MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Marianne's Corner' source. Mon, 17 Nov 2008 22:49:47 +0100 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2008/11/11/469.aspx Central venous catheters inserted for home TPN may be secured by sutures, cuffs, or both.  Knowing what type of catheter has been inserted helps determine whether sutures should be removed or not. A non-tunneled triple, double, or single lumen catheter requires sutures for the life of the catheter.  This type of catheter is inserted directly into the central venous system usually during a hospitalization.  It is indicated for temporary,...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=1951784 Wed, 12 Nov 2008 00:35:00 +0100 1951784 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2008/09/16/454.aspx Imagine going to the hospital and being discharged home with no end cap or covering on the hub of your tunneled catheter.  Or your catheter is dislodged because a hospital nurse did not place a securing loop when the dressing was changed.  What about health care providers not using alcohol swabs with friction when accessing your device?….and the list goes on.I just returned from the Association for Vascular Access (AVA) meeting in Savannah, Georgia.  The topic of medical professionals...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=1798057 Tue, 16 Sep 2008 21:46:00 +0100 1798057 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2008/08/06/450.aspx Preparing TPN, hooking up, flushing, and giving additional infusions or medications exposes the central venous catheter lumen to potential microorganisms that may contribute to catheter related blood stream infection. One activity that poses a very high risk of contamination is talking. During speaking, saliva particles are dispersed and may contain bacteria.  In addition, oral abscesses, gingivitis, and cavities contribute to an even higher oral bacterial count. ...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=1686165 Wed, 06 Aug 2008 15:51:00 +0100 1686165 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2008/06/19/422.aspx     Many home TPN consumers are preparing to travel to San Diego next week for the annual Oley Foundation meeting (www.oley.org).  Others are planning summer vacations to beaches, camping, and even abroad.    Contact your home infusion pharmacy and let them know your plans. They will advise you on whether they can ship to your travel location, or if you have to take supplies with you.  Call ahead...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=1531116 Fri, 20 Jun 2008 00:47:00 +0100 1531116 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2008/05/30/411.aspx Many different types of end caps or adapters are available for home TPN consumers to use on the hub (open) end of their central venous access device. There are needleless, dead end, injection ports, and split septum system caps. All connectors and caps need to be changed on a routine basis. The CDC and INS standards recommend cap change at least once weekly. In some cases, a more frequent change may be indicated....(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=1480620 Fri, 30 May 2008 22:41:00 +0100 1480620 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2008/04/27/396.aspx     On April 15 the Infusion Nurse's Society (INS) sponsored an on-line Webinar entitled "Current Guidelines for Flushing Vascular Access Devices."  This was a live presentation by Lynn Hadaway M.Ed., RN, BC, CRNI.  Lynn is a well known expert in infusion related topics and has an informative website www.hadawayassociates.com.  The Webinar was accessed via personal computer and slides could be viewed while Lynn lectured.  E-mailed questions were addressed following...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=1402937 Sun, 27 Apr 2008 20:45:00 +0100 1402937 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2008/04/04/392.aspx Total parenteral nutrition (TPN) has been identified as a risk factor for catheter related blood stream infection (CRBSI).  Central venous access devices (CVAD) used to administer TPN provide a direct pathway for pathogens to enter the blood stream either from skin or hub migration.            TPN solutions are susceptible to microbial growth because of the necessary nutritional components they contain. Fat emulsions, amino...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=1351980 Fri, 04 Apr 2008 20:41:00 +0100 1351980 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2008/03/11/388.aspx Several Nutrishare pharmacists, our dietician, and I attended the American Society for Parenteral and Enteral Nutrition (ASPEN) Clinical Nutrition Week in Chicago, IL last month. This conference focuses on topics related to nutritional support in the hospital and outpatient settings. Nutrition experts present a wealth of knowledge for clinicians to take back to their practice....(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=1296016 Tue, 11 Mar 2008 21:55:00 +0100 1296016 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2008/01/30/236.aspx Access devices are becoming more and more complex with various materials and configurations.  A new product recently developed by Bard Access Systems™ (C.R. Bard, Inc. Salt Lake City, Utah) is called a PowerPICC Solo Catheter™.  This catheter is inserted in the same manner as other peripherally inserted central catheters (PICC's) and is made of polyurethane.This PICC has a valve in the hub that simplifies care and maintenance.  It can be maintained by flushing with sodium chloride...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=1189972 Wed, 30 Jan 2008 20:59:00 +0100 1189972 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/12/26/171.aspx One of the most common complications associated with TPN is catheter related blood stream infection. In most instances this requires hospitalization. This always has been and will continue to be a hospital stay that is covered by insurance benefits.    In October 2008, Medicare is changing reimbursement for preventable complications that occur during hospitalization.  This means that if a home TPN consumer is admitted for another reason and a catheter...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=1117564 Wed, 26 Dec 2007 22:25:00 +0100 1117564 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/12/07/166.aspx Silicone tunneled catheters may develop ballooning or bulging during infusion and flushing which indicates a weakened catheter wall.  This ballooning is usually noticed at the end of the catheter before the thickened area at the hub, or on double lumen catheters at the “Y” area.  Polyurethane catheters (PowerLines™) are made of a more durable material and will not balloon. A weakened wall may occur on new as well as old catheters.  The weakening may be a result of...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=1079682 Fri, 07 Dec 2007 22:41:00 +0100 1079682 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/11/04/140.aspx Securing a tunneled catheter that hangs from the chest or abdominal area can be challenging for the home TPN consumer.  There is a very high risk for contamination and subsequent catheter related blood stream infection when catheter tubing hangs near an ostomy, gastrostomy tube, or diaper.  Tubing that gets tangled in clothing or caught on various household furnishings can cause chronic pulling at the exit site with eventual irritation or infection. Numerous different...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=1002753 Sun, 04 Nov 2007 17:22:00 +0100 1002753 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/10/19/61.aspx Home TPN consumers self-administer a highly technical infusion therapy.   They are very knowledgeable about pumps, tubings, syringes, medications, aseptic technique, and complication troubleshooting.  Many HPN consumers perform all aspects of their care independently, without the help of a back-up caregiver.  Although, taking charge of one’s health and well being is admirable, it is always a good idea to have another person who is also familiar with the procedures...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=964520 Fri, 19 Oct 2007 21:15:00 +0100 964520 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/10/19/60.aspx Attilio Di Fiore, BSc, BScEng, P Eng is a polyurethane engineer for Bard Access Systems.  He presented a breakout session comparing polyurethane to silicone tunneled catheters and PICC’s.  Historically, home TPN consumers have had tunneled silicone and port catheters.  Bard makes the very familiar Port-A-Cath™, Hickman™, Broviac™, and Leonard™ catheters.  Polyurethane catheters have recently become very popular.  Bard’s polyurethane PICC and tunneled catheters called...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=964521 Fri, 19 Oct 2007 21:11:00 +0100 964521 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/09/30/89.aspx Home TPN consumers self-administer a highly technical infusion therapy.   They are very knowledgeable about pumps, tubings, syringes, medications, aseptic technique, and complication troubleshooting.  Many HPN consumers perform all aspects of their care independently, without the help of a back-up caregiver.  Although, taking charge of one’s health and well being is admirable, it is always a good idea to have another person who is also familiar with the procedures and routines....(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=915305 Sun, 30 Sep 2007 20:40:00 +0100 915305 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/09/18/53.aspx Attilio Di Fiore, BSc, BScEng, P Eng is a polyurethane engineer for Bard Access Systems.  He presented a breakout session comparing polyurethane to silicone tunneled catheters and PICC’s.  Historically, home TPN consumers have had tunneled silicone and port catheters.  Bard makes the very familiar Port-A-Cath™, Hickman™, Broviac™, and Leonard™ catheters.  Polyurethane catheters have recently become very popular.  Bard’s polyurethane PICC and tunneled catheters...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=880106 Tue, 18 Sep 2007 14:51:00 +0100 880106 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/09/12/51.aspx I attended two sessions on catheter care and antisepsis.  Greg Art BA MBS NPDP, Aplicare, Inc. presented “Topical Antiseptics:  Separating Fact from Fiction in Catheter Antisepsis”.  He reviewed current research and FDA guidelines for effectiveness of various antiseptics.  The properties desired in a good antiseptic are:  fast acting, broad spectrum, large number kill, and persistence on the skin over time.  Although 70% isopropyl alcohol...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=867228 Thu, 13 Sep 2007 00:41:00 +0100 867228 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/09/06/50.aspx I will be attending the 21st annual AVA conference in Phoenix, Arizona this week.   AVA is an organization devoted to excellence in vascular access.   This conference incorporates poster sessions, exhibits, and formal presentations “outlining cutting-edge technology along with research and scientific-based information” on the latest knowledge in vascular access. This conference has an interesting mix of medical professionals along with engineers,...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=847232 Thu, 06 Sep 2007 14:19:00 +0100 847232 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/08/31/49.aspx Mitochondrial disease is a complex and large group of disorders that affect multiple organs.  The mitochondrion is the part of the cell responsible for energy production by glucose metabolism through the Krebs cycle.  Any defect within this cycle causes the disorder. The stomach and intestines can be affected by mitochondrial disease.  Some of these conditions are GERD (gastric-esophageal reflux disease), gastroparesis, chronic intestinal pseudo-obstruction...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=835393 Fri, 31 Aug 2007 16:37:00 +0100 835393 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/08/01/47.aspx I attended the Association of Gastrointestinal Motility Disorders (AGMD) meeting July 27-29 in Burlington, Massachusetts.  The target audience for AGMD conferences is anyone associated with digestive diseases.  This includes patients, family members, caregivers, and medical professionals.  An impressive faculty of experts presented three full days of adult and pediatric digestive motility topics, such as:  Irritable Bowel Syndrome, Constipation, Esophageal...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=773279 Wed, 01 Aug 2007 20:52:00 +0100 773279 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/07/06/46.aspx Many home TPN consumers wear gloves when admixing and setting up their TPN infusion.  Good hand washing practices are always necessary whether gloves are used or not.  There are two types of gloves, sterile and non-sterile. Non-sterile gloves are usually worn by healthcare workers or caregivers to protect themselves from contamination with blood or body fluids.  A nurse drawing blood peripherally or from a central line should wear gloves. Sterile...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=718780 Fri, 06 Jul 2007 19:17:00 +0100 718780 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/06/21/45.aspx A presentation entitled “Solve your Ostomy Problems So You Can Lead an Active Life” was given by Katie Hudson, RN, CWOCN, VCU Medical Center, Richmond, Virginia.  Many home TPN consumers also have ostomies, so this was very practical and useful information. Pouch leakage is one of the most disruptive and embarrassing problems experienced by ostomates.  Katie outlined 10 reasons for pouch leakage: Skin irritationHigh volume enzyme rich stoolSkin ...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=687682 Thu, 21 Jun 2007 17:24:00 +0100 687682 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/06/12/44.aspx Donald F. Kirby, MD, CNSP, CPNS, Division of Gastroenterology, Chief, Section of Nutrition, Medical College of Virginia, Richmond, VA presented “Crohn’s Disease Treatment: Past, Present, and Future”.  Dr. Kirby began his presentation with definitions of the types of Inflammatory Bowel Disease (IBD):  Crohn’s Disease, Ulcerative Colitis, and Colitis Indeterminate.  Early treatment options included Azulfidine, steroids, antibiotics, and “prayer and more prayer”...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=674480 Tue, 12 Jun 2007 21:47:00 +0100 674480 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/06/08/43.aspx     The first of two Pediatric speakers was Peter Ngo, MD, Floating Hospital for Children, Tufts-New England Medical Center, Boston, Massachusetts.    Dr. Ngo presented “Nutritional Strategies in Pediatrics:  Meeting the Challenge.”  He pointed out that children are not small adults.  Their growth and development and nutritional needs are constantly changing over time.  He stressed the importance...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=674481 Fri, 08 Jun 2007 20:41:00 +0100 674481 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/06/06/41.aspx We had eight expert speakers during the conference portion of the Nutrishare 15th Anniversary Disney Cruise.  The first topic I will review was presented by Stephen McClave, MD, Professor of Medicine, University of Louisville School of Medicine, Louisville, KY.   His presentation entitled “Hydration and Fluid Volume Status” was very timely for these hot summer months.  He described how reduced oral intake, short bowel syndrome with limited absorptive surface,...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=674482 Wed, 06 Jun 2007 22:02:00 +0100 674482 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/04/30/40.aspx Many Nutrishare consumers are preparing for the Disney Cruise Conference beginning this weekend.  I know everyone will have plenty of fun enjoying the water, sights, shows, and food.  Wednesday is the conference, and Reid has planned a day full of interesting speakers and topics.  There will be presentations in the morning by an impressive group of physicians and nurses, followed by a lunch break and roundtables in the afternoon.  I am excited that my colleague and friend,...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=582555 Mon, 30 Apr 2007 23:16:00 +0100 582555 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/04/23/39.aspx Nutrishare recommends that TPN be stored in an individual refrigerator.  The general household refrigerator is opened many times each day making it hard to maintain a consistent temperature.  Also, food, crumbs, and spills may carry bacteria that could be transferred onto the TPN bags and additive medications.  A thermometer should be kept in the refrigerator and a temperature of 40-42 degrees maintained.  Rotate the TPN and additive medications using the older...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=564049 Mon, 23 Apr 2007 20:14:00 +0100 564049 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/04/10/36.aspx Pump maintenance is key to ensuring dependable, trouble-free TPN delivery.  It is frustrating to experience pump failure in the middle of an infusion, and loss of fluids, nutrition, and electrolytes can cause dehydration and electrolyte imbalance.  Nutrishare consumers infusing 4 days or more per week should have a back-up pump on hand.  The pumps need to be rotated on a regular weekly basis or at minimum every 14 days.  This ensures that each pump remains in proper working...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=534653 Tue, 10 Apr 2007 17:37:00 +0100 534653 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/03/30/35.aspx Home TPN is a therapy that requires many supplies that must be assembled for each infusion.  There may be additional supplies for hydration or other intravenous medications.  An organized supply system can greatly reduce the amount of time spent on the hook-up task, leaving more minutes for personal time. TPN supplies and equipment should be stored close to the admixing and hook-up area.  Remember to select a quiet place that is free of drafts, fans,...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=511908 Fri, 30 Mar 2007 18:45:00 +0100 511908 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/03/23/34.aspx There are two main catheter materials used for long term tunneled catheters and ports.  The most common is medical grade silicone rubber.  This is a soft material and may be white or clear.  It is comfortable against the skin and easily looped and secured.  Silicone catheters may be open ended or have a valve in the hub or distal tip.  Because of the soft nature of silicone, these catheters can only withstand 25 psi and should be flushed with 10-12 ml syringes...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=496693 Fri, 23 Mar 2007 18:16:00 +0100 496693 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/03/15/33.aspx The exit site is where a tunneled catheter comes out of the body.  When a catheter is placed, a subcutaneous tunnel is created in the chest or abdomen. The catheter is inserted through this tunnel to the exit site on the exterior of the body.  Sutures are placed at the exit site to secure the catheter until the Dacron cuff adheres to the subcutaneous tissue in the tunnel.  This usually takes about 2-4 weeks, at which time the sutures should be removed. A healthy...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=477758 Thu, 15 Mar 2007 21:44:00 +0100 477758 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/03/03/32.aspx is a complication associated with TPN administration and access device placement.  The type of thrombus I am addressing is a blood clot that forms in the vessels close to the catheter site.  A variety of factors may contribute to catheter related central venous thrombosis.  Some of the most common causes are traumatic insertion, history of multiple insertions, dehydration, malposition, and altered coagulation as seen in protein C and S deficiencies....(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=461807 Sat, 03 Mar 2007 22:49:00 +0100 461807 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/02/22/31.aspx Gail Sansivero MS ANP, Vascular and Interventional Radiology from Albany Medical Center, presented “Managing VAD Complications with Imagery” at the ASPEN conference in January.  She has many years of experience inserting and troubleshooting central venous access devices.  Gail gave a “show and tell” of malpositioned  and malfunctioning devices by sharing radiology films with us.  It was interesting to actually see kinked, looped, and crossed lines discovered by X-ray....(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=461808 Thu, 22 Feb 2007 22:30:00 +0100 461808 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/02/14/30.aspx Marcia Ryder RN MS PhD is a well known expert on medical biofilms and vascular access.  She spoke at the ASPEN conference this month on “Treating Infected VADs in the Home.” In her presentation, she stressed the importance of accurate and early diagnosis of CRBSI.  Generally, the first sign of CRBSI is fever, with or without chills, and possibly inflammation of the tunnel or drainage at the exit site or port pocket.  When any of these signs and symptoms occur, it is important...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=461809 Wed, 14 Feb 2007 17:45:00 +0100 461809 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/02/12/29.aspx The American Society for Parenteral and Enteral Nutrition (ASPEN) sponsors an annual conference for nutrition support professionals from around the world.  This year researchers and clinicians gathered in Phoenix, Arizona to share knowledge, network, and see new technology and products. One session I attended was “Pre-Procedure Skin Antisepsis: Too Little/Too Late” presented by Robert Garcia.  He stressed the importance of adequate cleaning technique and timing...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=461810 Mon, 12 Feb 2007 22:19:00 +0100 461810 http://blogs.nutrishare.com/blogs/mariannes_corner/archive/2007/02/02/28.aspx Tunneled central venous access devices and ports can be placed in a variety of areas on the body.  The location of an exit site or port is important to maintain independence in device care.  An improperly placed device cannot be moved after insertion, so the best plan is to discuss options with the surgeon or radiologist prior to the procedure.The device should rest on a flat part of the chest, abdomen, or thigh.  It should be visible...(read more) (Source: Marianne's Corner) Marianne's Corner blogs http://www.medworm.com/rss/comments.php?id=461811 Fri, 02 Feb 2007 21:46:00 +0100 461811