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Jomar, Rafael Tavares, and Lilian Dos Santos Rodrigues. "Nursing care for critical patients receiving intravenous insulin infusion: review study." Revista de Enfermagem UFPE on line 6, no. 2 (January 7, 2012): 431. http://dx.doi.org/10.5205/reuol.2052-14823-1-le.0602201224.
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ABSTRACTObjective: to identify nursing scientific papers approaching intravenous (IV) insulin infusion in critical patients, analyzing its applicability to the nurse's clinical practice. Method: this is a literature review study carried out between July and August 2010 in the following databases: Latin American and Caribbean Literature in Health Sciences (LILACS), Scientific Electronic Library Online (SciELO), Nursing Database (BDENF), and Medical Literature Analysis and Retrieval System Online (MEDLINE), using the descriptors insulina/insulin; infusões intravenosas/infusions, intravenous; and enfermagem/nursing. For this, the following guiding question was developed: "What nursing care actions should be provided to the critical patient who needs continuous IV insulin infusion for glycemic control?". The analysis of the papers was carried out through critical and detailed reading, identifying the most relevant factors affecting the nurse's clinical practice with regard to the nursing care actions in the continuous IV insulin infusion in critical patients. Results: the nurse's work in the IV insulin infusion and in the prevention of its adverse effects showed to be wide and indispensable. Conclusion: one believes that the results from this study can be useful in order to turn the nursing assistance into a safer and better quality practice, as it contains updated information and stimulates nursing care actions. Descriptors: nursing care; infusions, intravenous; insulin; intensive care units.RESUMOObjetivo: identificar artigos científicos de enfermagem que contemplem a infusão intravenosa (IV) de insulina em pacientes críticos, analisando sua aplicabilidade à prática clínica do enfermeiro. Método: trata-se de estudo de revisão de literatura, realizado entre julho e agosto de 2010, nas seguintes bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), Base de Dados de Enfermagem (BDENF) e Medical Literature Analysis and Retrieval System Online (MEDLINE), empregando os descritores insulina/insulin; infusões intravenosas/infusions, intravenous; e enfermagem/nursing. Para isso, formulou-se a seguinte questão norteadora: “Quais cuidados de enfermagem devem ser prestados ao paciente crítico que necessita de infusão contínua de insulina IV para controle glicêmico?”. A análise dos artigos deu-se a partir da leitura crítica e detalhada, extraindo-se os fatores mais relevantes que afetam a prática clínica do enfermeiro no que se refere aos cuidados de enfermagem na infusão contínua de insulina IV em pacientes críticos. Resultados: a atuação do enfermeiro na infusão IV de insulina e na prevenção de seus efeitos adversos mostrou-se ampla e indispensável. Conclusão: acredita-se que os resultados deste estudo podem ser úteis para tornar a assistência de enfermagem uma prática mais segura e de melhor qualidade, por conter informações atualizadas e estimular cuidados de enfermagem. Descritores: cuidados de enfermagem; infusões intravenosas; insulina; unidades de terapia intensiva.RESUMENObjetivo: identificar artículos científicos de enfermería que aborden la infusión intravenosa (IV) de insulina en pacientes críticos, analizando su aplicabilidad a la práctica clínica del enfermero. Método: esto es un estudio de revisión de literatura realizado entre julio y agosto de 2010 en las siguientes bases de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Scientific Electronic Library Online (SciELO), Base de Datos de Enfermería (BDENF) y Medical Literature Analysis and Retrieval System Online (MEDLINE), empleando los descriptores insulina/insulin; infusões intravenosas/infusions, intravenous; y enfermagem/nursing. Para lo tanto, se formuló la siguiente cuestión orientadora: "¿Cuales cuidados de enfermería deben ser prestados al paciente crítico que necesita de infusión contínua de insulina IV para control glicémico?". El análisis de los artículos tuvo lugar a partir de la lectura crítica y detallada, se extrayendo los factores más relevantes que afectan la práctica clínica del enfermero en lo que se refiere a los cuidados de enfermería en la infusión contínua IV en pacientes críticos. Resultados: la actuación del enfermero en la infusión IV de insulina y en la prevención de sus efectos adversos se mostró amplia e indispensable. Conclusión: se cree que los resultados de este estudio pueden ser utiles para tornar la asistencia de enfermería una práctica más segura y de mayor calidad, por contener informaciones actualizadas y estimular cuidados de enfermería. Descriptores: atención de enfermería; infusiones intravenosas; insulina; unidades de terapia intensiva.
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Loonstra, Floor C., Johannis A. van Rossum, Zoé LE van Kempen, Theo Rispens, Bernard MJ Uitdehaag, and Joep Killestein. "Infusion-related events during natalizumab: No need for post-infusion monitoring." Multiple Sclerosis Journal 26, no. 12 (June 25, 2019): 1590–93. http://dx.doi.org/10.1177/1352458519860415.
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This retrospective cohort study assessed the timing of infusion-related adverse events (IAEs) during natalizumab (NTZ) administration in well-documented relapsing-remitting multiple sclerosis (RRMS) patients who had received NTZ infusions in our centre between 2006 and 2018. In 225 RRMS patients (14,174 NTZ infusions), 276 IAEs (1.95%) occurred in 60 patients. All documented severe IAE occurred during infusion. Of the 19 moderate adverse events, 17 were during infusion. None of the reactions that occurred after the infusion required intervention. These results suggest that post-infusion monitoring is not necessary in patients who do not have an adverse event during infusion.
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Sapsford, D. J., and C. Howard. "Epidural infusions-shortage of infusion devices." Anaesthesia 43, no. 4 (February 22, 2007): 332. http://dx.doi.org/10.1111/j.1365-2044.1988.tb08991.x.
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Munsel, Erin J., Peter J. Bryan, Bryce A. Binstadt, Danielle Bullock, Colleen K. Correll, Elissa M. Downs, Patricia M. Hobday, Catherine Larson-Nath, Boris Sudel, and Richard K. Vehe. "Rapid Infliximab Infusion in the Pediatric Population." Journal of Pediatric Pharmacology and Therapeutics 25, no. 8 (November 1, 2020): 705–8. http://dx.doi.org/10.5863/1551-6776-25.8.705.
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OBJECTIVES To compare infusion reaction rates between rapid infliximab (REMICADE, Janssen Biotech Inc) infusions and previous standard 2- to 3-hour infusions; additionally, to assess patient satisfaction and reduction in chair time associated with rapid infliximab infusions. METHODS Pediatric rheumatology and gastroenterology patients receiving maintenance infliximab therapy using a standard 2- to 3-hour titrated infusion had the opportunity to enroll in the non-titrated rapid 1-hour infusion protocol following tolerance of induction dosing at 0, 2, and 6 weeks. Patients were included from December 1, 2017, to March 31, 2018, via retrospective chart review and patient satisfaction surveys. RESULTS Data were collected on 55 patients receiving a total of 160 rapid infliximab infusions. There were 2 infusion reactions during the enrollment and data collection period, resulting in an overall infusion reaction rate of 1.3%. The patient satisfaction survey results showed all patients were at minimum satisfied with the information provided regarding rapid infliximab, decreased time spent in clinic, ease of scheduling, and overall process. CONCLUSIONS Our data suggest rapid infliximab infusions are safe in pediatric rheumatology and gastroenterology patients receiving maintenance infliximab infusion therapy. The overall infusion reaction rate of 1.3% in this study is well below the accepted infusion reaction rate of standard-length infliximab infusions of 2% to 3%.
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Waterson, James, and Arkadiusz Bedner. "Types and Frequency of Infusion Pump Alarms and Infusion-Interruption to Infusion-Recovery Times for Critical Short Half-Life Infusions: Retrospective Data Analysis." JMIR Human Factors 6, no. 3 (August 12, 2019): e14123. http://dx.doi.org/10.2196/14123.
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Background Alarm fatigue commonly leads to a reduced response to alarms. Appropriate and timely response to intravenous pump alarms is crucial to infusion continuity. The difficulty of filtering out critical short half-life infusion alarms from nonurgent alarms is a key challenge for risk management for clinicians. Critical care areas provide ample opportunities for intravenous medication error with the frequent administration of high-alert, critical short half-life infusions that require rigorous maintenance for continuity of delivery. Most serious medication errors in critical care occur during the execution of treatment, with performance-level failures outweighing rule-based or knowledge-based mistakes. Objective One objective of this study was to establish baseline data for the types and frequency of alarms that critical care clinicians are exposed to from a variety of infusion devices, including both large volume pumps and syringe drivers. Another objective was to identify the volume of these alarms that specifically relate to critical short half-life infusions and to evaluate user response times to alarms from infusion devices delivering these particular infusions. Methods The event logs of 1183 infusion pumps used in critical care environments and in general care areas within the European region were mined for a range of alarm states. The study then focused on a selection of infusion alarms from devices delivering critical short half-life infusions that would warrant rapid attention from clinicians in order to avoid potentially harmful prolonged infusion interruption. The reaction time of clinicians to infusion-interruption states and alarms for the selected critical short half-life infusions was then calculated. Results Initial analysis showed a mean average of 4.50 alarms per infusion in the general critical care pump population as opposed to the whole hospital rate of 1.39. In the pediatric intensive care unit (PICU) group, the alarms per infusion value was significantly above the mean average for all critical care areas, with 8.61 alarms per infusion. Infusion-interruption of critical short half-life infusions was found to be a significant problem in all areas of the general critical care pump population, with a significant number of downstream (ie, vein and access) occlusion events noted. While the mean and median response times to critical short half-life infusion interruptions were generally within the half-lives of the selected medications, there was a high prevalence of outliers in terms of reaction times for all the critical short half-life infusions studied. Conclusions This study gives an indication of what might be expected in critical care environments in terms of the volume of general infusion alarms and critical short half-life infusion alarms, as well as for clinician reaction times to critical short half-life infusion-interruption events. This study also identifies potentially problematic areas of the hospital for alarm fatigue and for particular issues of infusion and infusion-line management. Application of the proposed protocols can help create benchmarks for pump alarm management and clinician reaction times. These protocols can be applied to studies on the impact of alarm fatigue and for the evaluation of protocols, infusion-monitoring strategies, and infusion pump-based medication safety software aimed at reducing alarm fatigue and ensuring the maintenance of critical short half-life infusions. Given the frequency of infusion alarms seen in this study, the risk of alarm fatigue due to the white noise of pump alarms present in critical care, to which clinicians are constantly exposed, is very high. Furthermore, the added difficulties of maintaining critical short half-life infusions, and other infusions in specialist areas, are made clear by the high ratio of downstream occlusion to infusion starts in the neonatal intensive care unit (NICU). The ability to quantitatively track the volume of alarms and clinician reaction times contributes to a greater understanding of the issues of alarm fatigue in intensive care units. This can be applied to clinical audit, can allow for targeted training to reduce nuisance alarms, and can aid in planning for improvement in the key area of maintenance of steady-state plasma levels of critical short half-life infusions. One clear conclusion is that the medication administration rights should be extended to include right maintenance and ensured delivery continuity of critical short half-life infusions.
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Franco, Andrezza Serpa, Aline Affonso Luna, Flavia Giron Camerini, Danielle De Mendonça Henrique, Luana De Almeida Ferreira, and Roberto Carlos Lyra da Silva. "Segurança na utilização de bombas infusoras: análise dos alarmes." Revista de Enfermagem UFPE on line 12, no. 5 (May 1, 2018): 1331. http://dx.doi.org/10.5205/1981-8963-v12i5a231286p1331-1337-2018.
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RESUMOObjetivo: analisar o perfil dos alarmes de bombas infusoras em uma unidade intensiva. Método: estudo quantitativo, descritivo, observacional, transversal e seccional, realizado em uma unidade cárdio intensiva, com amostra de 72 alarmes disparados de bombas infusoras, coletados em instrumento estruturado. Análise realizada com tabulação e tratamento estatístico no programa SPSS® versão 2.1. e apresentados em figuras. Resultados: observou-se que os alarmes mais disparados pelas bombas infusoras estão relacionados ao fim de infusão (41,7%) e o de manipulação pela equipe (29,2%). Em relação aos tempos dos alarmes, identificou-se a média de 109,8 segundos, caracterizados por quatro alarmes com maior tempo: “pré-alarme fim de infusão”, “fluxo baixo”, “fim de stand by” e “fim de infusão”. Conclusão: a caracterização dos alarmes auxilia o enfermeiro a planejar ações para minimizar o tempo estimulo - resposta, com a finalidade de melhorar a qualidade da assistência de enfermagem e de aumentar a segurança para o paciente. Descritores: Cuidados de Enfermagem; Segurança do Paciente; Alarmes Clínicos; Enfermagem; Bombas de Infusão.ABSTRACT Objective: to analyze the profile of the infusion pump alarms in an intensive unit. Method: this is a quantitative, descriptive, observational, cross-sectional and sectional study carried out in an intensive cardiogenic unit with a sample of 72 alarms fired from infusion pumps, collected in a structured instrument. The analysis was performed with tabulation and statistical treatment in SPSS® software version 2.1. and presented in figures. Results: it was observed that the alarms triggered by the infusion pumps are related to the end of infusion (41.7%) and the manipulation by the team (29.2%). Regarding the time of the alarms, the average of 109.8 seconds was identified, characterized by four alarms with more time: “pre-alarm end of infusion”, “low flow”, “end of standby” and “end of infusion”. Conclusion: the characterization of the alarms helps the nurse to plan actions to minimize the stimulus-response time, improving the quality of the nursing care and increasing the safety for the patient. Descriptors: Nursing Care; Patient Safety; Clinical Alarms; Nursing; Infusion Pumps; Healthcare.RESUMEN Objetivo: analizar el perfil de las alarmas de bombas de infusión en una unidad intensiva. Método: estudio cuantitativo, descriptivo, observacional, transversal y seccional, realizado en una unidad cardio-intensiva, con muestra de 72 alarmas disparadas de bombas de infusión, recolegidas en instrumento estructurado. El análisis fue realizado con tabulación y tratamiento estadístico en el programa SPSS® versión 2.1. y presentados en figuras. Resultados: se observó que las alarmas más disparadas por las bombas de infusión están relacionadas al fin de infusión (41,7%) y la de manipulación por el equipo (29,2%). En relación a los tiempos de las alarmas, se identificó la media de 109,8 segundos, caracterizados por cuatro alarmas con mayor tiempo: “pre-alarma fin de infusión”, “flujo bajo”, “fin de stand by” y “fin de infusión”. Conclusão: la caracterización de las alarmas auxilia al enfermero a planear acciones para minimizar el tiempo estimulo - respuesta, con la finalidad de mejorar la calidad de la asistencia de enfermería y de aumentar la seguridad para el paciente. Descriptores: Atención de Enfermería; Seguridad del Paciente; Alarmas Clínicas; Enfermería; Bombas de Infusión.
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Casey, Julia. "Effectiveness of scheduled vital signs assessment during infliximab infusions in detecting infusion reactions: a multi-centre retrospective data review." British Journal of Nursing 31, no. 2 (January 27, 2022): S16—S22. http://dx.doi.org/10.12968/bjon.2022.31.2.s16.
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Purpose: To determine if scheduled vital signs monitoring is useful in the detection of infusion reactions to infliximab (IFX). Methods: The infusion records of 35,988 IFX infusions completed in 2017 were reviewed for infusion reactions that occurred during the infusion, which were then examined further to determine how those infusion reactions were detected. Results: Of the 90 complete infusion reaction records reviewed, no infusion reactions (0) were detected by scheduled vital signs assessment. Conclusions: According to the infusion reaction data reviewed, scheduled vital sign assessment did not detect any infusion reactions and may not be necessary for the purpose of monitoring patients during infusions for early detection of infusion reactions. Previous research into IFX infusion reactions reviewed also concluded that scheduled vital signs assessment may not be helpful in the detection of infusion reactions and, in many cases, vital signs did not vary significantly enough from baseline to signal an infusion reaction.
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Yu, Denny, Marian Obuseh, and Poching DeLaurentis. "Quantifying the Impact of Infusion Alerts and Alarms on Nursing Workflows: A Retrospective Analysis." Applied Clinical Informatics 12, no. 03 (May 2021): 528–38. http://dx.doi.org/10.1055/s-0041-1730031.
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Abstract Background Smart infusion pumps affect workflows as they add alerts and alarms in an information-rich clinical environment where alarm fatigue is already a major concern. An analytic approach is needed to quantify the impact of these alerts and alarms on nursing workflows and patient safety. Objectives To analyze a detailed infusion dataset from a smart infusion pump system and identify contributing factors for infusion programming alerts, operational alarms, and alarm resolution times. Methods We analyzed detailed infusion pump data across four hospitals in a health system for up to 1 year. The prevalence of alerts and alarms was grouped by infusion type and a selected list of 32 high-alert medications (HAMs). Logistic regression was used to explore the relationship between a set of risk factors and the occurrence of alerts and alarms. We used nonparametric tests to explore the relationship between alarm resolution times and a subset of predictor variables. Results The study dataset included 745,641 unique infusions with a total of 3,231,300 infusion events. Overall, 28.7% of all unique infusions had at least one operational alarm, and 2.1% of all unique infusions had at least one programming alert. Alarms averaged two per infusion, whereas at least one alert happened in every 48 unique infusions. Eight percent of alarms took over 4 minutes to resolve. Intravenous fluid infusions had the highest rate of error-state occurrence. HAMs had 1.64 more odds for alerts than the rest of the infusions. On average, HAMs had a higher alert rate than maintenance fluids. Conclusion Infusion pump alerts and alarms impact clinical care, as alerts and alarms by design interrupt clinical workflow. Our study showcases how hospital system leadership teams can leverage infusion pump informatics to prioritize quality improvement and patient safety initiatives pertaining to infusion practices.
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Hartung, Hans-Peter. "Ocrelizumab shorter infusion." Neurology - Neuroimmunology Neuroinflammation 7, no. 5 (June 4, 2020): e807. http://dx.doi.org/10.1212/nxi.0000000000000807.
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ObjectiveTo assess the safety of ocrelizumab (OCR) shorter duration infusion in patients with MS.MethodsENSEMBLE PLUS is a randomized, double-blind substudy to the single-arm ENSEMBLE study (NCT03085810). In ENSEMBLE, patients with early stage relapsing-remitting MS received OCR 600 mg initially as two 300 mg IV infusions 2 weeks apart and subsequently as a single 3.5-hour 600 mg infusion every 24 weeks for 192 weeks. In ENSEMBLE PLUS, OCR 600 mg administered over the approved 3.5-hour infusion time (conventional duration) is compared with a 2-hour infusion (shorter duration). The primary end point was the proportion of patients with infusion-related reactions (IRRs) after the first randomized dose (assessed during and up to 24 hours postinfusion).ResultsFrom November 1, 2018, to September 27, 2019, 580 patients were randomized 1:1 to the conventional or shorter infusion group. After the first randomized dose, 67 of 291 patients (23.1%) in the conventional and 71 of 289 patients (24.6%) in the shorter infusion group experienced IRRs. Most IRRs were mild or moderate in both groups; one patient in each group experienced a severe IRR, and in both groups, 98.6% (136 of 138) of all IRRs resolved without sequelae. No IRRs were serious, life-threatening, or fatal. No IRR-related discontinuation occurred. During the first randomized dose, 14 of 291 (4.8%) and 25 of 289 (8.7%) patients in the conventional and shorter infusion groups, respectively, had IRRs leading to infusion slowing/interruption.ConclusionThe frequency and severity of IRRs were similar between conventional and shorter OCR infusions. Shortening the infusion time to 2 hours reduces the total infusion site stay time and lessens the overall patient and site staff burden.Classification of evidenceThis interventional study provides Class I evidence that the frequency and severity of IRRs were similar at the first randomized dose using OCR (600 mg) infusions of conventional and shorter duration in patients with relapsing-remitting MS.Clinical trial identifier numberNCT03085810.
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Gaffney, Kelly J., Elizabeth M. Dahl, Michael P. Stanton, Elizabeth Starek, and Anthony S. Zembillas. "Rapid-Infusion Rituximab in a Pediatric Population." Journal of Pediatric Pharmacology and Therapeutics 25, no. 3 (April 1, 2020): 215–19. http://dx.doi.org/10.5863/1551-6776-25.3.215.
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OBJECTIVES The use of rapid rituximab infusion in certain pediatric populations has generally been regarded as safe. The safety of our institution's rapid rituximab protocol was evaluated. METHODS The primary end point was the number of and severity of adverse drug reactions. Secondary end points included a description of the patient population defined by the indication, dose, and number of rituximab infusions administered. Additionally, the difference in infusion times in hours of those receiving rapid rituximab infusions versus the theoretical infusion time of subsequent administration rate schedules was defined. RESULTS A total of 88 infusions for 22 patients were reviewed. No dose-limiting adverse reactions were observed. Three patients experienced grade 1 isolated infusion-related adverse events during a single infusion encounter. Two of the three patients received additional doses of rapid rituximab infusions without incident, whereas the other patient no longer required rituximab therapy. CONCLUSIONS The use of a 90-minute rituximab infusion protocol in pediatric patients with non-rheumatic diseases was well tolerated.
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von Roemeling, R., and W. J. Hrushesky. "Circadian patterning of continuous floxuridine infusion reduces toxicity and allows higher dose intensity in patients with widespread cancer." Journal of Clinical Oncology 7, no. 11 (November 1989): 1710–19. http://dx.doi.org/10.1200/jco.1989.7.11.1710.
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Continuous long-term 5-fluoro-2'-deoxyuridine (floxuridine; FUDR) infusion frequently causes severe and dose-limiting gastrointestinal toxicity when administered at a constant rate at commonly prescribed dose levels. In preclinical studies, a circadian infusion pattern peaking late in the daily activity phase was better tolerated and had superior antitumor activity than a constant infusion against a transplanted tumor. Based upon these data and upon other chronobiological cytokinetic and pharmacologic considerations, we compared a circadian patterned variable rate infusion with a maximal flow rate in the late afternoon/early evening and minimum flow rate during the early morning hours to a constant rate infusion in 54 patients with widespread cancer. All FUDR infusions were administered using an implanted drug pump. In a pilot crossover study and a second randomized trial, patients with metastatic malignancies treated with equal dose intensities experienced less frequent and less severe diarrhea, nausea, and vomiting following variable rate infusion. In a third study, the dose intensity of variable rate infusion was escalated stepwise to determine the maximum-tolerated dose. Patients receiving time-modified FUDR infusion tolerated an average of 1.45-fold more drug per unit time while evincing minimal toxicity. FUDR infusion was found to have activity against progressive metastatic renal cell cancer (RCC). Increased dose intensity achieved by optimal circadian shaping may improve the therapeutic index of infusional FUDR and may help control malignancies that are refractory to conventional chemotherapy.
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Bloomquist, Alison, and Laura Seiberlich. "Reducing Intermittent Infusion Syringe Pump Errors via Weight-Based Safety Parameters." Biomedical Instrumentation & Technology 49, s4 (January 1, 2015): 31–36. http://dx.doi.org/10.2345/0899-8205-49.s4.31.
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Historically, smart infusion pumps with dose error reduction software were implemented to improve safety associated with programming of continuous infusion modes on large-volume infusion pumps. Much of the published literature related to smart infusion pumps and safety alerts is focused on continuous medication infusions, with little available information related to their use with intermittent infusions. As a result of the focus on continuous infusions, an impression exists that intermittent infusions are less prone to programming errors and/or do not require comparably rigorous safety parameters, such as use of weightbased medication programming. Methods: A retrospective study was conducted with data from 10 pediatric inpatient hospitals, all of which used syringe infusion pumps for intermittent medications, to describe the impact of weight-based safety parameters on the occurrence of potential programming errors. The data were analyzed based on recorded safety alerts and alert triggers for weight-based (dose/kilogram/time) and non–weight-based (volume-over-time [VOT]) intermittent infusions. Results: Data from a total of 4,162 pumps, 943,448 total infusions, and 810,359 intermittent infusions between January 1 and December 31, 2013, were reviewed. Weight-based infusions had a greater percentage of safety alerts (83.3%) compared with VOT infusions (16.7%). Conclusion: Weight-based intermittent infusion modes can prevent programming errors and, compared with non–weight-based intermittent infusion modes, can be used to improve safety in the pediatric population. Additional research should be conducted to confirm a decrease in adverse drug events resulting from implementation of weight-based safety parameters.
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Hart, J. W., J. R. Murillo, M. S. Oholendt, and H. A. Preti. "Assessment of safety with abbreviated, weight-based bevacizumab infusions in a variety of solid tumors." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 19674. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.19674.
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19674 Background: Bevacizumab (BEV), a humanized monoclonal antibody that neutralizes vascular endothelial growth factor, has shown improved responses in patients with colorectal cancer (CRC) and non-small cell lung cancer (NSCLC) while displaying activity in a variety of other solid tumors. Phase I clinical trials with BEV utilized standard 90- 60-, and 30-minute infusions for 1st, 2nd, and subsequent infusions, as tolerated; initial doses reported less than 3% incidence of infusion-related adverse events (AEs), with 0.2% grade III/IV reactions. Recommended infusion rates for BEV remain unchanged despite the minimal risk of infusion-related AEs. Saltz and colleagues recently reported novel data supporting the safety and tolerability of abbreviated BEV infusions in CRC patients within a single institution. Our objective was to replicate previously reported safety profiles while utilizing abbreviated infusions of BEV in multiple tumor types. Methods: An internal retrospective analysis revealing minimal infusion AEs with standard infusions facilitated this current study. BEV- naïve and previously-treated patients were consented for the study utilizing the following weight-based infusion times: 5, 10, and 15 mg/kg doses over 10, 20, or 30 minutes, respectively, for all doses. Patients were assessed throughout and immediately following the infusion for any infusion-related AE. Results: A variety of tumor types are represented in 26 enrolled patients including CRC, NSCLC, breast, ovarian, pancreatic, and brain. Central nervous system involvement accounted for 35% of patients [primary brain (23%) and metastatic disease (12%)]. A considerable number of patients (19%) were treated with single-agent BEV. Nine BEV-naïve patients were initiated on abbreviated infusions, while 16 were converted from the standard infusion schedule. Seventy-seven total doses utilizing the abbreviated infusions failed to produce infusion-related AEs. Conclusion: These results support previous data affirming the safety and tolerability of abbreviated BEV infusions in CRC patients, while also reporting promising safety of abbreviated infusions in a variety of additionally unreported solid tumors types. No significant financial relationships to disclose.
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Aurran-Schleinitz, Thérèse, Gwaenaelle Gravis, Martine Vittot, Diane Coso, Jérôme Rey, Jean-Marc Schiano, Aude Charbonnier, Emmanuelle Fougereau, Dominique Maraninchi, and Reda Bouabdallah. "“One Hour” Rituximab Infusion Is Safe and Improves Patient Care and Outpatient Unit Management." Blood 106, no. 11 (November 16, 2005): 4759. http://dx.doi.org/10.1182/blood.v106.11.4759.4759.
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Abstract Background: Administration of the monoclonal anti-CD20 antibody Rituximab has been associated with infusional toxicity, leading to strict guidelines of use, i.e., infusion times from 4 to 6 hours. Even with pretreatment acetaminophen and diphenydramine, grade 3/4 adverse events including bronchospasm and hypotension occur in ~10% of patients with the first, and in < 2% with subsequent infusions. Presence of circulating malignant CD20 bearing cells represents a risk factor for developing grade 3/4 reactions. The pathophysiogy of this infusional toxicity is thought to be a “cytokine release syndrome” occuring within the 2 first hours of infusion. In few cases, it can be related to an anaphylactic reaction, occurring in the first minutes of infusion. Based on these observations and because infusional toxicity may be lower by the concomitant use of steroids, we established new guidelines of rituximab administration based on the number of circulating CD20+ cells, cycle number of the infusion, and allowing a total one-hour infusion time. Methods: A 1 mg/kg dose of steroids + diphenydramine + acetaminophen were given 20 minutes before each rituximab infusion. Rituximab dose was 375 mg/m2 diluted in 500 ml bottle. In the absence of circulating CD20+ cells, patients received their first course of rituximab according to the standard recommendations (from 50 mg/h and increasing by levels of 50mg/h every 30 min) until the fifth level. Then the remaining dose was administered at 500ml/h, with a total infusion time of ~3 h. The subsequent infusions were given at 100 mg/h for 15 minutes then at 500 ml/h, i.e. in one hour. In case of circulating malignant CD20+ cells, the first rituximab administration was administrated over 2 days: 50mg/m2 in 4h on day 1, and 325mg/m2 on day 2 according to the instructions described above. The subsequent infusions were administered according the one-hour protocol. Results: 69 patients have been treated in our outpatient unit, according to this protocol, for a total of 115 courses including 21 first cycles. Patients characteristics are as follows: median age 61 (range 26–85); 50% male; histology: 27 DLCBL including (IPI ≤1: 17 patients, IPI ≥2: 10 patients), 22 follicular, 2 mantle cell, 3 marginal zone, 2 lymphoplasmocytic, 1 Castelman disease, 11 CLL and 1 idiopathic thrombopenic purpura; treatment: R-CHOP in 51 patients, R-fludarabine/cytoxan in 15, R-chlorambucil in 1 and Rituximab alone in 2. Among the 21 first courses treatment was R-CHOP in 13, R- fludarabine/cytoxan in 3 and Rituximab in 5. No grade 3/4 toxicity was noted neither during the first nor the subsequent cycles. During the first infusion 2 patients developed grade 2, and 3 developed grade 1 reactions. One CLL patient had a grade 1 reaction after the second cycle. Conclusions: Taking into account the presence of circulating malignant CD20+ cells, a 3h first and one-hour subsequent infusion protocol is safe and well tolerated, independently of diagnosis and chemotherapy regimen. This protocol allows a sparing of 2 to 4 hours treatment time, very convenient for patients and in outpatient unit management.
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Hales, Jena B., Amber C. Ocampo, Nicola J. Broadbent, and Robert E. Clark. "Hippocampal Infusion of Zeta Inhibitory Peptide Impairs Recent, but Not Remote, Recognition Memory in Rats." Neural Plasticity 2015 (2015): 1–7. http://dx.doi.org/10.1155/2015/847136.
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Spatial memory in rodents can be erased following the infusion of zeta inhibitory peptide (ZIP) into the dorsal hippocampus via indwelling guide cannulas. It is believed that ZIP impairs spatial memory by reversing established late-phase long-term potentiation (LTP). However, it is unclear whether other forms of hippocampus-dependent memory, such as recognition memory, are also supported by hippocampal LTP. In the current study, we tested recognition memory in rats following hippocampal ZIP infusion. In order to combat the limited targeting of infusions via cannula, we implemented a stereotaxic approach for infusing ZIP throughout the dorsal, intermediate, and ventral hippocampus. Rats infused with ZIP 3–7 days after training on the novel object recognition task exhibited impaired object recognition memory compared to control rats (those infused with aCSF). In contrast, rats infused with ZIP 1 month after training performed similar to control rats. The ability to form new memories after ZIP infusions remained intact. We suggest that enhanced recognition memory for recent events is supported by hippocampal LTP, which can be reversed by hippocampal ZIP infusion.
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Nduom, Edjah K., Stuart Walbridge, and Russell R. Lonser. "Comparison of pulsed versus continuous convective flow for central nervous system tissue perfusion." Journal of Neurosurgery 117, no. 6 (December 2012): 1150–54. http://dx.doi.org/10.3171/2012.9.jns12506.
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Object Although pulsatile and continuous infusion paradigms have been described for convective delivery of drugs, the effectiveness and properties of each flow paradigm are unknown. To determine the effectiveness and properties of pulsatile and continuous convective infusion paradigms, the authors compared these convective flow methods in the gray and white matter of primates. Methods Six primates (Macaca mulatta) underwent convective infusion of Gd-DPTA (5 mM) into the cerebral gray matter (thalamus) or white matter (frontal lobe) using pulsed (intermittent pulses of 15 μl/min) or continuous (1 μl/min) convective flow. Results were assessed by clinical MRI and histological analyses. Results Distribution of Gd-DTPA infusate in gray and white matter by pulsed and continuous flow was clearly identified using MRI, which revealed that both convective flow methods demonstrated an increase in the volume of distribution (Vd) with increasing volume of infusion (Vi) in the surrounding gray and white matter. Although the mean (± SD) gray matter Vd:Vi ratio for the pulsed infusions (4.2 ± 0.5) was significantly lower than the mean Vd:Vi ratio for continuous infusions (5.4 ± 0.5; a 22% difference [p = 0.0006]), the difference between pulsed (3.8 ± 0.4) and continuous (4.3 ± 1.2) infusions in white matter was not significantly different (p = 0.3). Pulsed infusions were associated with more leakback (12.3% ± 6.4% of Vi) than continuous infusions (3.9% ± 7.8%), although this difference was not significant (p = 0.2). All animals tolerated the infusions and there was no histological evidence of tissue injury at the infusion sites. Conclusions Although pulsed and continuous infusion flow paradigms can be safely and effectively used for convective delivery into both gray and white matter, continuous infusion is associated with a higher Vd:Vi ratio than pulsatile infusion in gray matter. High rates of infusion (15 μl/min) can be used to deliver infusate without any significant leakback and without any clinical or histological evidence of injury.
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Avery, Pearl, Lisa Younge, Anya St Clair-Jones, Rachel Campbell, Deirdre Braim, Becky George, Heather Johnson, Tracy Naughton, Fiona Rees, and Frances Maw. "Limiting infusion and observation times for infliximab and vedolizumab in the COVID-19 pandemic: a UK multicentre audit of practice and safety." Gastrointestinal Nursing 18, no. 8 (October 2, 2020): 30–36. http://dx.doi.org/10.12968/gasn.2020.18.8.30.
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Background: Infusions units in the UK are under increasing pressure, and this has been increased by the SARS-COV-2 pandemic. People with inflammatory bowel disease (IBD) are considered vulnerable, requiring enhanced social distancing or shielding, as defined in the UKz government's recommendations for COVID-19. Evidence that post-infusion observation time is unnecessary for infliximab (IFX) and vedolizumab (VDZ) exists in the literature, but the summary of product characteristics for both agents states that anywhere from 0.5 hours to 2 hours of observation post-infusion is required. Methods: A call was put out using the Royal College of Nursing's Facebook page, and IBD nurses from eight trusts in the UK took part. Data were gathered on trusts' current practice, infusion times for IFX and VDZ and reported infusion reactions. Results: Two (25%) trusts reported already having reduced post-infusion observation periods for people receiving IFX infusions 1–3; this increased to three units (37.5%) for infusions 4–9 and six (75%) for infusions >10. No infusion reactions were seen after the first 20 minutes of infusion time in 3934 IFX and 1265 VDZ infusions. Conclusions: The audit results suggested that there is no safety signal reduced post-infusion observation time, supporting evidence already present in the literature, and this can support increased capacity in infusion units. The time burden for people with Crohn's disease (CD) or ulcerative colitis (UC) is reduced, which is increasingly important during the pandemic. The reduced length of time that people need to spend at hospital offers trusts an option to help shield those who need to be protected from COVID-19.
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Nasonov, K., M. Pomazkov, V. Kushnarev, and A. Yatsenko. "INFUSION PORTABLE SYSTEM." Amur Medical Journal, no. 15-16 (2016): 95. http://dx.doi.org/10.22448/amj.2016.15-16.95.
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Harvey, V. J., M. L. Slevin, G. W. Aherne, P. Littleton, A. Johnston, and P. F. Wrigley. "Subcutaneous infusion of bleomycin--a practical alternative to intravenous infusion." Journal of Clinical Oncology 5, no. 4 (April 1987): 648–50. http://dx.doi.org/10.1200/jco.1987.5.4.648.
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The phase specificity and short half-life of bleomycin make it likely that it would be more effective when administered by continuous infusion. This is supported by studies using cell lines, as well as by animal studies and clinical experience in humans. This study was conducted to compare the pharmacokinetics of intravenous (IV) and subcutaneous infusions of bleomycin. The serum concentrations of bleomycin were measured using a sensitive and specific radioimmunoassay. The results demonstrate similar plasma concentrations and area under the curve for both routes. The subcutaneous infusions were well tolerated, without local discomfort or excoriation. Subcutaneous infusion of bleomycin may thus offer a practical alternative to IV infusions and can be administered to patients who are ambulatory and out of hospital.
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Gill, David Michael, Wendy Burr, Mckenzie Bell, Alisa Thomas, Jenny Simmonds, Megan Mullalley, Libby Petersen, et al. "Barriers to patient-centered oncology care: Pilot study of home infusion of anticancer immunotherapy." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 36. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.36.
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36 Background: ASCO published a position statement regarding home infusion of anticancer therapy in June 2020. This statement recommends independent research to evaluate the safety and effectiveness of home infusions. Intermountain Healthcare (IM) incorporated this statement into its oncology care with an IRB-approved, prospective single-arm pilot study to determine the safety and feasibility of home administration of checkpoint inhibitor (CPI) immunotherapy with synchronous telemedicine visits. Methods: Patients with cancer receiving treatment at Intermountain Medical Center and Intermountain Cancer Center St. George were screened for enrollment into an IRB-approved, non-randomized pilot study of 20 patients. Eligibility criteria required patients to receive a CPI for an FDA-approved indication, live in Washington County or Salt Lake County, Utah, and have commercial payer coverage of CPI home infusion. Eligible patients were required to receive 2 doses of CPI at an infusion center, and patients who experienced an infusion reaction were excluded from receiving home infusion. Home infusion nurses are trained in oncology, CPIs, and home infusion reaction protocol. During synchronous video visits, infusion nurses are trained to perform the hands-on portions of the physical exam. A financial analysis estimated cost to IM and commercial payers for routine and home CPI infusions. Results: 622 patients were screened, of which 104 were receiving a CPI. 64 patients lived in an eligible county and 19 patients had commercial payer coverage. Of patients on CPIs, 8.7% (9/104) met all eligibility criteria accounting for 1.4% (9/622) of all patients with cancer screened (Table). Financial analysis estimated $829 cost (excluding drug cost) to IM for standard infusion reimbursement compared to $599 for in-home CPI infusions, accounting for savings of $230 per infusion. Majority of cost savings are from elimination of infusion center facilities fee ($495). Analysis includes $269 for home infusion nurse wages. Subsequent analysis for commercial payer SelectHealth estimates $270 reimbursement savings for the payer. Conclusions: Home immunotherapy infusions are estimated to be cost effective for both IM and commercial payers. However, lack of drug coverage and the rural demographics of Utahns with cancer are barriers to home CPI infusions. The pilot study was discontinued per infeasibility stopping criteria.[Table: see text]
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Nguyen, My L., Catherine Burdalski, Syed Abbas Ali, Lindsay Kohler, and Steven Gilmore. "Prevention and Management of Daratumumab Mediated Infusion Related Hypersensitivity Reactions Pre-and Post-Implementation of Rapid Infusion Protocol." Blood 134, Supplement_1 (November 13, 2019): 5811. http://dx.doi.org/10.1182/blood-2019-125391.
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Background: Multiple Myeloma (MM) is defined as a clonal proliferation of malignant bone marrow plasma cells with high and uniform expression of CD 38 (Kumar et al, J Natl Compr Canc Netw. 2019; 3 and Lin et al, Am J Clin Pathol. 2004; 121:482-488). Daratumumab, a human IgGk monoclonal antibody, targets and binds to CD38, induces antibody dependent cell mediated cytotoxicity, complement activation, and antibody mediated phagocytosis (Prescribing information. Daratumumab; Janssen Biotech, Inc 2016). Daratumumab is associated with infusion related reactions (IRRs), which present with symptoms of rhinitis, cough, dyspnea, bronchospasm, chills and nausea. In two phase 3 trials, CASTOR (Palumbo et al, N Engl J Med. 2016; 375:754-66) and POLLUX (Dimopolous et al, N Engl J Med. 2016; 375(14):1319-31), IRRs occurred in 45% and 48% of patients, respectively. Of these, 98% and 96%, respectively, occurred during the first infusion. Grade 3 IRRs occurred in 5.3% and 8.6% of patients in CASTOR and POLLUX, respectively. No grade 4 IRRs were observed in either trial. Standard of care includes extended infusion times for the first, second, and subsequent infusions with a three-drug pre-infusion prophylaxis strategy including diphenhydramine, dexamethasone or methylprednisolone, and acetaminophen with slow prolonged infusion times is recommended(Bhatnagar et al, Oncologist. 2017; 22:1347-53). A single-arm safety study of accelerated infusion rate indicate that administering daratumumab using a time-saving 90-minute infusion protocol can be safe. Of 28 patients treated with accelerated daratumumab infusion during their third and subsequent infusions, no IRRs were observed, and there was only one mild reaction with no further reactions during subsequent infusions at the 90-minute rate (Barr et al, Leukemia. Mar. 2018). Subsequently, a similar protocol for all daratumumab infusions was implemented at The Johns Hopkins Health System including five premedications and three medications (5+3) during the first two infusions. Premedication can be eliminated for lack of tolerance. The purpose of this study is to evaluate the safety and success of rapid daratumumab administration in clinical practice based on infusion times, IRRs prophylaxis medication administration, IRRs frequency, and management of IRRs in the ambulatory setting of the Johns Hopkins Health System, pre- and post-implementation of the 90-minute infusion protocol using a more robust premedication regimen (5+3) than previously published. Study Design and Methods: This study is approved by the institutional review board at The Johns Hopkins Hospital (IRB 00195519). This is a retrospective, chart review of daratumumab infusions prior to implementing the accelerated infusion rate. The inclusion criterion was adult patients who received daratumumab infusion in the ambulatory infusion clinic July 1, 2016 to May 25, 2018 for pre-implementation and July 1 2018 to June 30 2019 for the post-implementation period. Patients who only received inpatient administration of daratumumab were excluded due to limited infusion related documentation. The primary endpoint is the proportion of patients who experienced IRRs after daratumumab infusion. Secondary endpoints include proportion of patients with grade 1/2 or grade 3/4 IRRs, infusion duration (hours), and the number of pre and post infusion prophylaxis medications given. Other data collected will include but not limited to demographics, prior history of anaphylaxis, eczema, asthma, or other drug allergies to identify risk factors not previously defined. Results: Data collection and analysis are ongoing. The sample size for pre-implementation of rapid infusion is ninety-three patients. Documented IRRs occurred in 18 (19%) patients. The mean infusion time was 7.4 hours for first infusions (n=70), 8 hours for patients with IRRs in the first infusion (n=18) and 7.1 hours for patients without IRRs in the first infusion (n=52). The mean number of IRR prophylaxis medications given was 7.8 (range 2-9) for first or second infusions. All IRRs documented were grade 1 or 2. Additional data analysis will include descriptive statistics as well as comparison of infusion duration, and will use paired t-test within samples and student t-test across different samples. Final results will report safety of daratumumab rapid infusion in largest single center patient population to date. Disclosures Ali: Celgene: Research Funding; Poseida: Research Funding.
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Salar, Antonio, Dolors Casao, Carmen Pedro, Eugenia Abella, Montserrat Calafell, Alberto Alverez, and Carlos Besses. "Rapid Infusion of Rituximab with or without Steroid Containing Chemotherapy. A Single Centre Experience." Blood 106, no. 11 (November 16, 2005): 4772. http://dx.doi.org/10.1182/blood.v106.11.4772.4772.
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Abstract Introduction: Infusion-related toxicity is frequent after the administration of Rituximab despite the fact that strict guidelines have been recommended. Recently, a rapid rituximab infusion schedule in combination with a steroid containing chemotherapy regimen was well tolerated and safe. Purpose: To investigate the feasibility of a rapid infusion of rituximab with or without steroid containing chemotherapy. Methods: Inclusion criteria: lymphoproliferative disorder CD20+ and having been treated with a first infusion of rituximab according to the product monograph. Exclusion criteria: lymphocytosis > 5 x 109/L, toxicity grade 3/4 in the previous infusion of rituximab or dose > 375 mg/m2. Schedule: First infusion of rituximab according to the product monograph; Further infusions over a total time of 90 minutes (20% in the first 30 minutes and the remaining 80% over 60 minutes). Premedication: acetaminophen and diphenhidramine, plus methylprednisolone only in those patients receiving steroid containing chemotherapy. Results: A total of 50 patients were treated for a total of 165 infusions. Patient characteristics: median age 62 yr (range 28–83), 49 % males, DLBCL 36%, follicular 47%, mantle 6%, MALT 7%, other 4%. Chemotherapy regimens: R-CHOP 28%, R-EPOCH 9%, R-ESHAP 4%, R-other chemotherapy 8%, rituximab monotherapy 10%, rituximab maintenance 41%. Number of rituximab administrations with and without steroids: 68 and 97 infusions, respectively. Median time from previous rituximab infusion was 29 days (range 7–272). Sixteen rapid infusions were administered with an interval greater than 90 days from the previous standard infusions. This rapid rituximab administration schedule was very well tolerated. No grade 3/4 adverse events were seen. Two patients referred symptoms during rituximab infusion (both grade 1): abdominal discomfort that disappeared spontaneously and sore throat that required to slow down the infusion speed. All these reactions occurred in patients who did not receive premedication with steroids. Conclusions: Rituximab administration in a 90-minute infusion schedule is well tolerated and safe in this group of patients. This approach is beneficial, both in patients who are administered steroids and in patients who are not.
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Patel, Jolly R., Viet Q. Ho, Melissa L. Teichman, Lubomir Sokol, Celeste M. Bello, Jennifer L. Cultrera, Eduardo M. Sotomayor, and Gene A. Wetzstein. "Rapid Infusion Rituximab in Maintenance Therapy: Is It Feasible?" Blood 118, no. 21 (November 18, 2011): 4973. http://dx.doi.org/10.1182/blood.v118.21.4973.4973.
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Abstract Abstract 4973 Background/Rationale: Rituximab is an anti-CD-20 monoclonal antibody used in the management of lymphoproliferative disorders. Rituximab is indicated in maintenance therapy for follicular cell lymphoma and can be administered once every 2 months, once every 3 months, or weekly for 4 weeks every 6 months. The use of maintenance rituximab has improved progression free survival and overall survival in low grade follicular lymphomas. Although rapid rituximab infusions have been studied extensively, there is little data on the use of rapid infusions during maintenance therapy for low grade lymphomas. Herein we report our experience with rapid infusion rituximab in patients receiving maintenance therapy. Methods: All patients who received rapid infusion rituximab as maintenance therapy for low grade lymphoma between December 2007 and June 2011 were included. Patients were considered eligible for rapid infusions if they tolerated previous rituximab infusions and presented with a peripheral lymphocyte count of less than 4.8 k/μl. Rapid rituximab infusions were administered over 90 minutes (150 mL/hr for 30 minutes and then increased to 275 mL/hr until completion). Patients were monitored for signs and symptoms of reactions. In case of an infusion reaction supportive care medications were readily available. Demographic, laboratory and clinical data were collected. Adverse events were assessed through vital signs, symptoms of infusion related reaction and supportive care measures administered and graded according to the Common Terminology Criteria for Adverse Events Version 4. The primary and secondary objectives of this retrospective study were to evaluate the incidence of grade 3/4 and all grade infusion reactions with rapid rituximab infusions during maintenance therapy, respectively. Maintenance schedules were also compared with regards to incidence of infusion reactions. Results: A total of 105 patients received 629 rapid rituximab infusions. Patient demographics, laboratory, and clinical data are summarized in Table 1. All patients were eligible for rapid infusion rituximab according to institutional criteria. Two grade 2 infusion reactions and 4 grade 3 reactions were reported (1 patient experienced a grade 2 and 3 reaction); however none of these patients required hospitalization. All 5 patients received pharmacological and/or supportive care to relieve the symptoms associated with the reaction. Of these 5 patients, 3 patients went on to receive rapid infusions of rituximab; 2 patients were switched to standard infusion per physician request. The sample size was too small to determine if a correlation existed between infusion related reactions and the schedule of maintenance rituximab. Conclusion: The rapid infusion of rituximab in patients receiving maintenance therapy is well tolerated with minimal incidence of infusion-related reactions. Although the sample size was insufficient to assess differences in adverse effects according to the maintenance schedule, the low overall incidence of adverse effects suggests that rapid rituximab infusions are well tolerated regardless of maintenance schedule. Our study concludes rapid infusion rituximab is a safe and feasible option for maintenance therapy. Disclosures: Ho: Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees. Off Label Use: Maintenance Rituximab Therapy in Non-Hodgkin's Lymphoma. Cultrera:Genentech: Speakers Bureau. Sotomayor:Genentech: Membership on an entity's Board of Directors or advisory committees. Wetzstein:Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees.
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Broderick, Tom L., Paul Poirier, Angelo Tremblay, Claude Catellier, and André Nadeau. "Effect of exogenous insulin on plasma free carnitine levels during exercise in normal man." Canadian Journal of Physiology and Pharmacology 67, no. 12 (December 1, 1989): 1598–601. http://dx.doi.org/10.1139/y89-257.
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Preliminary data from our laboratory have shown that the decrease in plasma free carnitine levels normally found during prolonged exercise is blunted in type 1 diabetic man. This study was designed to test the hypothesis that this might be due to the sustained peripheral hyperinsulinemia seen during exercise in diabetics treated by subcutaneous insulin. Ten male subjects underwent 90 min of cycle ergometry at 60% of their maximal oxygen uptake capacity on two occasions, one with and the other without a constant 0.13 mU∙kg−1∙min−1 i.v. insulin infusion. Blood samples were taken at rest, during exercise, and after exercise for measurement of plasma glucose, insulin, C-peptide, free fatty acids, and carnitine. Plasma glucose dropped significantly (p < 0.01) from basal during both infusions, but values at 30, 45, and 60 min of exercise were lower (p < 0.05) during insulin infusion compared with the saline infusion. Exercise produced a significant (p < 0.01) fall in plasma insulin in both infusions. However, from 30 to 90 min of exercise, the plateau insulin level was higher during the insulin infusion compared with the saline infusion (91.4 ± 3.0 vs. 32.9 ± 3.0 pmol/L; p < 0.001). Plasma C-peptide decreased significantly (p < 0.01) during exercise and recovery in both infusions, but values between infusions were not significantly different. Plasma free fatty acids increased significantly (p < 0.01) at 90 min of exercise during the saline infusion, while during the insulin infusion this was noted during recovery only. Free fatty acid values at 75 (p < 0.05) and 90 min (p < 0.01) of exercise, and during recovery (p < 0.01), were lower during the insulin infusion than during the saline infusion. Plasma free carnitine declined (p < 0.01) during exercise and recovery. However, at 60 min of exercise and at 30 min of recovery, free carnitine levels were significantly (p < 0.05) lower during the saline infusion compared with the insulin infusion. The decrement in surface area below baseline in free carnitine was greater during the saline infusion than in the insulin infusion (−298 ± 52 vs. −133 ± 29 μmol∙L−1∙min−1; p < 0.01). Esterified carnitine increased (p < 0.01) similarly during both infusions. These data indicate that the fall in plasma free carnitine during exercise can be reduced by an exogenous insulin infusion in normal man. Indirectly, this suggests that the absence of a decline in plasma free carnitine during exercise in diabetics can be explained by their high insulin levels.Key words: insulin, free carnitine, free fatty acids, acute exercise.
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Schoorlemmer, G. H. M., A. K. Johnson, and R. L. Thunhorst. "Effect of hyperosmotic solutions on salt excretion and thirst in rats." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 278, no. 4 (April 1, 2000): R917—R923. http://dx.doi.org/10.1152/ajpregu.2000.278.4.r917.
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We investigated urinary changes and thirst induced by infusion of hyperosmotic solutions in freely moving rats. Intracarotid infusions of 0.3 M NaCl (4 ml/20 min, split between both internal carotid arteries) caused a larger increase in excretion of Na+ and K+ than intravenous infusions, indicating that cephalic sensors were involved in the response to intracarotid infusions. Intravenous and intracarotid infusions of hyperosmotic glycerol or urea (300 mM in 150 mM NaCl) had little or no effect, suggesting the sensors were outside the blood-brain barrier (BBB). Intracarotid infusion of hypertonic mannitol (300 mM in 150 mM NaCl) was more effective than intravenous infusion, suggesting that cell volume rather than Na+ concentration of the blood was critical. Similarly, intracarotid infusion (2 ml/20 min, split between both sides), but not intravenous infusion of hypertonic NaCl or mannitol caused thirst. Hyperosmotic glycerol, infused intravenously or into the carotid arteries, did not cause thirst. We conclude that both thirst and electrolyte excretion depend on a cell volume sensor that is located in the head, but outside the BBB.
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Choquette, Denis, Rafat Faraawi, Andrew Chow, Jude Rodrigues, William J. Bensen, and Francois Nantel. "Incidence and Management of Infusion Reactions to Infliximab in a Prospective Real-world Community Registry." Journal of Rheumatology 42, no. 7 (June 15, 2015): 1105–11. http://dx.doi.org/10.3899/jrheum.140538.
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Objective.Infliximab (IFX) is a therapeutic monoclonal antibody targeting tumor necrosis factor-α indicated in the treatment of chronic inflammatory diseases. IFX is administered by intravenous infusion and may be associated with different types of infusion reactions.Methods.RemiTRAC Infusion (NCT00723905) is a Canadian observational registry in which patients receiving IFX are followed prospectively to document premedication use, adverse events, infusion reactions, and the management of infusion reactions. The primary endpoint was to assess factors associated with infusion reactions.Results.There were 1632 patients enrolled and 24,852 infusions recorded. Most patients (63.1%) were treated for rheumatologic conditions such as rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis. Of the 1632 patients, 201 (12.3%) reported at least 1 infusion reaction. Three hundred twenty-two infusions were associated with an infusion reaction (1.3%), and most were mild to moderate in severity (95%). The most common infusion reactions were pruritus (19.9%), flushing (9.9%), or dyspnea (6.2%). Multivariate analysis showed that antihistamines premedication, number of previous infusion reactions, and female sex were significantly associated with an increased incidence of infusion reactions (p < 0.0011). The use of any concomitant immunosuppressant or corticosteroids did not influence the incidence of infusion reactions. Antihistamine premedication was associated with an increased incidence of infusion reactions (OR 1.58, p = 0.0007).Conclusion.This registry shows that in community-based infusion clinics, infusion reactions to IFX are uncommon and mild to moderate in nature. Antihistamines, intravenous steroids, and acetaminophen are widely used as preventative premedication, although this study showed an absence of benefit with their use.
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KELSALL, JOHN, PAMELA ROGERS, GRISELDA GALINDO, and MARY A. De VERA. "Safety of Infliximab Treatment in Patients with Rheumatoid Arthritis in a Real-world Clinical Setting: Description and Evaluation of Infusion Reactions." Journal of Rheumatology 39, no. 8 (May 15, 2012): 1539–45. http://dx.doi.org/10.3899/jrheum.110956.
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Objective.To describe acute and delayed infusion reactions in a large cohort of patients with inflammatory arthritis, treated with infliximab (IFX).Methods.We conducted a retrospective chart review of patients treated with IFX at the Mary Pack Arthritis Centre between 2000 and 2008. The primary outcome was the occurrence of acute infusion reactions during infusions or 1–2 hours after each infusion, and secondary outcome was the occurrence of delayed infusion reactions 1–14 days after an infusion. Descriptive analyses were conducted to summarize study outcomes and identify trends over followup.Results.Since 2000, 376 patients were referred to the Mary Pack IFX clinic and 200 received 4399 IFX infusions over a mean 140 ± 132 weeks of followup. Of these, 135 were patients with RA who received 2977 IFX infusions over mean followup of 138 ± 132 weeks. In total 258 episodes of acute reactions were observed for an overall acute reaction rate of 5.8%. Acute infusion reactions were mostly mild (42.6%) and moderate (43.8%) and commonly affected sites were head and neck (31.5%) and cutaneous (21.1%). A total of 37 delayed infusion reaction episodes were observed (0.9% rate); reactions were also mostly mild (16.2%) and moderate (64.9%).Conclusion.These clinical data from 200 patients treated with IFX demonstrate that acute and delayed infusion reactions occur infrequently and are mostly mild to moderate in presentation.
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Legeay, Clément, Henrique Bittencourt, Elie Haddad, Laurence Spiesser-Robelet, Valérie Thépot-Seegers, and Roxane Therrien. "A Retrospective Study on Infusion-Related Reactions to Rituximab in a Heterogeneous Pediatric Population." Journal of Pediatric Pharmacology and Therapeutics 22, no. 5 (September 1, 2017): 369–74. http://dx.doi.org/10.5863/1551-6776-22.5.369.
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OBJECTIVES To assess risks and outcomes of infusion-related reactions to rituximab in a heterogeneous pediatric population. METHODS All patients who received rituximab between July 2010 and July 2012 were retrieved from the pharmacy software and included for analysis. Data were collected according to 4 categories: demographic data, infusion data, infusion-related reactions, and biological data considered as risk factors (i.e., absolute lymphocyte count, lactate dehydrogenase levels). RESULTS Sixty-seven patients treated for a total of 17 different indications were included. A total of 282 rituximab infusions were administered. Forty-three, mostly grade 1 or 2, infusion-related reactions occurred in 30 patients. Reactions occurred in 39.2% “first-dose” infusions, but this rate dropped drastically to 2.7% in subsequent doses. In multivariate analysis, high absolute lymphocyte count was the only risk factor for infusion-related reaction (OR = 1.03; 95% CI: 1.01–1.06; p = 0.014). CONCLUSIONS Rituximab infusion-related reactions in a heterogeneous pediatric population were frequent on first infusion, but rare in subsequent ones. Overall, these reactions were mild and manageable through pharmacological treatment. Patients with an elevated absolute lymphocyte count before infusion were at greater risk for an infusion-related reaction.
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Hubert, Dominique, Evelyne Le Roux, Thibaud Lavrut, Benoit Wallaert, Philippe Scheid, Dominique Manach, Dominique Grenet, et al. "Continuous versus Intermittent Infusions of Ceftazidime for Treating Exacerbation of Cystic Fibrosis." Antimicrobial Agents and Chemotherapy 53, no. 9 (June 15, 2009): 3650–56. http://dx.doi.org/10.1128/aac.00174-09.
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ABSTRACT The present multicenter, randomized crossover study compared the safety and efficacy of continuous infusion with those of short infusions of ceftazidime in patients with cystic fibrosis. Patients with chronic Pseudomonas aeruginosa colonization received two successive courses of intravenous tobramycin and ceftazidime (200 mg/kg of body weight/day) for pulmonary exacerbation administered as thrice-daily short infusions or as a continuous infusion. The primary endpoint was the variation in the forced expiratory volume in 1 s (FEV1) during the course of antibiotic treatment. Sixty-nine of the 70 patients enrolled in the study received at least one course of antibiotic treatment. The improvement in FEV1 at the end of therapy was not statistically different between the two treatment procedures (+7.6% after continuous infusion and +5.5% after short infusions) but was better after continuous ceftazidime treatment in patients harboring resistant isolates (P < 0.05). The interval between the course of antibiotic treatments was longer after the continuous infusion than after the short infusion of ceftazidime (P = 0.04). The mean serum ceftazidime concentration during the continuous infusion was 56.2 ± 23.2 μg/ml; the mean peak and trough concentrations during the short infusions were 216.3 ± 71.5 and 12.1 ± 8.7 μg/ml, respectively. The susceptibility profiles of the P. aeruginosa isolates remained unchanged and were similar for both regimens. Quality-of-life scores were similar whatever the treatment procedure, but 82% of the patients preferred the continuous-infusion regimen. Adverse events were not significantly different between the two regimens. In conclusion, the continuous infusion of ceftazidime did not increase its toxicity and appeared to be as efficient as short infusions in patients with cystic fibrosis as a whole, but it gave better results in patients harboring resistant isolates of P. aeruginosa.
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Yu, Denny, Kang-Yu Hsu, Joon Hong Kim, and Poching DeLaurentis. "Infusion pump informatics approach to quantify impact of alerts and alarms on healthcare delivery." Proceedings of the Human Factors and Ergonomics Society Annual Meeting 61, no. 1 (September 2017): 681–85. http://dx.doi.org/10.1177/1541931213601657.
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Infusion pumps are medical devices that deliver medication, fluids, and nutrients in a precise and controlled manner that is critical to patient care. This study proposes using infusion pump informatics on all-infusion datasets to understand current impact of alerts and alarms on patient care and health practitioner workflow. All-infusion datasets contain infusion data for both normal and abnormal use, i.e., error states. Ten months of continuous data was collected from one health institution. Analysis of variance with log-transformation and logistic regressions were used to analysis contributing factors for alerts and alarms states. A total 64,511 minutes of alarm activation were observed, where alarms were active prior to being resolved. Mean resolution times for 83% of alarms were one minute or less; however, 3% or alarms required >4 minutes before getting resolved. Risk factors for infusions with alerts included nursing shift variables. Specifically, odds for alerts were 1.3 times higher for infusions that span across shifts than infusions in the day shift.
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Sehn, Laurie H., Jane Donaldson, Allison Filewich, Catherine Fitzgerald, Karamjit K. Gill, Nancy Runzer, Barb Searle, et al. "Rapid Infusion Rituximab in Combination with Steroid Containing Chemotherapy Can Be Given Safely and Substantially Reduces Resource Utilization." Blood 104, no. 11 (November 16, 2004): 1407. http://dx.doi.org/10.1182/blood.v104.11.1407.1407.
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Abstract Background Administration of rituximab, a chimeric anti-CD20 monoclonal antibody, can be associated with substantial infusion-related toxicity, including hypersensitivity reactions causing fever, rash, cardiovascular and respiratory compromise and rarely a fatal cytokine release syndrome. The risk of grade 3/4 infusion reactions is greatest with the first infusion (7%), and lower for all subsequent infusions (2% for fourth infusion). To minimize the risk of reaction, strict guidelines for administration have been developed, requiring lengthy infusion times (average 5–6 h for first infusion and 3–4 h for remaining infusions). As more patients are now receiving rituximab in combination with steroid containing chemotherapy regimens, the risk of reaction may be lower and the need for lengthy infusion unnecessary. Methods In March 2004, we began a pilot study investigating the safety of a rapid infusion rituximab schedule for all patients with non-Hodgkin’s lymphoma receiving rituximab in combination with CHOP or CVP chemotherapy. The schedule of administration for cycle 1 of therapy was unaltered and delivered according to the product monograph. All further cycles were administered the same day of chemotherapy, over a total infusion time of 90 minutes (20% of the dose in the first 30 min then the remaining 80% over 60 min; total dose delivered in 250 mL). Patients took their daily prednisone dose prior to receiving rituximab. Safety information was monitored prospectively using an infusion monitoring record. Results 67 patients have been treated for a total of 163 infusions (median infusions per patient: 2). Patient characteristics are as follows: median age, 64 y (range 21–90); 67% male; 66% stage III/IV; PS > 1, 19%; IPI score high/high-intermediate, 36%. Histology: 42 DLBCL, 6 follicular, 8 transformed, 4 mantle cell, 7 other. No patients had increased numbers of circulating lymphocytes. Chemotherapy regimen: 57 CHOP, 9 CVP, 1 other. The 90-minute rituximab infusion schedule was extremely well tolerated with no grade 3/4 adverse infusion related events observed. One patient developed mild transient asymptomatic hypotension, BP 97/71, grade 1 toxicity, which was managed with a 30-minute infusion delay. Four patients (6%) had an adverse event with their first cycle (administered at the standard rate) and subsequently tolerated the rapid infusion schedule without event. Five patients did not receive steroids with their treatment due to a prior history of hepatitis exposure and none of these patients developed an adverse event with the rapid infusion. The overall rate of grade 3/4 infusion related reactions observed with the rapid infusion protocol was 0% (95% CI 0–0.044), which is at least as low as the expected rate following the standard infusion schedule. No increased incidence in minor reactions was noted. Introduction of this shortened infusion schedule has enabled us to cut rituximab infusion times in half, allowing more patients to be conveniently treated and ensuring that both chemotherapy and rituximab can be given in one rather than two days. Conclusion A rapid (90-minute) rituximab infusion schedule in combination with a steroid containing chemotherapy regimen is well tolerated and safe when administered from the second infusion onward. This shortened infusion schedule has resulted in a substantial reduction in resource utilization.
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REES, F., A. Packham, C. Blake, E. Hills, G. Scutt, and A. St Clair-Jones. "P604 Can we reduce intravenous monoclonal antibody observation times without compromising patient safety? A single centre retrospective observational study." Journal of Crohn's and Colitis 14, Supplement_1 (January 2020): S504—S505. http://dx.doi.org/10.1093/ecco-jcc/jjz203.732.
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Abstract Background Monoclonal antibodies (MAbs) are integral to inflammatory bowel disease (IBD) management. The administration of intravenous (IV) MAbs, infliximab and vedolizumab, for Brighton and Sussex University Hospital patients is via an outpatient clinic. Licensing specifies lengthy observation times; infliximab for induction (infusion 1 to 3) and maintenance (infusion 4 onwards) requires 1 to 2 h observation. Vedolizumab for induction (infusion 1 to 2) requires 2 h observation and maintenance (infusion 3 onwards) 1-h observation. This can affect waiting times; 33% UK patients waited longer than two weeks for infliximab. A reduction in observation times could improve capacity but needs to be done without compromising patient safety. Methods A single centre observational study was conducted. Retrospective data were collected on all current patients receiving infliximab or vedolizumab at BSUH. Data were collected over 12 weeks (April to July 2019); patients seen twice in this period were included once. The presence of reaction from current and previous infusions was determined by patient questioning and patient records review. Reaction occurrence, nature and management were recorded. There is not a grading system for IBD infusion-related reactions. To standardise we used the cancer Common Terminology Criteria for Adverse Events; grade 3 and above is designated severe (grade 5 being death). Results For infliximab 130 patients were reviewed with 2607 infusions administered in total. For vedolizumab 69 patients were reviewed with 557 infusions administered in total. Due to the small sample size significance could not be reached. The survival plot indicates high levels of ‘no reactions’ observed in the first 4 infusions of infliximab 97.7% (+1.6%, -4.7%), and first 3 infusions of vedolizumab 96.9% (+2.3%, −8.8%). Considering capacity over 12 weeks, for infliximab a minimum of 121 could be recouped and 64 h for vedolizumab. Extrapolated this could equate to 740 h per year. Conclusion All reactions occurred within three infusions, were non-severe and managed within the infusion clinic. By removing the observation period from infusion 4 onwards, infusion clinic capacity could be increased but further data from multiple centres are required to prove significance.
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Fellows, I. W., T. Bennett, and I. A. Macdonald. "The effect of Adrenaline upon Cardiovascular and Metabolic Functions in Man." Clinical Science 69, no. 2 (August 1, 1985): 215–22. http://dx.doi.org/10.1042/cs0690215.
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1. On three separate occasions, at least 1 week apart, seven young healthy male subjects received intravenous infusions of either adrenaline, 50 ng min−1 kg−1 (high A), adrenaline, 10 ng min−1 kg−1 (low A) or sodium chloride solution (saline :154 mmol of NaCl/1) plus ascorbic acid, 1 mg/ml (control), over 30 min. 2. Venous adrenaline concentrations of 2.19 ± 0.15 nmol/l, 0.73 ± 0.08 nmol/l and 0.15 ± 0.03 nmol/l were achieved during the high A, low A and control infusions respectively. 3. Heart rate rose significantly by 19 ± 3 beats/min (high A) and by 6 ± 1 beats/min (low A). Heart rate remained significantly elevated 30 min after cessation of the high A infusion, despite venous plasma adrenaline concentration having fallen to control levels. 4. The diastolic blood pressure fell during the high A and low A infusions, but the systolic blood pressure rose only during the high A infusion. 5. Vasodilatation occurred in the calf vascular bed during both high A and low A infusions. The changes in hand blood flow and hand vascular resistance were not statistically significant, although there was a tendency to vasoconstriction during the infusion of adrenaline. 6. Metabolic rate rose significantly by 23.5 ± 1.8% (high A) and by 11.8 ± 1.6% (low A). Metabolic rate remained elevated between 15 and 30 min after termination of the high A infusion. There was an initial transient increase in respiratory exchange ratio (RER) during the adrenaline infusions. During the later stages of the adrenaline infusions and after their cessation, RER fell, probably reflecting increased fat oxidation. 7. Blood glucose, glycerol and lactate concentrations all rose significantly during the high A infusion, but only the blood glycerol concentration rose during the low A infusion. Plasma potassium concentration fell during and after the high A infusion but only after cessation of the low A infusion. 8. When adrenaline was infused intravenously at rates that elevated the plasma adrenaline concentration within the physiological range, peripheral circulatory effects were observed similar to those previously described for larger doses of adrenaline. The persistent tachycardia noted after stopping the high A infusion may, at least in part, have been a consequence of the concomitantly elevated metabolic rate.
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Ho, M., J. Armstrong, D. McMahon, G. Pazin, XL Huang, C. Rinaldo, T. Whiteside, C. Tripoli, G. Levine, and D. Moody. "A phase 1 study of adoptive transfer of autologous CD8+ T lymphocytes in patients with acquired immunodeficiency syndrome (AIDS)-related complex or AIDS." Blood 81, no. 8 (April 15, 1993): 2093–101. http://dx.doi.org/10.1182/blood.v81.8.2093.2093.
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Abstract Based on preclinical studies showing that CD8+ T lymphocytes of human immunodeficiency syndrome (HIV)-infected subjects have anti-HIV activities, a phase 1 study was undertaken to determine the safety and feasibility of infusing in vitro purified, activated, and expanded CD8+ cells as a therapeutic measure in seven patients with acquired immunodeficiency syndrome (AIDS)-related complex (ARC) or AIDS. Autologous CD8+ cells were first selectively isolated in monoclonal antibody-coated flasks from peripheral blood mononuclear cells recovered by leukapheresis. They were then cultured and expanded with phytohemagglutinin and recombinant interleukin-2 (rIL-2) before infusion. Five cycles of isolations and infusions of increasing numbers of CD8+ T cells were achieved in five of seven subjects. Five cycles could not be completed in two subjects with AIDS whose CD4+ cell counts were < or = 48/microliters. Infusions of CD8+ cells alone were well tolerated. Four patients received rIL-2 by continuous infusion for 5 days with their final cycle of CD8+ cells. All developed reversible adverse effects attributable to rIL-2. After infusion, 111In-labeled CD8+ cells quickly accumulated in the lungs, with less than 10% of the labeled cells remaining in the circulation. After 24 hours, labeled CD8+ cells were reduced in the lungs, but increased and persisted in liver, spleen, and bone marrow. Four of five patients who were treated with multiple infusions of CD8+ cells have improved or remained clinically stable, and the fifth developed Pneumocystis carinii pneumonia but recovered. This study demonstrated that infusion of autologous, in vitro expanded and activated CD8+ cells was feasible and clinically well tolerated in five of seven subjects with advanced HIV infections.
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Ho, M., J. Armstrong, D. McMahon, G. Pazin, XL Huang, C. Rinaldo, T. Whiteside, C. Tripoli, G. Levine, and D. Moody. "A phase 1 study of adoptive transfer of autologous CD8+ T lymphocytes in patients with acquired immunodeficiency syndrome (AIDS)-related complex or AIDS." Blood 81, no. 8 (April 15, 1993): 2093–101. http://dx.doi.org/10.1182/blood.v81.8.2093.bloodjournal8182093.
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Based on preclinical studies showing that CD8+ T lymphocytes of human immunodeficiency syndrome (HIV)-infected subjects have anti-HIV activities, a phase 1 study was undertaken to determine the safety and feasibility of infusing in vitro purified, activated, and expanded CD8+ cells as a therapeutic measure in seven patients with acquired immunodeficiency syndrome (AIDS)-related complex (ARC) or AIDS. Autologous CD8+ cells were first selectively isolated in monoclonal antibody-coated flasks from peripheral blood mononuclear cells recovered by leukapheresis. They were then cultured and expanded with phytohemagglutinin and recombinant interleukin-2 (rIL-2) before infusion. Five cycles of isolations and infusions of increasing numbers of CD8+ T cells were achieved in five of seven subjects. Five cycles could not be completed in two subjects with AIDS whose CD4+ cell counts were < or = 48/microliters. Infusions of CD8+ cells alone were well tolerated. Four patients received rIL-2 by continuous infusion for 5 days with their final cycle of CD8+ cells. All developed reversible adverse effects attributable to rIL-2. After infusion, 111In-labeled CD8+ cells quickly accumulated in the lungs, with less than 10% of the labeled cells remaining in the circulation. After 24 hours, labeled CD8+ cells were reduced in the lungs, but increased and persisted in liver, spleen, and bone marrow. Four of five patients who were treated with multiple infusions of CD8+ cells have improved or remained clinically stable, and the fifth developed Pneumocystis carinii pneumonia but recovered. This study demonstrated that infusion of autologous, in vitro expanded and activated CD8+ cells was feasible and clinically well tolerated in five of seven subjects with advanced HIV infections.
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Babu, Sijo C., Girish Sharma, Arati Sharma, Anupam Sharma, and Bunty Sirkek. "Elastomeric Infusion Pump: Evaluation of Different Infusion Rates for Postoperative Epidural Analgesia." Indian Journal of Anesthesia and Analgesia 7, no. 1 (P-I) (2020): 124–36. http://dx.doi.org/10.21088/ijaa.2349.8471.7120.18.
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Barcelos, Melina M., Gustavo Freu, Bruna G. Alves, Camylla P. Monteiro, and Marcos V. Santos. "Casein hydrolyzate for drying-off lactating mammary quarters in cows with chronic mastitis." Journal of Dairy Research 88, no. 2 (May 2021): 185–88. http://dx.doi.org/10.1017/s0022029921000467.
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AbstractIn this research communication we address the hypothesis that a single intramammary infusion of casein hydrolyzate (CH) would have a similar effect to three intramammary infusions of CH for drying-off quarters with chronic mastitis (CM) during lactation. Sixty cows with CM were selected and randomly distributed into two treatment groups: (a) three intramammary CH infusions (100 mg, 50 ml per infusion, with 24-h intervals) or (b) single intramammary CH infusion (300 mg, 50 ml). Milk samples from the treated and untreated quarters were collected for microbiological culture and somatic cell count (SCC) before and after CH infusions. Milk yield was recorded and a manual pressure index measurement was used to evaluate cessation of lactation. Of the 60 quarters selected, 43 (71.67%) had positive microbiological culture. The quarters treated with three intramammary CH infusions had higher udder pressure index than those treated with single CH infusion. However, the average milk yield and composite SCC of three functional quarters were not different among treatments. Therefore, a single infusion of CH has the potential to be used as an alternative method for drying-off mammary quarters with CM during lactation.
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Ramirez, Israel, Michael G. Tordoff, and Mark I. Friedman. "Satiety from fat? Adverse effects of intestinal infusion of sodium oleate." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 273, no. 5 (November 1, 1997): R1779—R1785. http://dx.doi.org/10.1152/ajpregu.1997.273.5.r1779.
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To determine whether damage to the intestinal mucosa by oleic acid causes the suppression of food intake observed in response to intraintestinal infusion of the fatty acid, we measured lactate dehydrogenase (LDH) activity, a marker for cell damage, in the intestinal lumen after intestinal infusion of fatty acid under conditions similar to those employed in studies of eating behavior. Infusions of 25 or 51 mM sodium oleate (neutralized oleic acid) markedly and rapidly increased LDH activity, whereas infusions of saline had little or no effect. Infusion of octanoate, which has been reported to be ineffective in reducing eating behavior, did not increase intestinal LDH activity relative to saline infusion. Similarly, infusion of ethyl oleate or free (nonneutralized) oleic acid neither increased luminal LDH activity nor suppressed food intake. Infusion of sodium oleate also produced a strong conditioned aversion to sucrose. The results strongly suggest that the suppression of food intake induced by intraintestinal infusion of sodium oleate is due to the injurious effects of this unphysiological form of the fatty acid.
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Kareva, Lidija, Kristina Mironska, Katerina Stavric, and Arjeta Hasani. "Adverse Reactions to Intravenous Immunoglobulins - Our Experience." Open Access Macedonian Journal of Medical Sciences 6, no. 12 (December 17, 2018): 2359–62. http://dx.doi.org/10.3889/oamjms.2018.513.
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BACKGROUND: Adverse reactions to intravenous immunoglobulins (IVIG) are divided by organ system involved, or by timing of onset–immediate which occur during infusion usually rate-related, true IgE-mediated anaphylaxis and delayed reaction which occur hours to days after the infusion.
AIM: To describe the adverse events of patients given IVIG infusions.
METHODS: Total number of patients receiving IVIG was 41 with 25 males (60.97%) and 16 females (39.02%), age 2 months-35 years. A total number of infusions was 1350.
RESULTS: Total number of adverse reactions 15, 14 patients with immediate-type and 1 with delayed type. Total percentage of adverse reactions in a given sample was 1.1% of all IVIG infusions. Fever was the most common immediate type of reaction occurring in 11 patients (78.57%) followed by acrocyanosis 10 patients (71.42%), skin rash 9 patients (64.28%) and headache 8 patients (57.14). Delayed-type of reactions (like fever, headache and vomiting) was present in one patient. Majority of the adverse effects occurred at the infusion rate higher than 1, 5 ml/kg/hour, which is still within recommended speed.
CONCLUSION: About 1.1% of IVG infusions where with adverse events. Most common manifestations where: fever, acrocyanosis, skin rash and headache, which occurred 1-6 hours from the beginning of the infusion. The occurrence of adverse reactions to IVIG was related to the infusion rates in a fashion that faster infusion rate gives more reactions. Adverse reactions were managed by reduction of the infusion rate and administration of medications such as paracetamol, antihistamines and steroids.
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Baker, M. A., and D. D. Dawson. "Inhibition of thermal panting by intracarotid infusion of hypertonic saline in dogs." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 249, no. 6 (December 1, 1985): R787—R791. http://dx.doi.org/10.1152/ajpregu.1985.249.6.r787.
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Six dogs were surgically prepared with a right carotid loop and with the left common carotid artery ligated low in the neck. Respiratory frequency (f) and body temperature (Tb) were measured while the animals were at rest in a warm chamber (36–40 degrees C) in four separate experiments: 1) right intracarotid infusion of hypertonic NaCl; 2) right intracarotid infusion of isotonic NaCl; 3) intravenous infusion of hypertonic NaCl; and 4) no infusions. In a fifth experiment, right and left jugular and cephalic venous blood samples were collected before, during, and after the hypertonic intracarotid infusions. A 10-min infusion of hypertonic NaCl into the right common carotid artery elevated right jugular plasma osmolality by 33 mosmol/kg H2O, left jugular plasma osmolality by 26 mosmol/kg H2O, and cephalic plasma osmolality by 8 mosmol/kg H2O. A significant reversible drop in f and a rise in Tb occurred during hypertonic intracarotid infusions. Neither intracarotid infusion of isotonic NaCl nor intravenous infusion of hypertonic NaCl affected f or Tb. In experiments with no infusion, f and Tb did not change. It is concluded that brain receptors sensitive to extracellular solute concentration are able to influence the rate of thermoregulatory panting. This may underlie, in part, the reduced evaporation and elevated body temperatures that occur in dehydrated mammals exposed to heat.
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Eisen, Susanne, John D. Davis, Ellen Rauhofer, and Gerard P. Smith. "Gastric negative feedback produced by volume and nutrient during a meal in rats." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 281, no. 4 (October 1, 2001): R1201—R1214. http://dx.doi.org/10.1152/ajpregu.2001.281.4.r1201.
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To investigate the gastric negative-feedback control of eating during a meal, we implanted male rats with pyloric cuffs and gastric catheters and gave them access to sweet milk for 30 min after overnight deprivation. Ingested milk and infused milk or saline were confined to the stomach because the pyloric cuffs were closed in all tests. Rats received five consecutive tests with no gastric infusion or with infusions of 3, 6, or 12 ml of milk or saline during the first 6 min of the test meal. Only 12-ml infusions decreased intake significantly compared with no infusion. Because 12 ml of saline inhibited intake as much as 12 ml of milk, the decreased intake was due to volume or rate of infusion, not nutrient. Although infusions of 3 and 6 ml of milk did not decrease intake, they decreased the number of licks after the infusions significantly more than equal volumes of saline. Thus a large volume or rapid rate of gastric infusion decreases intake, and some other aspect of small milk infusions decreases the rate of licking.
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Custódio, Carolina de Sousa, Marcia Aparecida Ciol, Stefane Laura Nunes de Sousa, Giovana Paula Resende Simino, Paula Elaine Diniz Dos Reis, and Christiane Inocencio Vasques. "Evaluation of a peripheral vein for intravenous chemotherapy: a prospective observational study." Enfermería Global 21, no. 2 (April 1, 2022): 28–45. http://dx.doi.org/10.6018/eglobal.485851.
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This study aimed to assess over time alterations of a peripheral vein used for chemotherapy infusion in patients with breast cancer. It is a prospective observational study which included patients who were scheduled to receive peripheral infusion of chemotherapy. These patients had the first peripheral vein used for infusion evaluated in five moments: before the venipuncture, after device removal at the end of the first chemotherapy infusion, and on days 21, 42, and 63 after the first infusion. The primary outcome was the caliber of the vein, measured in millimeters with a Veinlite LEDX® transilluminator and a tape measure. Fifty-nine women receiving doxorubicin and docetaxel for the first time were enrolled to the study. The caliber size varied from 2 to 4 millimeters at baseline, and decreased overtime. During the follow-up period, peripheral veins of 35 women (59.3%) were measured at 0 mm at day 63. The remaining 24 women (40.7%) had some recovery, but for 15 of them (62.5%) the vein became a palpable cord. The feasibility of using a peripheral vein to perform chemotherapy decreased as the treatment progresses. Este estudio tuvo como objetivo evaluar las alteraciones en el tiempo de una vena periférica utilizada para la infusión de quimioterapia en pacientes con cáncer de mama. Es un estudio observacional prospectivo que incluyó pacientes que estaban programados para recibir infusión periférica de quimioterapia. A estos pacientes se les evaluó la primera vena periférica utilizada para la infusión en cinco momentos: antes de la venopunción, después de la extracción del dispositivo al final de la primera infusión de quimioterapia y los días 21, 42 y 63 después de la primera infusión. El resultado primario fue el calibre de la vena, medido en milímetros con un transiluminador Veinlite LEDX® y una cinta métrica. Se inscribieron en el estudio 59 mujeres que recibieron doxorrubicina y docetaxel por primera vez. El tamaño del calibre varió de 2 a 4 milímetros en la línea de base y disminuyó con el tiempo. Durante el período de seguimiento, las venas periféricas de 35 mujeres (59,3%) se midieron a 0 mm el día 63. Las 24 mujeres restantes (40,7%) tuvieron cierta recuperación, pero para 15 de ellas (62,5%) la vena se convirtió en un cordón palpable. La viabilidad de utilizar una vena periférica para realizar quimioterapia disminuyó a medida que avanzaba el tratamiento. Este estudo teve como objetivo avaliar as alterações ao longo do tempo de uma veia periférica utilizada para infusão de quimioterapia em pacientes com câncer de mama. Trata-se de um estudo observacional prospectivo que incluiu pacientes que tinham indicação de receber infusão periférica de quimioterapia. A primeira veia periférica utilizada para infusão de quimioterapia nessas pacientes foi avaliada em cinco momentos: antes da punção venosa, após a retirada do dispositivo ao final da primeira infusão de quimioterapia e nos dias 21, 42 e 63 após a primeira infusão. O desfecho primário foi o calibre da veia, mensurado em milímetros com um iluminador transdérmico chamado Veinlite LEDX® e uma fita métrica. Cinquenta e nove mulheres que receberam doxorrubicina e docetaxel pela primeira vez foram incluídas no estudo. O tamanho do calibre variou de 2 a 4 milímetros no início do estudo e diminuiu com o tempo. Durante o período de acompanhamento, as veias periféricas de 35 mulheres (59,3%) foram medidas a 0 mm no dia 63. As 24 mulheres restantes (40,7%) tiveram alguma recuperação, mas para 15 delas (62,5%) a veia tornou-se um cordão palpável. A viabilidade do uso de uma veia periférica para a realização da quimioterapia diminuiu com o avanço do tratamento.
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Middleton, Helen J., Peter Mollee, Robert Bird, Anthony K. Mills, Paula Marlton, and Devinder Gill. "Accelerated Delivery of Rituximab Is Safe on an Out-Patient Basis." Blood 106, no. 11 (November 16, 2005): 4777. http://dx.doi.org/10.1182/blood.v106.11.4777.4777.
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Abstract Aim A prospective study to determine the safety of the accelerated delivery of rituximab. Methods A pilot study investigating the safety of the accelerated delivery of rituximab was commenced in September 2004. First doses of rituximab were delivered as per prescribing guidelines. Patients without infusion related toxicity were eligible for accelerated rituximab in second or subsequent infusions. In the first 4 patients the infusion was administered at 100mg/hr, increasing to 400mg/hr after 15 minutes in the absence of a reaction. All subsequent patients commenced the infusion at 400mg/hr. All patients received premedication with paracetamol, promethazine and hydrocortisone unless contra-indicated. Patients with a previous grade III/IV infusion related toxicity were excluded. Results 23 patients have been enrolled to date. Data is available for 62 infusions - median 3 infusions per patient (range: 1–6). Median age was 64 years (range: 28–85). 65% of patients were male. Diagnoses included non-Hodgkin’s Lymphoma - 20 patients (Diffuse Large Cell Lymphoma - 8, Follicular Lymphoma - 9, Mantle Cell Lymphoma - 1, Lymphoplasmacytic Lymphoma - 2), Immune Thrombocytopenic Purpura - 2 and Dermatomyositis-1. 44% of patients received single agent rituximab and 56% received it in combination with chemotherapy. The median dose of rituximab was 700mg (range: 600–800mg). There were 2 adverse events with no grade III/IV infusion related toxicity. One patient experienced grade I hypothermia. A second patient experienced grade II fevers and rigors which required interruption of the infusion. The patient was subsequently found to have pneumonia. The infusion was completed without further incident. Excluding data from the latter patient, median infusion time was 1 hour and 55 minutes and 76% of infusions were completed within 2 hours. Conclusion For second or subsequent infusions, the accelerated delivery of rituximab is safe and well tolerated allowing shorter outpatient stays and improving the efficiency of resource utilisation. The study has been extended to include patients with bulky lymphoma and Chronic Lymphocytic Leukaemia.
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Chiu, E. K. Y., H. Wang, and J. R. McNeill. "Role of sodium and water excretion in the antihypertensive effect of vasopressin in the spontaneously hypertensive rat." Canadian Journal of Physiology and Pharmacology 70, no. 10 (October 1, 1992): 1309–14. http://dx.doi.org/10.1139/y92-183.
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Mean arterial pressure (mmHg (1 mmHg = 133.322 Pa)), sodium excretion rate (μmol∙kg−1∙min−1), and urine flow (μL∙kg−1∙min−1) were measured in conscious unrestrained spontaneously hyptertensive rats (SHR) and normotensive Wistar–Kyoto rats (WKY) before, during, and after a 3-h intravenous infusion of arginine vasopressin (20 ng∙kg−1∙min−1), an equipressor dose of phenylephrine, or an infusion of the vehicle. Cessation of the phenylephrine infusion was associated with a return of arterial pressure to preinfusion control values in both SHR and WKY. Cessation of the vasopressin infusion was also associated with a return of arterial pressure to preinfusion values in WKY. In contrast, in the SHR, arterial pressure fell from a preinfusion control level of 164 ± 6.2 to 137 ± 4 mmHg within 1 h of stopping the vasopressin infusion. Five hours after stopping the infusion, pressure was 134 ± 3 mmHg (29 ± 5 mmHg below preinfusion levels). Similar to the WKY, cessation of a vasopressin infusion was associated with a return of arterial pressure to preinfusion values in Sprague–Dawley rats. Thus, the failure to observe a hypotensive response in normotensive rats was not a peculiarity of the WKY strain. Sodium excretion rates increased during the infusions of vasopressin to a greater extent in SHR than in WKY. However, the natriuresis induced by phenylephrine was not significantly different from that generated by vasopressin in SHR, and in WKY, the natriuresis was greater for phenylephrine than for vasopressin. Urine output increased to a greater extent during the infusions of phenylephrine in both SHR and WKY than during vasopressin infusion. Because the infusions of phenylephrine were associated with either a similar or greater natriuresis and diuresis than the infusions of vasopressin, it is unlikely that the large fall in arterial pressure that occurred following the withdrawal of the vasopressin infusion (the "withdrawal-induced antihypertensive phenomenon") was related to the preceding natriuresis and diuresis.Key words: vasopressin, spontaneously hypertensive rat, sodium excretion, water excretion, renal function, phenylephrine.
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Perreault, Sarah, Molly Schiffer, Virginia Clinchy-Jarmoszko, Nicole Bocchetta, Lisa Barbarotta, Osama Abdelghany, Francine Foss, Scott Huntington, Stuart Seropian, and Iris Isufi. "Mitigating the risk of COVID-19 exposure by transitioning from clinic-based to home-based immune globulin infusion." American Journal of Health-System Pharmacy 78, no. 12 (February 22, 2021): 1112–17. http://dx.doi.org/10.1093/ajhp/zxab072.
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Abstract Purpose Intravenous immune globulin (IVIG) therapy is used in patients with hypogammaglobulinemia to lower the risk of infections. IVIG and subcutaneous IVIG (SCIG) therapy have been to shown to be safe and effective when administered as clinic-based infusions. Concern from both patients and providers for increased transmission of the coronavirus disease 2019 (COVID-19) virus to immunosuppressed patients with scheduled medical visits and procedures made it necessary for us to reassess our process of how we manage patient care in general and chronic clinic infusions in particular. Here we describe our experience of transitioning patients from clinic-based to home based IVIG and/or SCIG infusions to decrease the risk of COVID-19 exposure. Methods Criteria were developed to identify high-risk immunosuppressed patients who would be appropriate candidates for potential conversion to home based IVIG infusions. Data were collected via chart review, and cost analysis was performed using Medicare Part B reimbursement data. A patient outcome questionnaire was developed for administration through follow-up phone calls. Results From March to May 2020, 45 patients met criteria for home-based infusion, with 27 patients (60%) agreeing to home-based infusion. Posttransition patient outcomes assessment, conducted in 26 patients (96%), demonstrated good patient understanding of the home-based infusion process. No infusion-related complications were reported, and 24 patients (92%) had no concerns about receiving future IVIG and/or SCIG doses at home. No patient tested positive for COVID-19 during the study period. Clinic infusion visits decreased by 26.6 visits per month, resulting in a total of 106 hours of additional available infusion chair time per month and associated cost savings of $12,877. Conclusion Transition of clinic based to home based IVIG/SCIG infusion can be successfully done to decrease potential exposure during a pandemic in a high-risk immunosuppressed population, with no impact on patient satisfaction, adherence, or efficacy. The home-based infusion initiative was associated with a reduction in costs to patients and an increase in available chair time in the infusion clinic.
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Gales, Mark A., and Barry J. Gales. "Rapid Infusion of Amphotericin B in Dextrose." Annals of Pharmacotherapy 29, no. 5 (May 1995): 523–29. http://dx.doi.org/10.1177/106002809502900512.
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Objective: To review the data examining the use of rapid infusion of amphotericin B in dextrose infusions. Data Sources: A MEDLINE search of the English-language literature and review of pertinent references' bibliographies was used to identify articles evaluating the effect of amphotericin B infusion rates on the incidence of adverse reactions. Study Selection and Data Extraction: Controlled and uncontrolled studies involving humans are reviewed; emphasis is placed on recent comparative trials. Pertinent information, as judged by the authors, was selected for discussion. Data Synthesis: Amphotericin B, a polyene antifungal agent with significant toxicity, remains the agent of choice for many serious fungal infections. The potential benefits of rapid administration of amphotericin B in reducing the incidence and/or severity of adverse reactions were noted soon after its introduction. Recent studies have examined the tolerability of rapid (0.75–1 h) amphotericin B infusions. Results of studies assessing the tolerability of rapid amphotericin B infusions suggest that tolerance to infusion-related reactions develops during therapy. Comparative trials have obtained variable results. The comparative trials supporting rapid amphotericin B infusion have generally used crossover designs, enrolled small numbers of patients, and excluded patients with significant renal or cardiovascular dysfunction. Conclusions: Rapid amphotericin B infusions should be avoided during initiation of therapy when infusion-related reactions tend to be most problematic, and in patients with cardiovascular disease, renal dysfunction, and potassium disorders because of the potential risk for cardiac arrhythmias. The literature currently available is conflicting and insufficient to support the routine use of rapid amphotericin B infusion.
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Bloor, Claire. "How to perform fluid therapy." Veterinary Nurse 10, no. 7 (September 2, 2019): 380–90. http://dx.doi.org/10.12968/vetn.2019.10.7.380.
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Veterinary nurses play an important role in infusion therapy and they are involved in all stages of intravenous fluid therapy (IVFT) provision. Examples of tasks undertaken within their role include pre-infusion blood sampling and testing, pre-infusion patient assessment, preparation of infusions, obtaining intravenous access, administering infusions safely and monitoring patient progress. This article will explore each of these tasks in turn, examining considerations to be mindful of to ensure a safe and efficient procedure, while highlighting any potential pitfalls and how they can be avoided.
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Block, Walter, Rasmus Birns, Miles Olsen, Samuel Hurley, Ethan Brodsky, Abigail Rajala, Caitlynn Filla, et al. "SCIDOT-44. CREATING CAUSAL CAPABILITIES IN FUNCTIONAL BRAIN MAPPING USING A CED APPROACH." Neuro-Oncology 21, Supplement_6 (November 2019): vi281. http://dx.doi.org/10.1093/neuonc/noz175.1180.
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Abstract INTRODUCTION The spatial and temporal resolution limits of functional MRI (fMRI) brain mapping provide primarily correlative information on brain connectivity. Determining how one region causally modulates and mediates activity in other regions remains difficult with fMRI. We demonstrate a simple means to add causality in resting state functional connectivity MRI (rs-fcMRI) using techniques developed first for convection-enhanced delivery (CED) of therapeutics. Here we use CED to guide and monitor pharmacologic alteration of a local brain region in anaesthetized Rhesus monkeys while monitoring rs-fcMRI signal changes. METHODS Pre-surgical MRI was used to determine skull locations for craniotomies for installation of NavigusTMbrain ports in two untrained monkeys slated for euthanasia. The ports were aligned in real–time to provide trajectories aimed at the central nucleus of the amygdala (CeA). Fused silica catheters were then inserted into the CeA where 24 mg of muscimol (inhibitory agent) was infused in 24 ml of buffered solution under pressure over 12 minutes, first on the right side and then on the left side. rs-fcMRI studies were done for 45 minutes before and after the unilateral infusion and then after the bilateral infusion. RESULTS Catheters were successfully aligned and inserted into the CeA targets with sub-mm accuracy. T2-weighted imaging detected the enhanced T2 from the infusion’s buffer. Pre-infusion rs-fcMRI provides results consistent with prior studies, which have shown that the CeA is most strongly connected to the contralateral CeA. This connectivity was significantly reduced following both unilateral and bilateral injections of muscimol into the CeA, demonstrating the effectiveness of the muscimol infusions. Conditional Grainger Causality (CGC) analysis shows unexpected new connectivity after the unilateral infusion. Upon the bilateral infusion, global effective connectivity in the region is reduced. CONCLUSION Expected and unexpected changes in resting state functional connectivity resulted from unilateral and bilateral infusions of inhibitory agents.
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Patel, Jolly, Melissa Ho, Viet Ho, Celeste Bello, Benjamin Djulbegovic, Lubomir Sokol, and Gene Wetzstein. "Rapid Infusion Rituximab for Maintenance Therapy: Is It Feasible?" Leukemia Research and Treatment 2013 (October 31, 2013): 1–4. http://dx.doi.org/10.1155/2013/629283.
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Rituximab is an anti-CD-20 monoclonal antibody used in the management of lymphoproliferative disorders. The use of maintenance rituximab has improved progression free survival and overall survival in follicular lymphomas. Although rapid rituximab infusions have been studied extensively, there is little data on the use of rapid infusions during maintenance therapy for low grade lymphomas. The primary objective of this retrospective analysis was to evaluate the incidence of Grade 3 and 4 toxicities with maintenance rapid infusion rituximab according to the Common Terminology Criteria for Adverse Events version 4 (CTC v. 4). Secondary objectives included evaluating all grade infusion related adverse events and correlation of adverse events with varying schedules of rituximab maintenance therapy. All patients who received rapid infusion rituximab as maintenance therapy for low grade lymphoma between December 2007 and November 2011 were included. Rapid rituximab infusions were administered over 90 minutes. Demographic, laboratory and clinical data were collected. A total of 109 patients received 647 rapid rituximab infusions. Three patients experienced an adverse reaction which resulted in one grade 1 infusion reaction and three grade 3 infusion reactions. No patients required hospitalization. All 3 patients received pharmacological and/or supportive care to relieve symptoms associated with the reaction.
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Rabinowitz, L., R. L. Sarason, and H. Yamauchi. "Effects of KCl infusion on potassium excretion in sheep." American Journal of Physiology-Renal Physiology 249, no. 2 (August 1, 1985): F263—F271. http://dx.doi.org/10.1152/ajprenal.1985.249.2.f263.
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To determine the quantitative relation of K excretion (UKV) to plasma K concentration (PK), three fasted, conscious, mature ewes were infused intravenously with 50 mmol KCl over 15, 30, and 60 min. Control experiments were without infusion. During KCl infusion PK was increased to 7.26 +/- 0.40 (15 min), 6.68 +/- 0.48 (30 min), and 5.59 +/- 0.3 meq/liter (60 min). During all three infusions the increase in UKV relative to the increase in PK was similar. The mean delta UKV/delta PK ratio was 160 +/- 30 (SD) mueq/min per meq/liter (range 102-203). On termination of each infusion PK decreased to control values, but UKV either remained elevated (60-min infusion) or first decreased and then increased (15- and 30-min infusions). The second, delayed kaliuresis began 30-45 min after initiation of KCl infusion and accelerated a return to the level of K balance of the control experiments. A plot of UKV against the corresponding period PK showed that, at a common value of PK, UKV was higher following KCl infusion when PK was dropping than during KCl infusion when PK was rising. The mechanisms responsible for this hysteresis phenomenon are not identified.