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Mowendabeka A, Bothorel P, Lauvray T, Douchez M, Fourcade L, Bedu A, Martinez S, Guigonis V, Ponthier L. Cognitive aid and performance for simulated umbilical venous catheter placement: A randomized trial. Arch Pediatr 2024:S0929-693X(24)00082-4. [PMID: 38876930 DOI: 10.1016/j.arcped.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/30/2024] [Accepted: 03/08/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Neonatal resuscitation may require urgent umbilical venous catheter (UVC) placement. Complications can be observed with umbilical venous catheterization, especially in a stressful context. Inspired by the aeronautic environment, medical routine checklists, also called "cognitive aids," secure the equipment and environment for the patients once they are admitted to the operating room. We hypothesized that reading a cognitive aid for UVC placement in the delivery room during neonatal resuscitation simulation scenarios can (a) improve the performance in reducing catheterization duration and (b) can limit complications. METHODS This was a prospective single-center randomized study. A total of 23 dyads for a simulation scenario were included: 12 in the control group and 11 in the cognitive aid group. In the cognitive aid group, the cognitive aid was read by the same facilitator for every scenario. RESULTS No significant difference concerning the duration of the procedure was identified between the cognitive aid and control groups: 412 s [342; 420] vs. 374 s [338;402], respectively (p = 0.781). Nevertheless, there were significantly fewer deviations from hygiene guidelines and improved prevention of air embolism in the cognitive aid group compared with the control group. CONCLUSION The UVC insertion time was similar between the control and cognitive aid groups. Moreover, cognitive aid can limit infectious complications or air embolism by allowing caregivers to follow UVC placement standards.
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Affiliation(s)
- Audrey Mowendabeka
- Department of Neonatal Intensive Care Unit, University Hospital Limoges, France; INSPEARS Limoges Simulation Center, Limoges Medical School, France
| | - Philipe Bothorel
- Department of Neonatal Intensive Care Unit, University Hospital Limoges, France; INSPEARS Limoges Simulation Center, Limoges Medical School, France
| | - Thomas Lauvray
- Department of Neonatal Intensive Care Unit, University Hospital Limoges, France; INSPEARS Limoges Simulation Center, Limoges Medical School, France
| | - Marie Douchez
- INSPEARS Limoges Simulation Center, Limoges Medical School, France; Department of Anesthesia, University Hospital Limoges, France
| | - Laurent Fourcade
- INSPEARS Limoges Simulation Center, Limoges Medical School, France; Department of Pediatric Surgery, University Hospital Limoges, France
| | - Antoine Bedu
- Department of Neonatal Intensive Care Unit, University Hospital Limoges, France; INSPEARS Limoges Simulation Center, Limoges Medical School, France
| | - Sophie Martinez
- Department of Obstetrics, University Hospital Limoges, France
| | - Vincent Guigonis
- Department of Neonatal Intensive Care Unit, University Hospital Limoges, France; INSPEARS Limoges Simulation Center, Limoges Medical School, France
| | - Laure Ponthier
- Department of Neonatal Intensive Care Unit, University Hospital Limoges, France; INSPEARS Limoges Simulation Center, Limoges Medical School, France.
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Zhang P, Jia M, Li WY, Li J, Niu JL, Ding H, Zhou WM. Cannulation via the external jugular vein--An alternative to conventional peripherally inserted central catheterisation for paediatric patients. BMC Pediatr 2023; 23:579. [PMID: 37980462 PMCID: PMC10657000 DOI: 10.1186/s12887-023-04403-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023] Open
Abstract
PURPOSE This study aimed to describe a peripherally inserted central catheterisation (PICC) for paediatric patients with inaccessible access and a high risk of general anaesthesia (GA). METHODS This was a retrospective observational study involving all paediatric inpatients who performed the PICC via an EJV approach without GA between September 2014 and September 2021 in a provincial key clinical speciality. RESULTS A total of 290 EJV line placement attempts were performed, and 29 were excluded due to missing placement results, resulting in a sample size of 261. The anatomical localisation, punctures, and catheterisation success rates for this practice were 100%, 100%, and 90.04%, respectively. The placement success rate in children younger than one year was 93.75% (45/48). The median line duration of use was 19 days, with a median length of catheter insertion of 13 cm. The most common complications were catheter malposition (n = 20) and dislodgement (n = 7). CONCLUSION The PICC via an EJV approach without GA is a feasible and safe practice with acceptable success and complication rates, and low costs. It might be an attractive alternative for obtaining central vascular access for paediatric patients.
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Affiliation(s)
- Ping Zhang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Open Fracture and Limb Reconstruction Nursing Professional Committee, Guangdong Nursing Association, Guangzhou, 510170, China
| | - Miao Jia
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Open Fracture and Limb Reconstruction Nursing Professional Committee, Guangdong Nursing Association, Guangzhou, 510170, China
| | - Wan-Yuan Li
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Juan Li
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jin-Lei Niu
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Hong Ding
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Wang-Mei Zhou
- Department of Emergency, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Jatczak L, Puton RC, Proença AJL, Rubin LC, Borges LB, Saleh JN, Corrêa MP. Complications of central venous catheterization at a vascular surgery service in a teaching hospital: a prospective cohort study. J Vasc Bras 2023; 22:e20230070. [PMID: 37790889 PMCID: PMC10545227 DOI: 10.1590/1677-5449.202300702] [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: 04/23/2023] [Accepted: 06/12/2023] [Indexed: 10/05/2023] Open
Abstract
Background Central venous catheters are essential for management of hospitalized patients, but their insertion is subject to complications that can make them unusable and/or cause patient morbidity. There are few data on the incidence of these complications and the variables associated with these outcomes in Brazil. Objectives To determine the incidence of mechanical complications and failures of short stay central venous catheters fitted by the vascular surgery service at a teaching hospital and identify variables associated with their occurrence. Methods This was a prospective cohort of 73 attempts to fit patients with a central venous catheter performed by the vascular surgery service at a teaching hospital from July to October of 2022. Results Mechanical complications occurred in 12 cannulation attempts (16.44%) and there were 10 failures (13.70%). The factors associated with mechanical complications were less experienced operators (p < 0.001), less specialized operators (p = 0.014), a failed attempt prior to requesting help from the vascular surgery service (p = 0.008), and presence of at least two criteria for difficulty (p = 0.007). Conclusions The local incidence of mechanical complications and central venous cannulation failures was similar to rates described in the international literature, but higher than rates in other Brazilian studies. The results suggest that the degree of experience of the person fitting the catheter, history of a failed prior attempt, and presence of at least two criteria for difficulty identified before the procedure were associated with worse outcomes.
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Affiliation(s)
| | - Renan Camargo Puton
- Instituto Vascular de Passo Fundo - INVASC, Passo Fundo, RS, Brasil.
- Hospital de Clínicas de Passo Fundo - HCPF, Passo Fundo, RS, Brasil.
| | | | | | - Luiza Brum Borges
- Instituto Vascular de Passo Fundo - INVASC, Passo Fundo, RS, Brasil.
- Hospital de Clínicas de Passo Fundo - HCPF, Passo Fundo, RS, Brasil.
| | - Jaber Nashat Saleh
- Instituto Vascular de Passo Fundo - INVASC, Passo Fundo, RS, Brasil.
- Hospital de Clínicas de Passo Fundo - HCPF, Passo Fundo, RS, Brasil.
- Universidade de Passo Fundo - UPF, Passo Fundo, RS, Brasil.
| | - Mateus Picada Corrêa
- Faculdade Meridional - IMED, Passo Fundo, RS, Brasil.
- Instituto Vascular de Passo Fundo - INVASC, Passo Fundo, RS, Brasil.
- Hospital de Clínicas de Passo Fundo - HCPF, Passo Fundo, RS, Brasil.
- Universidade de Passo Fundo - UPF, Passo Fundo, RS, Brasil.
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Lai F, Xie D, Weng Y, Mai S, Du J, Han Y, Zhang Y. Application of plan-do-check-act management to improve first-attempt insertion success rates of internal jugular vein catheterization for standardized training residents in an intensive care unit. BMC MEDICAL EDUCATION 2022; 22:420. [PMID: 35655205 PMCID: PMC9161493 DOI: 10.1186/s12909-022-03418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In the intensive care unit (ICU), internal jugular vein puncture and catheterization are basic rescue operations that physicians need to complete quickly and independently. It is necessary to improve the first-attempt success rate of internal jugular vein catheterization, shorten the catheterization duration and reduce the incidence of complications for standardized training residents (STRs). OBJECTIVE To improve first-attempt insertion success rates of internal jugular vein catheterization for STRs. METHODS Based on the PDCA cycle management method and current situation investigation, the PDCA management objectives were set, and the implementation content, monitoring items and continuous improvement plan were formulated. The data of residents who were trained in the ICU of Fangcun Hospital, Second Affiliated Hospital of Guangzhou University of Chinese Medicine, from January 2016 to April 2016 and managed by the PDCA cycle (PDCA group), were compared with the data of residents trained in the same department from August 2015 to November 2015 before the implementation of PDCA (historic control group), the first-attempt success rate of puncture and catheterization, the duration of puncture and catheterization, and the incidence of complications were analysed. RESULTS Thirty-six cases of internal jugular vein catheterization were performed by the PDCA group, 21 cases (58%) were performed by residents in the third year of standardized training, and 15 cases (42%) were performed by residents in the second year of standardized training. Compared with the historic control group, there was no significant difference in the seniority of residents (X2 = 0.240, P = 0.625) or the 'majors of the residents (X2 = 1.306, P = 0.835). The first-attempt success rate of puncture in the PDCA group was 94% (34/36), which was significantly higher than that of the historic control group (55% (11/20) (P = 0.001). In the PDCA group, the first-attempt success rate of puncture among third-year standardized training residents was 95% (20/21), and the first-attempt success rate in the second-year was 93% (14/15), which were significantly higher than the corresponding rates of 62% (8/13) and 43% (3/7) respectively, in the historic control group (all P = 0.021). The duration of catheterization was [4 (3,5)] min after PDCA, which was significantly shorter than that in the historic control group [9 (6.25,13.00)] min (Z = - 5.214, P < 0.001). The incidence rate of complications in the PDCA group was 0% (0 /36), which was significantly lower than the rate of 20% (4 / 20) in the historic control group (P < 0.013). CONCLUSION PDCA cycle management can help improve the first-attempt success rate of internal jugular vein puncture and catheterization, shorten the duration of puncture and catheterization, and reduce the incidence of complications. The idea and method of PDCA cycle management can be applied to other training and management protocols for STRs.
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Affiliation(s)
- Fang Lai
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China
| | - Dongping Xie
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China
| | - Yanna Weng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China
| | - Shutao Mai
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China
| | - Jiongdong Du
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China
| | - Yun Han
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China
| | - Yan Zhang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.
- Chao En-xiang Famous Chinese Medicine Expert Inheritance Studio, Guangzhou, Guangdong, China.
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