Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for diff...Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inapp展开更多
At present, it is projected that about 4 zettabytes （or 10^＊＊21 bytes） of digital data are being generated per year by everything from underground physics experiments to retail transactions to security cameras to ...At present, it is projected that about 4 zettabytes （or 10^＊＊21 bytes） of digital data are being generated per year by everything from underground physics experiments to retail transactions to security cameras to global positioning systems. In the U. S., major research programs are being funded to deal with big data in all five sectors （i.e., services, manufacturing, construction, agriculture and mining） of the economy. Big Data is a term applied to data sets whose size is beyond the ability of available tools to undertake their acquisition, access, analytics and/or application in a reasonable amount of time. Whereas Tien （2003） forewarned about the data rich, information poor （DRIP） problems that have been pervasive since the advent of large-scale data collections or warehouses, the DRIP conundrum has been somewhat mitigated by the Big Data approach which has unleashed information in a manner that can support informed - yet, not necessarily defensible or valid - decisions or choices. Thus, by somewhat overcoming data quality issues with data quantity, data access restrictions with on-demand cloud computing, causative analysis with correlative data analytics, and model-driven with evidence-driven applications, appropriate actions can be undertaken with the obtained information. New acquisition, access, analytics and application technologies are being developed to further Big Data as it is being employed to help resolve the 14 grand challenges （identified by the National Academy of Engineering in 2008）, underpin the 10 breakthrough technologies （compiled by the Massachusetts Institute of Technology in 2013） and support the Third Industrial Revolution of mass customization.展开更多
文摘Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inapp
基金Supported by the Program for New Century Excellent Talents in University of China under Grant No.NCET-05-0657(新世纪优秀人才支持计划)the Foundation for Distinguished Young Scientists of Hubei Province of China under Grant No.2006ABB028(湖北省青年杰出人才基金)
文摘At present, it is projected that about 4 zettabytes （or 10^＊＊21 bytes） of digital data are being generated per year by everything from underground physics experiments to retail transactions to security cameras to global positioning systems. In the U. S., major research programs are being funded to deal with big data in all five sectors （i.e., services, manufacturing, construction, agriculture and mining） of the economy. Big Data is a term applied to data sets whose size is beyond the ability of available tools to undertake their acquisition, access, analytics and/or application in a reasonable amount of time. Whereas Tien （2003） forewarned about the data rich, information poor （DRIP） problems that have been pervasive since the advent of large-scale data collections or warehouses, the DRIP conundrum has been somewhat mitigated by the Big Data approach which has unleashed information in a manner that can support informed - yet, not necessarily defensible or valid - decisions or choices. Thus, by somewhat overcoming data quality issues with data quantity, data access restrictions with on-demand cloud computing, causative analysis with correlative data analytics, and model-driven with evidence-driven applications, appropriate actions can be undertaken with the obtained information. New acquisition, access, analytics and application technologies are being developed to further Big Data as it is being employed to help resolve the 14 grand challenges （identified by the National Academy of Engineering in 2008）, underpin the 10 breakthrough technologies （compiled by the Massachusetts Institute of Technology in 2013） and support the Third Industrial Revolution of mass customization.
