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At least 991 records · Page 55Linked to original sources
PubMed2002

[Intraoperative electrophysiological monitoring of the recurrent laryngeal nerve in thyroid gland surgery--a prospective study].

INTRODUCTION: In the last few years the use of intraoperative electrophysiological monitoring of the recurrent laryngeal nerve (RLN) in thyroid gland surgery has become more and more important. PATIENTS AND METHOD: In a prospective study 223 nerves at risk in 116 patients were monitored with the Neurosign(R)100 (Fa. Magstim Ltd., UK). We used intramuscular needle electrodes inserted into the vocal muscle through the conic ligament. Practicability, complications, acceptance and predictive value of the method were documented. Recurrent nerve palsy rate and complications were compared with a control group operated upon without monitoring. RESULTS: The intraoperative delay using this method was on average 8.9 minutes. There were problems with monitoring equipment avoiding use in 6.4 %. In 2 cases (1.7 %) an accidental lesion of endotracheal tube cuff was found related to malpositioning of the needle and in 7.7 % a hematoma of the vocal cords was observed. 73.3 % of the surgeons accepted the method to identify and control the nerve integrity. False-positive and false-negative signals may occur. In cases of a final real stimulus response a regular vocal cord motility was found in 95 %. If a nerve conduction block was noted an immobility of ipsilateral vocal cord was diagnosed postoperatively in 50 %. There was no decrease in transient recurrent palsy rate using monitoring (10.7 % vs. 9.6 % without monitoring) but in permanent paralysis (1.8 % vs. 3.0 %). CONCLUSIONS: It may be concluded that intraoperative electrophysiological monitoring of the RLN is a simple and accepted method with low complications reducing the incidence of permanent RLN palsy rate. We found the monitoring especially useful for operations of recurrent goiter and carcinomas of the thyroid gland as well as for learning thyroid gland surgery.

Attitude of Health Personnel↗
PubMed2004

Monitoring the new antithrombotic drugs.

Today there is a diverse group of anticoagulant and antithrombotic drugs available that includes warfarin derivatives, heparin, low-molecular-weight heparins, thrombin inhibitors, factor Xa inhibitors, and various antiplatelet agents. Many of these new drugs do not alter measurable blood coagulation parameters, yet they are effective antithrombotic agents through their actions on vascular endothelial cells and proteins. Thus, these new agents do not affect the traditional clot-based prothrombin time/International Normalized Ratio (PT/INR) and activated partial thromboplastin time (aPTT) tests, and monitoring and standardization require the development of new methods. In addition to clot-based assays, chromogenic assays, enzyme-linked immunosorbent assay (ELISA), high-performance liquid chromatography (HPLC), flow cytometry, and other techniques have been used to monitor these new drugs. On the other hand, some of the new antithrombotic drugs do affect the PT, aPTT, and activated clotting time (ACT); however, they behave differently from the warfarin derivatives and heparin. The traditionally used relationship of target time to clot values and INR to clinical effect cannot necessarily be transferred to the new drugs. Unfortunately, monitoring is not as simple as it was for warfarin and heparin. Although the new antithrombotic drugs have been approved for clinical use, assay systems for monitoring most of them are still in development or have not been clinically validated. This applies to each of the clinical settings targeted for prophylaxis, treatment, or interventional procedures (i.e., high- and low-dosing regimens typically require different monitoring methods). In addition to basic monitoring, other issues such as sensitivity of the drug to different laboratory monitoring reagents and instrumentation, drug combination monitoring, and patient-related factors that contribute to the variability of the results still need to be addressed.

Chromatography, High Pressure Liquid↗
PubMed1991

[Cerebral monitoring].

Several studies have shown that most anaesthesia-related critical incidents are due to human error. There is evidence that cerebral monitoring procedures may be of value for an early detection of cerebral hypoxia or ischaemia. Monitoring of central nervous physiology includes both evaluation of systemic parameters like arterial blood pressure, arterial PO2, PCO2, and temperature, and more specific parameters for the assessment of central nervous system function and intracranial haemodynamics. It has been suggested that parameters from the processed EEG may be used as an indicator for depth of anaesthesia. Even though anaesthetic-induced EEG alterations are unspecific, depth of anaesthesia may be assessed quantitatively by combined monitoring of general parameters and processed EEG. Interpretation of the EEG signals has to take into account that critical events like hypoxia or cerebral ischaemia results in EEG patterns similar to those seen under deep anaesthesia. Sensory evoked potentials are frequently used to monitor specific neural pathways that are at risk during surgery. Different pathways may be tested using different trigger modalities (somatosensory, auditory, visual). Changes in latencies and amplitudes of primary components may indicate impaired conduction in the pathway monitored. For operations in which monitoring of evoked responses is indicated, the anaesthetic technique should have minimal impact on latencies and amplitudes. In patients, cerebral blood flow can be monitored only at discrete time intervals. In contrast, non-invasive transcranial Doppler sonography may provide continuous information on intracranial haemodynamics. Relative changes in cerebral blood flow velocity have been shown to correlate closely to changes in cerebral blood flow. Cerebral perfusion pressure can be calculated by monitoring of intracranial pressure in patients with compromised intracranial compliance.

Anesthesia↗
PubMed1990

Effects of electronic fetal-heart-rate monitoring, as compared with periodic auscultation, on the neurologic development of premature infants.

In a multicenter, randomized clinical trial, we assessed the early neurologic development of 93 children born prematurely whose heart rates were monitored electronically during delivery and compared it with that of 96 children born prematurely whose heart rates were periodically monitored by auscultation. All the children were singletons with cephalic presentation, and all weighed less than or equal to 1750 g at birth. The mental and psychomotor indexes of the Bayley Scales of Infant Development (standardized mean score +/- SD, 100 +/- 16) and a formal neurologic examination were administered at three follow-up visits (at 4, 8, and 18 months of age, corrected for gestational age). At 18 months, the mean mental-development scores in the groups receiving electronic fetal monitoring and periodic auscultation were 100.5 +/- 2.4 and 104.9 +/- 1.8, respectively (P greater than 0.1). The mean psychomotor-development scores in the two groups at 18 months were 94.0 +/- 2.4 and 98.3 +/- 1.8, respectively (P greater than 0.1). The incidence of cerebral palsy was higher in the electronically monitored group--20 percent as compared with 8 percent in the group that was monitored by auscultation (P less than 0.03). In the electronic-fetal-monitoring group (but not in the periodic-auscultation group), the risk of cerebral palsy increased with the duration of abnormal fetal-heart-rate patterns, as assessed by retrospective review (chi 2 trend = 12.71, P less than 0.001). The median time to delivery after the diagnosis of abnormal fetal-heart-rate patterns was 104 minutes with electronic fetal monitoring, as compared with 60 minutes with periodic auscultation. We conclude that as compared with a structured program of periodic auscultation, electronic fetal monitoring does not result in improved neurologic development in children born prematurely.

Birth Weight↗
PubMed2005

Measurement of fine particles in diesel emissions using a real-time aerosol monitor.

A real-time monitoring methodology to determine diesel fine particles in diesel emissions has been evaluated. The range of particle size captured by the monitor was approximately 0.1 microm to 1 microm. DustTrak real-time monitors were connected to the dilution tunnel of the vehicle exhaust to measure the emissions during the vehicle tests under both dynamic and steady-state driving conditions, and concentration data were recorded every 5 sec. Test variation of the real-time monitoring among different test days was similar to that measured by traditional filter-based gravimetric method, whereas the repeatability of the monitor data within the same-day tests was better than that of gravimetric method. Correlations between the two methods were established for different fuels tested on a single light duty vehicle. When the emissions from the reference fuel was used to convert the monitor's response to diesel fuels, the levels determined by the real-time monitor were consistent with those measured by gravimetric method among different fuels tested. Use of the real-time monitor could provide information on the levels of fine particles that is more relevant to the public health than the total particles.

Aerosols↗
PubMed2006

Evaluation of weather conditions for methyl bromide ambient air monitoring in Monterey, Santa Cruz, and Kern Counties in the year 2000.

Weather condition is one of the most important factors affecting spatial and temporal distributions of air pollutants, especially for short-term air dispersion. Abnormal weather conditions might lead to higher or lower ambient air concentrations than they would be under normal weather conditions. Therefore, testing for normality of weather conditions during the air monitoring period is an essential step for evaluating ambient air monitoring results. In this paper, a distance method was used to select a most representative weather station from the available candidates. An array of meteorological elements were identified that affect air dispersion and transportation. A statistical method was used to determine whether the weather conditions during the air monitoring period were significantly different from that of previous years. Using methyl bromide ambient air monitoring as a case study, this paper documents the methods, procedures, and results of weather analysis for Monterey, Santa Cruz, and Kern Counties during ambient air monitoring periods for methyl bromide in the year 2000. With a few exceptions, the meteorological elements and atmospheric stability factors, such as wind speeds, wind directions, and stability classes, during the monitoring period were in the normal range. Although there were higher frequencies of stable atmospheric conditions in Monterey/Santa Cruz Counties than in Kern County, weather conditions during the monitoring period were not significantly different from normal local weather conditions of previous years. Consequently, the subchronic air concentrations observed during the ambient air monitoring periods for methyl bromide in the year 2000 was taken under typical weather conditions of those areas at that time of the year.

Air Pollutants↗
PubMed1986

Evaluation of the Du Pont Pro-Tek Formaldehyde Badge and the 3M Formaldehyde Monitor.

The 3M Formaldehyde Monitor and the DuPont Pro-Tek Formaldehyde Badge were evaluated for performance and reliability. This evaluation revealed that the 3M monitor results were variable and lower than reference concentrations determined independently. When the monitors were humidified before use and then exposed in humid (ca. 80% RH) formaldehyde-containing atmosphere, the monitors did give accurate results. Results of additional experiments led to the conclusion that quantitative reaction between formaldehyde generated in our chamber and the absorbent pad in the 3M monitor required the presence of a minimum level of absorbed water. The DuPont badges gave good agreement with the reference concentrations determined independently under the following conditions: sampling period of 1 to 12 hr with a minimum integrated sample loading of 4 ppm-hr; at least 3 m/min (10 ft/min) face velocity; correction for blank badges; and correction for loss of reagent from the samples. The evaluation indicated that the DuPont badge was not well suited to short term sampling and was subject to evaporation of liquid from the absorbing liquid blister. Blank values also were found to be variable, necessitating the analysis of several blanks to be used for blank correction with each set of samples. This blank variability also contributed to high variability found when short term measurements were made. The badge also had a negative interference from phenol at high phenol-to-formaldehyde ratios. Some of the major problems observed with both passive monitors were found only after devices which had been aged under storage conditions were analyzed and these results interpreted. If all testing had been done with fresh sampling devices, many of the problems would not have been noticed. Based on the results of this study, this factor of diffusive monitor aging needs to be addressed in any further work on passive monitor evaluation.

Air Pollutants, Occupational↗
PubMed1987

Response characteristics of scattered light aerosol sensors used for control monitoring.

The response characteristics of scattered light aerosol monitors used in control monitoring applications were evaluated. In this report, "control monitoring" refers to continuous, fixed point monitoring used to ensure that dust controls are effective. Instruments evaluated included the following: an ATI-722, which uses a white light source; a RAM-S, which uses a LED source; and a PCAM-TX, which uses a LED source and provides a correction for particle size. The linearity of the monitors was evaluated from 0.5-10 mg/m3 with the use of coal dust as an aerosol. This concentration range was broken up into two smaller ranges since it was not possible to generate an aerosol with a constant size distribution over the entire range. All instruments showed a linear response with concentration for constant dust size distribution. The size sensitivity of the instruments was determined by passing a test aerosol through a series of impactor stages and measuring the mass response of each instrument relative to the indicated mass response of an Aerodynamic Particle Sizer (APS). The particle size was varied from 2-14 microns. The mass response of the instruments relative to the APS over this size range varied from as low as 0.1 to as high as about 5. The PCAM provides data that indicate changes in the size distribution of the aerosol being monitored. A simple model was developed to relate the net response of each test instrument to various log normal size distributions. The user of the instruments has to be aware of particle size changes in the aerosol being monitored since changes in the size distribution will affect the relationship between the response of the instruments and the mass concentration. Guidelines for instrument use are given in order to show how the instruments can be applied to the continuous monitoring of dust in the workplace.

Air Pollutants, Occupational↗
PubMed1998

Field validation of passive monitors for the determination of employee exposures to methylene chloride in pharmaceutical production facilities.

A series of field evaluations was performed to estimate the overall uncertainty of three manufacturers' passive monitors (Assay Technology Model 541 and 546, 3M Model 3520, and SKC Model 575-001) to determine methylene chloride (MeCl2) concentrations. Area samples were exposed in a pharmaceutical production facility at five MeCl2 air concentrations for both permissible exposure limit (PEL) and short-term exposure limit (STEL) periods. A specially designed evaluation chamber was used to concurrently expose six of each type of passive monitor while concurrently collecting six active samples from locations surrounding the dosimeter array. The active samples were used to estimate the actual concentration during the evaluation period. The precision, bias, and overall uncertainty were estimated for each monitor type at concentrations bracketing the Occupational Safety and Health Administration proposed exposure limits. The actual MeCl2 concentrations for the PEL sampling periods ranged from 0.9 to 63 ppm. The pooled overall uncertainty results for all the passive monitors evaluated under PEL sampling conditions met the NIOSH accuracy recommendations. Pooled overall uncertainty for PEL evaluations for the monitors were: Assay Technology Model 546 +/- 17%; 3M +/- 13%; and SKC +/- 17%. Actual MeCl2 concentrations for the STEL sampling periods ranged from 14 to 357 ppm. Pooled overall uncertainty results for Assay Technology and 3M monitors evaluated under STEL sampling conditions met the NIOSH accuracy recommendations; however, the SKC passive monitor was slightly greater than the NIOSH recommendation. Pooled overall uncertainty for STEL evaluations for the monitors were: Assay Technology Model 541 +/- 18%; 3M +/- 16%; and SKC +/- 27%.

Air Pollutants, Occupational↗
PubMed2006

A comparison of bispectral index and entropy monitoring, in patients undergoing embolization of cerebral artery aneurysms after subarachnoid haemorrhage.

BACKGROUND: Processed EEG monitoring of anaesthetic depth could be useful in patients receiving general anaesthesia following subarachnoid haemorrhage. We conducted an observational study comparing performance characteristics of bispectral index (BIS) and entropy monitoring systems in these patients. METHODS: Thirty-one patients of the World Federation of Neurosurgeons grades 1 and 2, undergoing embolization of cerebral artery aneurysms following acute subarachnoid haemorrhage, were recruited to have both BIS and entropy monitoring during general anaesthesia. BIS and entropy indices were matched to clinical indicators of anaesthetic depth. Anaesthetists were blinded to the anaesthetic depth monitoring indices. Analysis of data from monitoring devices allowed calculation of prediction probability (P(K)) constants, and receiver operating characteristic (ROC) analysis to be performed. RESULTS: BIS and entropy [response entropy (RE), state entropy (SE)] performed well in their ability to show concordance with clinically observed anaesthetic depth. P(K) values were generally high (BIS 0.966-0.784, RE 0.934-0.663, SE 0.857-0.701) for both forms of monitoring. ROC curve analysis shows a high sensitivity and specificity for all monitoring indices when used to detect the presence or absence of eyelash reflex. Area under curve for BIS, RE and SE to detect the absence or presence of eyelash reflex was 0.932, 0.888 and 0.887, respectively. RE provides earlier warning of return of eyelash reflex than BIS. CONCLUSION: BIS and entropy monitoring perform well in patients who receive general anaesthesia after good grade subarachnoid haemorrhage.

Adult↗
PubMed2005

Improved compliance with a gentamicin prescribing policy after introduction of a monitoring form.

OBJECTIVES: Compliance with our local hospital policy for gentamicin administration and monitoring was found to be inadequate on audit. A gentamicin monitoring form was introduced with the aim of improving staff compliance with the policy thus minimizing the risks of toxicity while ensuring adequate dosing. PATIENTS AND METHODS: The initial audit examined the prescribing, administration and monitoring of intravenous gentamicin given to 20 patients. The introduction of a gentamicin monitoring form was prompted by unsatisfactory initial dosing and subsequent monitoring and adjustment of gentamicin doses. RESULTS: Following introduction of the monitoring form, the proportion of appropriate starting doses had increased from 13 out of 20 to 18 out of 20 prescriptions. The timing of initial serum levels was significantly better: 18 timed correctly, compared with 12 in initial audit. Subsequent administration and monitoring appeared more compliant with fewer doses inappropriately omitted and more levels checked appropriately. No improvement was seen in the quality of dose adjustment. CONCLUSIONS: In conjunction with the support and advice of the pharmacy and microbiology departments, the use of a gentamicin monitoring form can improve the quality of intravenous gentamicin use in the hospital setting.

Anti-Bacterial Agents↗
PubMed2003

Reducing vascular access morbidity: a comparative trial of two vascular access monitoring strategies.

BACKGROUND: Thrombosis is the primary cause of access failure in polytetrafluoroethylene grafts and arteriovenous fistulas. It can lead to significant patient and access morbidity and mortality, and is difficult to prevent medically. Intervention is largely limited to maximizing access patency by detecting culprit lesions early and intervening with angioplasty or surgical revision. The most efficacious monitoring strategy is undetermined. METHODS: This 3 year prospective study took advantage of a change in monitoring strategy used in a large dialysis centre to compare the efficacy of two methods used to monitor grafts and fistulas in order to prevent access thrombosis. Accesses were monitored using Duplex ultrasonography in year 1, while the saline ultrasound dilution technique (Transonic) became the primary monitoring strategy in year 3 (year 2 was a transition year). Risk factors for thrombosis were determined using multivariate survival analysis, and the performance of Duplex ultrasonography and Transonic monitoring was assessed. RESULTS: A total of 303 656 access days at risk were assessed, with 344, 385 and 425 accesses in years 1, 2 and 3, respectively. The total thrombosis rate was 1.01/1000 access days in year 1 compared with 0.66/1000 access days in year 3. This was accomplished despite a reduction in procedure rates of 55% for angiograms, 13% for angioplasties and 31% for thrombolysis. CONCLUSION: Low flow rates detected using Transonic monitoring were associated with increased thrombosis, while stenosis detected using Duplex ultrasonography was not a strong predictor of incipient thrombosis; however, these different access characteristics were compared using monitoring techniques that may be ideal in different clinical situations.

Adult↗
PubMed1997

Comparison of usefulness of computer assisted continuous 48-h 3-lead with 12-lead ECG ischaemia monitoring for detection and quantitation of ischaemia in patients with unstable angina.

AIMS: The selection of ECG leads used for ST monitoring may influence detection and quantitation of ischaemia. METHODS: We compared on-line continuous 48-h 12-lead against 3-lead ST monitoring in 130 unstable angina patients (Mortara. ELI-100). Onset and offset of ST episodes were defined by the lead with the first > or = 100 microV ST change relative to baseline and the lead with the latest return to baseline ST level, respectively. ST episodes were calculated for 12 leads and 3 leads (V2, V5, III) separately. RESULTS: ST episodes were detected in 88 patients (77%) by 12-lead and in 71 patients (62%) by 3-lead ST monitoring (P < 0.02). The median number (25.75%) of episodes/patient was 1 (0.3) for 3-lead and 2 (1.6) for 12-lead (P < 0.0001). The total duration of ischaemia detected during 12-lead far exceeded 3-lead monitoring: 12.3 (1, 58.2) and 1.7 (0, 23.3) min respectively (P < 0.0001). The probability of recurrent ischaemia declined most during the first 24 h of monitoring. After a period without ST changes of 1, 12, 24 and 36 h, the probabilities of recurrent ischaemia were 63, 31, 14 and 9%, respectively. CONCLUSIONS: Continuous 12-lead ST monitoring increases detection rate and duration of ST episodes compared to 3-lead ST monitoring. The use of continuous 12-lead ECG monitoring devices on emergency wards and coronary care units is recommended.

Angina, Unstable↗
PubMed2004

Implementation of standards for individual monitoring in Europe.

A large number of standards are available for radiation protection and individual monitoring purposes. They are published by various organisations, international and national. Moreover, the increasing policy of "Quality" applied to individual monitoring requires the implementation of standards on Quality Assurance (QA) both in technical and management aspects of a dosimetric service. Implementation of standards is not mandatory; therefore, varying degrees of implementation can be found in different European countries. However, for a number of good reasons, a degree of harmonisation within the European Union (EU) of the requirements and procedures for individual monitoring would be desirable. Harmonisation as applied to dosimetric services does not mean that they should all follow exactly the same procedures, but that they should aim to meet the same general requirements, and their results should be comparable. This article aims to compile information on the use of all standards applied within individual monitoring practices, be it on the calibration of dosemeters or on the QA procedures to be applied to the overall dose evaluation process. Both "technical standards" and "quality standards" will be discussed. A list of documents of relevance to subjects such as recommendations and requirements in the field of individual monitoring, whose application could help in the harmonisation of procedures, will also be given. As it is agreed that implementation of quality standards is a relevant framework within which harmonisation can be achieved, guidance on the implementation of quality standards in a dosimetric service is given. Accreditation and approval of dosimetric services will be of relevance in the process of harmonisation of individual monitoring within the EU. In this article, a discussion of various procedures and the meaning of both forms of recognition is also provided. Although most of the text applies to the monitoring of internal and external exposure to ionising radiation, the emphasis of this practical guidance is on monitoring for external radiation with passive dosemeters.

Body Burden↗
PubMed1984

Computerized 24-hour ambulatory esophageal pH monitoring and esophagogastroduodenoscopy in the reflux patient. A comparative study.

Ambulatory 24-hour esophageal pH monitoring and esophagogastroduodenoscopy were performed in 72 patients with symptoms suggestive of gastroesophageal reflux. Additionally, 22 asymptomatic healthy volunteers underwent pH monitoring. In patients with classic reflux symptoms and endoscopic esophagitis, a mean of 5.41 minutes/hour of reflux below pH 4 was found compared to 0.70 minutes/hour in controls (p less than 0.0001). The mean number and duration of reflux events in this group were 1.51 events/hour and 4.0 minutes/event, compared with 0.31 events/hour and 2.26 minutes/event in volunteers (p less than 0.001, p less than 0.01). A new system for ambulatory esophageal pH monitoring is presented using a pH-sensitive radiotelemetry pill or a pH probe and computerized methods for ambulatory data collection, analysis, and storage. An overall sensitivity of 76% was obtained with a 91% selectivity for detection of acid reflux in 51 patients having classic symptoms of gastroesophageal reflux. Ambulatory pH monitoring was positive for acid reflux in seven of 11 patients with normal endoscopic findings. Conversely, eight of 12 patients with normal pH monitoring had endoscopic esophagitis. In 19 patients presenting with atypical symptoms or previous gastric surgery, endoscopic findings were normal in 15. Nine of these 15 were identified as acid refluxers by pH monitoring. A combined approach using both pH monitoring and endoscopy is warranted for maximal detection and quantification of disease. A clear clinical role for pH monitoring is seen in the early diagnosis of acid reflux, particularly in patients having normal endoscopic findings with nonspecific gastrointestinal complaints or previous gastric operations.

Adult↗
PubMed1994

Intracranial pressure monitoring in the 1990s.

Monitoring intracranial pressure (ICP) has grown beyond that of obtaining of a single pressure value. Critical thinking must be employed by health professionals before the insertion of an ICP monitoring device. Given the wide selection of monitoring devices currently available, consideration must be given to what the goal of monitoring is for an individual patient. Data obtained from an ICP monitoring device can be used to determine cerebral perfusion pressure, cerebral compliance, effectiveness of interventions, and the impact of the patient's environment on cerebral hemodynamics. Emerging trends in computer data collection and analysis may further extend the usefulness of continuous ICP monitoring. Ethical considerations encountered when monitoring ICP must also be considered. This article discusses these issues, as well as the ongoing interpretation and assessment required when caring for a patient with an ICP monitoring device.

Ethics, Nursing↗
PubMed1998

Neurologic monitoring in the ICU.

While structure of the central nervous system (CNS) is evaluated through diagnostic tests such as computed tomography or magnetic resonance imaging, CNS function requires special monitoring techniques. These techniques are particularly useful adjuncts to the clinical examination, especially in the critically ill patient. Monitoring techniques include intracranial pressure monitoring, cerebral blood flow monitoring, cerebral hemodynamic assessment, and electrophysiologic monitoring. Rationale and specific applications are unique to each technique. Nursing considerations focus on knowledge of rationale for monitoring, providing safe patient care, validating appropriateness of interventions based on monitoring, and investigating the relationship of monitoring to outcome.

Central Nervous System Diseases↗
PubMed1985

Infectious complications and duration of intracranial pressure monitoring.

We studied 65 children with acute brain injury to determine how the risk of infectious complications changed with duration of intracranial pressure (ICP) monitoring. More than half of the 72 monitors inserted in these patients were in place at least 7 days (range 1 to 28). Nine infections occurred on days 2 through 11. The overall risk was 1.5 infections per 100 monitor-days. After day 6 the risk of subsequent infection diminished, as did the percent of monitors which subsequently became infected. The declining risk of infection over time suggests that infection is introduced at the time of monitor insertion. These findings justify a protocol in which a single ICP monitoring device is used as long as necessary, with reinsertion of a new monitor only if a malfunction occurs, or if daily surveillance cultures demonstrate an infection. Routine reinsertion of a new monitor might increase risk by unnecessarily re-exposing the patient to contamination at the time of insertion.

Bacterial Infections↗