Midlines

Application and Use of Midlines

--Midlines measure 3-8 inches.
--They are peripheral catheters, not central, do not require x-ray
--Used for <30 days (short-term)
--May be used for blood draws
--when duration of therapy likely to >6days, use midline or PICC
--less than half infection rate of PICCs


AVERAGE DWELL TIMES:
PICC- 393 hours
Midline- 283 hours
PIV- 44 hours

Rates of infection:
highest-
non-tunneled
arterial
tunneledCVC
PICC
PIV
Midline
Implanted port
lowest

Midline:
--use for infusions appropriate for peripheral infusions
--does not require confirmation of terminal tip (x-ray)
--NOT appropriate fo rinfusions with osmolarity >600mOsm/L, or for TPN
--can be used for UP TO 29 days
--blood draws okay
--rate of occlusion 1.9-29%

PICC
--lower 1/3 of SVC (central)
--requires x-ray or EKG
--can be used for ALL infusions
--no limit on dwell time
--blood draw okay
-- rate of occlusion 25-33%

Per INS, meds appropriate for peripheral infusion have pH of 5-9
(Normal saline pH is 4.5) ??
No CDC standards

No "continuous vesicant medications and solutions"

same reimbursement code as PICC, with lower insertion costs

Deep veins of the upper arm have 5x the flow rate of the hand/forearm, which provides greater hemodilution

A vein should be 3x size of selected catheter

phlebogenic=causing phlebitis (inflammation of the vein wall)

helpful article

don't want to lose this: http://www.medscape.com/viewarticle/778654?nlid=29522_785&src=wnl_edit_medp_nurs&uac=117902AK&spon=24

Why don't whales get the bends, when divers can? - Naked Science Scrapbook

Bedside Assessment of Enteral Tube Placement: Aligning Practice with Evidence

Just read this article about how to make sure feeding tubes are in place. Reminds me of a (completely unrelated) book I want to read called Lies My Teacher Told Me.

lab abbreviations

panhypopituitarism

The pituitary gland is regulated by the hypothalamus, the small region of the brain below the thalamus and the major link between the nervous and endocrine systems. The hypothalamus secretes releasing hormones that stimulate the anterior pituitary, and inhibiting hormones that suppress the pituitary. (Painful, stressful, and emotional experiences all cause changes in hypothalmic activity.)

The anterior pituitary synthesizes human growth hormone (hGH), thyroid stimulating hormone TSH, the gonadotropins- leutenizing hormone and follicle-stimulating hormone (LH & FSH), Prolactin (PRL), adrenocorticotropic hormone (ACTH), and melanocyte-stimulating hormone (MSH). Human grown hormone promotes cells in many other tissues to secrete insulinlike growth factors (IGFs). IGFs help bones and muscles grow during childhood/adolescence, and help maintain bone and muscle mass during adulthood, as well as promoting healing and tissue repair; they enhance lipolysis in adipose tissues; they stimulate liver cells to release glucose into the blood. HGH is key to maintaining normoglycemia. TSH stimulates T3 and T4 production in the thyroid. In females, FSH stimulates the ovaries, initiating development of follicles each month, and stimulating secretion of estrogens. In males, FSH stimulates the testes to produce sperm. In females, LH triggers ovulation and stimulates formation of the corpus luteum and causes it to secrete progesterone. In males, LH stimulates the interstitial cells of the testes to secrete testosterone. PRL works with other hormones to cause lactation in females. ACTH acts on the adrenal cortex to produce and secrete cortisol (or hydrocortisone) and other glucocorticoids. Glucocorticoids stimulate formation of glucose and glycogen in the liver, increase lipolysis in adipose tissue, and also have anti-inflammatory and immunodepressant effects. MSH's exact role is unknown in humans, but it does play some role in brain activity.

The posterior pituitary doesn't synthesize hormones, but it stores and releases hormones from the hypothalamus: oxytocin (OT) and antidiuretic hormone (ADH), aka vasopresin. OT affects uterine and breast tissue in pregnant females; its affects on males and nonpregnant females are unclear. ADH causes water resorption in the kidneys, decreases water lost through sweating, and causes artery constriction.

Whenever the pituitary is underproducing one or more hormones, it is called hypopituitarism. If many or all of the hormones aren't being produced, it is called panhypopituitarism. Diagnosis is made by measuring pituitary hormones as well as hormones secreted by glands that the pituitary regulates.

Treatment involves replacing the hormones regulated by the pituitary.


source=http://www.emoryhealthcare.org/pituitary/treatments/medical-pituitary-treatments.html

Caffeine Content in Food & Drugs

Good reminders found here, such as:

Coffee has 100-200mg caffeine per cup.
A Starbucks Grande Iced Chai has 100mg caffeine per cup.
Brewed tea has 50-100mg caffeine per cup.
12oz of Dr Pepper has 42mg of caffeine.
8.3oz of Red Bull has 80mg of caffeine.
2 extra strength Excedrin have 130mg of caffeine.

Also very pertinent:
Ghirardelli 72% Twilight Delight chocolate has 22mg of caffeine per square (according to this.)
Dark chocolate generally has 20mg per ounce.
Milk chocolate generally has 6mg per ounce (according to this.)