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      Actualización en dispositivos sanitarios para administración de nutrición parenteral Translated title: Update in medical devices for the administration of parenteral nutrition

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          Abstract

          Resumen Introducción: La Nutrición Parenteral (NP) es un medio para proporcionar los nutrientes necesarios por vía intravenosa, cuando la situación clínica lo requiere. El aporte de NP conlleva un riesgo debido al carácter invasivo del procedimiento, que suele variar según el tipo utilizado. Por ello, los productos sanitarios empleados deben ser caracterizados conforme a los criterios de seguridad, comodidad, efectividad y coste económico para optimizar y maximizar los recursos disponibles en la administración de la NP. Método: Se realizó una revisión bibliográfica narrativa basada en la búsqueda, en distintas bases de datos tales como Medline, Science Direct y Scopus, de todos los artículos publicados, hasta marzo de 2022 sobre dispositivos para la administración de NP. Resultados y discusión: La administración de NP requiere de dispositivos sanitarios que garanticen las propiedades tecno-farmacéuticas de la NP, así como la seguridad en su administración. Conclusiones: Las bolsas y bombas de infusión junto con los catéteres constituyen los dispositivos clave sobre los que se debe seguir mejorando sus características y sistemas de seguridad con objeto de garantizar una optimización de la NP administrada.

          Translated abstract

          Abstract Introduction: Parenteral Nutrition (PN) is a means of providing the necessary nutrients intravenously when the clinical situation requires it. The provision of PN carries a risk due to the invasive nature of the procedure, which usually varies depending on the type used. Therefore, the medical devices used must be characterized according to the criteria of safety, comfort, effectiveness and economic cost to optimize and maximize the resources available in the administration of PN. Method: A narrative bibliographic review was carried out based on the search, in different databases such as Medline, Science Direct and Scopus, of all the articles published, up to March 2022, on devices for the administration of PN. Results: The administration of PN requires medical devices that guarantee the techno-pharmaceutical properties of the PN, as well as the safety of its administration. Conclusions: Infusion bags and pumps, together with catheters and their filters, are the key devices on which their characteristics and safety systems must be improved in order to optimize administered PN.

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          Most cited references64

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          Guidelines for the prevention of intravascular catheter-related infections.

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            The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis.

            Peripherally inserted central catheters (PICCs) are associated with central line-associated bloodstream infection (CLABSI). The magnitude of this risk relative to central venous catheters (CVCs) is unknown. To compare risk of CLABSI between PICCs and CVCs. MEDLINE, CinAHL, Scopus, EmBASE, and Cochrane CENTRAL were searched. Full-text studies comparing the risk of CLABSI between PICCs and CVCs were included. Studies involving adults 18 years of age or older who underwent insertion of a PICC or a CVC and reported CLABSI were included in our analysis. Studies were evaluated using the Downs and Black scale for risk of bias. Random effects meta-analyses were used to generate summary estimates of CLABSI risk in patients with PICCs versus CVCs. Of 1,185 studies identified, 23 studies involving 57,250 patients met eligibility criteria. Twenty of 23 eligible studies reported the total number of CLABSI episodes in patients with PICCs and CVCs. Pooled meta-analyses of these studies revealed that PICCs were associated with a lower risk of CLABSI than were CVCs (relative risk [RR], 0.62; 95% confidence interval [CI], 0.40-0.94). Statistical heterogeneity prompted subgroup analysis, which demonstrated that CLABSI reduction was greatest in outpatients (RR [95% CI], 0.22 [0.18-0.27]) compared with hospitalized patients who received PICCs (RR [95% CI], 0.73 [0.54-0.98]). Thirteen of the included 23 studies reported CLABSI per catheter-day. Within these studies, PICC-related CLABSI occurred as frequently as CLABSI from CVCs (incidence rate ratio [95% CI], 0.91 [0.46-1.79]). Only 1 randomized trial met inclusion criteria. CLABSI definition and infection prevention strategies were variably reported. Few studies reported infections by catheter-days. Although PICCs are associated with a lower risk of CLABSI than CVCs in outpatients, hospitalized patients may be just as likely to experience CLABSI with PICCs as with CVCs. Consideration of risks and benefits before PICC use in inpatient settings is warranted.
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              Strategies to prevent central line-associated bloodstream infections in acute care hospitals.

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                Author and article information

                Journal
                ars
                Ars Pharmaceutica (Internet)
                Ars Pharm
                Universidad de Granada (Granada, Granada, Spain )
                2340-9894
                March 2023
                : 64
                : 1
                : 53-69
                Affiliations
                [2] Andalucía orgnameUniversidad de Granada orgdiv1Departamento de Farmacia y Tecnología Farmacéutica Spain
                [1] Guadix Granada orgnameExcmo. Ayuntamiento de Guadix orgdiv1Unidad Municipal de Salud y Consumo España
                Article
                S2340-98942023000100004 S2340-9894(23)06400100004
                10.30827/ars.v64i1.26334
                82443201-9ac1-4484-9921-f9e683665cf2

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 18 November 2022
                : 16 December 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 65, Pages: 17
                Product

                SciELO Spain

                Categories
                Artículos de Revisión

                Nutrición parenteral,vascular access devices,administration,parenteral nutrition solutions,Parenteral nutrition,dispositivos de acceso vascular,bombas de infusión,administración,soluciones para nutrición parenteral,infusion pump

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