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Zhao X, Liu Y, Li X, Wei L, Bian L, Peng M. Placement of peripherally inserted central catheter through upper versus lower limb vein in neonates: A meta-analysis of randomized controlled trials. J SPEC PEDIATR NURS 2024; 29:e12417. [PMID: 37987242 DOI: 10.1111/jspn.12417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/07/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
AIM Peripherally inserted central catheter (PICC) is an important treatment for the drug and nutrition administration in neonates. We aimed to evaluate the effects and safety of PICC placement through upper versus lower limb vein in neonates, to provide insights into the clinical PICC nursing care. DESIGN A meta-analysis. METHODS We searched the Cochrane Library, Web of Science, PubMed, Science Direct, China national knowledge infrastructure, Wanfang Data Knowledge Service Platform, China Weipu Database, China Biomedical Literature Database for published randomized controlled trials (RCTs) on the placement of PICC via upper limb and lower limb venipuncture. Two reviewers independently evaluated and cross-checked the quality of the included studies in accordance with the quality standards of the Cochrane Manual. We used RevMan 5.3 software for statistical processing. RESULTS A total of 12 RCTs were included in this meta-analysis. Meta-analysis indicated that compared with upper limb veins, PICC insertion through lower limb veins is beneficial to increase the one-time puncture success rate (relative risk [RR] = 0.73, 95% confidence interval [CI]: 0.68-0.79) and the indwelling time (mean difference [MD] = -3.60, 95% CI: -5.35 to -1.86), reduce the operation time (MD = 10.37, 95% CI: 7.48-13.26), estimated bleeding volume (MD = 0.55, 95% CI: 0.34-0.75), incidence of catheter ectopia (RR = 2.46, 95% CI: 1.81-3.35), PICC-associated infection (RR = 2.82, 95% CI: 1.65-4.83), exosmosis (RR = 2.45, 95% CI: 1.49-4.04, p < .001) and phlebitis (RR = 1.40, 95% CI: 1.03-1.90). No significant difference in the Incidence of catheter obstruction between the upper and lower limb veins (RR = 1.20, 95% CI: 0.73-1.97, p = .48) was found. PUBLIC CONTRIBUTION There are certain advantages in neonatal PICC puncture through the lower limb vein. The lower limb vein may be the preferred choice for neonatal PICC puncture.
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Affiliation(s)
- Xuetang Zhao
- Surgical Intensive Care Unit (SICU), Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yingfei Liu
- Surgical Intensive Care Unit (SICU), Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoyan Li
- Surgical Intensive Care Unit (SICU), Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Li Wei
- Surgical Intensive Care Unit (SICU), Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lanzheng Bian
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mingqi Peng
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Kim J, Moon JW, Kim GR, Kim W, Hu HJ, Jo WJ, Baek SK, Sung GH, Park JH, Park JH. Safety tests and clinical research on buccal and nasal microneedle swabs for genomic analysis. Front Bioeng Biotechnol 2023; 11:1296832. [PMID: 38116201 PMCID: PMC10729317 DOI: 10.3389/fbioe.2023.1296832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
Conventional swabs have been used as a non-invasive method to obtain samples for DNA analysis from the buccal and the nasal mucosa. However, swabs may not always collect pure enough genetic material. In this study, buccal and nasal microneedle swab is developed to improve the accuracy and reliability of genomic analysis. A cytotoxicity test, a skin sensitivity test, and a skin irritation test are conducted with microneedle swabs. Polymer microneedle swabs meet the safety requirements for clinical research and commercial use. When buccal and nasal microneedle swabs are used, the amount of genetic material obtained is greater than that from commercially available swabs, and DNA purity is also high. The comparatively short microneedle swab (250 μm long) cause almost no pain to all 25 participants. All participants also report that the microneedle swabs are very easy to use. When genotypes are compared at five SNP loci from blood of a participant and from that person's buccal or nasal microneedle swab, the buccal and nasal microneedle swabs show 100% concordance for all five SNP genotypes. Microneedle swabs can be effectively used for genomic analysis and prevention through genomic analysis, so the utilization of microneedle swabs is expected to be high.
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Affiliation(s)
- JeongHyeon Kim
- Department of Bionano Technology and Gachon BioNano Research Institute, Gachon University, Seongnam, Republic of Korea
| | | | | | - Wonsub Kim
- Endomics Inc, Seongnam, Republic of Korea
| | - Hae-Jin Hu
- Endomics Inc, Seongnam, Republic of Korea
| | - Won-Jun Jo
- QuadMedicine R&D Centre, QuadMedicine Co. Ltd., Seongnam, Republic of Korea
| | - Seung-Ki Baek
- QuadMedicine R&D Centre, QuadMedicine Co. Ltd., Seongnam, Republic of Korea
| | - Gil-Hwan Sung
- QuadMedicine R&D Centre, QuadMedicine Co. Ltd., Seongnam, Republic of Korea
| | - Jung Ho Park
- Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung-Hwan Park
- Department of Bionano Technology and Gachon BioNano Research Institute, Gachon University, Seongnam, Republic of Korea
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Yu KC, Ai C, Jung M, Johnson H, Smith S, LaJoie J, Denny G. Prevalence of Hospital-Onset Bacteremia Pre- and Post-Implementation of a Needleless Blood Sampling Device From Existing Peripheral Catheters. JOURNAL OF INFUSION NURSING 2023; 46:332-337. [PMID: 37490579 PMCID: PMC10629599 DOI: 10.1097/nan.0000000000000513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Repeated access of peripheral intravenous (IV) devices theoretically increases the risk of bacterial exposure. PIVO™ (VelanoVascular) is a needleless, single-use device that enables blood sampling from an existing peripheral IV. The goal of this retrospective observational exploratory study was to evaluate the influence of PIVO use on rates of hospital-onset bacteremia and fungemia (HOB) by comparing HOB rates in the year before and after PIVO introduction in hospitals implementing PIVO and over similar time periods in "control" hospitals with no PIVO. Two hospitals implementing PIVO (Hospital 1, a large community hospital; Hospital 2, a tertiary oncology center), and 71 control hospitals were included. During the 1-year period before and after PIVO introduction, HOB rates decreased in hospitals 1 and 2 by 31.9% and 41.8%, respectively. Control hospitals that did not use PIVO had a 12.4% decrease in HOB rates. Multivariable logistic regression analyses found that PIVO was associated with a lower risk (Hospital 1 odds ratio [OR]: 0.63; 95% CI, 0.42-0.94) or no change (Hospital 2 OR: 1.05; 95% CI, 0.72-1.52) in HOB rates. Control hospitals also showed no change in HOB rates between the 2 time periods. These data do not support concerns about increased risk of bacteremia with PIVO.
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Affiliation(s)
- Kalvin C. Yu
- Corresponding Author: Kalvin C. Yu, MD, Becton, Dickinson and Company, 1 Becton Dr, Franklin Lakes, NJ 07417 ()
| | - ChinEn Ai
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
- Kalvin Yu, MD, FIDSA, is the vice president of medical and scientific affairs at Becton, Dickinson and Company (BD). Before BD, he was the chief integration officer and chief of infectious diseases at Southern California Kaiser Permanente. He has published on flu vaccine safety, readmissions, quality metric benchmarking, and hospital-acquired infections. Dr Yu was a member of the Centers for Disease Control and Prevention Antibiotic Utilization workgroup and has been an invited speaker at Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Pew Trusts, and Capitol Hill in Washington, DC
- ChinEn Ai, MPH; Molly Jung, PhD, MPH; and Scott Smith, PhD, are experienced population health researchers with expertise in epidemiology and statistics
- Heather Johnson, CIC, is an infection prevention subject matter expert at BD
- Judith LaJoie, DPN, RN, is the BD senior director of medical affairs for the Medication Delivery Solutions team based in the United States. As a registered nurse for 32 years, Dr LaJoie has worked in several health care spaces, including inpatient care, outpatient services, and now the medical device industry. Dr LaJoie currently oversees a team that is responsible for key opinion leader management and development, customer training and education, and the medical science liaison program, as well as managing the vascular access management program
- Gerald Denny, MD, is a nephrologist by training and is the BD global medical director for medical affairs for the Medication Delivery Solutions team
| | - Molly Jung
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
- Kalvin Yu, MD, FIDSA, is the vice president of medical and scientific affairs at Becton, Dickinson and Company (BD). Before BD, he was the chief integration officer and chief of infectious diseases at Southern California Kaiser Permanente. He has published on flu vaccine safety, readmissions, quality metric benchmarking, and hospital-acquired infections. Dr Yu was a member of the Centers for Disease Control and Prevention Antibiotic Utilization workgroup and has been an invited speaker at Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Pew Trusts, and Capitol Hill in Washington, DC
- ChinEn Ai, MPH; Molly Jung, PhD, MPH; and Scott Smith, PhD, are experienced population health researchers with expertise in epidemiology and statistics
- Heather Johnson, CIC, is an infection prevention subject matter expert at BD
- Judith LaJoie, DPN, RN, is the BD senior director of medical affairs for the Medication Delivery Solutions team based in the United States. As a registered nurse for 32 years, Dr LaJoie has worked in several health care spaces, including inpatient care, outpatient services, and now the medical device industry. Dr LaJoie currently oversees a team that is responsible for key opinion leader management and development, customer training and education, and the medical science liaison program, as well as managing the vascular access management program
- Gerald Denny, MD, is a nephrologist by training and is the BD global medical director for medical affairs for the Medication Delivery Solutions team
| | - Heather Johnson
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
- Kalvin Yu, MD, FIDSA, is the vice president of medical and scientific affairs at Becton, Dickinson and Company (BD). Before BD, he was the chief integration officer and chief of infectious diseases at Southern California Kaiser Permanente. He has published on flu vaccine safety, readmissions, quality metric benchmarking, and hospital-acquired infections. Dr Yu was a member of the Centers for Disease Control and Prevention Antibiotic Utilization workgroup and has been an invited speaker at Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Pew Trusts, and Capitol Hill in Washington, DC
- ChinEn Ai, MPH; Molly Jung, PhD, MPH; and Scott Smith, PhD, are experienced population health researchers with expertise in epidemiology and statistics
- Heather Johnson, CIC, is an infection prevention subject matter expert at BD
- Judith LaJoie, DPN, RN, is the BD senior director of medical affairs for the Medication Delivery Solutions team based in the United States. As a registered nurse for 32 years, Dr LaJoie has worked in several health care spaces, including inpatient care, outpatient services, and now the medical device industry. Dr LaJoie currently oversees a team that is responsible for key opinion leader management and development, customer training and education, and the medical science liaison program, as well as managing the vascular access management program
- Gerald Denny, MD, is a nephrologist by training and is the BD global medical director for medical affairs for the Medication Delivery Solutions team
| | - Scott Smith
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
- Kalvin Yu, MD, FIDSA, is the vice president of medical and scientific affairs at Becton, Dickinson and Company (BD). Before BD, he was the chief integration officer and chief of infectious diseases at Southern California Kaiser Permanente. He has published on flu vaccine safety, readmissions, quality metric benchmarking, and hospital-acquired infections. Dr Yu was a member of the Centers for Disease Control and Prevention Antibiotic Utilization workgroup and has been an invited speaker at Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Pew Trusts, and Capitol Hill in Washington, DC
- ChinEn Ai, MPH; Molly Jung, PhD, MPH; and Scott Smith, PhD, are experienced population health researchers with expertise in epidemiology and statistics
- Heather Johnson, CIC, is an infection prevention subject matter expert at BD
- Judith LaJoie, DPN, RN, is the BD senior director of medical affairs for the Medication Delivery Solutions team based in the United States. As a registered nurse for 32 years, Dr LaJoie has worked in several health care spaces, including inpatient care, outpatient services, and now the medical device industry. Dr LaJoie currently oversees a team that is responsible for key opinion leader management and development, customer training and education, and the medical science liaison program, as well as managing the vascular access management program
- Gerald Denny, MD, is a nephrologist by training and is the BD global medical director for medical affairs for the Medication Delivery Solutions team
| | - Judith LaJoie
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
- Kalvin Yu, MD, FIDSA, is the vice president of medical and scientific affairs at Becton, Dickinson and Company (BD). Before BD, he was the chief integration officer and chief of infectious diseases at Southern California Kaiser Permanente. He has published on flu vaccine safety, readmissions, quality metric benchmarking, and hospital-acquired infections. Dr Yu was a member of the Centers for Disease Control and Prevention Antibiotic Utilization workgroup and has been an invited speaker at Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Pew Trusts, and Capitol Hill in Washington, DC
- ChinEn Ai, MPH; Molly Jung, PhD, MPH; and Scott Smith, PhD, are experienced population health researchers with expertise in epidemiology and statistics
- Heather Johnson, CIC, is an infection prevention subject matter expert at BD
- Judith LaJoie, DPN, RN, is the BD senior director of medical affairs for the Medication Delivery Solutions team based in the United States. As a registered nurse for 32 years, Dr LaJoie has worked in several health care spaces, including inpatient care, outpatient services, and now the medical device industry. Dr LaJoie currently oversees a team that is responsible for key opinion leader management and development, customer training and education, and the medical science liaison program, as well as managing the vascular access management program
- Gerald Denny, MD, is a nephrologist by training and is the BD global medical director for medical affairs for the Medication Delivery Solutions team
| | - Gerald Denny
- Becton, Dickinson and Company, Franklin Lakes, New Jersey
- Kalvin Yu, MD, FIDSA, is the vice president of medical and scientific affairs at Becton, Dickinson and Company (BD). Before BD, he was the chief integration officer and chief of infectious diseases at Southern California Kaiser Permanente. He has published on flu vaccine safety, readmissions, quality metric benchmarking, and hospital-acquired infections. Dr Yu was a member of the Centers for Disease Control and Prevention Antibiotic Utilization workgroup and has been an invited speaker at Infectious Diseases Society of America, Society for Healthcare Epidemiology of America, Pew Trusts, and Capitol Hill in Washington, DC
- ChinEn Ai, MPH; Molly Jung, PhD, MPH; and Scott Smith, PhD, are experienced population health researchers with expertise in epidemiology and statistics
- Heather Johnson, CIC, is an infection prevention subject matter expert at BD
- Judith LaJoie, DPN, RN, is the BD senior director of medical affairs for the Medication Delivery Solutions team based in the United States. As a registered nurse for 32 years, Dr LaJoie has worked in several health care spaces, including inpatient care, outpatient services, and now the medical device industry. Dr LaJoie currently oversees a team that is responsible for key opinion leader management and development, customer training and education, and the medical science liaison program, as well as managing the vascular access management program
- Gerald Denny, MD, is a nephrologist by training and is the BD global medical director for medical affairs for the Medication Delivery Solutions team
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White AC, Byrd JJ, Schissel M, Strudthoff E, Wallace M. Outcomes of Pediatric Osteogenesis Imperfecta Patients Requiring Port-a-Cath Placement for Long-Term Vascular Access. JBMR Plus 2023; 7:e10752. [PMID: 37457882 PMCID: PMC10339085 DOI: 10.1002/jbm4.10752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/14/2022] [Accepted: 04/06/2023] [Indexed: 07/18/2023] Open
Abstract
Intravenous (iv) bisphosphonates are widely used to treat the skeletal manifestations of osteogenesis imperfecta (OI). Obtaining peripheral iv access in pediatric patients with OI is often difficult and traumatic. Although this may be mitigated with surgically placed iv ports (port-a-caths), surgeons may be hesitant to perform this procedure on these children because of the lack of safety data. This study aims to gain better insight into the safety and efficacy of port-a-cath use in this population and identify risk factors for port-a-cath complications. In the present study, we conducted a retrospective cohort analysis of patient characteristics and the incidence of port-a-cath-related complications in children with OI. Fifty-three port-a-caths were placed in 29 children (21 males and 8 females). Of the 29 patients, most are OI type III (n = 18), followed by type I (n = 4), type IV (n = 4), and type V (n = 3). At the time of initial port-a-cath placement, the median age was 52 months (10-191 months), and the median weight was 7.9 kg (5.1-41.1 kg). Most patients (n = 20) weighed less than 10 kg during initial placement. Weight correlated significantly with OI type (p = 0.048), sex (p = 0.03), and vessel used (p = 0.02). Median initial port-a-cath longevity was 43 months (1-113 months), and we found no significant difference in port-a-cath longevity between sexes, OI types, or vessels used. Most patients (n = 19) required multiple port-a-cath placements. There is a significant difference (p = 0.02) between the number of placements and OI type, with type IV having more than type III. Port-a-cath removal was almost always due to mechanical complications (n = 19) but also for infection (n = 1) and malposition (n = 1). Eight patients still had their initial port-a-caths in place at the conclusion of this study. These findings indicate that complications associated with port-a-cath placement are mild and can be used to safely deliver iv bisphosphonates to pediatric OI patients. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Andrew C White
- College of MedicineUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Jay J Byrd
- College of MedicineUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Makayla Schissel
- Department of Biostatistics, College of Public HealthUniversity of Nebraska Medical CenterOmahaNEUSA
| | - Elizabeth Strudthoff
- The Child Health Research InstituteUniversity of Nebraska Medical CenterOmahaNEUSA
- Children's Hospital and Medical CenterOmahaNEUSA
| | - Maegen Wallace
- Children's Hospital and Medical CenterOmahaNEUSA
- Department of Orthopaedic Surgery and RehabilitationUniversity of Nebraska Medical CenterOmahaNEUSA
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Gibb JJ, MacLeod R, Mahoney L, Elanjikal Z. Modified Seldinger technique for neonatal epicutaneo-caval catheter insertion: A non-randomised retrospective study. J Vasc Access 2023; 24:780-785. [PMID: 34758652 DOI: 10.1177/11297298211054637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Epicutaneo-Caval Catheters (ECCs) are critical for good neonatal care. No previous studies have evaluated which insertion method provides the highest likelihood of success. METHODS This study aimed to compare the success rates and cost of modified Seldinger technique (MST) and split needle technique (SNT). MST was introduced to St Michael's Neonatal Unit, SNT was already in use. Routinely documented data on ECC insertion was retrospectively collected from the clinical notes. Practitioners were able to use their preferred insertion method. A sub-group analysis of success rates in patients born at ⩾35-weeks GA was performed. RESULTS There was a significantly higher first pass (53% vs 26%; p = 0.014) and overall (72% vs 40%; p = 0.0046) successful ECC insertion rate with fewer venipunctures per successful ECC with MST (2.5 vs 6.5; p = 0.002). Logrank test demonstrated a significantly higher successful ECC insertion with MST for patients of all GA (p = 0.003) and for neonates born at ⩾35 weeks (p = 0.015). The cost per successful MST ECC was £156.41 versus £152.51 for SNT. CONCLUSION In this uncontrolled retrospective study, there was a higher chance of successful ECC insertion with MST, with a reduced number of venipunctures and similar costs per successful ECC. Further work in randomised studies is needed to verify this finding and should focus on other clinical outcomes, including rates in central line associated blood stream infections.
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Affiliation(s)
- Jack Jc Gibb
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rachael MacLeod
- Department of Neonatology, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Liam Mahoney
- Department of Neonatology, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ziju Elanjikal
- Department of Neonatology, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Wang Q, Luo F, Fan X, Cheng X, Ma X, Shi L, Zhang P. Application of epicutaneo-cava catheters with 24G indwelling needles in very low birth weight infants: a safe and simple innovative technique. Front Pediatr 2023; 11:1172164. [PMID: 37303751 PMCID: PMC10248414 DOI: 10.3389/fped.2023.1172164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Background Epicutaneo-cava catheter (ECC) is an ideal venous access for very low birth weight (VLBW) infants. However, because veins of VLBW infants are thin, ECC catheter is difficult to insert, and the success rate of puncture is low. This study aimed to use ECC with 24G indwelling needles to improve the outcomes of VLBW infants. Methods This retrospective study enrolled 121 VLBW infants (birthweight <1,500 g) who required ECC catheterization and were admitted to the Neonatal Intensive Care Unit of the Children's Hospital of Zhejiang University School of Medicine between January 2021 and December 2021. The patients were divided into the indwelling needle group and the conventional technique group according to the technique of ECC. The demographic and treatment data of the two groups were collected, and the success rate of first attempt cannulation of ECC and catheter-related complications of the two groups were analyzed and compared. Results There were no significant differences in gender, age, and body weight between the two groups on the day of ECC insertion and venipuncture site. It can be seen through model analysis that the success rate of first-attempt cannulation of ECC in the indwelling needle group was significantly higher than in the conventional technique group. In contrast, average catheterization time and catheterization-related bleeding risk in the indwelling needle group were significantly lower than in the conventional technique group (p = 0.00,and 0.00, respectively). Infection during catheter placement, indwelling catheter duration and catheter-related infection between the two groups (p > 0.05). Conclusion Application of ECC with 24G indwelling needles in VLBW infants can improve the success rate of first attempt cannulation of ECC, reduce the time of catheterization and the risk of bleeding, which may be popularized for widespread application.
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Affiliation(s)
- Qin Wang
- NICU, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feixiang Luo
- NICU, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyan Fan
- NICU, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoying Cheng
- Quality Management Office, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaolu Ma
- NICU, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liping Shi
- NICU, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Pei Zhang
- NICU, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Riskin A, Iofe A, Zidan D, Shoris I, Toropine A, Zoabi-Safadi R, Bader D, Gover A. An Observational Study on the Use of Peripheral Intravenous Lines vs. Central Lines in a Neonatal Intensive Care Unit. CHILDREN 2022; 9:children9091413. [PMID: 36138722 PMCID: PMC9498162 DOI: 10.3390/children9091413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 11/21/2022]
Abstract
Background and Objectives: There is a debate regarding the preferred intravenous (IV) access for newborns. Our aim was to study practices regarding the choice of vascular access and outcomes. Methods: A seven-month prospective observational study on IV lines used in all newborns admitted to Bnai Zion Medical Center’s neonatal intensive care unit (NICU). Results: Of 120 infants followed, 94 required IV lines. Infants born at ≤32 weeks gestation, or with a head circumference ≤29 cm were more likely to require two or more IV lines or a central line for the administration of parenteral nutrition or medications for longer periods. However, central lines (umbilical or peripherally inserted central catheters (PICC)) were not associated with better nutritional status at discharge based on weight z-scores. Only one complication was noted—a central line-associated bloodstream infection in a PICC. Conclusions: Our data suggest preferring central IV access for preterm infants born at ≤32 weeks or with a head circumference ≤29 cm. We encourage other NICUs to study their own data and draw their practice guidelines for preferred IV access (central vs. peripheral) upon admission to the NICU.
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Affiliation(s)
- Arieh Riskin
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
- Correspondence: ; Tel.: +972-48359063
| | - Adir Iofe
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
| | - Donia Zidan
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
| | - Irit Shoris
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
| | - Arina Toropine
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
| | - Rasha Zoabi-Safadi
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
| | - David Bader
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
| | - Ayala Gover
- Department of Neonatology, Bnai Zion Medical Center, 47 Golomb Street, P.O. Box 4940, Haifa 31048, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 32000, Israel
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Carneiro TA, Nobre KSS, Fontenele FC, Façanha APM, Ferreira RP. Peripherally inserted central catheter in newborns: association of number of punctures, vein, and tip positioning. Rev Esc Enferm USP 2021; 55:e20210043. [PMID: 34605534 DOI: 10.1590/1980-220x-reeusp-2021-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to assess the use of peripherally inserted central catheters regarding the neonate's profile, indications for use, and catheterized vein; the relation between the number of puncture attempts and vein; and assessment of the catheter tip position. METHOD documentary, descriptive, retrospective, quantitative study, developed in a tertiary maternity hospital in Ceará. A total of 3,005 PICC insertion formularies was included and 1,583 were excluded due to incomplete data, with a convenience sampling of 1,422 insertions being obtained. RESULTS There were 1,200 (84.4%) newborns with gestational age below 37 weeks; 781 (54.9%) males; Apgar score above 7 in the first (628-44.2%) and fifth minutes (1,085-76.3%); and weight between 1,000 and 1,499 grams on the day of insertion (417-29.3%). Antibiotic therapy had 1,155-53.8% indications for insertion; the basilic was the most used vein (485-34.1%); basilic and cephalic veins had lower median puncture attempts and 1,124-79% insertions were centrally positioned. CONCLUSION The results of this research highlight the continuous need to improve technical-scientific knowledge to qualify actions in neonatology.
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Avoidable Serum Potassium Testing in the Cardiac ICU: Development and Testing of a Machine-Learning Model. Pediatr Crit Care Med 2021; 22:392-400. [PMID: 33332868 DOI: 10.1097/pcc.0000000000002626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To create a machine-learning model identifying potentially avoidable blood draws for serum potassium among pediatric patients following cardiac surgery. DESIGN Retrospective cohort study. SETTING Tertiary-care center. PATIENTS All patients admitted to the cardiac ICU at Boston Children's Hospital between January 2010 and December 2018 with a length of stay greater than or equal to 4 days and greater than or equal to two recorded serum potassium measurements. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We collected variables related to potassium homeostasis, including serum chemistry, hourly potassium intake, diuretics, and urine output. Using established machine-learning techniques, including random forest classifiers, and hyperparameter tuning, we created models predicting whether a patient's potassium would be normal or abnormal based on the most recent potassium level, medications administered, urine output, and markers of renal function. We developed multiple models based on different age-categories and temporal proximity of the most recent potassium measurement. We assessed the predictive performance of the models using an independent test set. Of the 7,269 admissions (6,196 patients) included, serum potassium was measured on average of 1 (interquartile range, 0-1) time per day. Approximately 96% of patients received at least one dose of IV diuretic and 83% received a form of potassium supplementation. Our models predicted a normal potassium value with a median positive predictive value of 0.900. A median percentage of 2.1% measurements (mean 2.5%; interquartile range, 1.3-3.7%) was incorrectly predicted as normal when they were abnormal. A median percentage of 0.0% (interquartile range, 0.0-0.4%) critically low or high measurements was incorrectly predicted as normal. A median of 27.2% (interquartile range, 7.8-32.4%) of samples was correctly predicted to be normal and could have been potentially avoided. CONCLUSIONS Machine-learning methods can be used to predict avoidable blood tests accurately for serum potassium in critically ill pediatric patients. A median of 27.2% of samples could have been saved, with decreased costs and risk of infection or anemia.
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Oulego-Erroz I, Fernández-García A, Álvarez-Juan B, Terroba-Seara S, Quintela PA, Rodríguez-Núñez A. Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein may reduce central line-associated bloodstream infection in preterm infants. Eur J Pediatr 2020; 179:1655-1663. [PMID: 32382789 PMCID: PMC7223997 DOI: 10.1007/s00431-020-03663-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022]
Abstract
The objective of this study was to assess the risk of central line-associated bloodstream infection (CLABSI) of ultrasound (US)-guided cannulation of the brachiocephalic vein (BCV) compared to standard epicutaneous cava catheters (ECCs) in preterm infants. This was a retrospective cohort study in preterm infants with a birth weight of less than 1500 g. Each BCV catheter was matched 1:3 with ECCs according to sex, birth weight, and year of insertion. The main outcome was the CLABSI density rate per 1000 days. Secondary outcomes included CLABSI episodes, CLABSI episodes per infant, and CLABSI/death. A multivariate Cox regression analysis was performed to assess whether the type of catheter (ECC vs. BCV) was associated with CLABSI risk. Ninety-six catheters (21 BCVs and 75 ECCs) in 79 infants were included (993 catheter days). BCV catheters were associated with a reduced CLABSI density rate compared to ECCs (3.05/1000 days vs 21.1/1000 days; p < 0.001). ECCs were associated with increased CLABSI risk compared to BCV catheters in multivariate analysis (hazard ratio 36; (95% CI, 2.5-511); p = 0.008).Conclusion: US-guided supraclavicular cannulation of the BCV was associated with a reduced risk of CLABSI compared to ECCs. This finding deserves further multicenter research. What is Known: • An epicutaneous-cava catheter (ECC) is commonly used in preterm infants for routine care (eg. delivery of nutrition and antibiotics) but this device may not suffice in infants who need high-intensity care (multiple drugs, hemodynamic monitoring, fluid resuscitation etc.). • Ultrasound-guided brachiocephalic vein (BCV) catheterization has shown a high success rate and few immediate complications in neonates and small infants but it has never been compared to standard ECCs. What is New: • When the operator in properly trained, US guided cannulation of the BCV in preterm infants is feasible, safe and may reduce the risk of CLABSI compared to standard ECCs. • This fact may expand the use of BCV catheters in selected high-risk preterm infants who need a large bore venous access.
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Affiliation(s)
- Ignacio Oulego-Erroz
- Pediatric Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain
- Working Group on Bedside Ultrasound of the Spanish Society of Pediatric Intensive Care (SECIP), León, Spain
- IBIOMED - Biomedicine Institute of León, University of León, León, Spain
| | - Alba Fernández-García
- Neonatal Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain
| | - Beatriz Álvarez-Juan
- Neonatal Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain
| | - Sandra Terroba-Seara
- Neonatal Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain
| | - Paula Alonso Quintela
- IBIOMED - Biomedicine Institute of León, University of León, León, Spain
- Neonatal Intensive Care Unit, Complejo Asistencial Universitario de León, León, Spain
| | - Antonio Rodríguez-Núñez
- Pediatric Critical, Intermediate and Palliative Care Section, Hospital Clínico Universitario de Santiago, Research Institute of Santiago (IDIS), Santiago, Spain
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Jeong Y, Park H, Jung MJ, Kim MS, Byun S, Choi Y. Comparisons of laboratory results between two blood samplings: Venipuncture versus peripheral venous catheter—A systematic review with meta‐analysis. J Clin Nurs 2019; 28:3416-3429. [DOI: 10.1111/jocn.14918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/21/2019] [Accepted: 05/02/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Younhee Jeong
- College of Nursing Science Kyung Hee University Seoul Korea
- East‐West Nursing Research Institute Kyung Hee University Seoul Korea
| | - Hanjong Park
- College of Nursing Science Kyung Hee University Seoul Korea
- College of Nursing The Catholic University of Korea Seoul Korea
| | - Mi Jung Jung
- College of Nursing Science Kyung Hee University Seoul Korea
| | - Min Sun Kim
- College of Nursing Science Kyung Hee University Seoul Korea
| | - Seung Byun
- College of Nursing Science Kyung Hee University Seoul Korea
| | - Yoonhee Choi
- Division of Research Service Kyung Hee University Library, Kyung Hee University Seoul Korea
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Prävention von Gefäßkatheter-assoziierten Infektionen bei Früh- und Neugeborenen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:608-626. [PMID: 29671025 DOI: 10.1007/s00103-018-2718-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
PURPOSE OF REVIEW Central venous catheters (CVCs) have a prominent role in the diagnostic and therapy of neonates and children. Herein, we describe the multiple indications for CVC use and the different devices available for central venous access. Given the prevalent use of CVCs, healthcare systems are focused on reducing complications from their use, particularly central line-associated bloodstream infections (CLABSIs). The most up-to-date information available sheds light on best practices and future areas of investigation. RECENT FINDINGS Large systematic reviews of randomized trials suggest that ultrasound guidance for placement of CVCs in children is safer than using blind technique, at least for internal jugular vein access. Appropriate catheter tip placement is associated with decreased complications. Furthermore, the prophylactic use of ethanol lock between cycles of parenteral nutrition administration has reduced the rates of CLABSI. A recent randomized trial in pediatric CVCs showed a benefit with antibiotic-coated CVCs. SUMMARY Based on the available evidence, multiple techniques for CVC placement are still valid, including the landmark technique based on practitioner experience, but ultrasound guidance has been shown to decrease complications from line placement. Adherence to CVC care protocols is essential in reducing infectious complications.
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