide acetate, pentobarbital, phenobarbital, and phenytoin. Strict adherence to the recommended total daily dose and hourly infusion rates is recommended. Clearance is via endogenous lipoprotein lipase activity, which is limited in very premature (less than 28 weeks gestation) and infected infants. Twenty percent emulsions are preferred due to lower total phospholipid and liposome content per gram of triglyceride. Ten percent emulsions have been associated with hypercholesterolemia and hyperphospholipidemia. Pharmacology Synthetic opioid narcotic analgesic that is 50 to 100 times more potent than morphine on a weight basis. Significant withdrawal symptoms have been reported in patients treated with continuous infusion for 5 days or longer. Terminal Injection Site Incompatibility Azithromycin, pentobarbital and phenytoin. Fahnenstich H, Steffan J, Kau N, Bartmann P: Fentanyl-induced chest wall rigidity and laryngospasm in preterm and term infants. Muller P and Vogtmann C: Three cases with different presentation of fentanyl-induced muscle rigidity-A rare problem in intensive care of neonates. Transient rebound in fentanyl serum concentration may reflect sequestration and subsequent release of fentanyl from body fat. Monitoring 334 Micormedex NeoFax Essentials 2014 Monitor respiratory and cardiovascular status closely. Alprostadil, amiodarone, atropine, caffeine citrate, cimetidine, dexamethasone, dobutamine, dopamine, enalaprilat, epinephrine, esmolol, furosemide, heparin, hydrocortisone succinate, lidocaine, linezolid, lorazepam, metoclopramide, midazolam, milrinone, morphine, nafcillin, nicardipine, pancuronium bromide, potassium chloride, propofol, ranitidine, remifentanil, and vecuronium. Nausea, constipation, black stools, lethargy, hypotension, and erosion of gastric mucosa. Optimal effect may take 2 to 3 days of therapy to achieve, and steady-state plasma levels may not be reached until 3 to 5 days at a given dosage in patients with normal renal and hepatic function. Therefore, do not increase dosage more frequently than approximately once every 4 days. Follow trough serum concentrations closely at initiation, 3 to 5 days after any dose change, and with any significant change in clinical status or diet. Uses Treatment of supraventricular arrhythmias not responsive to conventional therapies. Flecainide is not recommended for use in patients with chronic atrial fibrillation. Elimination half-life in newborns after maternal administration is as long as 29 hours. Product Information: flecainide acetate oral tablets, flecainide acetate oral tablets. A retrospective study using historical controls reports direct hyperbilirubinemia in the absence of elevated transaminases in some infants treated prophylactically for 6 weeks. May also interfere with metabolism of aminophylline, caffeine, theophylline, and midazolam. Huttova M, Hartmanova I, Kralinsky K, et al: Candida fungemia in neonates treated with fluconazole: report of forty cases, including eight with meningitis. Extended dosing intervals should be considered for neonates with renal insufficiency (serum creatinine greater than 1. Note: the higher doses are based on recent pharmacokinetic data but have not been prospectively tested for efficacy or safety. Uses Treatment of systemic infections, meningitis, and severe superficial mycoses caused by Candida species. Resistance has been reported with C glabrata and C krusei and in patients receiving long-term suppressive therapy.


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The advantage to this method is less blood loss because there is no discarded blood. Catheter Repair Catheter damage can occur from exerting excessive pressure while flushing or by accidental cutting from scissors or the catheter clamp. Patients should be provided instructions on how to immediately clamp or fold the catheter to prevent blood loss or air embolism and informed to notify the nurse. Catheter repair kits are available and are specific to the manufacturer and size of the catheter. Risks versus benefits must be considered when weighing the appropriateness of catheter removal versus catheter repair. Factors to consider include risk for infection from the damaged catheter, catheter type and potential for repair, expected duration of catheter need, and patient safety. The risk of catheter-associated infection is reduced by nursing competence and use of sterile technique while performing the repair. If a catheter-related complication is suspected, the catheter should be removed after patient assessment and collaboration with the health-care team. Primary and secondary continuous administration sets used to administer fluids other than lipids, blood, or blood products should be changed no more frequently than every 96 hours. Blood sets and add-on filters should be changed after administration of each unit or at the end of 4 hours, whichever comes first. Any administration set that is suspected of being contaminated or product whose integrity is in question should be changed. Replace tubing used to administer blood or blood products every 4 hours and lipids every 24 hours. In contrast to adults, the femoral site is not contraindicated in pediatric patients. Implanted ports may be placed in children who have ongoing intermittent infusion needs, such as those with severe hemophilia requiring regular factor replacement. The umbilical vein is preferred in emergency infusions and can be used for up to 2 weeks. The umbilical artery is used for hemodynamic monitoring, arterial blood gas measurements, and obtaining blood for other laboratory work. Umbilical artery catheters should be removed as soon as possible when no longer needed or when any sign of vascular insufficiency to the lower extremities is observed. The nurse shall verify that informed consent for treatment of neonatal and pediatric patients, as well as for patients deemed emancipated minors, is documented. The nurse providing infusion therapy for neonatal and pediatric patients shall have clinical knowledge and technical expertise with respect to this population. The nurse providing infusion therapy should have knowledge and demonstrated competency in the areas of: a. Pain may cause short-term suffering, but there may also be long-term detrimental effects. Lasting negative effects may impact neuronal development, pain threshold and sensitivity, coping strategies, emotions, and perceptions of pain (Cohen, 2008). Patients undergoing certain vascular procedures at times may need sedation or general anesthesia. The use of transdermal anesthetics, as discussed earlier, is appropriate for children facing procedures such as implanted port access. With infants, nonnutritive sucking is an effective analgesic, especially when combined with sucrose solution. However, there is evolving evidence of chlorhexidine safety and efficacy for all age groups (Pedivan, 2010). For children younger than 2 months of age, povidone-iodine is considered an acceptable disinfectant. An exception is with infants younger than 2 months old, for whom it is recommended that povidone-iodine be removed with sterile normal saline or sterile water to prevent absorption of the product through the skin (Pedivan, 2010).


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