Digital Commons Network^™

An Interdisciplinary Process Change: Conversion Of Picc Line Capping Solution From Heparin To Normal Saline, Angela Colella, Brandon Bodager, Frank Spexarth, Natalie Mcdonough, Deb Kastenholz, Paul Grebe

Angela Colella, PharmD, BCPS

Background: Heparin-induced thrombocytopenia (HIT) and HIT with thrombosis syndrome (HITTS) are serious conditions. Patients are at increased risk for developing HIT/HITTS with any exposure to heparin, even intravenous line flushes. Patients may be exposed to heparin multiple times each day when they have a peripherally inserted central catheter (PICC) that is flushed and capped with heparin. At Aurora Health Care, heparin is the standard capping solution for PICCs, but with a recent switch to positive pressurized caps, normal saline may be a capping option that reduces patient exposure to heparin. Purpose: To reduce heparin exposure at a single hospital by …

Engineered Human Acidic Fibroblast Growth Factor (Fgf1) With An Enhanced Thermal And Proteolytic Stability, Duaa Abdullah Almansaf

Graduate Theses and Dissertations

Fibroblast growth factor receptor (FGFR) is made up of three significant domains. The most important domain is the intracellular domain where the dimerization and autophosphorylation occur. Fibroblast growth factor (FGF) interacts with specific FGFR to regulate many cellular processes during the embryonic stage. Furthermore, FGF is significant for adults because FGF plays an important role in regulating cellular differentiation as well as wound healing. The cellular regulating processes are initiated through binding FGF to heparin followed by binding FGF/heparin to FGFR to form FGF/heparin/FGFR complex. Thus, FGFR is dimerized and autophosphorylated. The phosphorylation of FGFR triggers downstream signaling pathways, which …

Direct Attachment Of 4-Hydroxybenzoic Acid Polymers And Capture Agents To Flat Sheet And Microdialysis Membranes For Improved Mass Transport, Sarah Jane Phillips

Graduate Theses and Dissertations

Microdialysis (MD) sampling is a diffusion-based separation method which has the ability to sample any analyte that can diffuse across the semi-permeable membrane. However one challenge for MD is that for soluble proteins greater than 10 kDa, the relative recovery (RR) using a 100 kDa MD probe is between 1-5%.1 There are two major barriers that lead to these low recovery values - nonspecific adsorption (NSA) and poor solute mass transport. To overcome these two barriers, the modification of PES-based MD membranes has been initiated by laccase. Previous researchers have used laccase to modify PES flat sheet and hollow fiber …

An Interdisciplinary Process Change: Conversion Of Picc Line Capping Solution From Heparin To Normal Saline, Angela Colella, Brandon Bodager, Frank Spexarth, Natalie Mcdonough, Deb Kastenholz, Paul Grebe

Journal of Patient-Centered Research and Reviews

Background: Heparin-induced thrombocytopenia (HIT) and HIT with thrombosis syndrome (HITTS) are serious conditions. Patients are at increased risk for developing HIT/HITTS with any exposure to heparin, even intravenous line flushes. Patients may be exposed to heparin multiple times each day when they have a peripherally inserted central catheter (PICC) that is flushed and capped with heparin. At Aurora Health Care, heparin is the standard capping solution for PICCs, but with a recent switch to positive pressurized caps, normal saline may be a capping option that reduces patient exposure to heparin.

Purpose: To reduce heparin exposure at a single hospital by …

Retrospective Evaluation Of Dosing Body Weight For Unfractionated Heparin In Obese Patients, Jingyang Fan, Billee John, Emily Tesdal

SIUE Faculty Research, Scholarship, and Creative Activity

Purpose: Using adjusted body weight (AdjBW) for heparin dosing in obese patients is a common but not validated clinical practice. The purpose of this study was to evaluate whether using AdjBW in obese patients would lead to quick achievement of therapeutic activated partial thromboplastin time (aPTT) and low bleeding risk with heparin therapy.

Methods: A retrospective cohort study was conducted in patients that received heparin before and after implementation of a revised heparin protocol that utilized AdjBW for obese patients. The primary outcome was percentage of first aPTT values within the therapeutic range. Secondary outcomes included time to first therapeutic …

Retrospective Evaluation Of Venous Thromboembolism Prophylaxis In The Adult Cancer Population, David J. Reeves, Chin Y. Liu

David Reeves

Study objectives. Hospitalized cancer patients are at an increased risk for venous thromboembolism (VTE) and it is recommended they receive pharmacologic prophylaxis unless otherwise contraindicated. The majority of data supporting this recommendation comes from sub-group analyses and extrapolation of data gathered in general medical/surgical patients. This study seeks to assess the safety and efficacy of VTE prophylaxis in cancer patients admitted to our institution. Methods. Charts of patients 18—89 years of age receiving VTE prophylaxis with unfractionated heparin, low molecular weigh heparin, or fondaparinux while admitted to Karmanos Cancer Center between September and October 2007 were retrospectively reviewed. Risk factors …

Heparin-Peptide Interactions, Jacqueline Anastasia Morris

Graduate Theses and Dissertations

Heparin is a polydispersed sulfated molecule that is part of the family called glycosaminoglycans found in the extracellular matrix and cell surfaces. This molecule is extremely important for the activation of proteins and protein-receptor interactions that are responsible for downstream cell signaling pathways. Heparin has been isolated from porcine intestine and used as an anticoagulant for the prevention of embolisms, heart thrombosis, and clotting during heart surgeries. This so-called miracle drug was in use until 2008, when isolated batches were found to be contaminated with other glycosaminoglycans similar to heparin. From 2008, there has been a dire need for a …

An Interdisciplinary Process Change: Conversion Of Picc Line Capping From Heparin To Normal Saline, Angela Colella, Brandon Bodager, Frank C Spexarth, Natalie Mcdonough, Deb Kastenholz

Angela Colella, PharmD, BCPS

Conclusion: Normal saline has demonstrated historical non-inferiority to heparin for maintaining PICC patency when used as the capping solution with positive pressured caps. Similar results were found during our pilot.

An Interdisciplinary Process Change: Conversion Of Picc Line Capping From Heparin To Normal Saline, Angela Colella, Brandon Bodager, Frank C Spexarth, Natalie Mcdonough, Deb Kastenholz

Pharmacy and Pharmacology

Conclusion: Normal saline has demonstrated historical non-inferiority to heparin for maintaining PICC patency when used as the capping solution with positive pressured caps. Similar results were found during our pilot.

Cost-Effectiveness Of Genomic-Based Warfarin Therapy, John Weissert, Kourosh Ravvaz

Genetics and Genomics

Conclusions: Using patients' clinical and genetic information in warfarin therapy protocols can significantly reduce IS [ischemic stroke] and ICH [intracranial hemorrhage] related healthcare expenditures over a five-year period. The PG-protocol 3 generates the greatest total average savings at $78.98 per patient over five-years. The clinical and PG-protocols [pharmacogenomic-based protocols] only modestly reduce the absolute even rate for IS and ICH when compared to the current AHC 'Best-Practice' warfarin therapy protocol. However, with an average of 3,000 patients annually initiating warfarin for AF and the large acute care and five-year costs associated with IS and ICH, even incremental reductions in adverse …

Fabrication And Characterization Of Heparin-Immobilized Electrospun Nanofibers For Vascular Suture Applications, Michael J. Dibalsi

All Theses

One of the most significant complications of vascular surgery is thrombosis, which is the formation of blood clots at the surgical site. Another significant complication is stenosis - an overgrowth of cells during the healing process, which narrows the same artery the surgeons were trying to open. These complications often lead to additional surgeries and carry increased morbidity and mortality for the patients. Numerous pharmaceutical agents have been tested to prevent these complications, but the results have been disappointing. The agents either have unacceptable systemic effects, or they cannot achieve a controlled, timed release in the circulation. Heparin is the …

In Vitro Studies Of Heparin-Coated Magnetic Nanoparticles For Potential Use In The Treatment Of Neointimal Hyperplasia, Andrew Hargett

All Theses

With the ever-increasing prevalence of atherosclerosis, procedures such as angioplasty and stenting have become common practice, both of which are simple techniques spouting relatively satisfying results for the past several decades. While successful in opening of occluded vessels, these therapies can be met down the line with thrombosis or even repeated occlusion of the vessel, known as restenosis. Similar to the issues faced within oncology, treatment of this restenosis via widespread drug administration throughout the body is not desirable. Cardiovascular and other medical fields have begun looking into the use of magnetic nanoparticles as a drug delivery vessel. Previously, our …

Characterization Of Rna Helicase Csha And Its Role In Protecting Mrnas And Small Rnas Of Staphylococcus Aureus Strain Newman, Samin Kim, Anna-Rita Corvaglia, Stefano Léo, Ambrose Cheung, Patrice Francois

Dartmouth Scholarship

The toxin MazF_sa in Staphylococcus aureus is a sequence-specific endoribonuclease that cleaves the majority of the mRNAs in vivo but spares many essential mRNAs (e.g., secY mRNA) and, surprisingly, an mRNA encoding a regulatory protein (i.e., sarA mRNA). We hypothesize that some mRNAs may be protected by RNA-binding protein(s) from degradation by MazF_sa. Using heparin-Sepharose-enriched fractions that hybridized to sarA mRNA on Northwestern blots, we identified among multiple proteins the DEAD box RNA helicase CshA (NWMN_1985 or SA1885) by mass spectroscopy. Purified CshA exhibits typical RNA helicase activities, as exemplified by RNA-dependent ATPase activity and unwinding of …

Guidance For The Practical Management Of The Heparin Anticoagulants In The Treatment Of Venous Thromboembolism., Maureen A. Smythe, Jennifer Priziola, Paul P. Dobesh, Diane Wirth, Adam Cuker, Ann K. Wittkowsky

Journal Articles: Pharmacy Practice

Venous thromboembolism (VTE) is a serious and often fatal medical condition with an increasing incidence. Despite the changing landscape of VTE treatment with the introduction of the new direct oral anticoagulants many uncertainties remain regarding the optimal use of traditional parenteral agents. This manuscript, initiated by the Anticoagulation Forum, provides clinical guidance based on existing guidelines and consensus expert opinion where guidelines are lacking. This specific chapter addresses the practical management of heparins including low molecular weight heparins and fondaparinux. For each anticoagulant a list of the most common practice related questions were created. Each question was addressed using a …

Designer Collagen-Fibril Biograft Materials For Tunable Molecular Delivery, Rucha Joshi

Open Access Dissertations

One of the biggest challenges in tissue engineering currently is the formation of a functional microvascular network as part of an engineered tissue graft. Despite many advances in tissue engineering methods, the field still awaits biograft designs that enable neovascularization at clinically relevant size scales. Critical to the design of such materials are tissue-specific physico-mechanical properties and controlled local therapeutic molecular release.

Nebulized Heparin For Patients Under Mechanical Ventilation: An Individual Patient Data Meta-Analysis, Gerie J. Glas, Ary Serpa Neto, Janneke Horn, Amalia Cochran, Barry Dixon, Elamin M. Elamin, Iris Farklas, Sharmila Dissanaike, Andrew C. Miller, Marcus J. Schultz

Faculty & Staff Scholarship

Pulmonary coagulopathy is a characteristic feature of lung injury including ventilator-induced lung injury. The aim of this individual patient data meta-analysis is to assess the effects of nebulized anticoagulants on outcome of ventilated intensive care unit (ICU) patients. A systematic search of PubMed (1966–2014), Scopus, EMBASE, and Web of Science was conducted to identify relevant publications. Studies evaluating nebulization of anticoagulants in ventilated patients were screened for inclusion, and corresponding authors of included studies were contacted to provide individual patient data. The primary endpoint was the number of ventilator-free days and alive at day 28. Secondary endpoints included hospital mortality, …

Effects Of Cepae Extract, Allantoin, And Heparin Mixture On Developing Andalready Formed Epidural Fibrosis In A Rat Laminectomy Model, Rafet Özay, Osman Yüksel Yavuz, Abi̇t Aktaş, Funda Yi̇ği̇t, Nuri̇ Eralp Çeti̇nalp, Haci Mustafa Özdemi̇r, Zeki̇ Şekerci̇

Turkish Journal of Medical Sciences

Background/aim: The study was designed to investigate whether local administration of a mixture composed of cepae extract, allantoin, and heparin (CAH) decreased already formed epidural fibrosis (EF) at the laminectomy site. Materials and methods: Twenty-four adult male Sprague Dawley rats were equally divided into four groups. Laminectomy was performed at the L5 level in all rats. The group 2 and group 4 rats were treated with local drug administration. While the group 1 and 2 rats were sacrificed after 6 weeks, the remaining rats were reoperated and CAH mixture was applied in group 4. The vertebral columns of all rats …