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PubMed1990

Heparin versus saline flushing solutions in a small community hospital.

Since no nursing policy on flushing procedures existed in their small community hospital, the authors thought it would be useful to clarify recent reports of the equivalency of saline to heparin flushes in their patient group before establishment of such a policy. They conducted a 2 month double-blinded, cross-over study of catheter failures when using either saline or heparin 10 units/mL flushing solutions. All medical and surgical floor patients were included in the study. Floor nurses were used as observers and characterized catheter failures as either loss of patency or phlebitis. Heparin was shown to cause more phlebitis than saline (p less than .025), but no difference was found between the two flushing solutions in loss of patency. Data revealed a statistically significant advantage to using saline flushes when both loss of patency and phlebitis were combined (p less than .05). They recommended adoption of a flushing procedure which did not contain heparin.

Catheters, Indwelling↗
PubMed2002

How does time-dependent dental unit waterline flushing affect planktonic bacteria levels?

The purpose of this study was to evaluate how time-dependent waterline flushing affects the presence of biofilm in otherwise-untreated dental unit waterlines (DUWLs). Water samples were obtained from twelve highspeed handpiece DUWLs located in the undergraduate treatment clinic at the University of Missouri-Kansas City, School of Dentistry. Baseline water samples (50 cc) were collected prior to the start of continuous flushing. Additional 50 cc samples were collected after two-, three-, and four-minute flushing intervals from the baseline. The levels of planktonic bacteria in DUWLs were quantified by counting colony forming units (CFUs). In addition, segments of water tubing from each of the highspeed handpiece waterlines were examined by scanning electron microscopy, which confirmed the presence of a residual biofilm in the lumen of each dental unit waterline. A one-factor repeated measures ANOVA showed a statistically significant (p<0.01) reduction in CFUs at all intervals compared to baseline and between each successive time interval. Indeed, after four minutes of continuous flushing, all waterlines still harbored CFU levels that exceed current American Dental Association (ADA) recommendations. It was concluded that water flushing of DUWLs produced a statistically significant reduction in planktonic bacteria at each time interval compared to the baseline and between each successive time interval. However, the level of CFUs after four minutes of continuous water flushing still exceeds the current ADA recommendations for acceptable levels of microorganisms.

Analysis of Variance↗
PubMed2005

Pseudomonas bloodstream infections associated with a heparin/saline flush--Missouri, New York, Texas, and Michigan, 2004-2005.

On January 26, 2005, CDC was notified of four cases of Pseudomonas fluorescens bloodstream infection among patients at an oncology clinic in Missouri. All patients had received a heparin/saline flush to prevent clotting of indwelling, central venous catheters. The flushes were preloaded in syringes by IV Flush and distributed by Pinnacle Medical Supply (Rowlett, Texas). On January 31, a nationwide alert against use of all heparin or saline flushes preloaded in syringes by IV Flush was issued by the Food and Drug Administration; the company recalled these products. As of February 15, state and local health departments and CDC had identified a total of 36 Pseudomonas species infections in patients in four states who were administered the heparin/saline flushes from multiple lots. This report describes the ongoing investigation and provides recommendations for investigation and management of potential cases.

Adolescent↗
PubMed2005

Clinical experience with venlafaxine in the treatment of hot flushes in women with a history of breast cancer.

OBJECTIVE: To obtain practical experience with venlafaxine for hot flushes in breast cancer patients and incorporate this in a treatment protocol. METHOD: Twenty-two women with a history of breast cancer (mean age 49.2 years, range 35-65) were referred for consideration of treatment with venlafaxine for hot flushes. Patients received extensive information on treatment with venlafaxine and were advised to self-monitor the frequency of their hot flushes. RESULTS: Eight women did not start venlafaxine because they had no postmenopausal complaints, were lost to follow-up, had too low a frequency of hot flushes, or refused treatment. Eventually 14 women started venlafaxine. Two of them did not tolerate venlafaxine, four reported some effect but stopped because of side effects, two women had no effect whatsoever. Six women observed a clear ( > 50%) reduction in their hot flush frequency that was maintained at a median follow-up of 13 months. CONCLUSION: The group of patients referred for treatment was more heterogeneous and more patients dropped out because of side effects than expected. Extensive patient education, patient selection and evaluation of the treatment effect (by self-monitoring of hot flush frequency) are mandatory to avoid useless (continuation of) treatment and to prepare patients for side effects. Under these conditions, a substantial minority of patients benefit from venlafaxine.

Adult↗
PubMed1992

Reliable eighteen-hour lung preservation at 4 degrees and 10 degrees C by pulmonary artery flush after high-dose prostaglandin E1 administration.

Pulmonary preservation is improved by hypothermia, but the optimal preservation temperature is not known. The effects of two different preservation temperatures, 4 degrees and 10 degrees C, on lung function were studied in a canine left lung allograft survival model allowing selective perfusion of either lung. After donor treatment with high-dose prostaglandin E1, (25 micrograms/kg), lungs were flushed with modified Euro-Collins solution (50 ml/kg) and stored in Euro-Collins solution for 18 hours at 4 degrees C in group I (n = 8) and 10 degrees C in group II (n = 6). Pulmonary gas exchange and hemodynamics were compared on the day of transplantation (day 0) and 3 days later (day 3). Rapid, high-flow, low-pressure flush was achieved uniformly in both groups (flush time: group I, 35.1 +/- 2.4 second; group II, 35.3 +/- 3.0 seconds; p = 0.96; flush pressure: group I, 9.8 +/- 0.7 mm Hg; group II, 10.1 +/- 1.1 mm Hg; p = 0.8). Transplanted lungs provided similar excellent oxygenation in both groups on day 0 (arterial oxygen tension, group I, 451 +/- 82 mm Hg; group II, 497 +/- 37 mm Hg; p = 0.61; inspired oxygen fraction = 1.0) and day 3 (arterial oxygen tension, group I, 551 +/- 57 mm Hg; group II, 587 +/- 19 mm Hg; p = 0.55), with a statistically significant improvement from day 0 to day 3 in both groups (group I, p = 0.034; group II, p = 0.038). There was no difference in arterial carbon dioxide tension, base excess, cardiac output, blood pressure or pulmonary artery pressure between the two groups. We conclude that a large bolus of prostaglandin E1 into the pulmonary artery produces a high-flow, low-pressure flush with modified Euro-Collins solution; with this technique, equivalent, reliable 18-hour lung preservation can be achieved at 4 degrees and 10 degrees C flush and storage temperatures.

Alprostadil↗
PubMed2005

Failure of anti-retraction valves and the procedure for between patient flushing: a rationale for chemical control of dental unit waterline contamination.

PURPOSE: To evaluate the efficacy of anti-retraction valves; and to compare between-patient flushing with water and with using a chemical treatment to control patient-to-patient contamination through dental unit waterlines (DUWL). METHODS: For the first aim, nine new antiretraction valves from three different manufacturers were utilized. Each valve was installed along the water line connecting the high-speed handpiece to the dental unit. The handpieces were made to run and stop in a container filled with a solution of about 7 log10/mL of Bacillus subtilis spores (used as a marker) and retraction of spores was measured. Subsequently, all nine valves were installed in dental units in use in private offices, and all tests repeated after 15, 30 and 60 working days. For the second aim, the efficacy of mechanical flushing (30 seconds for each instrument) was compared with that of mechanical flushing in combination with pressurized air and of a between-patient disinfecting procedure (2 minutes contact with TAED and persalt utilizing an "autosteril" system). Before each test (10 tests for each procedure), known concentrations of Pseudomonas aeruginosa (ATCC 27853) suspension (4 to 7 log10cfu/mL) was loaded in the DUWL and let sit for 20 minutes. RESULTS: In the anti-retraction valve experiment, at baseline only one anti-retraction valve showed a failure in opposing fluid retraction. After 15 days, three valves, after 30 days, six valves, and after 60 days, eight valves showed failure. In the flushing experiment, a highly significant linear correlation (r =.9178) was found between values before and after mechanical flushing. Post flush log10cfu/mL values showed the removal of about only 1 log10cfu/mL of the microorganisms (only about 10% in absolute counts). On the other hand, no cfu/mL was detected in waterlines after the "autosteril" disinfecting cycles.

Colony Count, Microbial↗
PubMed1991

Why flush peripheral intravenous cannulae used for intermittent intravenous injection?

We aimed to investigate whether regular flushing of peripheral intravenous cannulae used for intermittent injections with heparin-saline, in a unit for acute medicine for the elderly, reduced the incidence of complications necessitating cannula removal. We wanted to see if this could also prolong the time that cannulae may remain functional in situ. In a prospective, open study, 50 consecutively inserted cannulae were flushed regularly and a subsequent 50 consecutive cannulae were not flushed. The incidence of complications necessitating removal was not significantly different between the two groups (18% flushed, 22% unflushed). Overall, only 5% of cannulae were removed because of blockage. Heparin-saline flushes did not significantly increase the time that cannulae remained in situ. Antibiotic use was found to be associated with an increased rate of complications necessitating cannula removal. We found no significant advantage in heparin-saline flushing of peripheral intravenous cannulae used for intermittent administration of medications.

Aged↗
PubMed1987

Opsonins of Streptococcus in uterine flushings of mares susceptible and resistant to endometritis: control of secretion and partial characterization.

The release of opsonins into the uterine lumen of mares susceptible or resistant to endometritis was examined after intrauterine inoculation of a filtrate of Streptococcus culture fluid or vehicle. Uterine flushings were collected at 0.5 hour before and 2, 4, 6, 8, and 24 hours after inoculation on day 2 or 3 of estrus and on day 7 or 8 after ovulation. Amounts of opsonins in flushings were quantified as the H2O2 produced by leukocytes incubated with flushings-opsonized bacteria, compared with H2O2 produced by leukocytes incubated with nonopsonized bacteria. Opsonin values in flushings increased (P less than 0.025) in all mares after inoculation of filtrate or vehicle. For mares resistant to endometritis, opsonin values were greater at diestrus than at estrus. The opposite was true for mares susceptible to endometritis, resulting in a status (susceptible vs resistant) X stage of cycle interaction (P less than 0.025). Overall, opsonins were higher (P less than 0.05) in flushings of mares susceptible to endometritis than in flushings of mares resistant to endometritis, but this difference was only apparent at estrus. Preliminary characterization of opsonins in uterine secretions by ammonium sulfate fractionation and gel filtration indicated that opsonins were mainly associated with an ammonium sulfate-soluble fraction of high molecular weight (greater than 4 X 10(6] and an ammonium sulfate-precipitable fraction that was associated with immunoglobulin G.

Animals↗
PubMed1993

Evaluation of the effects of heparinized and nonheparinized flush solutions on the patency of arterial pressure monitoring lines: the AACN Thunder Project. By the American Association of Critical-Care Nurses.

OBJECTIVE: To evaluate the effects of heparinized and nonheparinized flush solutions on the patency of arterial pressure monitoring lines. SAMPLE: A total of 5139 patients from 198 participating sites comprised the sample for this large-scale, randomized clinical trial. METHODS: Patients were randomly assigned to heparinized and nonheparinized flush solution treatment groups. Data were collected at 4-hour intervals for up to 72 hours on presence of acceptable square waveform and arterial backflow. RESULTS: Arterial pressure monitoring lines maintained with heparinized flush solutions had a significantly greater probability of remaining patent over time than lines maintained with nonheparinized flush solutions. In addition to heparin, four other variables significantly influenced the probability of lines remaining patent: receiving other anticoagulants or thrombolytics, having a catheter longer than 2 inches, femoral insertion site and male gender. CONCLUSIONS: Chances for patency are greatest in men with long femoral lines who receive other anticoagulants or thrombolytics and heparinized flush solutions. Risks of nonpatency are greatest in women with short nonfemoral lines who do not receive other anticoagulants or thrombolytics and have nonheparinized flush solutions.

Adolescent↗
PubMed1996

Growth and metabolism of murine and bovine embryos in bovine uterine flushing-supplemented culture media.

The aim of this study was to compare the development and metabolic activity of cultured murine and bovine embryos in 2 standard media (HAM F-10 and RPMI) in the presence or absence of bovine uterine flushings. Murine morulae (n = 653) and day 7 bovine embryos (n = 273) were cultured for 18 h or 36 h in either HAM F-10 or RPMI in the presence or absence of bovine uterine flushings. After culture, the development, quality, and metabolic activity (glucose utilization or methionine uptake and incorporation) of embryos was assessed. It was found that HAM F-10 (without uterine flushings) was a more suitable medium than RPMI for optimal development and metabolism of murine and bovine embryos. Poor quality and development, as well as decreased metabolism, were evident after culture of murine embryos in RPMI; in contrast, this medium had no adverse effects on bovine embryos in culture. Supplementation of HAM F-10 with bovine uterine flushings improved the growth of murine embryos and the protein synthesis (as measured by an increased methionine incorporation) for both murine and bovine embryos. However, supplementation with bovine uterine flushings could not overcome deficiencies of an inappropriate medium (RPMI) for murine embryos. Supplementation of a well-defined culture medium with uterine flushings increased metabolism of embryos in culture, and thus might help to increase pregnancy rates after transfer of such embryos to recipient cows.

Animals↗
PubMedDate not supplied

Patency of 24-gauge peripheral intermittent infusion devices: a comparison of heparin and saline flush solutions.

The purpose of this study was to compare the effectiveness of heparin and normal saline flush solutions in maintaining the patency of 24-gauge peripheral intermittent infusion devices (PIIDs). A prospective, non-randomized, sequential, blinded study design was conducted on a pediatric and a neonatal intensive care unit. The sample consisted of 134 catheters in 61 patients. Heparin and saline flush groups were similar for age, PIID placement site, irritating substances infused, and initial IV function. The median duration of catheters flushed with heparin was 42 hours and with saline was 35.3 hours. Kaplan-Meier Survival Analysis indicated that the duration of catheters flushed with heparin was significantly longer than those flushed with saline (p = .02). More catheters flushed with saline were removed because of problems (p = .027). Results of this study suggest that heparin is more effective than saline in maintaining the patency of small, 24-gauge catheters.

Catheterization, Peripheral↗
PubMed1995

Flush induced by fluoroquinolones in canine skin.

The flush induced by two fluoroquinolone antibacterial agents, balofloxacin and ofloxacin, was studied in beagle dogs. Intradermal injection of the fluoroquinolones at concentrations above 10(-5) M produced a localized flushed area. The flush responses to fluoroquinolones were inhibited by co-administration with H2-antagonist(s) (ranitidine or cimetidine), but not with H1-antagonist(s) (mepyramine or chlorpheniramine). Similar inhibitory effects of these H2-antagonists were observed for the response to histamine. The flush responses to fluoroquinolones were inhibited by a local pretreatment with compound 48/80 administered to deplete the local stores of mast cell-bound histamine. When the fluoroquinolones were orally administered at a dose of 400 mg/kg, the concentration of histamine in plasma was increased, being accompanied by systemic erythema. These results indicate that the flush induced by fluoroquinolones is mediated by histamine release from canine cutaneous mast cells and H2-receptor stimulation.

Animals↗
PubMed1995

Hot flushes in men with pituitary adenoma.

BACKGROUND: Hot flushes are common in menopausal women and also in men made acutely hypogonadal after orchiectomy or testicular injury. It is, however, an unusual symptom in patients with hypogonadism secondary to pituitary tumors. METHODS: In evaluating the histories of men with hypogonadal state associated with nonfunctioning pituitary macroadenoma we were struck by the presence of hot flushes in four of them. RESULTS: All four of the patients were hypogonadal with sexual dysfunction preoperatively. All had low gonadotropins and low testosterone levels with varying degrees of panhypopituitarism. All had successful transsphenoidal removal of tumors. None had endocrine improvement following surgery. All patients had improvement in sexual function and the hot flushes with administration of testosterone postoperatively. CONCLUSIONS: Hot flushes are an uncommon presentation in men with pituitary adenoma. Perhaps the symptom will become more prominent if it is specifically questioned. We postulate that the cause of the flushing is related to nonsuppressed pulsatile secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus.

Adenoma↗
PubMed1994

A clinicopathologic study of ten patients with recurrent unexplained flushing.

We describe the clinicopathologic features of 10 patients with recurrent unexplained flushing. These patients were referred to the National Institutes of Health with a diagnosis of mastocytosis or idiopathic anaphylaxis. Both diagnoses were eliminated after evaluation. Patients reported attacks of flushing lasting 15 minutes to 2 days and associated with such symptoms as anxiety, chest tightness, paresthesia, slurred speech, weakness, and pruritus. Abdominal pain was a constant feature, often associated with cramping and an increase in stool frequency. Attacks witnessed by physicians consisted of an exaggerated blush response of the face and upper part of the chest, and were sometimes associated with tachycardia, mild hypertension, and tachypnea. Hives, angioedema, wheezing, and hypotension were not observed. Routine laboratory studies and 5-hydroxyindoleacetic acid, vanillylmandelic acid, and plasma histamine levels were normal. Plasma histamine levels did not elevate during attacks. When performed, results of bone marrow examinations, skin biopsies, and bone scans were normal. Psychiatric examinations frequently revealed somatization disorders. Patients had often been prescribed a wide variety of medications including antihistamines, nonsteroidal anti-inflammatory drugs, and steroids, with little or no benefit. Despite the benign nature of the clinical and laboratory findings, patients had undergone repeated, often invasive, examinations for several years. Whether such patients have a prominent flush response exaggerated through a somatization disorder or a relatively benign flushing disorder associated with putative mediator release remains to be determined. Recognition of this category of patients with unexplained flushing will avoid subjecting such patients to unwarranted repeated examinations, procedures, and inappropriate therapy.

Adolescent↗
PubMed1984

The relation of physiological changes to subjective symptoms in postmenopausal women with and without hot flushes.

This study was designed to fully correlate the temporal relationship between augmented digital perfusion, (vasodilatation) and hot flushes, peripheral temperature, plasma luteinizing hormone, (LH) epinephrine and norepinephrine. Plasma samples were measured every 3 min for 2-4 h, in 5 symptomatic women before and after estrogen replacement and in 3 asymptomatic post-menopausal women. In all 5 symptomatic women the augmented digital perfusion occurred at a mean (+/- SEM) of 1.5 +/- 0.2 min before the initiation of the flush, at least 3 min before the initial rise in temperature and 9 min before the LH rise. There was a significant (P less than 0.05) rise in epinephrine but not norepinephrine at 3 and 6 min after the initiation of augmented digital perfusion. Although subjective improvement occurred in all 3 women receiving estrogen, all measured parameters disappeared in only 1 subject and the 2 others continued having augmented digital perfusion, flushes, and temperature vasomotor changes although the related LH increase was absent. Surprisingly, asymptomatic women who never received estrogens also demonstrated similar augmented digital perfusion and temperature changes, but failed to show the LH related rise, as observed in women with short-term estrogen treatment. In conclusion, these results demonstrate that augmented digital perfusion consistently precedes the hot flush, the rise in temperature and plasma LH in symptomatic post-menopausal women. The increase in epinephrine may be a homeostatic mechanism to compensate for the peripheral vasodilatation. The finding that augmented digital perfusion and temperature changes also occur in asymptomatic post-menopausal women indicates that objective changes are more specific and reliable indicators of vasomotor instability than the subjective sensation of hot flushes.

Adult↗
PubMed1992

Behavioral treatment of menopausal hot flushes: evaluation by ambulatory monitoring.

OBJECTIVES: We attempted to develop an effective behavioral treatment for menopausal hot flushes and to determine the active behavioral components of this procedure. STUDY DESIGN: Thirty-three women with frequent menopausal hot flushes were randomly assigned to receive eight sessions of training in paced respiration, muscle relaxation, or alpha-wave electroencephalographic biofeedback (placebo control). Hot flushes were objectively measured by means of 24-hour ambulatory monitoring of the sternal skin conductance level. RESULTS: Subjects undergoing paced respiration had significant reductions in hot flush frequency and respiration rate, as well as increases in tidal volume. CONCLUSION: Paced respiration training may be a useful treatment alternative for the reduction of hot flushes in women who cannot tolerate hormone replacement therapy.

Ambulatory Care↗
PubMed1988

Why is flushing limited to a mostly facial cutaneous distribution?

Despite the systemic nature of many agents that provoke flushing reactions, the erythema is most prominent in the "blush area." To elucidate the physiologic basis for such a limited distribution, two types of flushing challenges were studied in normal volunteers. Nicotinic acid provokes flushing through a direct action of vasodilator prostaglandins on vascular smooth muscle. The flushing reaction provoked by oral thermal challenge is mediated via neural mechanisms. Both agents led to increases in cutaneous blood flow at both malar and forearm sites. Both absolute and proportional increases were consistent with the view that the greater vascular capacitance in the visible, superficial cutaneous vasculature in the blush area accounts for the limited distribution of flushing in response to a systemic stimulus.

Adult↗
PubMed1997

Perceived control over menopausal hot flushes: exploring the correlates of a standardised measure.

OBJECTIVES: A substantial minority of women report considerable distress during hot flushes. Coping with various chronic health problems has been related to perceived control in previous studies. Hence this study developed a standardised measure to investigate whether perceived control is associated with less distress during menopausal hot flushes. METHOD: The study presented a suitably re-worded 15-item scale (the Arthritis Helplessness Index, originally developed by Nicassio et al., J Rheumatol 1985;12:462-467. Scoring was reversed so that high scores signified greater perceived control. A volunteer sample of 43 women (mean age 51 years) completed the scale together with several further measures. A total of 35 women returned 12 month follow-up questionnaires. RESULTS: The Perceived Control Index (PCI) scores correlated with standardised measures of self-esteem and simple self-ratings (0-100) of perceived control, and remained very stable over 12 months. Self-rated distress during flush episodes was more closely related to perceived control than to more objective factors such as flush frequency and chronicity. CONCLUSION: These findings support further investigation into whether subjective coping with flushes may be improved by psychological interventions that enhance perceived control and self-esteem.

Adaptation, Psychological↗