Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children

Background Guidelines and clinical practice for the prevention of complications associated with central venous catheters (CVC) around the world vary greatly. Most institutions recommend the use of heparin to prevent occlusion, however there is debate regarding the need for heparin and evidence to suggest 0.9% sodium chloride (normal saline) may be as effective. The use of heparin is not without risk, may be unnecessary and is also associated with increased cost. Objectives To assess the clinical effects (benefits and harms) of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children. Search Methods The Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (last searched April 2015) and the Cochrane Register of Studies (Issue 3, 2015). We also searched the reference lists of retrieved trials. Selection criteria Randomised controlled trials that compared the efficacy of normal saline with heparin to prevent occlusion of long term CVCs in infants and children aged up to 18 years of age were included. We excluded temporary CVCs and peripherally inserted central catheters (PICC). Data Collection and Analysis Two review authors independently assessed trial inclusion criteria, trial quality and extracted data. Rate ratios were calculated for two outcome measures - occlusion of the CVC and central line-associated blood stream infection. Other outcome measures included duration of catheter placement, inability to withdraw blood from the catheter, use of urokinase or recombinant tissue plasminogen, incidence of removal or re-insertion of the catheter, or both, and other CVC-related complications such as dislocation of CVCs, other CVC site infections and thrombosis. Main Results Three trials with a total of 245 participants were included in this review. The three trials directly compared the use of normal saline and heparin, however, between studies, all used different protocols for the standard and experimental arms with different concentrations of heparin and different frequency of flushes reported. In addition, not all studies reported on all outcomes. The quality of the evidence ranged from low to very low because there was no blinding, heterogeneity and inconsistency between studies was high and the confidence intervals were wide. CVC occlusion was assessed in all three trials (243 participants). We were able to pool the results of two trials for the outcomes of CVC occlusion and CVC-associated blood stream infection. The estimated rate ratio for CVC occlusion per 1000 catheter days between the normal saline and heparin group was 0.75 (95% CI 0.10 to 5.51, two studies, 229 participants, very low quality evidence). The estimated rate ratio for CVC-associated blood stream infection was 1.48 (95% CI 0.24 to 9.37, two studies, 231 participants; low quality evidence). The duration of catheter placement was reported to be similar between the two study arms, in one study (203 participants). Authors' Conclusions The review found that there was not enough evidence to determine the effects of intermittent flushing of heparin versus normal saline to prevent occlusion in long term central venous catheters in infants and children. Ultimately, if this evidence were available, the development of evidenced-based clinical practice guidelines and consistency of practice would be facilitated.

Solid-state Thermal Polymerization of Sodium Acrylate

Initiation and propagation processes in thermally initiated solid-state polymerization of sodiumvacrylate have been studied. The kinetics of initiation, followed with the electron spin resonancev technique, leads to an activation energy E of 28.8 kcal/mol, which is attributed to the formation of dimeric radicals. The activation energy of 16 f 1 kcaVmol obtained for the solid-state polymerization of sodium acrylate by chemical analysis and differential scanning calorimetry has been attributed to the propagation process.

Thermoanalysis of ammonium perchlorate and sodium nitrate mixture

A binary mixture of ammonium perchlorate-sodium nitrate in molar proportion undergoes partial fusion at 223°C and the transformation of the mixture to sodium perchlorate-ammonium nitrate occurs in the broad endothermic region. The mixture was heated and quenched at various temperatures in a differential thermal analysis assembly. Thermogravimetric analysis, X-ray diffraction, and infrared spectroscopic techniques were used to determine the composition of the quenched sample in order to explain the overall thermal phenomenon. Visual observations of the morphological changes that occur during the course of heating were made using a hot-stage microscope, 30–350°C.

Interfacial area measurement in a gas - liquid ejector for a sodium chloride - air system

Interfacial area measurement has been carried out experimentally by measuring the bubble size and holdup for air-sodium chloride solution system. The size of the bubble is predominantly established by the air hold up. High speed photography technique for bubble size measurement and gamma ray attenuation method for holdup measurements are followed. The measured values are compared with the theoretically predicted values. Interracial area as a function of the liquid flow rate and also its distance from the nozzle of the ejector has been reported in this paper. The results obtained for this non-reactive system are also compared with those of air-water system.

High-Pressure Nmr And Compressibility Evidence For A Phase-Transition In The Protonic Conductor (NH4)4Fe(CN)6.1.5H2o

1H NMR at high hydrostatic pressures and compressibility studies show that the protonic conductor (NH4)4Fe(CN)6·1.5H2O undergoes a phase transition around 0.45 GPa. The transition is characterized by a large hysteresis. From the NMR studies, an activation volume of 6% is obtained below the phase transition, indicating the dominance of Frenkel defects.

Persistence of sodium monofluoroacetate (1080) in fox baits and implications for fox management in south-eastern Australia

The persistence of 1080 in two commonly used fox baits, Foxoff ® and chicken wingettes, was assessed under different climatic and rainfall conditions in central-western New South Wales. The rate of 1080 degradation did not change significantly between the Central Tablelands and the relatively hotter and drier environment of the Western Slopes. Loss of 1080 from wingettes was independent of the rainfall and climate conditions, with wingettes remaining lethal to foxes for, on average, 0.9 weeks. Foxoff ® baits remained lethal for longer than wingettes under all tested conditions, although their rate of degradation increased generally with increasing rainfall. As a result, areas baited with Foxoff® will require longer withholding periods for working dogs than those baited with wingettes, especially during dry periods. Wingettes may have advantages for use in sensitive areas where long-term hazards from toxic baits are undesirable. We found significant variations in 1080 concentration in freshly prepared baits that may result in efficacy, non-target and regulatory concerns for baiting campaigns. As a result, the superior quality control and shelf-stability of manufactured Foxoff® may be important criteria for favouring its use over freshly prepared bait types. However, use strategies for any bait type must ensure that foxes consume lethal doses of 1080 to avoid potential problems such as the development of learned aversion to baits or pesticide resistance.

Identification of a mutation in the para-sodium channel gene of the cattle tick Rhipicephalus (Boophilus) microplus associated with resistance to synthetic pyrethroid acaricides

Resistance against synthetic pyrethroid (SP) products for the control of cattle ticks in Australia was detected in the field in 1984, within a very short time of commercial introduction. We have identified a mutation in the domain II S4-5 linker of the para-sodium channel that is associated with resistance to SPs in the cattle tick Rhipicephalus (Boophilus) microplus from Australia. The cytosine to adenine mutation at position 190 in the R. microplus sequence AF134216, results in an amino acid substitution from leucine in the susceptible strain to isoleucine in the resistant strain. A similar mutation has been shown to confer SP resistance in the whitefly, Bemisia tabaci, but has not been described previously in ticks. A diagnostic quantitative PCR assay has been developed using allele-specific Taqman® minor groove-binding (MGB) probes. Using the assay to screen field and laboratory populations of ticks showed that homozygote allelic frequencies correlated highly with the survival percentage at the discriminating concentration of cypermethrin.

1H and 19F NMR relaxation time studies in (NH4)2ZrF6 superionic conductor

1H and 19F spin-lattice relaxation times in polycrystalline diammonium hexafluorozirconate have been measured in the temperature range of 10–400 K to elucidate the molecular motion of both cation and anion. Interesting features such as translational diffusion at higher temperatures, molecular reorientational motion of both cation and anion groups at intermediate temperatures and quantum rotational tunneling of the ammonium group at lower temperatures have been observed. Nuclear magnetic resonance (NMR) relaxation time results correlate well with the NMR second moment and conductivity studies reported earlier.

Sodium santalbate-dimethyl sulfate inclusion complex

A molecular inclusion complex has been obtained from the major acetylenic acid, santalbic acid (octadec-11-en-9-ynoic acid ortrans-11-octadecen-9-ynoic acid) of the seed oil ofSantalum album L. by a simple treatment of its sodium salt with dimethyl sulfate. Aqueous solutions (0.5–1%) of the complex produce good lather and have efficient cleansing (detergent) action on grease and dirt particles.

Thermoanalysis of ammonium perchlorate and sodium nitrate mixture

A binary mixture of ammonium perchlorate-sodium nitrate in molar proportion undergoes partial fusion at 223°C and the transformation of the mixture to sodium perchlorate-ammonium nitrate occurs in the broad endothermic region. The mixture was heated and quenched at various temperatures in a differential thermal analysis assembly. Thermogravimetric analysis, X-ray diffraction, and infrared spectroscopic techniques were used to determine the composition of the quenched sample in order to explain the overall thermal phenomenon. Visual observations of the morphological changes that occur during the course of heating were made using a hot-stage microscope, 30–350°C.

The composer and conductor Leon Kopf holding a musical score Portraits Men

Kopf conducted the Jewish People’s Philharmonic Chorus, New York from 1948-1952

Studies of phosphazenes. 28. Reactions of pentachloro- and pentafluoro(triphenylphosphazenyl)cyclotriphosphazenes with sodium methoxide. Mechanistic aspects and their implications for nucleophilic displacement at a tetrahedral phosphorus(V) center

Abstract is not available.

Oxidation Of Sodium Sulfide In A Foam Bed Contactor

Oxidation of sodium sulphide to sodium thiosulphate has been experimentally investigated in a foam bed contactor using air as oxidizing medium. The var.

Reaction of Hexachlorocyclotriphosphazene with Sodium p-Cresoxide

The reaction of hexachlorocyclotriphosphazene (N3P3Cl6) with sodium p-cresoxide proceeds by a predominantly nongeminal pathway. The presence of geminal isomers at the bis- and tris-stages of substitution in tiny quantities (< 5%) has also been observed. All the chloro(p-cresoxy)cyclotriphosphazenes and their dimethylamino derivatives have been characterized by 1H-, 13C{1H}-, and 31P{1H}-NMR spectroscopy. The reaction of N3P3Cl6 with sodium phenoxide has been reinvestigated. The relative yields of the products at various stages of substitution and their isomeric compositions are almost the same for both phenoxy and p-cresoxy systems. Possible mechanisms to explain the observed isomeric compositions are discussed. A through-space interaction involving oxygen-2p and phosphorus-3d orbitals is invoked to explain the greater yield of the cis isomer of N3P3Cl4(OAr)2 than that of its trans isomer.