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of acetaminophen in humans: first evidence of a central serotonergic mechanism. Clinical Pharmacology and Therapeutics 2006; 79: 371–8. ve V, Loriot MA, EschaPickering G, Este lier A, Dubray C. Acetaminophen reinforces descending inhibitory pain pathways. Clinical Pharmacology and Therapeutics 2008; 84: 47–51. Bandschapp O, Filitz J, Urwyler A, Koppert W, Ruppen W. Tropisetron blocks analgesic action of acetaminophen: a human pain model study. Pain 2011; 152: 1304–10. Jokela R, Ahonen J, Seitsonen E, Marjakangas P, Korttila K. The influence of ondansetron on the analgesic effect of acetaminophen after laparoscopic hysterectomy. Clinical Pharmacology and Therapeutics 2010; 87: 672–8. Pickering G, Faure M, Commun F, et al. Tropisetron and paracetamol association in post-operative patients. Fundamental and Clinical Pharmacology 2012; 26: 432–7. Tiippana E, Hamunen K, Kontinen V, Kalso E. The effect of paracetamol and tropisetron on pain: experimental studies and a review of published data. Basic and Clinical Pharmacology and Toxicology 2013; 112: 124–31. doi:10.1111/anae.13112
Further benefits of cyanoacrylate glue for central venous catheterisation We read with interest the letters on the use of cyanoacrylate glue as an alternative to suturing central venous catheters securely [1, 2]. We have used glue for this purpose at our hospital for many years now, not just for securing devices, but more for reducing peri-catheter bleeding at the exit site, specifically for peripherally inserted central catheters (PICCs) [3]. Bleeding occurs after 40% of PICC placements without reverse tapering at 1 h, and 15% at 25 h, and causes patients anxiety and logistical 758
Correspondence
problems. Using glue, we have reduced this prevalence to 0% at 1 h and 24 h in 45 patients. Sealing the exit site of catheters with glue also reduces the risk of extra-luminal contamination, presumably by reducing bacterial translocation at the puncture site [4]. Glue may also reduce the risk of catheter displacement when sutureless devices, which are currently recommended as the optimal method for securement, are used [5]. We hypothesise that glue may reduce ‘in and out’ movement of the catheter at the exit site, reducing local damage to the endothelium of the vein, and so reducing the risk of intravenous thrombus formation. Convinced of the benefits and safety of cyanoacrylate glue, we have extended its use in our hospital for sealing the exit site of all central venous access devices, cuffed and non-cuffed tunneled catheters and totally implanted port reservoirs, and for closing the skin after the removal of these. We would be interested in hearing from researchers interested in studying the antibacterial and antithrombotic potential of cyanoacrylate glue during central venous catheter insertion and removal. G. Scoppettuolo L. Dolcetti A. Emoli A. La Greca D. G. Biasucci M. Pittiruti Catholic University Hospital, Rome, Italy Email:
[email protected] No external funding and no competing interests declared. Previously
posted on the Anaesthesia correspondence website: www.anaesthesia correspondence.com.
References 1. Lawrence H, Hackling M. Histoacryl for securing central venous catheters: not so sticky!. Anaesthesia 2014; 69: 1407–8. 2. Wilkinson JN, Sheikh N, Jayamaha J. Tissue adhesive as an alternative to sutures for securing central venous catheters. Anaesthesia 2007; 62: 969–70. 3. Pittiruti M, Emoli A, Scoppettuolo G. Cyanoacrylate glue prevents early bleeding of the exit site after PICC placement. Journal of Vascular Access 2012; 13: 27. 4. Wilkinson JN, Chikhani M, Mortimer K, Gill SJ. The antimicrobial effect of histoacryl skin adhesive. Anaesthesia 2008; 63: 1382–84. 5. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Diseases 2011; 52: e1–32. doi:10.1111/anae.13105
Guaranteeing drug delivery during total intravenous anaesthesia In their correspondence regarding the design of total intravenous anaesthesia (TIVA) sets, Drs Denning and Barley invite a response from a manufacturer of such sets to allay their concerns about superfluous clamps [1]. As a consultant anaesthetist and medical director of a company that designs and markets TIVA sets, I feel I am qualified to comment. The authors cite a diagram used by the Safe Anaesthesia Liaison Group (SALG) to illustrate the safety features of a TIVA set [2]. I agree with Denning and Barley that
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