8/3/2023 0 Comments Mp3 tag lyrics editorThings offer lots of flexibility! That's exactly the tool I was lookingįor. Like it! It is a bit more technical than other tools but these technical Have been testing your mp3tag-software since one week. Great looking user interfaces and great design, but are totally useless. There are lots of tools out there which have I have been looking a long time for a good and I'll have no hesitation in purchasing furtherĬongratulations. The SYLT Editor is a utility to create or edit synchronized lyrics (or text) that is embedded in an MP3 track. The latest version of the program is supported on PCs running Windows XP/XP Professional/Vista/7/8/10/11, 32-bit. Lyrics Editor lies within Multimedia Tools, more precisely Players. This free program is an intellectual property of Doof The Mighty. GREAT product!Įxcellent utility which works very well. Description The 2.14 version of Lyrics Editor is available as a free download on our website. Wow! The Free M4a to MP3 Converter installed so easily, was super easy to use, and BAM! my files were converted in (and I'm not kidding) about 90 seconds total, download, install, and conversion. The online album databases make it simple to tag all your digital I've used other MP3 Tag software but found "MP3Tag" to have everything I You can sort audio files by tags and edit tags for. It does exactly what it says it does, simply and easily. Puddletag is a free and open source audio tag editor that shows tags in a spreadsheet-like tabular interface. I just wanted to say this application is brilliant. ![]() It is a great piece of software and you provide one of the best customer services I have ever come to! Congratulations on such a great enterprise, and thanks again for your help. (mp3Tag Pro) I have just downloaded and installed version 9.2. (Free M4a to MP3 Converter) Thanks guys!!! Been using this software for years and it is always consistent, reliable and fast (even on my old XP laptop).
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8/3/2023 0 Comments Hp spectre x360 charging port![]() (HP uses the same AC charger design on its thin, light, and leather-wrapped Spectre Folio.) With the Spectre x360 13 reviewed here, we see yet another evolution, with curved sides so you can wrap the 65-watt cloth-braided cable around the body for storage. The company moved to a more modern shape with the last generation. The original USB-C brick HP used as recently as two years ago was literally a small brick as boring as what you’d get with an $11 hard drive enclosure. It’s no surprise that the Spectre x360 13 uses a standard USB-C Power Delivery charger, but the charger’s design shows HP has been listening. “Too thin” for USB Type A? HP says that’s just a bunch of malarkey The corner location fixes both of those issues. ![]() We also find that side-mounted power buttons force a lot of head-tilting to find that button when you need it. Raise your hand if you’ve picked up your laptop and accidentally pressed its side-mounted power button, putting it into sleep mode or worse. The other feature that’s just stupidly clever is the relocation of the power button to the cut-out corner. Yes, the beloved square USB you’ve known for so long actually fits on this thin laptop, saving you from dongle hell. The right side of the Spectre x360 13 is sparser, but it offers two very important things. You can see that although it’s about as thin as the Dell XPS 13 9380, the Spectre has a larger foot print. The right side of the new HP Spectre x360 13 features two Thunderbolt 3 ports, an analog headset jack, and microSD slot. You probably can’t see it, but there’s also a tiny slide switch to let you disable the webcam. The HP Spectre x360 13 sports two Thunderbolt 3 ports on the right side, plus a microSD port and analog headset port. The clever use of the corner allows the HP to angle the cable away from the laptop when in use and doesn’t interfere with how the screen folds. ![]() For weight, our scale put it 2 pounds, 14 ounces, which is a few ounces heavier than Dell’s XPS 13 9380. Its 0.57-inch girth sounds thick, but it’s actually comparable to that of other laptops in its class. The laptop is 12.1 inches wide about 8.6 inches deep. ![]() I can go on and on about the other absurd prices, but you get the idea. Here, you want $185 for the same one hour massage. In the States, you can get a massage for roughly $60 for one hour and often less in many places. Here they are on vacation and they can’t afford to use any of the services offered in the spa. I saw two mothers with their teen daughters asking about the prices, and then they walked out very defeated and disappointed. While the spa is huge, it was virtually empty. Reason being is that it is essentially unaffordable for the majority of your guests. This is probably the most disappointing of all. By contrast, the deserts in the evening restaurants are excellent! The spa…. Guests would enjoy and eat their entire desert. A better option would be to limit the quantity and focus on quality and deliciousness with a limited variety. So you have a lot of waste, and this is not economical for your establishment, nor enjoyable for the guests. Many guests take a bite and leave the rest. Rather the custard tastes like a glob of nothing. Neither the custard nor the chocolate melt in your mouth. You can very easily see the ingredients are less than, because the quality just isn’t there. while very pretty to look at, they are basically tasteless, or inedible. So you have 90% of the lounging chairs vacant with a towel on them, and many guests (who are wanting to actually use the chair) walking around with no place to rest. This leaves others guests who would actually use the chair, no chair. Folks get there early, put a towel down, and considerate it their chair for the entire day, even though they’re not using the chair 98% of the time. My first qualm….It is not considerate for guests to monopolize the loungers in the pool area. The staff are terrific, accommodating and friendly. I want to preface my review by saying the food, excluding the desserts in the buffet area, is excellent!! I also want to say that the grounds of the resort are very beautiful, spacious and well maintained. The Cosmopolitan of Las Vegas, Autograph Collection.Hotels near Wasabi Loco Sportfishing Adventures.Hotels near Riviera Elite Private Yacht Tours.Hotels near Adoratorio, Ruinas Chac-hal-al.Puerto Aventuras Hotels with Bike Rentals.Puerto Aventuras Hotels with Steam Room.All Inclusive Resorts in Puerto Aventuras.Adults Only and Adult Friendly Resorts Puerto Aventuras.Barcelo Hotels & Resorts in Puerto Aventuras. 8/3/2023 0 Comments Kobotoolbox app![]() KoBoCollect is based on the OpenDataKit, and is used by professionals wherever reliable and professional field data collection is needed. Together, these tools are used by thousands of humanitarians, development professionals, researchers, and private companies to to design and implement primary data collection projects around the world. KoBoToolbox consists of several software tools to help you with your digital data collection. Advanced users can also install their own KoBoToolbox instance on a local computer or server. To visualize, analyze, share, and download your collected data just go back to your KoBoToolbox account online. Once your form is created and active, configure this app to point to your account, following the instructions in our tool. This app requires a free KoBoToolbox account: Before you can collect data create a free account with your computer on and create a blank form for data entry. There are no limits on the number of forms, questions, or submissions (including photos and other media) that can be saved on your device. With this app you enter data from interviews or other primary data - online or offline. Select one of the answers chosen to be an option.KoBoCollect is based on the OpenDataKit and is used for primary data collection in humanitarian emergencies and other challenging field environments. Once a point is placed, continue the process to create a polygon of three or more points.įor “Select One” answers, a drop-down screen will be available. If you selected an area or polygon as the desired answer type, then create a polygon by long-pressing the screen to create a point. Once a pin is placed, proceed to press down on the map where you would like to connect from the previous point. Wait for the screen to lock and add marker button to start by pressing down on where you would like to create a path. If you selected a line as the desired answer type, then select “Start GeoTrace”. To proceed to the next question, select the arrow pointing to the dot on the top right of the screen. ![]() If you selected a “point” then use the map to determine your location. Select the form to which you would like to enter data and go through all the questions (swiping your finger from right to left).Open KoBo Collect on your device and click on “Fill Blank Form”.In this case, we are using an Andriod applicationĬollect Data with KoBoCollect on an Android Device ¶ After this, you must select the form of data collection under the Collect Data segment. In order to input this data, select DEPLOY under the project form.If you would like to return to the main menu, click the save button at the top right of the screen and then the green icon on the top left of the screen to return to your list of projects.To start collecting data you need to first deploy the draft form as a new data collection project.Close the Form Preview and save the form by clicking the Create/Save button on, then ‘X’ to close the form. Scroll to the bottom of the page and select “Validate”. ![]() Click Preview Form ( The eye icon near the top of the page) to quickly view the questions and test skip logic.Save the project and return to the main menu.Note: If you are asking a question with discrete answers or options, you may select the icon for “Select One” and insert the answers. Below is a table of possible appearance attributes and how questions appear in the form. These options will allow you to change the appearance of questions on the form. Notice the “Appearance (Advanced)” option on the bottom of the screen.Q2: What directions did you take to get to school this afternoon? You can also select “Skip Logic” to display the question only when other conditions apply. Here you can edit the name, add a hint, tag, and use a default response. To evaluate options for the question, select the settings symbol to the right of the question.The symbol will be to the left of the new question. Once you type in a question and a preferred response type. ![]() Here are the different Types of Geo Responses you can Use: You may also select Text if you have a metadata question. If the question is a geography question, select Point, Line or Area. Type in a question in the search bar and click “add question”.
8/3/2023 0 Comments Awaken book![]() Ozan Varol is one of my favorite thinkers on thinking. Ozan Varol's a brilliant mind, a warm and kind heart, and the exact type of spirit we need putting resilient vibes into the world right now.- Neil Pasricha, New York Times-bestselling author of Book of Awesome Ozan Varol is like Nassim Taleb meets Daniel Kahneman.- Clara Shih, CEO of Salesforce Service Cloud If you looked up the word ‘polymath’ in the dictionary, you may see a picture of Ozan Varol.- Nir Eyal, Bestselling author of Hooked and Indistractable When the stakes are high, the unknowns are threatening, and the problems seem insurmountable, you need a superhero-which means you need Ozan Varol.- Daniel Pink, New York Times-bestselling author of Drive "Ozan Varol always makes me think."- Adam Grant, #1 New York Times bestselling author Awaken: With Min Namkoong, Seol-Hyun Kim, Chung-Ah Lee, Sun-Woo Yoon. Readers who feel stuck in a rut will find this a boon.”- Publishers Weekly “Varol succeeds in distilling from their stories sensible advice that benefits from his encouraging tone. You’ll give birth to your genius, the universe-denter you were meant to be. You’ll discover how to look where others don’t look and see what others don’t see. You’ll be equipped to escape your intellectual prisons and generate original insights from your own depths. You’ll learn how to discard what no longer serves you and discover your first principles-the qualities that make up your genius. We call these people geniuses-as if they’re another breed. They stand out from the crowd because they embody their own shape and color. They think and act with genuine independence. We sleepwalk through life, find ourselves on well-worn paths that were never ours to walk, and become a silent extra in someone else’s story.Įxtraordinary people carve their own paths as leaders and creators. But implicit in this cliché is that the rest of us march to the same beat. ![]() We say some people march to the beat of a different drummer. ![]() Unlock your originality and unleash your unique talents with this simple guide from the acclaimed author of Think Like a Rocket Scientist. 8/3/2023 0 Comments Aero fighters 2 pilot![]() aero squadrons at the front but none are known to have flown in combat.Ĭlick on the following links to learn more about enlisted pilots.Ĭlick here to return to the World War II Gallery. During World War I, 60 enlisted mechanics earned wings in France and ferried aircraft from French factories to U.S. By April 1917, 26 other enlisted regular Army personnel had become pilots. Sporting a thick mustache and a parrot, Silver’s A-10 comes equipped with a powerful straight-fire machine gun, and his bomber attack drops a tactical nuke that lingers on screen for a second. Carl Crane revolutionized aviation by developing a system of flying by instruments that made all-weather flight possible. Ocker (1914), who was commissioned in 1917. Lamkey became the second on record, but he purchased his discharge and flew in Mexico for Pancho Villa. There are 10 levels in Aero Fighters 2 spanning all across the world from Japan to New York, to Australia and many more places. On July 18, 1914, Congress authorized the training of enlisted pilots and William A. ![]() Yet in USAF history about 4,150 pilots trained and flew not as commissioned officers but as enlisted men - almost 3,000 rated pilots and nearly 1,150 liaison pilots. Lahm's message announcing that one of the two new aviators he had trained was a corporal. Continued abuse of our services will cause your IP address to be blocked indefinitely."It is not the policy of the War Department to train enlisted men in flying aeroplanes. Please fill out the CAPTCHA below and then click the button to indicate that you agree to these terms. If you wish to be unblocked, you must agree that you will take immediate steps to rectify this issue. If you do not understand what is causing this behavior, please contact us here. If you promise to stop (by clicking the Agree button below), we'll unblock your connection for now, but we will immediately re-block it if we detect additional bad behavior.
8/3/2023 0 Comments Whatsapp plus 2020![]() It will make you feel free in a quite busy position and can’t attend to or reply to your loved ones. Similar to Whatsapp Business, set some auto-reply for specific events or positions and make your life a lot easier. Tweak everything according to your taste Auto-Reply No need for custom themes just like Whatsapp, go ahead and have fun with multiple customizing options from font size to their colors. Unlike the official app, you will find a customized interface where you can change everything according to your choice. It also gives you detail of your account activities such as spending time on the app and existing of it also. The feature enables you to save your mobile data also and the recording of your online activities helps you to track your data and time. It is a step ahead of the official app and provides a plethora of interesting emojis and emoticons as it is integrated with Google Hangout to get emojis and enrich your library with fantastic emoticons and emojis. You are also capable of using symbols to describe your feelings in a different style. Just avoid the most common font styles and enjoy a library of fonts with 20+ that is housed on the interface. Fonts & StylesĪvail a great variety of fonts including different shapes, sizes, and styles. You are gifted with a regularly updated addition of themes for your library as well. Whatsapp Plus you can perform multiple tasks such as profile color changing, changing the home screen, and so on. As we know, in the official app, we only change the background of the screen and not anything else. Personalize your chatting screen using up to 700 different styles of themes. Here we are describing some of the features offered by the groundbreaking app. It covers all the privacy features that are missing in the original one. Whatsapp Plus offers multiple amazing features specifically the most demanding capabilities are part of it. ![]() You can’t use it as an add-on with the original app and the end-to-end encryption enables the user not to compromise on security as well as privacy issues. You will find Whatsapp Plus a standout utility because of its unique features and the simplicity of its interface. So, Whatsapp Plus became one of the most adorable mods of Whatsapp. ![]() When developers of third parties felt the need of revolutionizing Whatsapp, they decide to create mods of the king app while adding missing features of it to them. The reason for the popularity of Whatsapp is the excellent features that attracted millions of people from around the world. It is including with three fantastic mods that are presented by AlexMods, Fouad Mods, and Hey Mods. ![]() Whatsapp Plus is a simple and customizable mode of Whatsapp offered by Rafalete, a senior member of XDA. How to Switch from Whatsapp to Whatsapp Plus.Difference between Whatsapp and Whatsapp Plus.But, it has lack multiple privacy features. No doubt, Whatsapp has resolved our big communicating issue and gives us easy access around the world. You will find multiple amazing mods of Whatsapp with a plethora of fantastic features. Messaging apps at present are completely different from a few years ago. If you are a regular internet user, you know everything on time. Same as in IT a lot of new software is developed and old ones are updated regularly. We know, it is a time of fast competition and we find different developments with everyday passing, specifically, in the field of science and technology. But, on Whatsapp, you can share any personal information without any risk of leaking your information. The fool-proof security and privacy offered by Whatsapp may be a specialty related to the app, as you have to face any type of security or privacy flaws with other such messaging apps. Whatsapp Plus Blue enables the digital world stronger while offering instant messaging functionality, no matter, whether you want to contact your family, your friend, or discuss a business deal with your colleagues. Whatsapp Plus is one of them that got great fame around the world for the features that are added in it by the developers. in fact, the mods are the presentation of different third parties with the addition of extra features to enhance the flexibility and user experience. Whatsapp Plus Apk Download 2023 Latest Version is a Mod of Whatsapp that proved a big development in the communication system. 8/3/2023 0 Comments Openttd conditional orders![]() All users of 0.5.0 are encouraged to update to this new release. This 0.5.1 release is a bugfix release for 0.5.0 which solves many of the issues found in 0.5.0 with stability and fair play in multiplayer.The 0.5.2 release of OpenTTD is a bugfix release for the 0.5 series.Please refer to the readme for more information.Changelog hat geschrieben: OpenTTD v0.5.2. These can be installed automatically by the Windows and OS/2 installers. There are also the freeĪlternatives: OpenGFX (graphics), OpenSFX (sound) and OpenMSX (music). (you need to own a Transport Tycoon Deluxe CD). Support for other (sized) fonts where the user interface scales based on the font and translationįor OpenTTD you can use the original Transport Tycoon Deluxe data files More hotkeys for even less mouse-clicking Snappy and sticky windows that always stay on top and neatly align themselves to other windows Game speed increase (through fast forward button or by pressing the TAB key) Resolution and refresh rate selection for fullscreen mode More currencies (including Euro introduction in 2002)Įxtra viewports to view more parts of the game world at the same time Screenshots can be in BMP, PNG or PCX format (select in game options menu) Sell whole train by dragging it to the dynamite trashcanĪdvanced options configuration window, change settings from within the game Mouse wheel support (scroll menus, zoom in/out)Īutoscroll when the mouse is near the edge of the screen/window Sorting of most lists based on various criteria (vehicle, station, town, industries, etc.) These include:Ĭonvert rail tool (to electrified rail, monorail, and maglev)ĭrag&drop support for almost all tools (demolition, road/rail building/removing, stations, scenario editor, etc) Lots of effort has been put into making OpenTTD easy to use. Zooming further out in the normal view and zooming out in the small map OpenTTD has already been translated into over 50 languagesĭynamically created town names in 18 languages, plus NewGRF support for additional languagesįreely distributable graphics, sounds and music Significant internationalisation support. Save games using zlib compression for smaller sizes, while not interrupting gameplay Many configuration settings to tune the game to your liking Support for TTDPatch NewGRF features offering many options for graphics and behaviour configuration/modificationĭrive-through road stops for articulated road vehicles and trams ![]() Presignals, semaphores, path based signalling Reworked airport system with many more airports/heliports (e.g. Longer and higher bridges including several new designs, plus fully flexible tracks/roads under bridges The possibility to build on slopes and coastsĪdvanced/conditional orders, share and copy orders Larger, non-uniform stations and the ability to join them togetherĭifferent configurable models for acceleration of vehiclesĬlone, autoreplace and autoupdate vehicles New pathfinding algorithms that makes vehicles go where you want them toĪutorail/-road build tool, improved terraforming In game downloading of AIs, NewGRFs, scenarios and heightmaps IPv6 and IPv4 support for all communication of the client and server Stable multiplayer mode for up to 255 players in 15 companies, or as spectatorsĭedicated server mode and an in-game console for administration Significant enhancements from the original game include: The creators don't just fix things, they put in new additions such as bigger maps (up to 64 times in size) and stable multiplayer mode for up to 255 players. This is the OpenTTD v1.3.1 Final release, which is a constantly updated Open Source Transport Tycoon Deluxe. But now you can play it today, without even having to own the original. There was so so much more to this game, let alone the growing cities and new factories that I spent many hours in non stop play time. It was just an incredible game! To be able to run your own transport company with the ability to transport goods, make your own railroad set ups, bus routes with the ease of use that a kid could pick up and play, no wonder it was so popular. It was also one of Microprose's all time best titles. In my opinion and I'm sure many others would agree, that Transport Tycoon Deluxe was one of the greatest transport simulation games ever to be released. And there's a lot that I can't do or look at or listen to anymore because it's too hard, but that song is like a hug. And it - honestly, it doesn't make me sad to hear it. (Crying) It's lost some of its specialness, I guess, but she'll put the stereo on. My daughter still asks if she can play in the garage. VETO: You know, we'll go home a lot still. THE TURTLES: (Singing) When you're with me, baby, the skies will be blue for all my life. Like, literally, like, it's that cliche and awesome. VETO: How do you even describe it? Like, if their lives were, like, a movie montage - you know? - like, that song would be playing in the background while they're, like, swinging on swings and throwing rocks into ponds. THE TURTLES: (Singing) I can't see me loving nobody but you for all my life. Or - that was his partner in crime, you know? He used to say, I'm going to squeeze you until you fart (laughter) to her, and she'd laugh. Or he knew a guy that had a pet pig, and they'd go see that. VETO: He would take her - he'd take her on all these just adventures. It's only right to think about the girl you love and hold her tight. THE TURTLES: (Singing) Imagine me and you. But when "Happy Together" came on, you know, honestly, it really put into words how he felt about her and didn't know how to articulate. And he got this, you know, "Turtles' Greatest Hits" CD (laughter), and he would play that whole "Greatest Hits" CD for her. You know, one of the first things she always asked him was, can we play in the garage? And so he'd empty all the vehicles out of the garage, and he'd turn the stereo on - six-disc CD player. And, you know, she'd be like (imitating child) grandpa. You know, we'd be pulling up in the driveway, and before we even had the car stopped, my dad would be there getting my daughter (laughter) out of the car seat. And, you know, my husband, my daughter, the two dogs, the cat, every Friday after work, pack up the car and drive there for the weekend. VETO: My dad had the most magnetic personality ever. STEPPENWOLF: (Singing) I like to dream - yes, yes - right between the sound machine. VETO: Anything that really rocked, he was into - anything with a good baseline - but, you know, the classics like Jimi Hendrix and Zeppelin, Black Sabbath and Steppenwolf. (SOUNDBITE OF THE JIMI HENDRIX EXPERIENCE SONG, "PURPLE HAZE") And, you know, he was a huge lover of classic rock. He played bass in a bunch of, you know, high school bands and everything, taught himself to play. It was called Tom's - or it is called Tom's Floor Shop, and it's been running for about 35 years now. STEPHANIE VETO: My dad owned and operated his own flooring business with his cousin, my Uncle Ronnie (ph). Their song is "Happy Together" by the Turtles. Today, we have Stephanie Veto, who remembers her father, Tom Makosky, and the incredible bond he shared with his 6-year-old granddaughter, Autumn (ph). ![]() We're calling our tribute Songs Of Remembrance. To remember some of those who lost their lives, NPR is sharing the music that moved them and hearing stories from their friends and families. from COVID-19 since the pandemic hit last year. If you believe that any review contained on our site infringes upon your copyright, please email us.More than a half million people have died in the U.S. All submitted reviews become the licensed property of Sheet Music Plus and are subject to all laws pertaining thereto.If you have any suggestions or comments on the guidelines, please email us. We cannot post your review if it violates these guidelines.Avoid disclosing contact information (email addresses, phone numbers, etc.), or including URLs, time-sensitive material or alternative ordering information.Please do not use inappropriate language, including profanity, vulgarity, or obscenity. Be respectful of artists, readers, and your fellow reviewers.Feel free to recommend similar pieces if you liked this piece, or alternatives if you didn't. ![]() Are you a beginner who started playing last month? Do you usually like this style of music? Consider writing about your experience and musical tastes.Do you like the artist? Is the transcription accurate? Is it a good teaching tool? Explain exactly why you liked or disliked the product. ![]() Remove the needle while holding the guidewire in place.Feed 15–20 cm of guidewire through the needle.Hold the needle firmly and remove the syringe. ![]() Apply negative pressure to the syringe plunger and advance the needle until blood flashback occurs.Place the needle beneath the center of the probe at a 45° angle to the skin.This approach uses a thin wall needle (referred to as “needle” from here on) and the Seldinger technique. Tunneled CVLs for long-term use nontunneled CVLs for short-term use.Hemodialysis catheters: can be a long-term CVL or a short-term CVL.Long-term CVLs: e.g., PICC lines, tunneled CVLs, surgically implantable catheters.Sheath introducer (large gauge): used for rapid or high-volume fluid administration, or to aid insertion of other lines (e.g., Swan-Ganz catheter).Small gauge: decreases the risk of vessel thrombosis.Single-lumen CVL: 1 channel allows administration of a single solution at a given rate.Double-lumen CVL: 2 channels typically large gauge that allows high rates of fluid exchange, e.g., for hemodialysis or plasmapheresis.Triple-lumen CVL: 3 channels allows simultaneous administration of multiple solutions at different rates.Short-term CVLs: nontunneled CVLs typically intended to remain in place ≤ 14 days.Higher risk of pneumothorax than IJ line.Enters below the left or right clavicle via the subclavian vein.Higher risk of infection than subclavian line.Lower risk of pneumothorax than subclavian line insertion.Enters the neck via the left or right IJV.DefinitionĬomparison of CVLs by insertion site Complications include arterial puncture, pneumothorax, bloodstream infections, and venous thrombosis. Insertion is most commonly performed using the Seldinger technique and usually occurs under ultrasound guidance. The internal jugular vein is frequently chosen for central line placement because it is easy to access and is associated with fewer procedural adverse events than other sites. Smaller gauge, multiple-lumen catheters are used for prolonged fluid and medication administration. Large-gauge, single-lumen catheters are used for the rapid administration of fluid or blood products. The type of catheter used and anatomical location of placement are based on the patient's condition or injury and comorbidities. It also allows for specialist interventions such as advanced hemodynamic monitoring, transvenous pacing, and hemodialysis. The adjacent orifices at the tip of the end hole of the double-lumen catheter appeared to permit interaction of the two effusing streams of the incompatible drugs, whereas the staggered orifices of the triple-lumen catheter reduce this interaction.Placement of a catheter in a large, central vein provides reliable venous access in patients who are critically ill, have poor venous access, and/or require administration of vesicants, irritant solutions, or large volumes of fluid. In some cases, millimeter-size fragments of phenytoin precipitate were seen to dislodge from the tip of the double-lumen catheter. Infusion through the double-lumen catheter resulted in an average of 6% loss of phenytoin to precipitate, which, on microscopic examination, appeared as spindle-shaped crystals 25 to 50 microns in length and 5 to 10 microns wide. White clouds of phenytoin precipitation were observed near the tip of the double-lumen catheter but not the triple-lumen catheter. Video recordings were made of drug interactions, and assays of phenytoin concentration were performed on samples of the circulating fluid. Flow conditions and drug infusions in the venous model were designed to mimic the in vivo clinical situation to evaluate two central venous catheter types, a double- and a triple-lumen catheter. This study utilized an in vitro model flow system to examine the physicochemical phenomena that occur when two incompatible drugs (phenytoin and total parenteral nutrition) are simultaneously administered through multilumen catheters. Though there are no known documented reports that this practice has been responsible for harmful events in patients, likewise there are no published data to verify the safety and efficacy of this practice. Multilumen catheters are commonly used to simultaneously administer incompatible drugs to critically ill patients. |
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