Percutaneous removal of a nonopaque silastic catheter from the pulmonary artery in two premature infants

A modified snare was made from a 0.016' guidewire and a 0.1-mm fishing string to remove a nonopaque Silastic catheter via a femoral vein approach in 2 premature infants at the 44th and 120th day of life, respectively. A foldover guidewire loop snare had failed in 1 infant before this technique was successfully applied.

Changes in plasma levels of lipids and lipoprotein composition in patients with Kawasaki disease

Studies on the response of plasma lipids and lipoproteins to Kawasaki disease are scarce so far. The purpose of this study was to investigate the changes in plasma levels of lipids and apolipoproteins as well as the composition of different lipoproteins in patients during the acute and convalescence phases of Kawasaki disease. The results showed that during the acute phase, the concentrations of plasma high density lipoprotein (HDL)-cholesterol, apolipoprotein A-I (apoA-I) and A-II (apoA-II) were significantly reduced. While the reduction of HDL-cholesterol was mainly related to the lowering of esterified and unesterified cholesterols in HDL2 during the acute stage of Kawasaki disease, most of which recovered during the subsequent convalescence phase. The plasma concentration of triglycerides was 46% higher in patients during the acute phase of Kawasaki disease than in the control subjects, which may be ascribed to the increase of triglycerides in very low density lipoprotein (VLDL), low density lipoprotein (LDL) and HDL2. The variables studied above did not appear to be independent parameters. The level of plasma apoA-I showed a stronger negative association with triglyceride concentration (r = -0.22) than apoA-II (r = -0.11) and HDL-cholesterol (r = -0.07). Furthermore, the levels of cholesterol, apoA-I and apoA-II in HDL2, but not in HDL3, were inversely correlated with the levels of triglyceride. We conclude that the temporary changes of lipid levels associated with Kawasaki disease results predominantly from alterations of lipoprotein composition.

XTT-colorimetric assay as a marker of viability in cryoprocessed cardiac valve

This study sought to evaluate the use of tetrazolium salt XTT reduction as an indicator of valvular viability in a cryoprocessed porcine cardiac homograft model. The XTT tetrazolium assays was based on the metabolic reduction of Sodium 3'-[1-(phenylamino-carbonyl)-3,4-Tetrazolium]-bis(4-methoxy-6-nitro) benzene sulfonic acid hydrate. The relationship between XTT reduction and: (1) leaflet tissue with various weight (n = 24); (2) morphometric evaluation (n = 30); (3) cadaveric ischemic intervals (n = 30); (4) freeze-thawing (n = 30) has been studied. The measurement of XTT reduction were significantly correlated with the weight of cardiac leaflets, in the range of 30 to 180mg (y=0.015x-0.063; r=0.99). Compared to morphometry of valvular damage, the reduction of mitochondrial enzymatic activity in cardiac leaflets was correlated with matrix cells without irreversible damage (r=0.89, P<0.005). The depletion of XTT reduction occurred dependent of ischemic time intervals. In general, freeze-thawing reduced more than 20% activity of mitochondrial dehydrogenase. We concluded that XTT tetrazolium assay is highly sensitive to determine valvular injury. The study demonstrated its potential for testing of cryopreserved cardiac valve.

Malignant epithelial neoplasm consistent with primitive cystic hepatic neoplasm with mesothelial differentiation: a case report

Mesothelioma are primary tumors of the celiomic cavity and are seen more often in adults than in children: only an estimated 2-5% of all cases present within the first two decades of life. To best knowledge of the reviewing world literature reported to date, no more than 80 proved cases of this tumor have occurred in children. One-third of mesothelioma originate in the peritoneum and two-thirds arise in the pleural cavity. Mesothelioma of the liver are extremely rare; a review of the English literature shows only three adult cases that have been reported as fibrous mesothelioma of the liver; experience with these cases suggests a high potential for recurrence, but no progression to malignancy. Cystic mesothelioma occur mainly in adults and are considered to be benign and curable. We describe a case of malignant epithelial neoplasm consistent with primitive cystic hepatic neoplasm with mesothelial differentiation arising in a 3-year-old boy, a condition which has never before been reported in childhood. Malignant primitive cystic mesothelioma is possible that some cases of intraabdominal mesenchymoma or hamartoma with malignant differentiation may have been misdiagnosed in the past; future cases should be fully evaluated, to establish the true incidence of mesothelioma disease in children.

High-frequency oscillatory ventilation--a new management for respiratory distress syndrome and intractable respiratory failure

High-frequency oscillatory ventilation (HFOV) has been proved to decrease the incidence of volutrauma and improve oxygenation and ventilation in severe pulmonary diseases by many investigators with animal studies and clinical reports, particularly in prematurities with severe respiratory distress syndrome. Patients with intractable respiratory failure or air-leak syndrome may be rescued by HFOV. During HFOV small volume, less than dead space, is delivered at high frequencies. Both inspiration and expiration are active. Oxygenation is mainly maintained by mean airway pressure to achieve optimal lung volume. Carbon dioxide elimination is mainly controlled by delivered volume. Mean airway pressure, fraction of inspiratory oxygen and amplitude are the only three items that need frequent adjustments after initial settings. The first two items determine the oxygenation and the last one determines ventilation. Careful monitoring of conditions the patients, discontinuous learning and cooperation of all coworkers are important to use the new therapy. Further studies with long-term follow-up are important to assess its appropriate role in different treatment methods and different degrees of respiratory diseases.

Congenital hypothyroidism and concomitant anomalies

To search for concomitant anomalies among babies with congenital hypothyroidism, 120 newborn babies with confirmed congenital hypothyroidism were studied at the Veterans General Hospital, Taipei. The incidence of concomitant anomalies was estimated to be 11.67% (14/120). Among these anomalies, cardiac and gastrointestinal systems were the most commonly involved, comprising 35.7% (5/14) and 28.6% (4/14) of all anomalies, respectively. The type (i.e. agenesis, ectopia or eutopic goiter) as well as the severity of hypothyroidism were analyzed between groups of babies with or without concomitant anomalies. No differences existed between the two groups of babies regarding these two aspects.

Aortic stenosis in children: 19-year experience

BACKGROUND

In the Taiwanese literature, few articles describe the pertinent features of aortic stenosis (AS). This study explores the features of AS in Chinese children.

METHODS

3808 children with congenital heart diseases have undergone cardiac catheterization at our institution over the past 19 years. Among them, 51 (1.3%) cases were AS. The clinical, electrocardiographic, echocardiographic and catheterization findings, the methods of treatment and outcomes were reviewed.

RESULTS

Valvular AS occurred in 39 children (76.5%), subvalvular AS in 5 (9.8%), and supravalvular AS in 7(13.7%). Male was predominant (M/F ratio, 2.6) except in supravalvular type. Forty-three patients had associated cardiovascular defects. Aortic regurgitation (AR) was the most common one. Most patients (56.9%) were asymptomatic. Classic symptoms included exertional dyspnea (17.6%), syncope (9.8%), and chest pain (7.8%), etc. Left ventricular hypertrophy was noted in 31.2% of cases. The mean duration of follow-up was 3.9 +/- 3.4 years. Ten patients received open-heart surgery and 2 received balloon dilation. The pressure gradients across the stenotic area dropped from 95.3 +/- 29.3 to 51.4 +/- 35.8 and 53.1 +/- 12.3 mm Hg in early and late Doppler follow-up studies, respectively (p < 0.05). The average gradient increased from 36.9 +/- 25.3 to 40.8 +/- 32.6 mm Hg in nonsurgical patients. The result was insignificant. No mortality occurred following open-heart surgery. One child expired due to heart failure after the ligation of the patent ductus arteriosus and dilation of the stenotic aortic valve on the surgical table under general anesthesia. Autopsy revealed valvular rupture. In the nonsurgical group, no mortality occurred, but one patient was brought home by parents in critical condition and later died.

CONCLUSIONS

We found that some clinical features of AS in Chinese children were different from those in occidental populations. (1) The incidence of AS was relatively low. (2) Subvalvular AS was the least common type in contrast to supravalvular AS in western studies. (3) Male predominance was not present in the supravalvular type, which lacked sexual proclivity. (4) Williams syndrome was a more frequently associated anomaly. Turner syndrome was not present in our study. (5) Isolated AS was less frequent. (6) The unusual finding such as right ventricular hypertrophy on EKG was present due to associated cardiac anomalies. Open-heart surgery is effective and safe, but the efficacy of balloon dilation requires further investigation.

Neonatal thyroid function is unaffected by single treatment with different preparations of povidone-iodine on a wide skin surface

Povidone-iodine (PV-I) are commonly used for disinfection in hospitals. Previous investigators had proved that iodine can be absorbed from the skin. In an attempt to determine the effect of single treatment of various PV-I preparations on thyroid function in fullterm newborns, serial measurements of serum thyroxine (T4) and Thyroid stimulating hormone (TSH) were done in 48 neonates treated with one dose antiseptics (tincture PV-I, aqueous PV-I, tincture PV-I followed with 75% alcohol and no treatment in control group). The results revealed no significant change of thyroid function in any study group. In conclusion, PV-I with different preparations, aqueous or tincture, did not significantly influence neonatal thyroid function if they were used to a fullterm neonate only once and even to a wide skin surface.

Evaluation of the severity of illness in infants by the Baby Check Score

BACKGROUND

The Baby Check Score System was developed for the measurement of severity of illness for infants less than six months of age. The purpose of this study was to evaluate the clinical application of the system in Chinese infants.

METHODS

A prospective study was carried out in 134 of 495 babies who were brought to the emergency room of Veterans General Hospital (VGH)-Taipei from April 1992 to July 1992. The on-duty interns scored each baby, and the on-duty residents graded the severity of illness in ignorance of the score. Two senior pediatricians reviewed the medical records retrospectively, in ignorance of the score or the on-duty resident's gradings.

RESULTS

The concordance between the score and the senior pediatricians' gradings was similar to that between the on-duty residents and senior pediatricians. The sensitivity of a score of 13 or more was as sensitive as the on-duty residents in identifying moderately or seriously ill babies. The specificity of a score of 0 to 12 was similar to that of the on-duty residents' gradings in identifying well or mildly ill babies.

CONCLUSIONS

The Baby Check Score System is as reliable as a junior doctor in judgement of illness severity and it can be used as an adjunct assessment in the evaluation of the severity of illness in Chinese infants under six months of age.

Stomach rupture associated with physical struggle in a child

A 5-year-old girl with spontaneous rupture of the stomach was treated successfully with excision of the ischemic edges of the perforation with primary repair. In this case, vigorous resistance against medical measurement resulted in rupture of the stomach, which was already distended with a large amount of fluid and air. The child survived following immediate surgical intervention and intensive postoperative care.

Clinical implication of transient hyperglycemia in childhood

The incidence of insulin-dependent diabetes (IDDM) in Chinese is much lower than for Western persons. The study was designed to determine whether Chinese children with transient hyperglycemia would develop diabetes as frequently as Western children. Ten children presenting with transient hyperglycemia were investigated using glucagon stimulation test, oral glucose tolerance test (OGTT) and i.v. glucose tolerance test (IVGTT) to estimate pancreatic insulin secretory function. They were followed up for one to three years. Islet cell antibodies and insulin autoantibodies were also measured. During the follow-up period, 2 of the 10 children developed diabetes at 1 month and 1 year, respectively, after the occurrence of transient hyperglycemia. Both of them had lower C-peptide peak level to glucagon stimulation, decreased first phase insulin release to IVGTT and a diabetic sibling. Islet cell antibodies and insulin autoantibodies were all negative except in one of the two children who later developed diabetes. Although it is still premature owing to the small sample size to conclude that Chinese children with transient hyperglycemia are less likely to develop diabetes than Western children, it is advisable to closely follow up those with a family history of IDDM who seem to be at the greatest risk.

Complications of intra-cardial placement of silastic central venous catheter in pediatric patients

A three-year prospective study was undertaken to determine the incidence and early complications from intra-cardiac placement of percutaneous central venous catheter (CVC). CVC was inserted by using "Catheter-through-needle" technique, and the insertion length was measured by body surface landmark. CVC course and tip location were routinely checked by roentgenography. Echocardiography was performed in case of arrhythmia. After analysis of 784 CVCs, 104 (13.3%) were proved to be intra-cardial, as located by either roentgenography or echocardiography. However, catheters passed via the upper trunk (14.5%) were significantly (p < 0.05) more intra-cardially located than those via the lower trunk (4.8%). Catheters which passed via the right upper trunk veins (basilic, cephalic, or external jugular veins) were also more intra-cardially located than those via their left veins counterparts, but the finding was not statistically significant (p > 0.05). The mean body weight (3.1 +/- 2.4 kg) in the intra-cardial placement group was significantly (p < 0.05) less than that in the non-intracardial placement group (7.9 +/- 4.5 kg). In intra-cardial placement patients, 32 cases (30.8%) had episode(s) of cardiac arrhythmia including 31 premature ventricular depolarization and 1 supra-ventricular tachycardia. All cases showed the presence of intra-ventricular catheter. All arrhythmias ceased abruptly after the catheters were pulled from the hearts. No other early complications were observed.

CONCLUSIONS

the incidence of the intracardiac placement of CVC is high, especially in small infants or when the insertion via the upper trunk. Short term intra-cardiac catheter placement has a benign clinical course except that the intraventricular catheter may cause arrhythmia. However, this kind of arrhythmia can be resolved spontaneously by withdrawing the catheter.

The correlation of serum ferritin level to Ca-P metabolism and bone density study in thalassemic patients

A study of Ca-P related hormones and bone densities was carried out in seven homozygous beta-thalassemia patients. The levels of Ca, P, and Ca-P related hormones were not significantly changed except for 1,25(OH)2D3 which was significantly lower than in the control group and was inversely related to patients' ferritin levels. Bone densities were markedly reduced in all the thalassemic patients.

Detachment of balloon in an infant: a rare complication of balloon pulmonary valvuloplasty

A 3-month-old infant with severe tetralogy of Fallot underwent percutaneous balloon valvuloplasty. After the successful dilatation, the balloon could not be deflated completely and the partial deflated balloon was totally peeled off from the catheter at the junction of inferior vena cava and right common iliac vein when we attempted to move it out. The skin of the balloon was successfully retrieved with a snared guidewire without sequel.

A clinical observation of term infants with critical cardiovascular disorders

BACKGROUND

Cardiovascular disorders are known to be the major causes for infants requiring intensive care. The consequences of the treatment given to these infants suffering from congestive heart failure and/or cyanosis need to be evaluated.

METHODS

A total of 210 infants both at term suffering from critical cardiovascular problems were hospitalized in the pediatric and neonatal ICU between July 1990 and December 1993. The etiology, clinical data, emergency procedures and outcomes of infants with or without congestive heart failure or cyanosis were analyzed.

RESULTS

Congenital cardiac defects were the most common cause of critical cardiovascular disorders in infancy. These included ventricular septal defect in 42 (20%), Tetralogy of Fallot in 22 (10.5%), Dtransposition of the great arteries in 20 (9.5%) cases, etc. The most common symptoms and signs observed were congestive heart failure in 162 (77.1%) and cyanosis in 137 (65.2%) cases. In spite of aggressive medical and surgical treatments, the outcomes were still unsatisfactory. The mortality rate was found to be the same in infants with or without congestive heart failure, but was significantly higher in infants with cyanosis than in those without cyanosis, after operation (28.5% vs 5.5%, p < 0.05).

CONCLUSIONS

Infants suffering from critical cardiovascular disorders need urgent medical and surgical treatments in intensive care units. In spite of treatment, the outcomes are still unsatisfactory.

Direct tracheobronchial suction for massive post-extubation atelectasis in premature infants

A prospective four-year study was done in a neonatal intensive care unit (NICU) to evaluate a technique, called direct tracheobronchial suction (DTBS), for rapidly removal of obstructive secretions from the tracheobronchial tree in newborn infants with massive post-extubation atelectasis (PEA). Selected cases who met the following criteria were enrolled: 1) developing new massive atelectasis within 48 hours after extubation; 2) no response to vigorous chest physiotherapy(CPT) and continuous deterioration; and 3) no air-bronchogram in the atelectatic lung field. DTBS was carried on at bedside by direct insertion a 6.5 Fr suction catheter into tracheobronchial tree and suctioning. Clinical and laboratory assessments were made in each case prior to and at two hours after DTBS for comparison. A total of 145 (19.7%, 145/736)) PEA occurred in a consecutive 736 postextubated newborn infants. Thirty-one atelectasis (4.2%, 31/736) that developed in 18 infants were managed with DTBS. There was a significant higher incidence of PEA developed, as well as a higher ratio of PEA been treated by DTBS, in the group of body weight < 1,500 g than the group of > or = 1,500 g. All except one infants weighed less than 1,500 g, with a mean of 1,043 +/- 269 g. Sixteen infants had been intubated for more than seven days with a mean of 14.1 +/- 5.0 days. Nine infants required more than one session of DTBS. DTBS was quite effective in immediate removal of retained secretions and improvement of pulmonary condition. By clinical assessment, respiratory distress improved with increased audible air entry on the affected lung, decreased chest retractions, and a significant fall in respiratory rate and heart rate. Arterial blood gases analysis showed significant improvement of pH, partial pressure of carbon dioxide and oxygenation ratio. By chest radiograph, DTBS resulted partial or nearly complete resolution of the atelectasis in all cases. DTBS procedures were well tolerated by all infants without significant sequelae.

CONCLUSION

This study suggests that DTBS is a simple and effective therapeutic modality to rapidly correct the massive PEA which resist to vigorous CPT in small infants.

Determination of the food specific IgE antibodies: comparison of MAST-CLA and CAP systems

BACKGROUND

This study was carried out to compare two techniques used to determine the food specific IgE antibody.

METHODS

Thirty-four allergic patients were evaluated for most common food IgE antibodies by multiple allergosorbent chemiluminescent assay (MAST-CLA). IgE antibodies to eight of these food allergens were also measured by Pharmacia CAP (CAP) test.

RESULTS

The food specific IgE showed good agreement between MAST-CLA and CAP (kappa = 0.3-0.77). The sensitivity of MAST-CLA assay for food specific IgE antibody was variable comparing with that of CAP system. The accuracy ranged from 0.76 to 0.97. The agreement between the results of MAST-CLA and skin test was variable (kappa = 0.03-0.58). The agreement was poor in wheat, peanut and soybean (kappa = 0.03-0.12). Similar result between CAP and skin test was also obtained (kappa = 0.06-0.82). The agreement was poor in wheat (kappa = 0.06) and milk (kappa = 0.15).

CONCLUSIONS

Different results might be related to quality of the extract, how they are performed in vitro test and difference of correspondent allergens employed in the tests.

The clinical evaluation of an outbreak of aseptic meningitis in children

BACKGROUND

Aseptic meningitis is a common disease in children; The present report describes the clinical and laboratory studies of 62 children involved in an outbreak of aseptic meningitis.

METHODS

Sixty-two children with aseptic meningitis having been hospitalized from February to June 1993 were evaluated. The clinical data were obtained by review of the medical records. Initial cerebrospinal fluid (CSF) laboratory values were recorded, and CSF specimens were submitted to determine the viral etiology.

RESULTS

Thirty-three percent of the cases were aged 2-5 years. Echovirus 30 was isolated from CSF specimens in 17 children, this is the only virus isolated from CSF during this period. The illness was characterized by transient fever, headache and vomiting. There was wide variation in the number of leukocyte from 14 to 2333 cell/mm3 in the spinal fluid. CSF protein ranged from 19 mg/dL to 114 mg/dL, and CSF sugar was normal in all specimens. Virus isolation was related to the cell count in CSF. There was no significant relationship between CSF cell count and protein content (r = 0.162, p = 0.2237). Hospital stay ranged from 1 to 14 days with an average of 3.9 days. CONCLUSIONS. The disease was mild and self-limiting without death or complication. Enterovirus isolation from CSF can substantially establish the diagnosis and the subsequent management, therefore, early discharge is expectable.

Bearing Localized Defect Detection by Bicoherence Analysis of Vibrations

For automatic detection and diagnosis of localized defects in rolling element bearings, bicoherence spectra are used to derive features that signify the condition of a bearing. These features quantitatively describe the degree of phase correlation among any three harmonics of bearing characteristic defect frequencies. In this paper, theory of bicoherence is explored to establish its utilization in the detection of bearing localized defects. Experimental results show that the proposed method is effective in bearing defect detection and sensitive to incipient defects.

The application of a modified mini-flexible-fiberoptic endoscopy in pediatric practice

BACKGROUND

The application of bronchoscopy in infants and small children is still restricted in most institutions because of their limited airways. The purpose of this study was to evaluate the usefulness of a modified mini (2.1 mm OD) flexible fiberoptic endoscope (FFE) in diagnosis and therapy of suspected pediatric airway problems.

METHODS

A prospective two-year study was carried out in a tertiary care neonatal/pediatric intensive care unit and general ward in a children medical center of a university-affiliated hospital. The employed mini-FFE (Machida ENT-30 F III, Tokyo, Japan) was modified with the addition of an external silastic catheter (0.5 mm inward diameter, 0.9 mm outward diameter) for suctioning, oxygen delivery, and medications during study.

RESULTS

Totally, 247 laryngoscopies and 212 bronchoscopies were performed in 207 patients without significant morbidity or any associated mortality. The age of patients ranged from 1 day to 10 years. About one-fifth of the procedures (larngoscopy 21.5%, 53/247; bronchoscopy 19.8%, 42/212) were performed in patients under the age of one month. Patient's body weight ranged from 650 g to 40 kg. About fifty-five percent of the procedures (laryngoscopy 55.1% 136/247; bronchoscopy 55.2%, 117/212) were performed in patients weighing less than 5 kg. The most common path of either laryngoscopy (94.3%, 233/247) or bronchoscopy (94.8%, 201/212) was through the nasal route. In 102 patients who had been demonstrated to have upper airway problems, 16 patients (15.7%) also proved to ahve significant lesion(s) below the glottis.

CONCLUSIONS

This modified FFE is a safe and a valuable instrument that can serve as an important aid in the diagnosis and therapy as well as a guide for surgical intervention of respiratory tract disorders in small infants and children.

Comparison of radioisotopic and ultrasonic scanning in the evaluation of neonatal hypothyroidism

BACKGROUND

Technetium-99m pertechnetate (Tc-99m) scan is presently the best diagnostic modality to delineate the anatomy of the neonatal thyroid. Because several factors will inhibit Tc-99m uptake in a normal thyroid gland and the Tc-99m scan requires expensive equipment and sometimes raises fear of radiation in parents, the ultrasonography might be an important complementary method for neonatal thyroid disorders. We described our experience with ultrasonography of the thyroid in 52 infants with suspected congenital hypothyroidism to compare the results obtained by using Tc-99m imaging in the same infants.

METHODS

From Dec. 1991 to May 1992, 52 neonates with suspected congenital hypothyroidism by newborn screening were referred to Veterans General Hospital-Taipei for confirmatory diagnoses. All of them were investigated with Tc-99m and ultrasonography of the thyroid gland. Results of Tc-99m scan and ultrasonography were compared and analyzed.

RESULTS

The ultrasonography failed to identify any ectopic gland and all cases were misinterpreted as hypoplasia or hemiagenesis of thyroid gland, but it never misinterpreted them as normal thyroid glands. The ultrasound never misinterpreted normal thyroid gland, while the Tc-99m scan misguided a normal gland as an athyreotic gland.

CONCLUSIONS

The ultrasonography may be adopted as the first line image examination for the babies with suspected congenital hypothyroidism. If sonography shows abnormal thyroid gland such as hypoplasia, hemiagenesis or agenesis, the isotopic scan may be a good complementary method to confirm the diagnosis.

Palliative treatment for tetralogy of Fallot with percutaneous balloon dilatation of right ventricular outflow tract

Percutaneous balloon pulmonary dilatation of the right ventricular tract was performed on 16 children with tetralogy of Fallot for palliative purposes after routine cardiac catheterization. Immediate improvement in aortic saturation from 73.4 +/- 6.8 to 84.0 +/- 4.8% (mean +/- SD = 10.6 +/- 2.7%, p < 0.001) and clinical symptoms were achieved in all 16 cases. The pressures in the right ventricle, pulmonary artery, left ventricle and aorta showed no remarkable changes after percutaneous balloon dilatation. The diameters of the proximal end and at the first branching of the right and left pulmonary arteries, pulmonary arterial index and the diameter of the descending aorta at the diaphragm increased significantly after balloon dilatation (p value 0.0004-0.006). One child suffered from repeated cyanotic spells in spite of the immediate improvement of aortic saturation. She received a left side Blalock-Taussig shunt 2 months after the balloon dilatation. None of the children had a significant complication. Eight had follow-up cardiac catheterization one year later and demonstrated much improvement in the diameters of the proximal end and at the first branching of the right and left pulmonary arteries, pulmonary arterial index and the diameter of the descending aorta at the diaphragm (p value 0.005-0.04). All 8 patients had their cardiac lesions successfully corrected. Percutaneous balloon dilatation is an alternative palliative therapy for children with tetralogy of Fallot.

The evaluation of percutaneous central venous catheters--a convenient technique in pediatric patients

OBJECTIVE

To evaluate the feasibility and effectiveness of 3 different types of silastic catheters that were used for percutaneous central venous catheterization (PCVC) through peripheral veins.

DESIGN AND SETTING

The study was prospective and consecutive for 6 years at a pediatric/neonatal intensive care unit and pediatric ward in Veterans General Hospital-Taipei, a university-affiliated medical center, in Taiwan, ROC.

PARTICIPANTS AND INTERVENTIONS

The patients who had PCVC were consecutively enrolled from January 1988 to December 1993. Three types of silastic catheters were used. The classification was according to the caliber as small catheter (SC, 0.30 mm ID), mid-size catheter (MC, 0.51 mm ID) and large catheter (LC, 0.64 mm ID). The same insertion technique, catheter-through-needle, was used for all PCVC placements through the peripheral vein. After insertion, each catheter was connected to a conventional short cannula (24-, 22-, or 20-gauge) of compatible caliber, and then linked to the infusion system.

RESULTS

1318 PCVCs were used in 1126 consecutive patients, that included 754 SCs in 649 infants (among them 60.9% were less than 1500 g), 383 MCs in 319 toddlers, and 181 LCs in 158 children. Mean (SD) body weight at the time of catheter insertion was SC 1.7(0.9)kg, MC 12.1(6.5)kg and LC 19.3(7.6)kg. Overall, mean (SD) duration of these PCVC was 16.4(8.4) days. A significantly longer duration was noted in: (a) SC group with 19.7(10.4) days than the other two groups [MC 12.4(6.5) days, LC 11.2(5.0) days]; (b) patients with body weight equal to or less than 3.0 kg [18.7(8.6) versus 14.1(6.1); and (c) insertion sites other than external jugular vein (EJV) [18.8(9.7) versus 11.7(6.0)]. These PCVCs provided reliable venous access for multiple purposes such as hyperalimentation, venous access or sampling of blood, antibiotic therapy and chemotherapy. MC and LC were also used for monitoring the central venous pressure. Most of the time, SC and MC were inserted through the superficial peripheral vein of the scalp, neck and extremities, while LC was almost approached via the EJV. The overall success rate of insertion was 92.4% (1318/1427). No significant difference was observed among the different catheter groups [93.4% (754/807) in SC, 90.5% (383/423) in MC and 91.9% (181/197) in LC] and the different insertion sites. Within each group of PCVC, more than eighty percent of catheters were removed electively: 83.3% in SC, 89.6% in MC and 84.5% in LC. Probable catheter-related sepsis accounted for 2.7% (36/1, 318) of all PCVCs. With this study, the cost of each PCVC set is 3.0 US dollar.

CONCLUSION

This study indicates that the use of three different calibers of silastic catheter is feasible and effective for PCVC in pediatric practice.