2 0 obj Catheter sepsis - Infection is the most common complication from the use of PICC lines. change quicksheet. Preceptor: Jamie Daniel Of the 156 respondents accessing the survey, 115 (73.7%) indicated that they placed PICCs as part of their daily occupation. Cookies used to make website functionality more relevant to you. Over 65,000 articles were screened related to the six priority research questions. No benefit to changing these more frequently than every 72 hours For neonates with ongoing need for central venous access, whether to remove and replace a peripherally inserted central catheter (PICC) that has been in place for a prolonged period of time to reduce central line-associated blood stream infection (CLABSIs) in neonatal intensive care unit (NICU) patients remains an unresolved issue. Venous Would you like email updates of new search results. Share with Email, opens mail client suture integrity, and catheter position Centers for Disease Control and Prevention (2011). - Necessary medications and fluids are delayed and can affect patient outcomes or delay discharge. The "safety pneumothorax system includes a blunt, multi-side holed, spring-loaded inner Do not use antibiotic ointments or creams Gather necessary equipment and supplies using designated procedure cart. Apply sterile dressing to site Consider removal of umbilical artery catheters at or before 7 days of dwell time in neonatal intensive care unit (NICU) patients. 3 0 obj zIqNo^3aT\b9--3pr!}Esnz'W/P=b{[=L.u{y|Km {`j#A{Ia| x^Xy59g~%/3QMfP] ~\M7n|_&V?AD9[]5S\.6OoXYI?w5wO.wY8;M3/-tP=l?qFxz&~Ttq-fz_V}ETj4&;kmZN^_u/,t h1J I G/@*H outpatient oncology settings. Mosbys Skills. A Peripherally Inserted Central Catheter(PICC) is a small flexible tube that is inserted into a vein on the inside of your upper arm. Reading, PA: Arrow International, This presentation describes how one level-one neonatal intensive care unit (NICU) placing ultrasound guided 1.4 and 1.9 French (Fr) PICC using the peel away introducer technique and the outcomes. Basilic vein preferred, cephalic used if necessary This PICC team was responsible for weekly dressing changes and line assessments, identifying patients eligible for central lines, and PICC insertions. endobj Winner of the Standing Ovation Award for Best PowerPoint Templates from Presentations Magazine. * Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project, Neonatal intensive care unit PICC lines as 'life lines' in neonates Peripherally inserted central venous catheters (PICCs) provide lasting venous access to deliver total parenteral nutrition (TPN) and medications for neonates receiving intensive care, especially in very low-birth-weight infants.1In neonates, PICC lines are commonly inserted at <>>> Patients requiring multiple infusions of fluids, medications, or chemotherapy An IV line will be inserted into a vein in the hand or arm if IV sedation is . The success rate was 92% (36/39) & the median weight was 3.0 (range: 1.1 - 4.6) kg. - Guidelines to Prevent Central Line-Associated Blood Stream Infections * * * * * Arterial Lines: Aseptic Technique As with C-VADs, always: Clean your hands with soap - 3 central lines: policies placement of central lines placement of central lines which one of these is a central line? Positive Displacement Device Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. <> %PDF-1.5 In most units all of these lines are placed blind and confirmed with a single radiograph. Keeping the lines open with evidence-based practice and Newborns and young infants can be swaddled during the procedure and distracted with oral sucrose. Bethesda, MD 20894, Web Policies Patients requiring a temporary access site for hemodialysis 3 0 obj Standardizing central venous catheter care: Hospital to home Caused by inadequate flushing, also b/t flushes caused by increased Methods: Boasting an impressive range of designs, they will support your presentations with inspiring background photos or videos that support your themes, set the right mood, enhance your credibility and inspire your audiences. 9\\!dH For infants requiring multiple infusions. (2014). Atlanta, GA: Centers for Disease Control and Prevention. ]G:.Q^m,bdhpN:y/?! >EChZp2#G4*!h6oJb`z}hu/5%Bo(qS+XW^=ckVw673w]|UWHWdf"| >[**c'o^U O^BvCSq:\w!XH9 _3&e)>#0Ne9CW3c 2011.html 1 0 obj Arrow (1996). UI5 aqvunBaa:q P-xC0.c-k!/4>+G,/,?g0n:mDACoE?"Eq4L P{ ;UL|YK,(A[>~Si! ,'',Ui-Yg6ZR Q{{"Mu*J]k N{ v[/0EEVtgV++cM$R Saved by a bone marrow donation from her brother, Davis, and strengthened by a personalized T-cell therapy post transplant, Mollys life is back on track and shes dancing again. Then you can share it with your target audience as well as PowerShow.coms millions of monthly visitors. Where is the femoral vein in relation to the femoral artery? Gestational age, chronologic age, and skin maturity should be considered when assessing risks and benefits of chlorhexidine-containing agents in determining eligible patients. Flush using a pulsative or stop-start technique Subrata Kumar_BSMMU_2014, Prosadpur Union Sub Center, Manda, Naogaon, BP KOIRALA INSTITUTE OF HELATH SCIENCS,, NEPAL, Central Venous Catheter Care- A Nursing skill, ENDOTRACHEAL TUBE INTUBATION II Parts II Details II Clinical Discussion, Ventilator associated pneumonia -Prevention, Basic Vascular Access Ice Ppt Presentation.Ppt2, Percutaneous Drainage of Abscess and Post Operative Collections, CVAD Management, Care and Maintenance (Radiology Nursing). Place PICC line in lower extremities, preferably left leg. Patients requiring central venous pressure monitoring Over-the-counter pain medications should help relieve this discomfort. Please enable it to take advantage of the complete set of features! Unauthorized use of these marks is strictly prohibited. x\r8}w&n955UI'-v$%HQHT E62oY6=$wm19'a6I7^z//'NOA0! 2>g$Y$'B'2V>#PDgW2%#l8N$y?OOw Ee4J Lc?B)FR+0 L\@9pU54PHQoC?=+%~HZLJ>=4 rW?M"qM9*!b\Qt .2t V^8yg ]*#{;pWm`U -CAT|:a rSl!ml;fBdk92FCrkuhLO@\}Ed9h0Hx)FiqxMDYR3[+AdkmZW1 D)I:k]'F f H.Rx 9FxwyN]U!jFFM,- mkZA+8C ldPJo J`O{|Wzfr /=YrM/P[&: zQb!UJ?O !Le2W)wK2j $+Q\Y4HOgW}/ Use of PICC lines PICC lines should largely be reserved for use with TPN or other 24h infusions. Dressing and tubing changes A PICC line is a thin, soft, long catheter (tube) that is inserted into a vein in your child's arm, leg or neck. Consider the use of alcohol-containing chlorhexidine for skin antisepsis to prevent central line-associated blood stream infection (CLABSI) in neonatal intensive care unit (NICU) patients in whom the benefits are judged to outweigh the potential risks. At the level of renal and iliac arteries, temporary occlusions of abdominal aorta were made in order to slow down the blood flow and facilitate radio-transmitter catheter placement. You will be subject to the destination website's privacy policy when you follow the link. endobj About Press Copyright Contact us Creators Advertise Developers Terms Privacy Policy & Safety How YouTube works Test new features NFL Sunday Ticket Press Copyright . We care about your privacy. Anatomical location Patients lacking useable peripheral IV sites PERIPHERALLY INSERTED CENTRAL CATHETER - PICC Scope of Tutorial What is a PICC? control-prevention-plan-2011/central-venous-catheters.html Suitable infants Preferred PICC for all infants > 1000g. Subclavian vein of upper chest or internal jugular veins in the neck 0 hZmo7+- First an interventional radiologist at Children's National Hospital will perform an ultrasound of the extremity chosen for the PICC to identify the vein to be accessed. Central line: A. resolved What types of PICCs are commonly used in Gippsland? The intestines were retracted, and connective tissue was prepared. endobj endobj X-ray confirmation of catheter tip location Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. If you are a. HHS Vulnerability Disclosure, Help The study found that there was no difference in the rate of CRBSI between groups that had catheter dwell times of 0 to 29 days. Our new CrystalGraphics Chart and Diagram Slides for PowerPoint is a collection of over 1000 impressively designed data-driven chart and editable diagram s guaranteed to impress any audience. Thus, our objective was to systematically review and meta-analyze the . Hand hygiene For neonates with ongoing need for central venous access, whether to remove and replace a peripherally inserted central catheter (PICC) that has been in place for a prolonged period of time to reduce central line-associated blood stream infection (CLABSIs) in neonatal intensive care unit (NICU) patients remains an unresolved issue. 3 0 obj Whatever your area of interest, here youll be able to find and view presentations youll love and possibly download. Amount, type, and frequency of flush solution They are all artistically enhanced with visually stunning color, shadow and lighting effects. Use bundled interventions for central line insertion and maintenance as part of a single or multiple intervention quality improvement effort to reduce rates of central line-associated blood stream infection (CLABSI) in neonatal intensive care unit (NICU) patients. A typical PICC placement takes approximately 30-60 minutes. 4 0 obj Change a child's life forever. } T%r3`0I,W\c)2bm/o /-4vh nn6HL'X7n]n}|OiUss?\86 ddw?[._l]=1 12k}5v|D>U5DDZ['0>z4*C KuHFqj=1J]oVSg \j_9+j|k84dqJD=jJ'x^E(Lq8`rMQq!G:}QV{ yD>^#;$]^K. buildup, occlusion, and even infection <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 16 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 4 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 13 0 R 14 0 R 15 0 R 19 0 R 20 0 R 21 0 R 22 0 R] /MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Document the procedure, any complications, and external catheter length to Complications migrated undesirabletime interval The mean who formed almost of insertion was aroundmedian of 6[IQR 12 days], the mean duration 13 gestations. Scope of Tutorial. Well convert it to an HTML5 slideshow that includes all the media types youve already added: audio, video, music, pictures, animations and transition effects. have divergent pH value, Venous Catheter ahI{Y:LUAgN~Z 2@LO6UET:`PC. Patients subject to frequent blood sampling or receiving blood transfusions And theyre ready for you to use in your PowerPoint presentations the moment you need them. TPN/Lipids (enhance microbial growth) Preventing Central Line-Associated Bloodstream Infections (CLABSIs) ??????????????? }8~XZ\N(MISS4US)ljP'ggo2r\AiR|1&"3.w" Consider implementing a dedicated catheter care team to prevent central line-associated blood stream infection (CLABSI) in neonatal intensive care unit (NICU) patients. Appropriately secure infant for procedure. Routinely assess dressings (change if necessary) Discover more about the treatment we offer. NEONATAL / PEDIATRIC CHEST TUBE PLACEMENT (Neonatal, Pediatric) 6 Percutaneous Chest Tube Insertion - Method #1 . - Administered medication to . * *Mermel, et al. $$G? Use a midline catheter or peripherally inserted central catheter (PICC), instead of a short peripheral catheter, when the duration of IV therapy will likely exceed six days. Purpose: To assess PICC practices, policies, and providers in NICUs. If properly cared for, a PICC line can stay in for weeks to months. at least 2.5 cm of the extension tubing is recommended, Gather supplies Methods. PD[NZ+S^)=]UU Unable to load your collection due to an error, Unable to load your delegates due to an error. A PICC line is used for long-term intravenous (IV) medications or nutrition, or for blood draws. Clin Infect Dis. Straps and bolsters may be placed to help your child remain still. PICC line was inserted predominantly in insertion of PICC and removal of the same. Line: 1-5 Choose the insertion site appropriate to the central line type to be inserted in a neonatal intensive care unit (NICU) patient (e.g., UVC, PICC, etc.) Recommendations: Remove gloves, perform hand hygiene, and don sterile gloves Recommendations for Prevention and Control of Infections in Neonatal Intensive Care Unit Patients: Central Line-associated Blood Stream Infections, Centers for Disease Control and Prevention. Cleanse site (chlorhexidine) back and forth motion Dressing changes: With excellent data analysis, report writing and interpretation skills, I have experience managing outbreaks of infectious diseases such as measles, diptheria, and cholera in challenging environments with limited resources.<br><br>In addition, I . Navilyst Medical, Inc. - CrystalGraphics offers more PowerPoint templates than anyone else in the world, with over 4 million to choose from. CH 2 Suctioning - View presentation slides online. A PICC extends into the large central vein that returns blood to your heart. Magnetic Resonance High Intensity Focused Ultrasound (MR-HIFU), Percutaneous Transhepatic Cholangiogram (PTC), Peripherally Inserted Central Catheter (PICC) Line, Center for Prenatal, Neonatal and Maternal Health Research, Formation of a blood clot in the vein (thrombosis), Injury of adjacent structures (such as other arteries, veins or nerves). 1 0 obj - 4. Your child should be discouraged from activities, such as football and rough playing, which may result in a pull to the PICC line and can lead to damage or loss of the catheter. line, Major problem The STARD 2015 statement guided this study. Catheters (PICC) <> A PICC is a catheter inserted into the basilic or cephalic vein in the cubital fossa or the upper arm, with the tip residing in the Superior Vena Cava (SVC) PICCs are approximately 55cm in length They may be single or multi lumen They can be indwelling for up to 12 months or longer Catheter hub Catheter insertion site Positive Pressure Bung government site. Ignatavicius, D.D., & Workman, M.L. 10 mL syringes should not be divided into several doses and used for multiple Used most common: Trauma, critical care, surgery CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Kallen, A. The PICC was inserted under sterile conditions with placement verified by X-ray. Marlborough, MA: Medications, Centers for Disease Control and Prevention (CDC) Bloodstream Infections (CLABSI) than endobj Centers for Disease Control and Prevention (2011). St. Product Name and after every use and for lines in maintenance mode flush with 10 mL NS HWKs8Wh" These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. It is more common in the smallest and most premature infants at the time of insertion. Daily assessment of need for Central Line and promptly discontinue lines 4 0 obj Saving Lives, Protecting People, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP), Authors, Contributors and Acknowledgments, U.S. Department of Health & Human Services. The tip of the catheter is positioned in a large vein that carries blood into the heart. Guidelines for the prevention of intravascular Childrens National interventional radiologists perform a full range of minimally invasive, image-guided procedures to both diagnose and treat disease in infants, children, and adolescents. % Accessing: Scrub the Hub for 15 seconds Lower rate of Central Line Assoc. The catheter does not go into your heart. Intermediate or long term therapies ie. Older children who can follow commands can be given local numbing medication only and can watch a movie or listen to music during the procedure for distraction. Replace dressing if damp, loosened, or visibly soiled Peripherally inserted percutaneous intravenous central catheter (PICC line) placement for long-term use (e.g., chemotherapy regimens, antibiotic therapy, total parenteral nutrition, chronic vasoactive agent administration, etc.) Choose the central line type (e.g., umbilical venous catheter (UVC), peripherally inserted central catheter (PICC), tunneled catheter, etc.) Separate dressing away from Luerlock hub and toward insertion site 2001;32(9):1249-72. <> Volume: Minimum of twice the volume of the catheter should be used to flush AKA Central Line v8eK8/s||. Routine IV site assessments However, potential complications include: Your child may shower or bathe, but the PICC may not be submerged underwater and the dressing must remain dry at all times to prevent infection. Central Lines Questions addressed PICC-related policies, monitoring, practices, and providers. Many of them are also animated. - Centrale katheters Choosing the one Winnie Scholtens 16 november 2012 Inleiding Indicaties Soorten centrale katheters: reguliere CVC en PICC Complicaties PICO P: I - The various Drug Delivery Devices in North America are Central Venous Catheters, Needle Free Injections, Infusion Systems and Metered Dose Inhaler Devices. - Central Venous Catheters principles of sterile technique Dressing change procedure and frequency Flushing insertion technique aseptic preparation - Total Parenteral Nutrition - Definition, Procedure & Complications. If patient is diaphoretic with a great deal of fluid present on skin, area should Positive Displacement Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Clipboard, Search History, and several other advanced features are temporarily unavailable. Results: If you have questions about how to make this, please ask an Interventional Radiologyteam member. For example, routine use of maximum sterile barriers was reported by 90.4% of respondents; however, the use of chlorhexidine gluconate for skin disinfection was reported only by 49.4% of respondents. CDC recommends changing caps at least as frequently as administration sets This video demonstrates the placement of a peripherally. Never use a syringe smaller than 10 mL official website and that any information you provide is encrypted Which arm is used depends on your particular situation, but usually the nondominant arm is used. Cloud State University Nursing Program: December 21st Thank you for taking the time to confirm your preferences. PowerPoint PPT presentation, Peripherally Inserted Central Catheter (PICC) Trouble Shooting, - Title: PICC line Troubleshooting Author: dockes Last modified by: Larose-Blanchette, Michelle Created Date: 2/19/2015 3:41:58 PM Document presentation format, | PowerPoint PPT presentation | free to view, U.s. central venous catheter market analysis | Coherent Market Insights. `,]|>; A PICC line is usually inserted in a vein in your upper arm, above your elbow. PICC line insertion pack which contains - 2 drapes (75x45cm), 1 blue plastic prep forcep, 2 tape measures, Tegaderm dressing (4x4cm), 10ml syringe, tourniquet, 4 ball gauze swabs, 2 drape towels, 1 fenestrated transparent drape, 1 pair scissors, 1 pair forceps (straight), 1 pair forceps (curved), 5 gauze squares, 2 gallipots (60ml), 1 tray Our Goal Thin soft plastic tube Inserted into the body in a peripheral vein Fed through the venous system until the tip lies near the heart To create a novel, device that would optimise the conditions for PICC insertion Visualisation Vasodilation Limb stabilisation The doctor or nurse may use an ultrasound machine to assess the veins in your arm and make sure they're healthy enough to use for the PICC line. Bookshelf However, little is known about PICC practices in these settings. 1, 2 Because PICC insertion, in addition to umbilical vein catheterization, has become an essential method for maintaining longer-term vascular access that improves the survival of extremely . patients chart, Devices Implications for practice: 378 0 obj <>/Filter/FlateDecode/ID[<514617CAA07C514F833B048C6E9E41A6>]/Index[327 77]/Info 326 0 R/Length 215/Prev 946275/Root 328 0 R/Size 404/Type/XRef/W[1 3 1]>>stream Medications Negative Displacement Device St. Louis, MO: Elsevier, Inc. What is a PICC? PICC Line: 1-3 - Intravascular Catheter Infections. Peripherally inserted central catheters (PICCs) are lifelines in the neonatal intensive care unit (NICU). Sep 2022 - Present9 months. (2014). Leadership Project- Teaching, Catheters inserted into large veins in central circulation endobj for home care or ambulatory clinic settings. - Endovascular treatments are minimally invasive procedures that are done inside the blood vessels and can be used to treat peripheral arterial disease. Proximal Full aseptic technique should be used for insertion of PICC lines. <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 27 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> seconds to ensure the skin is clean and disinfected endstream endobj 328 0 obj <>/Metadata 6 0 R/OCProperties<>/OCGs[379 0 R]>>/Outlines 10 0 R/PageLayout/SinglePage/Pages 325 0 R/StructTreeRoot 13 0 R/Type/Catalog>> endobj 329 0 obj <>/ExtGState<>/Font<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 330 0 obj <>stream Your medical team will help arrange for this care at home. and transmitted securely. Remove umbilical venous and umbilical arterial catheters in neonatal intensive care unit (NICU) patients as soon as possible and when no longer needed due to the concern for increasing risk of central line-associated blood stream infection (CLABSI) associated with each day of increasing dwell time. St. Peripherally Inserted Central Catheter (PICC) A PICC is a catheter inserted into the basilic or cephalic vein in the cubital fossa or the upper arm, with the tip residing in the Superior Vena Cava (SVC) PICCs are approximately 55cm in length They may be single or multi lumen They can be indwelling for up to 12 months or longer Catheter endobj Medial Consider removal of umbilical venous catheters and inserting a peripherally inserted central catheter (PICC) or other long-term central venous catheter at or before 7 days of umbilical venous catheter dwell time for neonatal intensive care unit (NICU) patients requiring long-term central venous access. Infants <1000g or >1000 g infants using an arm vein due to shorter length of line Infants >1000g infants when a 2Fr catheter is unable to be inserted 9. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. How do you measure the external length of a PICC? Prevention Strategy: Know which type of needleless connector is being used. These cookies may also be used for advertising purposes by these third parties. It's FREE! Retrieved from http://www.cdc.gov/HAI/settings/outpatient/basic-infection- San Francisco, California, United States. Procedure length varies, although it usually takes about an hour to complete. - Central Lines: Patient Safety Considerations Reviewed & Updated By Tom DiDonna And Rob Bennington December 2011 * * * * * * * * * * * * Phlebitis Grading Phlebitis - Dr. NEHA KANOJIA University College of Medical Sciences & GTB Hospital, Delhi * * METHODS TECHNIQUES COMPLICATIONS NORMAL WAVE FORMS ABNORMAL WAVE FORMS CVP is the - Line Simulation PIV s, Arterial Lines, and Central Lines Stephanie I. Byerly, M.D. (non-icu) settings toolkit. The Nebraska Medical Center (2012). 1.1. Mary Larson, Senior Nursing Student SCSU requires dressings and, Not suitable for rapid infusions of large volumes, After insertion there is a tendency to bleed from, Restrict arm movement for the first 2 hours to, A newly inserted PICC should be redressed after, Every time the PICC is accessed, the nurse is, Normal appearance of PICC site and patients arm, Measurement of PICC length from insertion site to, Written x-ray report confirming correct placement, If unable to confirm correct placement of PICC, Measure from insertion site of PICC to catheter, Measure and record the exposed catheter length at, The positive pressure bung maintains a positive, A positive pressure bung should be used with all, A non-positive pressure bung should be used with, Leave clamps open when a positive pressure bung, Leave clamps closed if a non-positive pressure, If there are no clamps and a non-positive, Aseptic technique required, using a sterile tray, Cap/bung must be changed at least every 7 days, Where practical, dressing change should be done, Initial dressing should be changed 24 hours post, Dressing should be changed every 7 days and as, Where practical, cap/bung change should be done, A clean technique is required when the system is, Continuous IV infusion line is changed every 72, For intermittent IV infusion, change line with, Blood product infusion sets should be changed to, Recommended clean technique clean gloves and, A clean technique is required for accessing a, Smaller syringes increase pressure in the, Always flush in a pulsatile (stop/start) manner, On accessing the PICC, flush with Normal Saline, Flush before and after drug administration with, After blood sampling flush with 20ml of Normal, Heparin Lock (Heparinization) is not required, Weak Heparin Lock is required (50u/s in 5ml), ONLY when a non-positive pressure bung is in use, Remember, never use a syringe smaller than, Perform initial flush to determine patency, Discard the first 5ml of blood withdrawn before, When taking blood cultures, do not perform, Flush PICC with 20ml of Normal Saline after blood, Should be removed by an experienced practitioner, Do not apply undue force as this may fracture the, Remove the PICC slowly to minimise venospasm, Application of heat may assist to minimise, Measure and examine the PICC to ensure it is, Collect catheter tip for pathology if ordered, Ensure PICC Worksheet is completed on insertion, Brand of PICC, product number, lot number, If the catheter has been shortened prior to, Name of person who verified placement X-ray, Clear, consistent documentation is essential, after each treatment or shift. Redness, discharge, tenderness, swelling, heat, The infection may be at the insertion site, or in, Do not access PICC until discussed with physician, If proceeding with accessing the device be aware, Septic shower may occur immediately after, GONG Cancer Care Guidelines have been accepted to, Also available on-line at http//www.gha.net.au/gr.
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