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Introduction -A central venous catheter (CVC) is thin, a flexible tube (catheter) that is placed into a large vein above the Heart. It may be inserted through A vein in the Neck, (internal jugular) chest (subclavian vein. Axillary vein) groin (femoral vein), or through veins in the arms known as a PICC, or peripherally inserted central catheters. Site- Internal jugular vein, subclavian vein, axillary vein, femoral veins, the best approach or access point for Central line insertion. Indications - The indications for central venous access are broad and are often situational. Inability to obtain venous access in emergent situations, chemotherapy administration, medications administration (Vasopressors. inotropic administration Total Parental nutrition administration, Hemodynamic monitoring are common indications for CVC insertion. Contraindication- Local cellulitis, Low platelet count, Local infections, Thrombocytopenia, Congenital anomalies, Trauma are common contraindications of CVC insertion. Complications - Numerous potential complications can occur during the procedural placement of a central venous catheter, but also as a result of the indwelling equipment. Arrhythmias, Arterial puncture, Pulmonary puncture with or without resultant pneumothorax, Bleeding – hematoma formation, which can obstruct the airway, Tracheal injury, Air emboli during venous puncture or removal of the catheter, Pulmonary embolism, Local cellulitis, Catheter infection, Cardiac tamponade, Intravascular loss of guidewire, Hamo thorax, Phrenic nerve injury, Brachial plexus injury, Cerebral infarct from carotid artery cannulation, Bladder perforation, Bowel perforation, Sterile Thrombophlebitis. Post-procedural complications: Catheter-related bloodstream infections – bacterial or fungal, Central vein stenosis, Thrombosis, Delayed bleeding with multiple attempts in a coagulopathic patient Clinical Significance - Ensure that sterile products are not contaminated and that there is no evidence of damage to the packaging. Follow sterile procedures at all times. Central line infections can be a serious and life-threatening illness. Always ensure that the catheter is appropriately placed through one or several methods: radiographic evidence, measurement of CVP, or by analyzing a venous blood gas. Never use excessive force during any part of this procedure. It will lead to damage to local structures. Nursing Responsibility - After a CVC placement, nurses are responsible for maintaining, monitoring, and utilizing central venous catheters. The assigned nurse must check complications such as infections, hematoma, thrombosis of the catheter, and signs of pneumothorax and bleeding. Nurses are also responsible for ensuring that the site is maintained in a clean and sterile fashion. Daily inspection of the access site and device patency should be performed during nursing rounds. In particular, nursing officers must disinfect injection ports, catheter hubs, and needleless connectors with institutionally approved antiseptics. Intravenous administration sets should be changed regularly per hospital policy. The site should be checked for bleeding, hematoma formation, and signs of cellulitis, which include erythema, purulent drainage, and/or warmth. Dressings should be changed if visibly soiled. This must be performed with proper sterile technique. Keywords: CVC, Central Line, Central venous catheter.

Introduction: Antibiotic resistance is global problem. According to World Health Organization data more than 23000 people die or become critically ill due to resistance of antibiotic therefore the unavoidable threat to human life is rising day by day. India has the highest infectious disease burden in the world and consequently antibiotics play a critical role in limiting morbidity and mortality. Objectives: To assess knowledge attitude and practices regarding antibiotic administration and its resistance, to assess the association between knowledge, attitude and practice. Research Methodology: Evaluative research approach and descriptive design is used in this study. The major variables in the study were knowledge, attitude and practice of nursing professionals. Self-structured knowledge questionnaire is used for collection of data.100 staff nurses were selected from population based on inclusion criteria. A non-probability convenient sampling technique was used to select samples. Result: Total 100 nursing professional from various District of Chhattisgarh state participated in study, in which knowledge score found 27(27%) having Adequate knowledge, 50(50%) having Moderately adequate knowledge and 23(23%) having Inadequate knowledge, level of attitude found 38(38%) having Favourable attitude, 61(61%) having Moderate attitude, 1(1%) Unfavourable attitude and level of practice found 22(22%) having Good practice, 46(46%) having Moderate practice score and 32 (32%) having Poor practice score. Correlation found between Knowledge & Practice. Correlation is significant at the 0.01 level. Keywords: Antibiotic resistance, antibiotic administration, nursing professionals.

Hyperthermic (or Heated) Intraperitoneal Chemotherapy (HIPEC) is a surgical procedure that's giving new hope to patients with abdominal cancers. Immediately after removing visible tumors through cytoreductive surgery, surgeons give a dose of heated chemotherapy inside a patient's abdomen. The technique involves macroscopic resection of disease burden and metastases, followed by infusion of chemotherapy heated to 41°C-43°C into the peritoneal cavity through a special device. After 90 minutes of the infusion, the chemo is washed out and incisions are closed. Chemotherapy: -In HIPAC (Intraperitoneal) mitomycin-c is the most common drug administrated and platinum-based drugs, cisplatin, carboplatin, and oxaliplatin which have a synergistic effect with heat, and doxorubicin, paclitaxel, docetaxel, and 5fluorouracil drugs are commonly less used. The technique of Hyperthermic intraperitoneal chemotherapy Administration: HIPEC is administrated by two classical methods, the open abdomen method, and the closed method. Skin preparation of patient: Skin preparation is from the mid-chest to midthigh with the preparation of the genitalia and catheterization. Safety guidelines for administration of HIPEC:A sign the HIPEC is in progress should be placed at the door and the entry of personnel not involved in the procedure should be restricted. N95 grade mask provides the best protection against surgical smoke produced during the use of electrocautery. Doors should be closed during the operation with pressurized closures. The temperature should be 18-26 degrees Celsius and air humidity 45-60 %. The Association for peri-Operative Registered Nurses (AORN) recommends that operating room air exchanges should be maintained at a minimum of 15 air exchanges per hour. Air inflow volume should be 15 % higher than the outflow, airspeed must be lesser than 0.3 m/s. Appropriate PPE (personal protective equipment) consists of an N95 face mask (a simple surgical mask does not provide adequate protection), gloves, protective gown, and overshoes or laggings to provide adequate protection to all involved team members. Handling of the chemotherapy during HIPEC: it should be prepared in the bio-safety cabinet not in the ward because of the danger from spillage and contamination, while preparing cytotoxic drugs to wear nitrile or neoprene powder-free long cuff gloves and wear a gown non-permeable long sleeve, cuffed and solid fronted and use an aerosol-free mask. Every effort should be taken to avoid any spill. Hospital policies to prevent spills should be adopted by the surgical and operation theatre team members and written procedures must specify the team responsible for spill management. Health care institutions should develop a plan and policy for handling hazardous medications. Collection, labeling, storage, transport, and disposal of contaminated waste should be done as per hospital policy. Cleaning the operating room after HIPEC: Soap water is adequate to clean the operating room after HIPEC three consecutive times. 70% of isopropyl alcohol i...

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