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Additional file 4. Relation between levels of LCONV, the corresponding values of LMX and the reduction in lumens where Ddrugs = 2 min.

Additional file 1. Compatibility chart.

Additional file 8. Number of IV lumens required by multiplex scheduling (LMX; panels A-E and G-K) and by conventional scheduling (Lconv; panels F and L). Values of Lconv and Lmx were determined over 1 h periods (panels A-F) and the maximal values of Lconv and Lmx aggregated over 24 h periods from midnight to midnight (panels G and L). Note that for Ddrugs = 1, 2, and 5 a maximum of 4 lm is required, whereas for Ddrugs = 10 and 20 a maximum number of 6 lm is required.

Supplemental material, Supplementary_material for Quantitative assessment of required separator fluid volume in multi-infusion settings by Frank Doesburg, Daniek Middendorp, Willem Dieperink, Wouter Bult, Maarten W Nijsten and Daan J Touw in The Journal of Vascular Access

Additional file 3. Relation between levels of LCONV, the corresponding values of LMX and the reduction in lumens where Ddrugs = 1 min.

Additional file 6. Relation between levels of LCONV, the corresponding values of LMX and the reduction in lumens where Ddrugs = 10 min.

Additional file 9. Relation between the multiplex administration rate (QMX) and the conventional rate (QCONV) for different values of Ddrugs.

Additional file 7. Relation between levels of LCONV, the corresponding values of LMX and the reduction in lumens where Ddrugs = 20 min.

Additional file 5. Relation between levels of LCONV, the corresponding values of LMX and the reduction in lumens where Ddrugs = 5 min.

Additional file 2. Flow of study data.

Intravenous (IV) therapy is one of the most commonly used medical treatments worldwide. In hospitals IV therapy is commonly performed using an IV pump that administers drug solutions contained in an IV bag or syringe into the bloodstream of the patient. Despite its wide application there are various risks in all stages of the therapy. Multi-infusion, the administration of multiple different infusions simultaneously, is common in the intensive care unit (ICU). In the ICU more than twice the number of drugs are administered compared to other hospital departments, which also increases the risks of IV therapy in the ICU. In this thesis we explored the various challenges as well as opportunities of multi-infusion. One of these challenges is how to objectively identify phlebitis, a common complication of IV therapy. Using infrared (IR) thermography we were able to detect a temperature difference between the IV insertion site and a reference point that was related to early onset phlebitis. Another challenge is the incompatibility of IV drug solutions, where solutions react chemically when co-administered through the same IV tube. We developed a new protocol to determine which common IV drug solutions can safely be co-administered. We also developed a novel way to avoid drug incompatibilities called multiplex infusion. Using this technique incompatible drug solutions are separated within the same IV tube using a third solution that is compatible with both surrounding solutions. We found that this technique could reduce the number of IV access points required in multi-infusion and may also prevent the occurrence of phlebitis. We developed and tested a new user interface that allowed the simultaneous control and monitoring of multiple infusion pumps that could serve as a platform for multiplex infusion. Finally, we developed new algorithms that allowed for a quicker detection of occlusions (blockages) in the IV tube than traditional occlusion detection algorithms.

Infections pose a major threat to intensive care (ICU) patients, with considerable mortality and long-term sequelae in survivors.In this thesis, three major subjects regarding infections in ICU patients are discussed. The aim of included studies is the improvement of prevention and treatment of such infections.The first part describes the incidence of highly resistant microorganisms (HRMOs), comparing characteristics and outcome of ICU-patients with versus those without HRMO. In this cohort, a small but relevant proportion of patients was HRMO-positive, with most HRMOs imported to as opposed to acquired in the ICU. Most HRMOs were Gram-negatives. The clinical outcome was worse in those with HRMO compared to those without HRMO.The second part describes the pharmacokinetics of beta-lactam antibiotics. First, plasma concentrations of continuously dosed piperacillin in ICU-patients were evaluated, followed by evaluation of plasma concentrations of cefotaxime in a randomised trial. In this trial, one group was treated by intermittent, the other group by continuous dosing of cefotaxime. In both trials, continuous dosing did not guarantee the attainment of target concentrations, but in the cefotaxime-trial continuous dosing led to adequate plasma concentrations more often compared to intermittent dosing.The third part describes the dynamics of fecal microbiota in ICU-patients admitted for planned cardiosurgery. Bacterial diversity decreased during admission compared to baseline. Also, the relative abundance of anaerobes, considered part of a ‘healthy’ gut microbiota decreased, whereas the relative abundance of some pathobionts increased. In most patients the change in microbiota during hospital stay reverted to the original composition post-discharge.