Complications in pediatric enteral and vascular access

Enhancing pediatric stoma care: Analyzing YouTube videos for pediatric stoma pouch changing techniques

PURPOSE

The purpose of this study was to evaluate the quality, content, and reliability of YouTube videos that address ostomy bag change techniques in children. As digital platforms are increasingly used for health-related information, especially for those caring for pediatric ostomy patients, this study aims to identify the strengths and limitations of available online resources.

DESIGN

A descriptive, retrospective, and cross-sectional research design was used to evaluate YouTube videos focused on pediatric ostomy bag change techniques.

SUBJECTS AND SETTING

The study included a total of 33 YouTube videos identified through searches conducted between May 3 and May 30, 2024. Videos included infants, children, and adolescents and were selected based on their relevance to pediatric double pouch ostomy care.

METHODS

Videos were scored using the modified DISCERN score and the Global Quality Scale (GQS) to assess video quality and reliability. A checklist based on established ostomy care guidelines was used for content analysis and identification of common procedural errors. The view rates, video/likes ratio, and popularity of the videos were calculated as the video power index. Data were analyzed using SPSS 27 and statistical significance was determined with a p-value of less than 0.05.

RESULTS

The analysis showed that 54.5 % of the videos were uploaded by independent publishers and 45.5 % by healthcare institutions. Videos aimed at caregivers were the most common (66.7 %). The mean number of views was 24,026.57, with a mean modified DISCERN score of 2.53 and a GQS score of 2.80. There was also a positive correlation between video length and quality scores. Significant differences in video quality were found between those published by healthcare organizations and independent publishers, with healthcare organization videos generally scoring higher. The most common errors in the videos included inadequate stoma coverage and improper disposal procedures.

CONCLUSIONS

The study shows that there is significant variability in the quality and reliability of YouTube videos on how to change an ostomy pouch in children. Compared to videos produced by independent publishers, videos produced by healthcare institutions had higher quality and reliability. The findings underscore the need for improved educational resources and quality control in digital platforms in order to better support the caregivers of pediatric ostomy patients.

Feeding and nutrition in children with medical complexity

Providing adequate and appropriate nutrition to children with medical complexity (CMC) is often a challenging task. These patients are a diverse group whose varying nutritional needs must be carefully assessed and monitored. Optimal feeding and nutrition strategies in CMC require an individual approach and may include oral, enteral (gastric or jejunal), or parenteral provision of nutrients. Complications of enteral feeding, including those associated with medical devices such as feeding tubes, are common, and provider familiarity with some of the more common complaints is helpful. We provide here a summary of different feeding approaches, with exploration of the rationale for each, as well as discussion of common complications and some practical troubleshooting tips.

Hickman Central Venous Catheters in Children: Open Versus Percutaneous Technique

BACKGROUND

The ideal technique for insertion of tunneled central venous catheters (CVCs) in children is still debatable. This study aimed to compare the outcomes of open versus percutaneous technique for the insertion of tunneled CVCs.

METHODS

The study included 279 patients who had CVCs insertions from 2010 to 2020. Patients were divided into two groups according to the technique of insertion: group 1 (n = 90) included patients who had the open cutdown method and group 2 (n = 189) included patients who had the percutaneous technique.

RESULTS

There was no difference in age and gender distribution between groups (P = 0.152 and 0.102, respectively). Chemotherapy was the most common indication of insertion (77 [85.56%] vs. 165 [87.30%]); in group 1 vs. 2, P = 0.688). The left external jugular was the most common site of insertion in group 1 (n = 66; 73.33%), and the left subclavian was the most common site in group 2 (n = 77; 40.74%). Complications of insertion were nonsignificantly higher in group 2 (P = 0.170). Nine patients in group 2 required conversion to cutdown technique (4.76%). Complications during removal were nonsignificantly higher in group 2 (P = 0.182), and the most common was bleeding (n = 4; 2.12%). The most common indication for catheter removal was the completion of the treatment (36 [40%] vs. 85 [44.97%] in groups 1 and 2, respectively).

CONCLUSIONS

Percutaneous and open tunneled central venous catheter insertion are safe in pediatric patients who require long-term venous access. Both techniques have a low complication rate. The choice of each method should be tailored to the condition of each patient.

Speeding the Detection of Vessel Cannulation: An In-Vitro Stimulation Study

BACKGROUND

Some practitioners "prime" small IV angiocatheter needles with 0.9% sodium chloride-claiming this modification speeds visual detection of blood in the angiocatheter flash chamber on vessel cannulation.

METHODS

We compared the time required for human blood to travel the length of saline-primed and saline-unprimed 24- and 22-gauge angiocatheter needles (Introcan Safety IV Catheter; B. Braun, Bethlehem, PA). A syringe pump (Medfusion 4000, Cary, NC) advanced each angiocatheter needle through the silicone membrane of an IV tubing "t-piece" (Microbore Extension Set, 5 Inch; Hospira, Lake Forest, IL) filled with freshly donated human blood. When the angiocatheter needle contacted the blood, an electrical circuit was completed, illuminating a light-emitting diode. We determined the time from light-emitting diode illumination to visual detection of blood in the flash chamber by video review. We tested 105 saline-primed angiocatheters and 105 unprimed angiocatheters in the 24- and 22-gauge angiocatheter sizes (420 catheters total). We analyzed the median time to visualize the flash using the nonparametric Wilcoxon rank sum test in R (http://www.R-project.org/). The Stanford University Administrative Panel on Human Subjects in Medical Research determined that this project did not meet the definition of human subjects research and did not require institutional review board oversight.

RESULTS

In the 24-gauge angiocatheter group, the median (and interquartile range) time for blood to travel the length of the unprimed angiocatheter needle was 1.14 (0.61-1.47) seconds compared with 0.76 (0.41-1.20) seconds in the saline-primed group (P = 0.006). In the 22-gauge catheter group, the median (interquartile range) time for blood to travel the length of the unprimed angiocatheter needle was 1.80 (1.23-2.95) seconds compared with 1.46 (1.03-2.54) seconds in the saline-primed group (P = .046).

CONCLUSIONS

These results support the notion that priming small angiocatheter needles, in particular 24-gauge catheters, with 0.9% sodium chloride may provide earlier detection of vessel cannulation than with the unprimed angiocatheter.

Incidence, severity and outcome of central line related complications in pediatric oncology patients; A single center study

BACKGROUND

Central venous access device (CVAD)-related complications are associated with high morbidity rates. This study was performed to underline the importance of CVAD-complication prevention and treatment.

METHODS

An audit of practice of CVAD-related complications in pediatric oncology patients receiving a CVAD between January 2015 and June 2017 was performed. CVADs included were totally implantable venous access ports (TIVAPs), Hickman-Broviac® (HB), nontunneled, and peripherally inserted CVADs.

RESULTS

A total of 201 children, with 307 CVADs, were analyzed. The incidence rates per 1000 CVAD-days for the most common complications were 1.66 for malfunctions, and 1.51 for central line-associated bloodstream infections (CLABSIs). Of all CVADs inserted, 37.1% were removed owing to complications, of which 45.6% were owing to CLABSIs. In 42% of the CLABSIs, the CLABSI could be successfully cured with systemic antibiotic treatment only. Of all included patients, 5.0% were admitted to the intensive care unit owing to CLABSI. The HB-CVAD compared to the TIVAP was a risk factor for CVAD-related complications, CLABSIs and dislocations in particular.

CONCLUSIONS

The incidence of CVAD-related complications is high. Research on the prevention and treatment of CVAD-related complications in pediatric oncology patients should be a high priority for all health care professionals.

TYPE OF STUDY

Prognosis study (retrospective).

LEVEL OF EVIDENCE

Level II.

Making Medicines Baby Size: The Challenges in Bridging the Formulation Gap in Neonatal Medicine

The development of age-appropriate formulations should focus on dosage forms that can deliver variable yet accurate doses that are safe and acceptable to the child, are matched to his/her development and ability, and avoid medication errors. However, in the past decade, the medication needs of neonates have largely been neglected. The aim of this review is to expand on what differentiates the needs of preterm and term neonates from those of the older paediatric subsets, in terms of environment of care, ability to measure and administer the dose (from the perspective of the patient and carer, the routes of administration, the device and the product), neonatal biopharmaceutics and regulatory challenges. This review offers insight into those challenges posed by the formulation of medicinal products for neonatal patients in order to support the development of clinically relevant products.

Investigating the effect of local warming on vein diameter in the antecubital area in adults aged 20-40 years

BACKGROUND

peripheral intravenous cannulation is the most prevalent invasive procedure performed on patients admitted to hospital. The procedure is not always easy to undertake and can lead to problems for the patient and nurse. Alongside various procedures, local warming is one technique that could be used to increase the diameter of superficial veins. This prospective non-randomised trial aimed to determine the effect of local warming on vein diameter in the antecubital area in adults aged 20-40 years.

METHOD

the subjects included 55 volunteers who were in good health. The cephalic vein diameter of the right arm cubital area was measured for each participant using ultrasound guidance. The arm was warmed for 10 minutes using a heating device maintained at 42ºC. A second ultrasound scan was then undertaken immediately afterwards and cephalic vein diameter measured.

RESULTS

local warming increased the cephalic vein diameter in the cubital area by 0.43±0.4 mm. There was no significant relationship between change in cephalic vein diameter and participants' gender, age or body mass index.

CONCLUSION

the results indicate that the application of heat is an effective technique for venodilation and could be considered in emergencies or in cases when other veins are difficult to access.

Paediatric gastrostomy stoma complications and treatments: A rapid scoping review

AIMS AND OBJECTIVES

To provide a scoping review of the types of treatments used to address paediatric skin-related stoma complications specific to infection, hypergranulation and gastric leakage, and explore their effectiveness and indications for use.

BACKGROUND

Stoma-related complications can be a common occurrence for children with gastrostomy (G) and gastrojejunostomy (GJ) tubes. Nurses require guidance to inform decision-making of the broad spectrum of treatments used in clinical practice.

DESIGN

A scoping review using a rapid review approach.

METHODS

Working with a multidisciplinary health professional team, search terms were generated. A systematic search of CINAHL, MEDLINE and EMBASE databases was completed, coupled with an Internet search to identify relevant clinical practice guidelines and hand searching of citation lists. Eligible articles were peer-reviewed English publications, focused on paediatric populations aged 18 years and under, dating from 2002-2016 and described complications and treatment approaches related to G- and GJ-tube stomas. Pertinent information was extracted using a standardised template, and a narrative synthesis approach was used to analyse the data.

RESULTS

Twenty-five articles were included in this review. Study designs varied, and complication management was often a secondary focus. A broad spectrum of treatments was used to manage each complication type. There was a lack of consensus on lines of therapy; however, a stepwise approach was often used for complication management, particularly for infections.

CONCLUSIONS

The evidence on the comparative effectiveness of different treatment strategies of skin-related gastrostomy stoma complications in paediatric practice is sparse. Current evidence is generally limited to expert opinions. Future studies examining efficacy of treatments and their indications for use with children are warranted.

RELEVANCE TO CLINICAL PRACTICE

Effective management of skin-related stoma complications is important to maintain health and wellness among children who rely on G- and GJ-tubes for nutrition support.