Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “EXIT”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMedDate not supplied

Decrease in Staphylococcus aureus exit-site infections and peritonitis in CAPD patients by local application of mupirocin ointment at the catheter exit site.

OBJECTIVE: To evaluate the potential effectiveness of the application of mupirocin ointment at the catheter exit site in preventing exit-site infection and peritonitis caused by Staphylococcus aureus (SA). DESIGN: This prospective, historically controlled study was done on 181 peritoneal dialysis patients treated between 1 November 1996 and 1 November 1997. They were instructed to apply mupirocin at the catheter exit site daily or three times per week at the conclusion of their exit-site care (Study 1). The patients were not screened to determine whether they were SA carriers. The group's historical control was the infection data from the previous year among these patients. A second group of 70 patients, who started using mupirocin within a month after catheter implantation (1996-1997), was compared with a historical group of 118 patients (controls) who were on continuous ambulatory peritoneal dialysis (CAPD) for 1 year after in-patient implantation without mupirocin, (1990-1995) (Study 2). RESULTS: In the group of 181 patients (Study 1), application of mupirocin at the exit site led to a significant reduction in SA exit-site infections--21 versus 3 episodes (0.11 vs 0.01 episodes/patient/year)--and a significant reduction of SA peritonitis--35 episodes in the year preceding mupirocin versus 11 episodes during the year of mupirocin treatment (0.19 vs 0.06 ep/pt/yr). The same results were observed in Study 2: the incidence of SA exit-site infection was significantly lower in the mupirocin-treated group--17 episodes among the 118 nontreated patients versus 4 episodes among 70 patients using mupirocin (0.14 ep/pt/yr vs 0.06 ep/pt/yr, respectively). Similarly there were 20 episodes of SA peritonitis among 118 patients during their first year of CAPD versus 4 episodes in 70 mupirocin-treated patients (0.16 ep/pt/yr vs 0.06 ep/pt/yr, respectively). No adverse effects were observed among the patients treated with mupirocin. Overall peritonitis rates decreased from 0.87 to 0.48 ep/pt/yr (p < 0.01) in Study 1 and from 0.56 to 0.41 ep/pt/yr (p = NS) in Study 2. We observed no differences in the incidence of exit-site infection and peritonitis rates among patients applying mupirocin ointment at the exit site daily, compared to three times per week. CONCLUSIONS: Mupirocin application at the exit site significantly lowers the incidence of SA exit-site infections and peritonitis due to SA infections. Since SA infections are accompanied by significant morbidity and occasional mortality, this treatment may improve long-term survival of patients on CAPD.

Administration, Topical↗
PubMed1995

A new porous surface modification technology for peritoneal dialysis catheters as an exit-site cuff to reduce exit-site infections.

Catheter exit-site infection continues to be a more common morbid event in patients undergoing peritoneal dialysis. Previous attempts to place a biointegration material at the next site have failed to reduce infection rates. This study reports the use of an innovative microporous silicone material placed as a cuff around the catheter at the exit site. The porous material has a pore-sized distribution that stimulates and facilitates capillary ingrowth into the pores. This capillary ingrowth prevents scar tissue formation, increases blood supply, and theoretically improves the immunological competence of the tissue at the vulnerable exit site. Twenty-five test catheters (12 using standard exit-site creation and 13 using the Moncrief-Popovich implantation technique) were implanted in a canine model. The exit-site infection rate in a canine model without the microporous material was 100% at 2 months. The corresponding results with the microporous material was 40% at 2 months. The majority of the test catheters showed progressive drying and healing at the exit site. Sixty percent of the catheters healed quickly and remained infection-free. Biointegration of the microporous material at the exit-site was demonstrated. Several exit site infections with the test catheters treated only with local therapy (without systemic or topical antibiotics) demonstrated progressive healing and secondary adequate biointegration. Because of these encouraging results, human studies were initiated, with the first human implant occurring in August, 1994. A 10-patient project is planned for the next year.

Animals↗
PubMed1996

Sealing the catheter exit site with dressing film and its effectiveness in preventing exit-site infection: bacterial culture.

In this study, we performed exit-site care using one of three methods (A: cleanse the exit site with povidone-iodine daily and apply gauze dressing; B: cleanse the exit site with povidone-iodine once a week, cover the site with a small gauze, and seal it completely with dressing film; C: the same as in B, above, except once every two weeks). The results show that there was a higher rate of positive bacterial growth in method A (17/24, 71%), and we concluded that the sterility of the exit site was not maintained 24 hours after cleansing. In methods B and C, in which the exit site was kept sealed, we did not detect bacterial growth in almost any of the cases (B = 0/44, C = 1/7). Although the patients took a bath and did not perform any care of the exit site for one to two weeks, the results show that the exit site was protected from bacterial invasion. We believe that this method could reduce exit-site infection while requiring no daily care.

Aged↗
PubMed1990

Changes in female sexual behavior of old female rats: comparison between exit method and non-exit method.

The female sexual behavior including proceptivity, receptivity and sociosexual behavior of preferential approach to males was tested in 12 young adult female rats aged from 6 to 7 months and in 59 old female rats aged from 18 to 21 months with the exit method and the traditional non-exit method. The percentage of rats displaying a high lordosis quotient (LQ) and that of rats showing solicitation were lower in old females than in young females tested either with the non-exit method or the exit method. Only with the non-exit method were the mount frequency per minute of male rats toward old females of the high-LQ group and the solicitation score of old female rats lower as compared to young females. The incidence of preferential approach of the female rats, whether young or old, toward intact young males and their time spent in the compartment of intact young males were not different, however, the frequency of old female rats to visit the arena of intact young males was lower than that of young females. In summary, the major age-related changes in female sexual behavior, the low percentage of rats displaying high LQ and of rats showing solicitation, are quite robust and environmentally independent.

Age Factors↗
PubMed1997

Efficiency of a silver ring in preventing exit-site infections in adult PD patients: results of the SIPROCE Study. Silver ring Prophylaxis of the Catheter Exit Site.

A randomized, multicenter clinical trial was conducted to evaluate the efficiency in preventing exit-site infection of a silver ring mounted on peritoneal dialysis (PD) catheter and placed at skin level (designed by Grosse-Siestrup, 1992). Eligible patients stratified by diabetes mellitus were monitored prospectively for 12 months using a detailed structured inventory. New patients starting PD treatment during the study period were followed for at least 3 months. Basic characteristics of the silver ring group (N = 86) and controls (N = 88) such as age, sex, S. aureus nasal carriage, type of PD catheter placement and catheter indwelling time, mode of PD, and number of connections for bag exchanges did not differ significantly between the two groups. Nineteen exit-site infections occurred in the silver ring group and 15 in the control group. The incidence of "equivocal" exit-site findings and time of improvement to a "good" or "perfect" exit site were similar in both groups. Kaplan-Meier analysis of the probability of an infection-free time interval revealed no statistically significant difference between subjects with the silver device and controls. In 6 of the 86 cases, displacement of the silver ring caused severe tunnel infection followed by catheter loss in 2. We conclude that the silver ring used in this setting is not effective in preventing exit-site infections in PD patients.

Bacterial Infections↗
PubMed1990

Exit-site care and exit-site infection in continuous ambulatory peritoneal dialysis (CAPD): results of a randomized multicenter trial.

A total of 127 patients from 8 hospitals were randomized into 1 of 2 exit-site care regimes to evaluate their effect on rate of exit-site infection (ESI). Group 1 used povidone iodine and nonocclusive dressings changed 2 to 3 times weekly; Group 2 simply cleansed the exit site with nondisinfectant soap and water. Incidence, cause, duration, and treatment of ESI and peritonitis (P) were noted. Groups were analysed for age, sex, end-stage renal disease (ESRD), catheter, and systems. Total cumulative follow up time was 95.6 years. There was a significantly higher rate (p = 0.0183) of ESI in Group 2 (soap and water). The mean rate of ESI was 0.27 episodes/patient year for Group 1 versus 0.71 episodes/patient year for Group 2. Rates of P for the two groups were not significantly different (p greater than 0.50): 0.446 episodes/year for Group 1 versus 0.574 episodes/year for Group 2. S. aureus was responsible for 83% of ESI in Group 1 and 67% of ESI in Group 2. Protective dressing with a disinfectant is associated with significantly less ESI than minimum care. However, further research in exit-site care aimed specifically at reducing S. aureus infection is still required.

Adult↗
PubMed1990

Exit of recirculating lymphocytes from lymph nodes is directed by specific exit signals.

During recirculation, lymphocytes leave the peculiar structurally inverted lymph nodes (LN) of pigs via blood vessels instead of via efferent lymphatics, as in sheep and other mammals. This functional difference provided an opportunity to show the existence of signals directing lymphocyte exit from LN. The recirculation of pig peripheral blood lymphocytes was traced through fetal sheep LN and of sheep PBL into and out of unsuckled newborn piglet LN, using the lack of natural antibody or natural killer cell function in these immunologically mature young to compare foreign and homologous lymphocyte behavior. In spite of some 50 million years of evolutionary divergence, the detailed kinetics and route of recirculation of the xenogeneic PBL were essentially the same as those of the host species. Thus determinants guiding the anomalous blood exit from pig LN must involve conserved "exit" signals in a new site and not changes in pig lymphocyte homing receptors.

Animals↗
PubMed1996

Exit-site healing post catheter implantation.

The study goals were (1) to describe the natural healing process post peritoneal dialysis catheter implantation; (2) to discern factors that predispose to exit infection; (3) to recognize signs of early exit-site infection; and (4) to ascertain the influence, if any, of the healing process on subsequent peritonitis rates and final catheter outcomes. There were 226 evaluations of 43 exits [range 3-6 per exit, mean 5.2 + or - 1.1 (SD)] in 41 patients. Eleven exits were in the parasternal area and 32 exits were in the abdomen. Exit sites and sinus tracts were examined weekly for 6 weeks with a magnifying loupe and macro-photographed. Cultures were taken from sterile saline sinus washouts, periexit smears, and nares. Exit sites were categorized into four types: (1) fast-healing exits had no drainage or minimal moisture deep inside by the third week; epidermis started to enter into the sinus within 2-3 weeks, progressed steadily, and covered at least half the visible sinus tract 4-6 weeks after implantation; (2) in slow-healing exits without infection, epidermis started to enter into the sinus after 3 weeks or progressed slowly and did not cover half the visible sinus by 5 weeks; the sinus might have had serous or serosanguineous, but never purulent, drainage persistent up to 4 weeks; (3) healing interrupted by infection initially looked identical to the fast-healing exit, but within 6 weeks the epidermis did not progress or regress, granulation tissue became soft or frankly fleshy; drainage increased and/or became purulent; (4) in slow-healing exits due to early infection, granulation tissue became soft or fleshy and/or drainage became puru lent by 2-3 weeks; sinus epidermization was delayed or progressed slowly, only after infection was appropriately treated. Compared with patients with fast-healing exits, patients with early infected exits were more likely (although not significantly) to be diabetics, to have an abdominal catheter, wound hematoma, higher body mass index, and higher percentage of positive cultures for Staphylococcus aureus in nares. Early colonization of the exit was the most significant factor in determining the healing pattern: the later the colonization, the better the healing. Positive culture from either washout or periexit smear one week after implantation was associated with early exit infection, a higher peritonitis rate, and a high probability of catheter loss due to an exit/tunnel infection, and higher peritonitis rate; however, the time to the first peritonitis episode was not shorter than in the groups with later exit colonization. We postulate that exit infections and peritonitis rates may be decreased by delaying exit colonization using prophylactic antibiotics for at least 2 weeks after implantation and sterile exit dressing procedure for the entire healing time of approximately 6 weeks.

Adult↗
PubMed1997

Two-dimensional exit dosimetry using a liquid-filled electronic portal imaging device and a convolution model.

BACKGROUND AND PURPOSE: To determine the accuracy of two-dimensional exit dose measurements with an electronic portal imaging device, EPID, using a convolution model for a variety of clinically relevant situations. MATERIALS AND METHODS: Exit doses were derived from portal dose images, obtained with a liquid-filled EPID at distances of 50 cm or more behind the patient, by using a convolution model. The resulting on- and off-axis exit dose values were first compared with ionization chamber exit dose measurements for homogeneous and inhomogeneous phantoms in open and wedged 4,8 and 18 MV photon beams. The accuracy of the EPID exit dose measurements was then determined for a number of anthropomorphic phantoms (lung and larynx) irradiated under clinical conditions and for a few patients treated in an 8 MV beam. The latter results were compared with in vivo exit dose measurements using diodes. RESULTS: The exit dose can be determined from portal images with an accuracy of 1.2% (1 SD) compared with ionization chamber measurements for open beams and homogeneous phantoms at all tested beam qualities. In the presence of wedges and for inhomogeneous phantoms the average relative accuracy slightly deteriorated to 1.7% (1 SD). For lung phantoms in a 4 MV beam a similar accuracy was obtained after refinement of our convolution model, which requires knowledge of the patient contour. Differences between diode and EPID exit dose measurements for an anthropomorphic lung phantom in an 8 MV beam were 2.5% at most, with an average agreement within 1% (1 SD). For larynx phantoms in a 4 MV beam exit doses obtained with an ionization chamber and EPID agreed within 1.5% (1 SD). Finally, exit doses in a few patients irradiated in an 8 MV beam could be determined with the EPID with an accuracy of 1.1% (1 SD) relative to exit dose measurements using diodes. CONCLUSIONS: Portal images, obtained with our EPID and analyzed with our convolution model, can be used to determine the exit dose distribution with an accuracy of 1.7% (1 SD) for most clinically relevant situations. EPID exit dosimetry is therefore a good alternative for diode dosimetry. The EPID system is a powerful tool in a dosimetric quality control programme during high dose/high precision radiotherapy.

Humans↗
PubMed1996

Desflurane is not associated with faster operating room exit times in outpatients.

STUDY OBJECTIVE: To determine the influence of anesthetic technique and primary drug on operating room (OR) exit time (time between end of surgery until time patient exists the OR) after addition of desflurane to the hospital formulary. DESIGN: Prospective study. SETTING: Ambulatory surgery unit of a university hospital. PATIENTS: 1,568 outpatients requiring anesthesia. INTERVENTIONS: Addition of desflurane to the hospital formulary, and substitution of desflurane vaporizers for enflurane vaporizers in the ambulatory surgery unit. MEASUREMENTS AND MAIN RESULTS: The following information was recorded for all anesthetic encounters over a six-month time interval: demographics, duration of surgery, primary anesthetic technique, primary anesthetic drug, and exit times. General anesthesia was used in 907 patients [desflurane: 209 patients, isoflurane: 429 patients, halothane: 192 patients, propofol: 72 patients, other intravenous (i.v.): 5 patients], major conduction anesthesia (spinal and epidural) in 43 patients, peripheral nerve blocks in 90 patients, and i.v. sedation in 528 patients. The exit time was significantly greater ( < 0.05) in patients who received general anesthesia (mean +/- SEM 14 +/- 0.2 min) compared with spinal/epidural (8 +/- 0.7 min), nerve blocks (8 +/- 0.4 min) and i.v. sedation (7 +/- 0.2 min). Exit times were longer in older patients receiving general anesthesia (exit time = 12.3 + 0.04 x age, SE = 6.7 min, p < 0.0009), whereas exit times were shorter in older individuals receiving i.v. sedation (exit time = 8.97 - 0.038 x age, SE = 3.6 min, p < 0.0001). For patients receiving i.v. sedation, exit times were shorter as duration of surgery increased (exit time = 7.86 - 0.015 x duration of surgery, SE = 3.6 min, p < 0.0002). Primary anesthetic drug did not affect exit times. CONCLUSION: Regional anesthesia and i.v. sedation were associated with faster OR exit times compared with general anesthesia. Despite desflurane's shorter elimination kinetics and recovery characteristics, use of this drug did not result in shorter exit times.

Adolescent↗
PubMed1996

Nursing interventions related to peritoneal catheter exit-site infections.

Nursing interventions related to peritoneal catheter exit-site infection include an emphasis on prevention and early diagnosis as well as exit-site care. The key elements to prevention of exit-site infections are avoiding trauma to the exit-site and tunnel, avoiding gross contamination of the exit-site, and cleaning a wet or dirty exit-site as soon as possible. Early diagnosis of exit-site infection is promoted by (1) teaching the patient or caregiver to assess the exit-site and tunnel routinely and to promptly recognize and report signs and symptoms of inflammation, and (2) routine exit-site evaluation by health care providers in the outpatient clinic. Care of the infected exit-site should focus on preventing cross contamination, keeping the exit-site dry, avoiding trauma and irritation, and in addition to routine care, may require removal of stubborn crusts and cauterization of proud flesh. Topical soaks and therapy have been recommended, but improvement of infected exit-sites has not been consistently documented.

Catheterization, Peripheral↗
PubMed1996

Nursing practice related to peritoneal catheter exit site care and infections.

OBJECTIVE: The purpose of the study was to obtain information from nephrology nurses on existing policies and protocols related to peritoneal catheter exit site care and treatment of exit site infections. DESIGN: This was an explorative, descriptive study. SAMPLE/SETTING: Fifty-four nurses who attended the 1995 Consensus Conference on Peritoneal Dialysis at the 26th Annual American Nephrology Nurses' Association National Symposium completed a survey questionnaire on exit site care and management of exit site infections. METHODS: A survey was mailed to nephrology nurses preregistered to attend the 1995 ANNA Consensus Conference related to peritoneal dialysis at the 26th National Symposium. Surveys were also collected at the meeting. RESULTS: Hydrogen peroxide and povidone iodine are frequently used in the nursing care of both healing and chronic exit sites. Almost all of the dialysis units require patients to stabilize or secure the catheter. The majority of respondents had a standardized method of assessing exit sites. Risk factors for exit site infections are presented for both the immediate post-catheter insertion period and the well-healed exit site. There were many different combinations of cleansing agents used to treat inflamed and infected exit sites. CONCLUSIONS: Procedures for exit site care vary widely. Prospective, randomized studies of exit site care protocols and cleansing agents are necessary to determine the most effective procedures to promote healthy exit sites.

Catheters, Indwelling↗
PubMed1996

Frequent involvement of the internal cuff segment in CAPD peritonitis and exit-site infection - an ultrasound study.

BACKGROUND: The extent of involvement of the subcutaneous Tenckhoff catheter tract in CAPD peritonitis and catheter-related infections is of major therapeutic importance. By definition, both peritonitis and exit-site infections do not involve the catheter tract. However, diagnosis of these infections as well as the more sinister tunnel infection is based mainly on clinical signs. METHODS: We examined the usefulness of ultrasound examination (US) of the catheter tract in delineating catheter-related (exit-site and tunnel) infections, and their relationship to each other and to peritonitis. CAPD patients with no evidence of peritonitis or catheter-related infections for 6 months prior to examination served as controls. US were performed by one of two experienced radiologists using the Acuson 128XP/10 scanner with a 7-MHz linear transducer. A positive US was defined as an area of hypoechogenicity (indicative of fluid collection) >2 mm in width along any portion of the catheter tract. Findings were localized into segments(S) as follows: S1, limited to external cuff; S2, intercuff segment adjacent to the external cuff; S3, intercuff segment adjacent to the internal cuff; S4, limited to the internal cuff; and S5, involvement extending throughout the catheter tract. RESULTS: Between March 1993 and January 1995, 39 CAPD patients, all with a double-cuff straight Tenckhoff catheter with the exit site situated above the point of entry into the peritoneum were studied. A total of 56 US were performed divided among 26 episodes of peritonitis, four tunnel infections, 13 exit-site infections,and 13 controls. There were 30 positive US distributed among 16 peritonitis, four tunnel, eight exit site infections and two control patients. The two positive controls went on to develop peritonitis within 1 month of the US. The majority of the US findings (13/16 in episodes of peritonitis and 5/8 exit site infections were localized to segment 4, that is, to the internal cuff region. Apart from a significant increase in width in all infected segments versus a normal tunnel, no differences in size were seen between peritonitis, exit-site, or tunnel infections, nor were there any differences in size and localization in these infections when comparing the offending organism (Gram-positive, negative, or culture negative). CONCLUSIONS: We conclude that peritonitis and exit-site infections are frequently accompanied by involvement of the catheter tract. The localization of infection to the internal cuff region in cases of exit-site infection probably occurred as a result of downward migration along the catheter tract. This supports the notion that ideally the exit site should be pointing caudally or that the peritoneal catheter have a swan-neck configuration. With regard to peritonitis, infection within the peritoneal cavity appears to extend and involve the internal cuff region. Thus both the internal and external cuffs do not seem to pose an effective barrier against the spread of infection.. Based on our data, we recommend that US be performed as a routine investigation in all cases of exit-site infection and in cases of refractory or relapsing peritonitis.

Adult↗
PubMed1998

Adherence of Staphylococcus aureus isolated in peritoneal dialysis-related exit-site infections to HEp-2 cells and silicone peritoneal catheter materials.

BACKGROUND: Peritoneal catheter exit-site infections cause a relevant morbidity in peritoneal dialysis patients and are frequently caused by Staphylococcus aureus. We tested the hypothesis that adherence of exit-site-derived S. aureus to epithelial cells and peritoneal catheter silicone tubes discriminates virulent and less virulent strains. METHODS: The binding of isolated S. aureus to an epithelial cell line (HEp-2) and to silicone tubes was analyzed using light-microscopy or radioactive labeling of bacteria. RESULTS: Of 378 exit-site swabs, 99 (26%) were positive for microbial growth. S. aureus was cultured in 25 of 99 positive swabs; three of 13 swabs taken in exit-site infections grade 3 and 4 that had tested positive for S. aureus. Adherence of S. aureus from exit-site infections grade 2, 3 and 4 to Hep-2 cells did not differ from adherence of bacteria isolated from asymptomatic or moderately inflamed catheter exit sites (grade 0-2). However, binding of S. aureus to silicone tubes was enhanced in grade 0/1 compared with grade 2-4 exit-site isolates. CONCLUSIONS: Staphylococcus aureus is an important pathogen in CAPD-related exit-site infection being isolated in about 6.6% of all exit-site swabs (and in 25% of all positive swabs). Silicone-adhesive strains may be of more clinical significance in peritoneal dialysis patients since adhesion to silicone was increased in S. aureus strains isolated in more severe exit-site infections.

Bacterial Adhesion↗
PubMed1996

Late emigrating neural crest cells migrate specifically to the exit points of cranial branchiomotor nerves.

Morphological segmentation of the avian hindbrain into rhombomeres is also reflected by the emergent organisation of branchiomotor nerves. In each case, the motor neurons of these nerves lie in two adjacent rhombomeres (e.g. of the Vth nerve in r2 and r3, VIIth in r4 and r5 etc.), and their outgrowing axons emerge into the periphery through defined exit points in rhombomeres r2, r4 and r6, respectively. Sensory axons of the cranial ganglia also enter the neuroepithelium at the same points. Motor axon outgrowth through experimentally rotated rhombomeres has suggested that a chemoattractive mechanism, involving the exit points, may form a component of their guidance. Yet so far, nothing is known about the establishment of the exit points or the identity of the cells that form them. In this study, we describe a group of late emigrating cranial neural crest cells which populate specifically the prospective exit points. Using chimaeras in which premigratory chick neural crest had been replaced orthotopically by quail cells, a population of neural crest was found to leave the cranial neural tube from about stage 10+ onwards and to migrate directly to the prospective exit points. These cells define the exit points by stage 12+, long before either motor or sensory axons have grown through them. The entire neural crest population of exit point cells expresses the recently described cell adhesion molecule c-cad7. Further, heterotopic grafting experiments show that midbrain and spinal cord crest, grafted at late stages in place of r4 crest, share the same migratory behaviour to the facial nerve exit points and express the same markers as cells contributed by the native r4 crest. It was not possible to generate new exit points in odd numbered rhombomeres simply by experimentally increasing their (normally insignificant) amount of crest production. Initiation of the exit point region probably lies, therefore, in the neuroepithelium.

Animals↗