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A Prospective Study to Compare Routine versus Need Based Change of IV Cannula on Development of Infusion Phlebitis in Adult Surgical Patients

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Journal of Health Science 2017年第5期5卷 251-262页

作者： divyanti mishra Kumar Nishant Central Referral Hospital Gangtok 73 7102 lndia

（IV） Intravenous therapy is one of the most commonly performed procedures in hospitalized patients yet phlebitis affects 27% to 70% of all patients receiving IV therapy. The incidence of phlebitis has proved to be a menace in effective care of surgical patients, delaying their recovery and increasing duration of hospital stay and cost. The recommendations for reducing its incidence and severity have been varied and of questionable efficacy. The current study was undertaken to evaluate whether elective change of IV cannula at fixed intervals can have any impact on incidence or severity of phlebitis in surgical patients. All patients admitted to the Department of Surgery, SMIMS undergoing IV cannula insertion, fulfilling the selection criteria and willing to participate in the study, were segregated into two random groups prospectively： Group A wherein cannula was changed electively after 24 hours into a fresh vein preferably on the other upper limb and Group B wherein IV caunula was changed only on development of phlebitis or leak i.e. need-based change. The material/brand and protocol for insertion of IV cannula were standardised for all patients, including skin preparation, insertion, fixation and removal. After carmulation, assessment was made after 6 hours, 12 hours and every 24 hours thereafter at all venepuncture sites. VIP and VAS scales were used to record phlebitis and pain respectively. Upon analysis, though there was a lower VIP score in group A compared to group B （0.89 vs. 1.32）, this difference was not statistically significant （p-value = 0.277）. Furthermore, the differences in pain, as assessed by VAS, at the site of puncture and along the vein were statistically insignificant （p-value 〉 0.05）. Our results are in contradiction to few other studies which recommend a policy of routine change of carmula. Further we advocate a close and thorough monitoring of the venepuncture site and the length of vein immediately distal to the puncture site, as well as a

关键词： IV cannula thrombophlebitis infusion phlebitis cohort study

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Transurethral Resection of Prostate Lessons Learnt

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Journal of Health Science 2017年第6期5卷 303-306页

作者： mishra Vinod Kumar mishra divyanti Kanpur Urology Centre Kanpur 208012 India

Introduction ＆ Objective： TURP （transurethral resection of prostate） is the gold standard of treatment for patients with BPE （benign prostatic enlargement）. But TURP is criticized due to its morbidity and mortality. We analyzed our two decade data and found that the morbidity can be reduced by taking simple precautions in the later decade. Methods： A total of 13,786 patients were studied in the past two decades （Jan. 1994-Dec. 2014） operated by single surgeon, grouped in A （Jan. 1994-Dec. 2004） and B （Jan. 2004-Dec. 2014）. Patients with concomitant stricture urethra, vesical calculus/tumor and carcinoma prostate were excluded from the study. Patients were operated under good antibiotic cover. The demographic profile, operative findings, weight, biopsy and post op follow up for 6 months ＆ the immediate and immediate six months post operative complications were recorded. All patients in group B had urethral dilatation up to 27 F, restricted resection time of 90 minutes, concomitant bilateral BNI （bladder neck incision） in small glands （〈 30 gms.）, catheter care twice a day with betadine lotion and neosporin ointment ＆ long term antibiotic prophylaxis in biopsy proven BPH （Benign prostatic hyperplasia） with chronic prostatitis patients. Results： A total of 6,800 patients were enrolled in Group A and 6,986 in Group B. In the immediate postop period there was significant drop in TUR （Trans urethral resection） syndrome and clot evacuation （p 〉 0.01） in group B. In the Late complications there is significant drop in the incidence of meatitis, meatal stenosis, stricture urethra ＆ bladder neck stenosis （p 〉 0.001） in group B. Conclusions： TURP is still the gold standard of treatment for BPE and its morbidity can be reduced by simple measures like restricting resection time to 90 minutes urethral dilatation before insertion of resectoscope, catheter care ＆ concimitent concomitant BNI in glands of 〈 30 gins.

关键词： Transurethral prostate complications

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Is the Cut off Limit of Normal Uric Acid ＆ Calcium in Tropical Countries Different？

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Journal of Health Science 2017年第5期5卷 267-269页

作者： divyanti mishra Vinod Kumar mishra Kanpur Urology Centre Kanpur 208012 India

Introduction： Nephrolithiasis is quite common in this part of the *** the metabolic workup Uric acid and Calcium assay are important. Calcium ＆ Uric acid lithiasis accounts for significant number of cases. But, the values given as reference do not seem to apply in tropical countries like India. We tried to analyse the values of Serum Calcium ＆ Uric acid in both normal healthy individuals and those with calculus disease in out patient department. Material and methods： The study was conducted in outpatient department wherein Serum Uric acid, Calcium ＆ Phosphorus levels were assessed in fasting state in all patients irrespective of age and sex in the period Jan. 2010- June 2015. A total of 9887 patients with stone disease were kept in Group A and 8967 patients with other diseases in group B who acted as control, were enrolled for the study. The demographic profile was recorded and associated metabolic disorders were also documented. Patients with associated features of bony pains and gout were also specified. Result： The Uric acid levels in the control group B were quite lower than the reference values in either sex. However, the values were more than 6 mg/dl in nephrolithiasis group A. The *** levels of control in group B were significantly lower than the reference value and patients with nephrolithiasis in group A also had hypocalcemia. Conclusion： Nephrolithiasis is a metabolic disorder with majority of patients having higher Uric acid levels with hypocalcemia in our *** normal values in control group is on the lower side of reference value which could be due to variation on account of climatic, dietary and geographical factors. It needs broader studies to redefine reference values of Uric acid and Calcium in tropical countries like India.

关键词： Urolithiasis uric acid metabolic disorder Calcium gout tropical countries hyperuricemia hypocalcemia.

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