1
|
Zaidi Z, Littlechild H, Hill S, Köglmeier J. Causes and Outcome of Central Venous Catheter Repair in Children with Intestinal Failure on Home Parenteral Nutrition. J Pediatr Gastroenterol Nutr 2023; 77:796-800. [PMID: 37771033 DOI: 10.1097/mpg.0000000000003946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
OBJECTIVES Children requiring a central venous catheter (CVC) for long-term parenteral nutrition (PN) are at risk of CVC breakage. Modern intestinal failure (IF) management aims to preserve vascular access sites. CVC repair rather than removal is hence attempted for broken catheters. The aim of this study was to describe causes and outcomes of CVC repairs in home PN dependent children. METHODS All patients (ages 0-17 years) with CVC dependency enrolled in the IF rehabilitation program of a pediatric referral center were identified, and those who underwent a CVC repair between January 2019 and November 2020 included. Data on associated cause for breakage and incidence of central line-associated bloodstream infections (CLABSIs) post repair were documented retrospectively. Descriptive statistics including medians, percentages, and frequencies were used. RESULTS Forty children, 15 males (37%) and 25 females (63%), were identified. Fifteen of 40 (37.5%) patients underwent a total of 29 CVC repairs (0.1 repairs per 1000 catheter days); 8 of 15 (53%; 33% females) were <5 years of age. The most common reason for repair was CVC fracture by biting (41%) followed by catheter occlusion with intraluminal PN deposition (13.2%). Repair was successful in 100% cases. Only 1 patient had a confirmed CLABSI post repair (1/29 repairs; 3%) who presented 3 days late after the initial catheter breakage. Catheter salvage was successful with antibiotics. CONCLUSION CVC repair in our cohort was very successful and infection rate after repair minimal. CVC repair rather than removal is recommended to preserve central venous access.
Collapse
Affiliation(s)
- Zafar Zaidi
- From the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | | | | | | |
Collapse
|
2
|
Kimball A, Gibson E, Quinn L, Cooksey R, Molony D, Lodge M, Carney B, Jeeves A. Thrombosis incidence in major paediatric burns. ANZ J Surg 2023; 93:2721-2726. [PMID: 37680024 DOI: 10.1111/ans.18664] [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] [Received: 01/04/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Major burns are associated with multiple risk factors for thrombosis such as decreased mobilization and systemic inflammation. It is unclear if these factors are offset by the inherent lower thrombosis risk in the paediatric patient. As such there is no consensus on thromboprophylaxis for paediatric burns patients, in contrast to this being a mainstay of treatment in the adult population. This retrospective cohort study examines the incidence of, and risk factors for, thrombotic events in major paediatric burns with a view to establish guidelines for prevention. METHOD Review of major paediatric burns, defined as % total body surface area (%TBSA) ≥30%, at the Adelaide Women's and Children's Hospital (WCH) over a 16-year period. Coding data and the local burns database were used to identify participants with subsequent review of case files. RESULTS Of the cohort (n = 23), six cases (26%) were complicated by thrombotic events. These patients had the most extensive burns averaging 68.5% TBSA, longer PICU admissions and associated interventions. These data points were more than doubled in the cohort diagnosed with a thrombus. Of the six events, five were secondary to central venous catheters (CVC) and one deep venous thrombosis (DVT) to the left calf. CONCLUSION The incidence of thrombotic events in our study was significant albeit in a small population. There is a strong association between large %TBSA and thrombus, with clots mostly forming around CVCs. While further research is required, this study demonstrates screening and targeted thromboprophylaxis may be required for major paediatric burns.
Collapse
Affiliation(s)
- Ashlee Kimball
- Burns Service, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Edward Gibson
- Burns Service, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Linda Quinn
- Burns Service, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Rebecca Cooksey
- Burns Service, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Darren Molony
- Burns Service, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Michelle Lodge
- Burns Service, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Bernard Carney
- Burns Service, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| | - Amy Jeeves
- Burns Service, Women's and Children's Health Network, North Adelaide, South Australia, Australia
| |
Collapse
|
3
|
Jarraya A, Kammoun M, Chtourou A, Ammar S, Kolsi K. Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000523. [PMID: 38328394 PMCID: PMC10848620 DOI: 10.1136/wjps-2022-000523] [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: 11/01/2022] [Accepted: 02/09/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Assessing central venous catheter-related complications with regular feedback and investigating risk factors are mandatory to enhance outcomes. The aim of this study is to assess our experience in the management of pediatric subclavian vein catheters (SVCs) and to investigate the main risk factors for complications. Methods In this prospective observational study, we included children aged 3 months to 14 years who underwent infraclavicular subclavian vein catheterization consecutively using the anatomic landmark technique. Patients were divided into two groups: group 1 included complicated catheters and group 2 included non-complicated catheters. The management protocol was standardized for all patients. After comparing the two groups, univariate and multivariate logistic regression were used to investigate the risk factors for complications. Results In this study, we included 134 pediatric patients. The rate of complications was 32.8%. The main complications were central line-associated bloodstream infection (63.6%), bleeding and/or hematoma (22.7%), mechanical complications (13.6%), and vein thrombosis (13.6%). After adjustment for confounding factors, predictors of catheter-related complications were difficult insertion procedure (adjusted odds ratio (aOR)=9.4; 95% confidential interval (CI): 2.32 to 38.4), thrombocytopenia (aOR=4.43; 95% CI: 1.16 to 16.86), comorbidities (aOR=2.93; 95% CI: 0.58 to 14.7), and neutropenia (aOR=5.45; 95% CI: 2.29 to 13.0). Conclusions High rates of complications were associated with difficult catheter placement and patients with comorbidities and severe thrombocytopenia. To reduce catheter-related morbidity, we suggest an ultrasound-guided approach, a multidisciplinary teaching program to improve nursing skills, and the use of less invasive devices for patients with cancer.
Collapse
Affiliation(s)
- Anouar Jarraya
- The Anesthesiology department, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Manel Kammoun
- The Anesthesiology department, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Ameni Chtourou
- The Anesthesiology department, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Saloua Ammar
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
- University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| | - Kamel Kolsi
- The Anesthesiology department, University of Sfax Faculty of Medicine of Sfax, Sfax, Tunisia
| |
Collapse
|
4
|
Shashi KK, Callahan MJ, Tsai A. Diagnostic challenges with central venous catheter studies. Pediatr Radiol 2022; 52:1581-1591. [PMID: 35460037 DOI: 10.1007/s00247-022-05362-2] [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: 11/09/2021] [Revised: 02/18/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
A central venous catheter is typically made of silicone rubber or polyurethane and inserted into a large central vein to provide prolonged and direct access to central venous circulation. These catheters provide a safe and effective method to administer intravenous medications, nutritional supplements, fluids and blood products. However, a myriad of complications is associated with central venous catheters, including, but not limited to, mechanical malfunction or fracture, kinking, erroneous placement, line infection, fibrin sheath formation and venous thrombosis. Following clinical and radiographic evaluation, contrast-enhanced line studies constitute the next best diagnostic tool to assess the functionality of central venous catheters. However, there is a lack of standardization in the literature outlining how these studies should be performed. In addition, the interpretation of these studies can be problematic for general pediatric radiologists, many of whom are often not familiar with placement or manipulation of these catheters. In this pictorial review, we highlight the challenges associated with performing and interpreting fluoroscopically guided contrast injection studies, using case studies drawn from a large tertiary children's hospital database for illustration. Revealing these challenges and understanding their causative mechanisms can improve the performance of these line studies.
Collapse
Affiliation(s)
- Kumar K Shashi
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Michael J Callahan
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Andy Tsai
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
| |
Collapse
|
5
|
Lischka J, Arbeiter K, de Gier C, Willfort-Ehringer A, Walleczek NK, Gellai R, Boehm M, Wiegman A, Greber-Platzer S. Vascular access for lipid apheresis: a challenge in young children with homozygous familial hypercholesterolemia. BMC Pediatr 2022; 22:131. [PMID: 35279116 PMCID: PMC8917672 DOI: 10.1186/s12887-022-03192-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Homozygous familial hypercholesterolemia (hoFH) is a rare genetic disorder leading to extremely increased LDL-cholesterol (LDL-C), resulting in high cardiovascular risk in early childhood. Lipid apheresis (LA) is an effective treatment and should be started as early as possible to prevent premature cardiovascular events. As peripheral punctures in children can be challenging due to small vessels and anxiety, this study aimed to evaluate feasibility and safety of central venous catheters (CVCs) as vascular access for LA in young children with hoFH. Methods Retrospective analysis (2016-2019) on four children with hoFH aged 3-5 years, performing weekly or biweekly LA with a CVC. Results LDL-C decreased by> 60%. In three children, the use of a permanent CVC for 698, 595, and 411 days, respectively, avoided difficult peripheral access, without the occurrence of occlusion or thrombosis. Unfortunately, one child had recurrent CVC-related infections and needed an arteriovenous fistula from the age of 5.
Although the mean dwell time per catheter was 212 days, there were, as expected, severe side effects of early catheter infections with sepsis and accidental self-removal. Starting LA at an early age improved or stabilized carotid intima-media thickness (IMT) in three children. However, IMT did increase in one child caused by intolerance to peripheral punctures and LA interruption. Conclusions Permanent CVCs are a viable temporary access choice for LA in young children with hoFH until peripheral venipuncture is practicable. The risk of CVC-related infections needs to be taken into account. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03192-7.
Collapse
|
6
|
High Rates of Central Venous Line Replacement or Revision in Children With Cancer at US Children's Hospitals. J Pediatr Hematol Oncol 2022; 44:43-46. [PMID: 33633028 DOI: 10.1097/mph.0000000000002098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Most children with cancer utilize a central venous line (CVL) for treatment. Complications often necessitate early replacement, revision, or addition (RRA), but the rate of these procedures is not known. This study sought to determine rates of RRA in pediatric oncology patients, and associated risk factors. MATERIALS AND METHODS Data queried from the Pediatric Health Information System including patients ≤18 years old with malignancy and CVL placement. Analysis included: first CVL placement of the calendar year and subsequent procedures for 6 months thereafter. RESULTS A total of 6553 children met inclusion criteria (55.9% male, median age 6 years, interquartile range: 2 to 12). RRA within 6 months was required in 25.6% of patients, with 1.7% requiring 5 or more lines. Patients with Central Line-Associated Bloodstream Infection (CLABSI) were 2.78 times more likely to require RRA within 6 months of initial CVL placement, but accounted for only 16% of RRA patients. Factors associated with RRA were age below 1 year, CLABSI, hematologic malignancy, malnutrition, clotting disorder, deep vessel thromboembolism, and obesity. Patients with implantable ports as initial CVL (42%) were less likely to need RRA. CONCLUSION Twenty-five percent require at least 1 RRA within 6 months, with associated morbidity and costs. Though strongly associated, most revisions were not related to CLABSI episodes.
Collapse
|
7
|
Nellis ME, Remy KE, Lacroix J, Cholette JM, Bembea MM, Russell RT, Steiner ME, Goobie SM, Vogel AM, Crighton G, Valentine SL, Delaney M, Parker RI. Research Priorities for Plasma and Platelet Transfusion Strategies in Critically Ill Children: From the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding. Pediatr Crit Care Med 2022; 23:e63-e73. [PMID: 34989706 PMCID: PMC8769351 DOI: 10.1097/pcc.0000000000002859] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To present a list of high-priority research initiatives for the study of plasma and platelet transfusions in critically ill children from the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding. DESIGN Systematic review and consensus conference of international, multidisciplinary experts in platelet and plasma transfusion management of critically ill children. SETTING Not applicable. PATIENTS Critically ill pediatric patients at risk of bleeding and receiving plasma and/or platelet transfusions. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A panel of 13 experts developed research priorities for the study of plasma and platelet transfusions in critically ill children which were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding experts. The specific priorities focused on the following subpopulations: severe trauma, traumatic brain injury, intracranial hemorrhage, cardiopulmonary bypass surgery, extracorporeal membrane oxygenation, oncologic diagnosis or stem cell transplantation, acute liver failure and/or liver transplantation, noncardiac surgery, invasive procedures outside of the operating room, and sepsis and/or disseminated intravascular coagulation. In addition, tests to guide plasma and platelet transfusion, as well as component selection and processing, were addressed. We developed four general overarching themes and 14 specific research priorities using modified Research and Development/University of California, Los Angeles methodology. CONCLUSIONS Studies are needed to focus on the efficacy/harm, dosing, timing, and outcomes of critically ill children who receive plasma and/or platelet transfusions. The completion of these studies will facilitate the development of evidence-based recommendations.
Collapse
Affiliation(s)
- Marianne E Nellis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, NY
| | - Kenneth E Remy
- Division of Pediatric Critical Care Medicine and Pulmonary/Critical Care Medicine, Departments of Pediatrics and Internal Medicine, Washington University of St. Louis, St. Louis, MO
| | - Jacques Lacroix
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Jill M Cholette
- Division of Pediatric Critical Care Medicine, University of Rochester Golisano Children's Hospital, Rochester, NY
| | - Melania M Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert T Russell
- Department of Surgery, University of Alabama Birmingham, Birmingham, AL
| | - Marie E Steiner
- Divisions of Critical Care and Hematology, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Susan M Goobie
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Adam M Vogel
- Division of Pediatric Surgery Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Gemma Crighton
- Department of Haematology, Royal Children's Hospital, Melbourne, Australia
| | - Stacey L Valentine
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA
| | - Meghan Delaney
- Division of Pathology and Laboratory Medicine, Children's National Hospital; Department of Pathology and Pediatrics, The George Washington University Health Sciences, Washington, DC
| | - Robert I Parker
- Department of Pediatric Hematology/Oncology, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY
| |
Collapse
|
8
|
van den Bosch CH, Jeremiasse B, van der Bruggen JT, Frakking FNJ, Loeffen YGT, van de Ven CP, van der Steeg AFW, Fiocco MF, van de Wetering MD, Wijnen MHWA. The efficacy of taurolidine containing lock solutions for the prevention of central-venous-catheter-related bloodstream infections: a systematic review and meta-analysis. J Hosp Infect 2021; 123:143-155. [PMID: 34767871 DOI: 10.1016/j.jhin.2021.10.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/16/2021] [Accepted: 10/30/2021] [Indexed: 12/25/2022]
Abstract
The incidence of central venous catheter (CVC)-related bloodstream infections is high in patients requiring a long-term CVC. Therefore, infection prevention is of the utmost importance. The aim of this study was to provide an updated overview of randomized controlled trials (RCTs) comparing the efficacy of taurolidine containing lock solutions (TL) to other lock solutions for the prevention of CVC-related bloodstream infections in all patient populations. On 15th February 2021, PubMed, Embase and The Cochrane Library were searched for RCTs comparing the efficacy of TLs for the prevention of CVC-related bloodstream infections with other lock solutions. Exclusion criteria were non-RCTs, studies describing <10 patients and studies using TLs as treatment. Risk of bias was evaluated using the Cochrane Risk of Bias 2 tool. A random effects model was used to pool individual study incidence rate ratios (IRRs). Subgroup analyses were performed based on the following factors: CVC indication, comparator lock and bacterial isolates cultured. A total of 14 articles were included in the qualitative synthesis describing 1219 haemodialysis, total parenteral nutrition and oncology patients. The pooled IRR estimated for all patient groups together (nine studies; 918 patients) was 0.30 (95% confidence interval 0.19-0.46), favouring the TLs. Adverse events (10 studies; 867 patients) were mild and scarce. The quality of the evidence was limited due to a high risk of bias and indirectness of evidence. The use of TLs might be promising for the prevention of CVC-related bloodstream infections. Large-scale RCTs are needed to draw firm conclusions on the efficacy of TLs.
Collapse
Affiliation(s)
- C H van den Bosch
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - B Jeremiasse
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - J T van der Bruggen
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F N J Frakking
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Y G T Loeffen
- Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - C P van de Ven
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - M F Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Mathematical Institute, Leiden, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | | | - M H W A Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| |
Collapse
|
9
|
van den Bosch C, van Woensel J, van de Wetering MD. Prophylactic antibiotics for preventing gram-positive infections associated with long-term central venous catheters in adults and children receiving treatment for cancer. Cochrane Database Syst Rev 2021; 10:CD003295. [PMID: 34617602 PMCID: PMC8495768 DOI: 10.1002/14651858.cd003295.pub4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This is an updated version of a Cochrane Review last published in 2013. Long-term central venous catheters (CVCs), including tunnelled CVCs (TCVCs) and totally implanted devices or ports (TIDs), are increasingly used when treating people with cancer. Despite international guidelines on sterile insertion and appropriate CVC maintenance and use, infections remain a common complication. These infections are mainly caused by gram-positive bacteria. Antimicrobial prevention strategies aimed at these micro-organisms could potentially decrease the majority of CVC-related infections. The aim of this review was to evaluate the efficacy of prophylactic antibiotics for the prevention of gram-positive infections in people with cancer who have long-term CVCs. OBJECTIVES To assess the effects of administering antibiotics prior to the insertion of long-term CVCs or as a flush/lock solution, or both during long-term CVC access to prevent gram-positive CVC-related infections in adults and children receiving treatment for cancer. SEARCH METHODS The search for this updated review was conducted on 19 November 2020. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE via Ovid and Embase via Ovid. We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform portal for additional articles. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared either the administration of prophylactic antibiotics prior to long-term CVC insertion versus no administration of antibiotics, or the use of an antibiotic versus a non-antibiotic flush/lock solution in long-term CVCs, in adults and children receiving treatment for cancer. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two authors independently selected studies, classified them and extracted data onto a predesigned data collection form. The outcomes of interest were gram-positive catheter-related infection events and total number of CVCs and CVC days. We pooled the data using a random-effects model for meta-analyses. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS: For this update, we identified 310 potentially relevant studies and screened them for eligibility. We included one additional RCT with 404 participants. The original review included 11 RCTs with a total of 840 people with cancer (adults and children). In total this review included 12 RCTs with 1244 participants. Antibiotics prior to insertion of the CVC Six trials compared the use of antibiotics (vancomycin, teicoplanin, ceftazidime or cefazolin) versus no antibiotics given before the insertion of a long-term CVC. One study did not observe any CVC-related infection events in either group was not included in the quantitative analysis as it was not possible to calculate a risk ratio. Administering an antibiotic prior to insertion of the CVC may not reduce gram-positive CVC-related infections (pooled risk ratio 0.67, confidence interval (CI) 95% 0.32 to 1.43; control versus intervention group risk 10.4% versus 7.3% of the participants; 5 studies, 648 participants; moderate-certainty evidence). We sought adverse event data, but these were not described by the authors. The overall risk of bias was deemed low. Antibiotics as a flushing or locking solution Six trials compared a combined antibiotic (vancomycin, amikacin or taurolidine) and heparin solution with a heparin-only solution for flushing or locking the long-term CVC after use. One study did not observe any CRS events and was not include this study in the quantitative analysis as it was not possible to calculate a risk ratio. Flushing and locking long-term CVCs with a combined antibiotic and heparin solution likely reduced the risk of gram-positive CVC-related infections compared to a heparin-only solution (pooled rate ratio 0.47, CI 95% 0.26 to 0.85; control versus intervention group rate ratio 0.66 versus 0.27 per 1000 CVC-days; 5 studies, 443 participants; moderate-certainty evidence). One trial reported a higher incidence of occlusions and participants in one trial reported an unpleasant taste after flushing associated with a combined antibiotic and heparin solution. The overall risk of bias was deemed low. AUTHORS' CONCLUSIONS: Since the last version of this review, we included one additional study. There was no observed benefit of administering antibiotics before the insertion of long-term CVCs to prevent gram-positive CVC-related infections. Flushing or locking long-term CVCs with an antibiotic solution likely reduces gram-positive CVC-related infections experienced in people at risk of neutropenia through chemotherapy or disease. However, a limitation of this review is heterogeneity between the studies for both outcomes. Insufficient data were available to evaluate if the conclusions apply equally for different CVC types and for adults versus children. It must be noted that the use of an antibiotic flush/lock solution may increase microbial antibiotic resistance, therefore it should be reserved for high-risk people or if the baseline CVC-related infection rates are high. Further research is needed to identify high-risk groups most likely to benefit from these antibiotic flush/lock solutions.
Collapse
Affiliation(s)
- Ceder van den Bosch
- Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Job van Woensel
- Pediatrics, Emma Children's Hospital / Academic Medical Centre, Amsterdam, Netherlands
| | | |
Collapse
|
10
|
Mooli RK, Sadasivam K. Peripheral Inotropes in Critically Ill Children: Is It Safe? Glob Pediatr Health 2021; 8:2333794X211022250. [PMID: 34104702 PMCID: PMC8170275 DOI: 10.1177/2333794x211022250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/13/2021] [Indexed: 11/15/2022] Open
Abstract
Many children needing pediatric intensive care units care require inotropes, which are started peripherally prior to securing a central venous access. However, many hospitals in low- and middle-income countries (LMIC) may not have access to central lines and the vasoactive medications are frequently given through a peripheral venous access. Aim: The aim of our study was to describe the role of peripheral vasoactive inotropes in children. Methods: Children requiring peripheral vasoactive medications were included in this study. We retrospectively collected data at 2 time points on use and complications of peripheral vasoactive medications. Results: Eighty-four children (51 pre-COVID era and 33 COVID pandemic) received peripheral vasoactive medications. Only 3% of children (3/84) developed extravasation injury, all of whom recovered completely. Conclusions: Results from our study suggest that extravasation injury due to peripheral inotrope infusion is very low (3%) and it may be safely administered in children at a diluted concentration.
Collapse
Affiliation(s)
- Ravi K Mooli
- Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
| | | |
Collapse
|
11
|
Adverse events associated with administration of vasopressor medications through a peripheral intravenous catheter: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:146. [PMID: 33863361 PMCID: PMC8050944 DOI: 10.1186/s13054-021-03553-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is unclear whether vasopressors can be safely administered through a peripheral intravenous (PIV). Systematic review and meta-analysis methodology was used to examine the incidence of local anatomic adverse events associated with PIV vasopressor administration in patients of any age cared for in any acute care environment. METHODS MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of controlled trials, and the Database of Abstracts of Reviews of Effects were searched without restriction from inception to October 2019. References of included studies and related reviews, as well as relevant conference proceedings were also searched. Studies were included if they were: (1) cohort, quasi-experimental, or randomized controlled trial study design; (2) conducted in humans of any age or clinical setting; and (3) reported on local anatomic adverse events associated with PIV vasopressor administration. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials or the Joanna Briggs Institute checklist for prevalence studies where appropriate. Incidence estimates were pooled using random effects meta-analysis. Subgroup analyses were used to explore sources of heterogeneity. RESULTS Twenty-three studies were included in the systematic review, of which 16 and 7 described adults and children, respectively. Meta-analysis from 11 adult studies including 16,055 patients demonstrated a pooled incidence proportion of adverse events associated with PIV vasopressor administration as 1.8% (95% CI 0.1-4.8%, I2 = 93.7%). In children, meta-analysis from four studies and 388 patients demonstrated a pooled incidence proportion of adverse events as 3.3% (95% CI 0.0-10.1%, I2 = 82.4%). Subgroup analyses did not detect any statistically significant effects associated with stratification based on differences in clinical location, risk of bias or design between studies, PIV location and size, or vasopressor type or duration. Most studies had high or some concern for risk of bias. CONCLUSION The incidence of adverse events associated with PIV vasopressor administration is low. Additional research is required to examine the effects of PIV location and size, vasopressor type and dose, and patient characteristics on the safety of PIV vasopressor administration.
Collapse
|
12
|
Fujikawa T, Uemura S, Aoto Y, Nambu Y, Nagano C, Nakatani N, Nino N, Yamamoto N, Mori T, Nishimura N, Iijima K. Catheter-related blood stream infection caused by Mycobacterium chelonae in a child with myeloid leukemia associated with Down syndrome. Clin Case Rep 2021; 9:835-840. [PMID: 33598254 PMCID: PMC7869324 DOI: 10.1002/ccr3.3646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/18/2020] [Accepted: 11/22/2020] [Indexed: 12/01/2022] Open
Abstract
Rapidly growing nontuberculous mycobacteria should be considered if GPRs gram-positive rods are detected in blood cultures 2-3 days after the blood sample collection.
Collapse
Affiliation(s)
- Tomoko Fujikawa
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Suguru Uemura
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Yuya Aoto
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Yoshinori Nambu
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - China Nagano
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Naoko Nakatani
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Nanako Nino
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Nobuyuki Yamamoto
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| | - Takeshi Mori
- Department of Hematology and OncologyKobe Children’s HospitalKobeJapan
| | | | - Kazumoto Iijima
- Department of PediatricsKobe University Graduate School of MedicineKobeJapan
| |
Collapse
|
13
|
Development of a Clinical Prediction Model for Central Line-Associated Bloodstream Infection in Children Presenting to the Emergency Department. Pediatr Emerg Care 2020; 36:e600-e605. [PMID: 30985631 PMCID: PMC6788929 DOI: 10.1097/pec.0000000000001835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The majority of the children with a central line who present to the emergency department with fever or other signs of bacteremia do not have a central line-associated bloodstream infection (CLABSI). Our objective was to develop a clinical prediction model for CLABSI among this group of children in order to ultimately limit unnecessary hospital admissions and antibiotic use. METHODS We performed a nested case-control study of children with a central line who presented to the emergency department of an urban, tertiary care children's hospital between January 2010 and March 2015 and were evaluated for CLABSI with a blood culture. RESULTS The final multivariable model developed to predict CLABSI consisted of 12 factors: age younger than 5 years, black race, use of total parenteral nutrition, tunneled central venous catheter, double-lumen catheter, absence of other bacterial infection, absence of viral upper respiratory tract infection symptoms, diarrhea, emergency department temperature greater than 39.5°C, fever prior to presentation, neutropenia, and spring/summer season. The clinical prediction score had good discrimination for CLABSI with a c-statistic of 0.81 (confidence interval, 0.77-0.85). A cut point less than 6 was associated with a sensitivity of 98.5% and a negative predictive value of 99.2% for CLABSI. CONCLUSIONS We were able to identify risk factors and develop a clinical prediction model for CLABSI in children presenting to the emergency department. Once validated in future study, this clinical prediction model could be used to assess the need for hospitalization and/or antibiotics among this group of patients.
Collapse
|
14
|
Cui YH, Choi YJ, Kim EH, Yu JH, Seong HY, Choi SU, Yoon SZ, Huh H. Effects of blood flow on the antibacterial efficacy of chlorhexidine and silver sulfadiazine coated central venous catheter: A simulation-based pilot study. Medicine (Baltimore) 2020; 99:e22218. [PMID: 32991414 PMCID: PMC7523804 DOI: 10.1097/md.0000000000022218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Chlorhexidine and silver sulfadiazine coated central venous catheters (CSS-CVC) may cause loss of antimicrobial efficacy due to friction between the CVC surface and sheer stress caused by the blood flow. Therefore, the aim of this study was to investigate the antibacterial efficacy of CSS-CVC at various flow rates using a bloodstream model. METHODS Each CVC was subjected to various flow rates (0.5, 1, 2, and 4 L/min) and wear-out times (0, 24, 48, 72, 96, and 120 hours), and the optical density (OD) 600 after a Staphylococcus aureus incubation test was used to determine the antibacterial effect of CSS-CVC. RESULTS In the 0.5 L/min group, there was no significant change in the OD600 value up to 120 hours compared with the baseline OD600 value for CSS-CVC (P > .467). However, the OD600 values of CSS-CVC in the 1 L/min (P < .001) and 2 L/min (P < .001) groups were significantly reduced up to 72 hours, while that in the 4 L/min (p < 0.001) group decreased rapidly up to 48 hours. CONCLUSION This study suggests that there is a doubt whether sufficient antibacterial function can be maintained with prolonged duration of catheter placement.
Collapse
Affiliation(s)
- Yong Huan Cui
- Department of Medicine, Graduate School Korea University, Seoul, Republic of Korea
| | - Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi- do, Republic of Korea
| | - Eung Hwi Kim
- Institute for Healthcare Innovation, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joon Ho Yu
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Young Seong
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung-uk Choi
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung Zhoo Yoon
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyub Huh
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
15
|
Standardizing Preoperative Evaluation for Pediatric Central Venous Access: A Care Algorithm to Improve Safety. JOURNAL OF INFUSION NURSING 2020; 43:262-274. [PMID: 32881813 DOI: 10.1097/nan.0000000000000386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Central vascular access device (CVAD) placement is a common procedure in children. When selecting a CVAD, available evidence and specified indications should be used to choose the device that best supports the patient's treatment and carries the lowest risks. A multidisciplinary team developed a care algorithm to standardize preoperative screening before pediatric CVAD placement, with 3 major parts: CVAD selection, patient risk stratification, and preoperative evaluation. Using a stepwise approach of provider education and incorporation into the electronic health record, the team achieved 82% stratification among inpatients. The team's algorithm integrates the existing literature and recommendations for safe and effective CVAD placement.
Collapse
|
16
|
Montes-Tapia F, Hernández-Trejo K, García-Rodríguez F, Jaime-Reyes J, Treviño-Garza C, Cárdenas-Del Castillo B, Rodríguez-Balderrama I, de la O-Cavazos M. Predicting the optimal depth of ultrasound-guided right internal jugular vein central venous catheters in neonates. J Pediatr Surg 2020; 55:1920-1924. [PMID: 31937448 DOI: 10.1016/j.jpedsurg.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Poor positioning of a central venous catheter (CVC) can cause severe complications. The objective is to create a formula that predicts the optimal insertion depth of a real time ultrasound-guided CVC in the right internal jugular vein (RIJV) in newborns. METHODS Between 2015 and 2017, 91 newborns that required a CVC were included in a prospective observational study. Variables such as gestational age, gender, weight, height, and neck length were studied. On the chest x-ray, the distance between the insertion site on the skin and the catheter tip was measured. RESULTS Of the patients included, 50 (54.9%) were males and 40 (44.4%) females; 64 (70.3%) were preterm. Mean gestational age was 33.44 (25 to 41) weeks, weight 2020 (580 to 3980) g, and height 43.04 (26 to 53) cm. Variables were correlated with catheter length and an algorithm was modeled for the introduction method, in which the highest corrected determination coefficient was obtained for weight (R2 = 0.723). CONCLUSION This study demonstrated that the weight of the newborn was the most significant individual predictor of optimal insertion depth of a CVC in the RIJV. The formula Y = 2.6 + 0.7 (weight in kg) that we suggest is practical and reproducible. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Fernando Montes-Tapia
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Pediatric Surgery, Department of Pediatrics, Monterrey, Mexico.
| | - Karla Hernández-Trejo
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
| | - Fernando García-Rodríguez
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
| | - Julio Jaime-Reyes
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
| | - Consuelo Treviño-Garza
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
| | - Barbara Cárdenas-Del Castillo
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Neonatology, Department of Pediatrics, Monterrey, Mexico
| | - Isaías Rodríguez-Balderrama
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Neonatology, Department of Pediatrics, Monterrey, Mexico
| | - Manuel de la O-Cavazos
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina y Hospital Universitario, "Dr. Jose Eleuterio Gonzalez", Department of Pediatrics, Monterrey, Mexico
| |
Collapse
|
17
|
Cunningham AJ, McClellan KV, Dewey E, Krishnaswami S, Butler MW, Nolt D, Fialkowski E, Haag MC, Hamilton NA. Perioperative neutropenia is not an independent risk factor for infectious complications of central venous line placement in children: A propensity score-matched analysis. J Pediatr Surg 2020; 55:1339-1343. [PMID: 31515110 DOI: 10.1016/j.jpedsurg.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/08/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The infectious risk of central venous line (CVL) placement in children with neutropenia (absolute neutrophil count [ANC] <500/mm3) is not well defined. This study aims to investigate the early (≤30 days) and late (>30 days) infectious complications of CVLs placed in pediatric patients with and without neutropenia. METHODS A retrospective review was conducted of all CVLs placed by pediatric surgeons at two institutions from 2010 to 2017. Multivariable logistic regression was performed to identify risk factors for line infection. Propensity score-matched cohorts of patients with and without neutropenia were compared in a 1:1 ratio. Wilcoxon rank-sum, Chi-square, Fisher's exact, and log-rank tests were also performed. RESULTS Review identified 1,102 CVLs placed in 937 patients. Fifty-four patients were neutropenic at the time of placement. Multivariable analysis demonstrated tunneled catheters and subclavian access as associated with line infection. The propensity score-matched cohort included 94 patients, 47 from each group. Demographic and preoperative data were similar between the groups (p > 0.05). Patients with neutropenia were no more likely to develop early (4.3% vs. 2.1%, p = 1.000) or late (19.1% vs. 17.0%, p = 1.000) infectious complications than patients without neutropenia, with similar median time to infection (141 vs. 222 days, p = 0.370). CONCLUSION A policy of selective CVL placement in neutropenic patients with standardized postoperative line maintenance is safe. Future directions include defining criteria by which neutropenic patients could be prospectively selected for safe CVL placement. LEVEL OF EVIDENCE II - Retrospective cohort study.
Collapse
Affiliation(s)
- Aaron J Cunningham
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
| | | | - Elizabeth Dewey
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Sanjay Krishnaswami
- Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Marilyn W Butler
- Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Dawn Nolt
- Division of Pediatric Infectious Diseases, Oregon Health & Science University, Portland, OR, USA
| | - Elizabeth Fialkowski
- Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Meredith C Haag
- School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Nicholas A Hamilton
- Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
18
|
Milford K, von Delft D, Majola N, Cox S. Long-term vascular access in differently resourced settings: a review of indications, devices, techniques, and complications. Pediatr Surg Int 2020; 36:551-562. [PMID: 32200406 DOI: 10.1007/s00383-020-04640-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 11/26/2022]
Abstract
Central venous access is frequently essential for the management of many acute and chronic conditions in children. Millions of central venous access devices (CVADs) are placed each year. In this review article, we discuss the indications for long-term vascular access, the types of devices available, the state of the art of central venous cannulation and device placement, and the complications of long-term central venous access. We pay a special attention to the challenges of, and options for long-term central venous access, also those in developing countries, with limited financial, human, and material resources.
Collapse
Affiliation(s)
- Karen Milford
- The Division of Urology, The Hospital for Sick Children, The University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Dirk von Delft
- Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Nkululeko Majola
- Department of Paediatric Surgery, Frere Hospital, Walter Sisulu University, East London, South Africa
| | - Sharon Cox
- Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
19
|
Chan KWE, Lee KH, Wong HYV, Tsui SYB, Wong YSS, Pang KKY, Mou JWC, Tam YHP. The fibrous sheath of tunnelled central venous catheters: A simple and reliable access for revision. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kin Wai Edwin Chan
- Division of Paediatric Surgery & Paediatric Urology, Department of SurgeryThe Chinese University of Hong Kong, Prince of Wales Hospital Hong Kong China
| | - Kim Hung Lee
- Division of Paediatric Surgery & Paediatric Urology, Department of SurgeryThe Chinese University of Hong Kong, Prince of Wales Hospital Hong Kong China
| | - Hei Yi Vicky Wong
- Division of Paediatric Surgery & Paediatric Urology, Department of SurgeryThe Chinese University of Hong Kong, Prince of Wales Hospital Hong Kong China
| | - Siu Yan Bess Tsui
- Division of Paediatric Surgery & Paediatric Urology, Department of SurgeryThe Chinese University of Hong Kong, Prince of Wales Hospital Hong Kong China
| | - Yuen Shan Sammi Wong
- Division of Paediatric Surgery & Paediatric Urology, Department of SurgeryThe Chinese University of Hong Kong, Prince of Wales Hospital Hong Kong China
| | - Kristine Kit Yi Pang
- Division of Paediatric Surgery & Paediatric Urology, Department of SurgeryThe Chinese University of Hong Kong, Prince of Wales Hospital Hong Kong China
| | - Jennifer Wai Cheung Mou
- Division of Paediatric Surgery & Paediatric Urology, Department of SurgeryThe Chinese University of Hong Kong, Prince of Wales Hospital Hong Kong China
| | - Yuk Him Peter Tam
- Division of Paediatric Surgery & Paediatric Urology, Department of SurgeryThe Chinese University of Hong Kong, Prince of Wales Hospital Hong Kong China
| |
Collapse
|
20
|
Blanco P. Central venous cannulation in the critically ill pediatric patient: Another victory for ultrasound. Med Intensiva 2019; 44:69-71. [PMID: 31732186 DOI: 10.1016/j.medin.2019.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/09/2019] [Accepted: 09/20/2019] [Indexed: 11/19/2022]
Affiliation(s)
- P Blanco
- Intensive Care Physician, Intensive Care Unit, Clínica Cruz Azul, 2651, 60 St., Necochea 7630, Argentina.
| |
Collapse
|
21
|
Lin ZJ, Lee YT, Chua JHY, Wang R, Lee V, Cheah SM, Saffari SE, Lam JCM, Loh AHP. Evaluation of a Novel Bony Landmark-Based Method for Teaching Percutaneous Insertion of Subclavian Venous Catheters in Pediatric Patients. World J Surg 2019; 43:2106-2113. [PMID: 30953198 DOI: 10.1007/s00268-019-04997-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Surgical trainees performing subclavian vein (SCV) cannulation often incorrectly perceive needle trajectory and anatomical relations. As surface landmark-based methods derived from adult surgical practice may be less effective in younger patients, we developed and evaluated a novel bony landmark-based method for teaching SCV cannulation for central venous access device (CVAD) placement in children. METHODS Over 2 sequential 3-year periods, pediatric surgical trainees were taught infraclavicular SCV cannulation via surface- and bony-landmark approaches, respectively. We prospectively recorded patient, surgeon and operative details on all Hickman line and port-a-cath insertions placed by trainees as the first surgeon via percutaneous infraclavicular SCV puncture and compared procedural outcomes and complications across both periods. RESULTS Of 271 cases included in the study, trainees performed 52 (50.5%) and 92 (54.8%) procedures in the first and second periods, respectively. Patients in both periods did not differ by gender, disease, CVAD device, or prior CVAD, chemotherapy or infection status. In the second (bony landmark) period, although patients were younger (6.0 vs. 8.7 years, P = 0.003) mean procedural duration was shorter (42.5 vs. 58.3 min, P < 0.001). Also, cannulation attempts and complication rates did not differ significantly between study periods (P = 0.257 and 1.0, respectively). CONCLUSIONS With the bony landmark approach, trainees could perform the procedures faster despite operating on younger patients, without impacting complication rates and cannulation attempts. Bony landmarks may better approximate SCV position across a range of ages, thus improving the consistency of SCV cannulation in CVAD placements in children.
Collapse
Affiliation(s)
- Zhiyang Jace Lin
- Flinders University School of Medicine, Flinders University, Adelaide, Australia
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | | | - Rachel Wang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vanessa Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sue Mei Cheah
- Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Seyed Ehsan Saffari
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Joyce Ching Mei Lam
- Department of Paediatric Subspecialties Haematology Oncology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Amos Hong Pheng Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| |
Collapse
|
22
|
Chan AP, Baldivia PS, Reyen LE, Lund AN, Marcus EA, Venick RS, Vargas JH, Wozniak LJ. Central venous catheter repair is highly successful in children with intestinal failure. J Pediatr Surg 2019; 54:517-520. [PMID: 29980344 DOI: 10.1016/j.jpedsurg.2018.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/09/2018] [Accepted: 06/03/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Damaged central venous catheters (CVCs) are commonly repaired to avoid line replacement and preserve vascular access. However, limited data suggest an increased risk for central line-associated bloodstream infections (CLABSIs) associated with the repair procedure. The purpose of this study was to describe outcomes of CVC repairs among parenteral nutrition (PN) dependent children with intestinal failure (IF). METHODS A 2-year retrospective review was performed on children with IF on home PN > 6 months. Outcomes of interest were repair success and postrepair CLABSI incidence. Descriptive statistics included medians and frequencies. RESULTS A total of 36 pediatric IF patients underwent 96 CVC repairs during the study period. The median CVC repair count was 1.5 repairs/patient (range, 1 to 16 repairs/patient) with >1 repair in half the patients. Ninety-four broken catheters (98%) were successfully repaired with restoration of function. Of the unsuccessful repairs (2%), the two catheters eventually required surgical removal and replacement. One repair (1%) was followed by a CLABSI with Enterococcus faecalis in an immunocompromised patient. CONCLUSION CVC repair is a highly successful procedure with a low risk for infection. Catheter repair should be considered whenever possible as it may extend the lifetime of the catheter and decrease the risk for vascular access loss. LEVEL OF EVIDENCE Treatment study; level IV.
Collapse
Affiliation(s)
- Alvin P Chan
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Pamela S Baldivia
- Department of Nursing, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Laurie E Reyen
- Department of Nursing, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Alissa N Lund
- Department of Nursing, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Elizabeth A Marcus
- Pediatric Gastroenterology, Hepatology, and Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, CA; VA Greater Los Angeles Health Care System, Los Angeles, CA
| | - Robert S Venick
- Pediatric Gastroenterology, Hepatology, and Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jorge H Vargas
- Pediatric Gastroenterology, Hepatology, and Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Laura J Wozniak
- Pediatric Gastroenterology, Hepatology, and Nutrition, David Geffen School of Medicine at UCLA, Los Angeles, CA
| |
Collapse
|
23
|
Hartman C, Shamir R, Simchowitz V, Lohner S, Cai W, Decsi T, Braegger C, Bronsky J, Cai W, Campoy C, Carnielli V, Darmaun D, Decsi T, Domellöf M, Embleton N, Fewtrell M, Fidler Mis N, Franz A, Goulet O, Hartman C, Hill S, Hojsak I, Iacobelli S, Jochum F, Joosten K, Kolaček S, Koletzko B, Ksiazyk J, Lapillonne A, Lohner S, Mesotten D, Mihályi K, Mihatsch WA, Mimouni F, Mølgaard C, Moltu SJ, Nomayo A, Picaud JC, Prell C, Puntis J, Riskin A, Saenz De Pipaon M, Senterre T, Shamir R, Simchowitz V, Szitanyi P, Tabbers MM, Van Den Akker CH, Van Goudoever JB, Van Kempen A, Verbruggen S, Wu J, Yan W. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Complications. Clin Nutr 2018; 37:2418-2429. [DOI: 10.1016/j.clnu.2018.06.956] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/12/2018] [Indexed: 12/30/2022]
|
24
|
Alturki N, Alkahtani M, Daghistani M, Alyafi T, Khairy S, Ashi M, Aljuffri A. Incidence and risk factors for deep vein thrombosis among pediatric burn patients. Burns 2018; 45:560-566. [PMID: 31018912 DOI: 10.1016/j.burns.2018.09.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patients with major burns covering a large total body surface area (%TBSA) fulfill all the criteria of Virchow's triad, as a sequela of their injury. This places these patients at increased risk for developing deep vein thrombosis (DVT). However, data regarding the incidence of DVT in burn patients are minimal, especially in the pediatric age group. Therefore, the aim of this study is to determine the incidence of DVT in pediatric burn patients, identify possible risk factors for developing DVT, and explore the need for prophylactic treatment. METHODS A retrospective chart review of 95 patients admitted to our Burn Unit was conducted. We included all pediatric patients with second- and third-degree burns admitted to the unit. Exclusion criteria were adult patients, those with first-degree burns and admitted to the unit for <72h, patients discharged against medical advice, those admitted for elective reconstructive surgery, secondary admissions for non-healing/infected burns, and patients with trauma-induced skin loss. A data collection sheet was utilized. RESULTS The total incidence of thrombosis in our population was 4.2% (DVT, 3.1%; arterial thrombosis, 1.1%). Factors significantly associated with DVT included length of hospitalization (p=0.012), central venous catheter placement (p=0.013), and %TBSA (p=0.004). Unlike adult patients, weight for age (percentile) and body mass index were not significant risk factors for DVT in our patients. CONCLUSION Burns are a major risk factor for DVT, especially when covering large surface areas (≥40% TBSA) and combined with other factors (i.e., prolonged hospitalization and central lines). Thus, investigations for DVT and prophylactic anticoagulation should be considered for pediatric burn patients with these risk factors, even if they are asymptomatic.
Collapse
Affiliation(s)
- Nouf Alturki
- Department of Plastic and Reconstructive Surgery, National Guard Hospital, Jeddah, Saudi Arabia.
| | - Mohamed Alkahtani
- Department of Plastic and Reconstructive Surgery, National Guard Hospital, Jeddah, Saudi Arabia
| | - Mamoon Daghistani
- Department of Plastic and Reconstructive Surgery, National Guard Hospital, Jeddah, Saudi Arabia
| | - Tawfeik Alyafi
- Department of Plastic and Reconstructive Surgery, National Guard Hospital, Jeddah, Saudi Arabia
| | - Salahaldin Khairy
- Department of Plastic and Reconstructive Surgery, National Guard Hospital, Jeddah, Saudi Arabia
| | - Mohamed Ashi
- Department of Plastic and Reconstructive Surgery, National Guard Hospital, Jeddah, Saudi Arabia
| | - Ahmed Aljuffri
- Department of Plastic and Reconstructive Surgery, National Guard Hospital, Jeddah, Saudi Arabia
| |
Collapse
|
25
|
Nourian MM, Schwartz AL, Stevens A, Scaife ER, Bucher BT. Clearance of tunneled central venous catheter associated blood stream infections in children. J Pediatr Surg 2018; 53:1839-1842. [PMID: 29397962 PMCID: PMC6015769 DOI: 10.1016/j.jpedsurg.2017.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/28/2017] [Accepted: 12/03/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal time to reinsert central venous catheters (tCVC) after a documented central line associated blood stream infection (CLABSI) is unclear. The goal of this study is to identify risk factors for children who develop persistent bacteremia after tCVC removal due to CLABSI. METHODS We performed a retrospective cohort study from a tertiary children's hospital. Children who underwent removal of a tCVC due to CLABSI were included in our analysis. Our primary outcome was persistent bacteremia after tCVC removal defined by a persistently positive blood culture. Salient patient demographic and clinical factors were extracted from the medical record. RESULTS A total of 140 patients met inclusion criteria and 27 (19%) had a persistent CLABSI after removal of the tCVC. There were no significant differences between the patients who cleared their bacteremia and those who develop persistent bacteremia. The median (IQR) time to positive blood culture after tCVC removal was 2.7 days (1.7- 4.0). CONCLUSIONS We did not identify any patient risk factors distinguishing between a child who will clear a CLABSI versus develop a persistent CLABSI after tCVC removal. Blood stream infection clearance was rapid after tCVC removal, supporting a brief line holiday prior to tCVC reinsertion. LEVEL OF EVIDENCE Level III Retrospective Case-Control Study.
Collapse
Affiliation(s)
- Maziar M Nourian
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
| | - Angelina L Schwartz
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Austin Stevens
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Eric R Scaife
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Brian T Bucher
- Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| |
Collapse
|
26
|
Silvetti S, Aloisio T, Cazzaniga A, Ranucci M. Jugular vs femoral vein for central venous catheterization in pediatric cardiac surgery (PRECiSE): study protocol for a randomized controlled trial. Trials 2018; 19:329. [PMID: 29941012 PMCID: PMC6019231 DOI: 10.1186/s13063-018-2717-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 06/01/2018] [Indexed: 12/11/2022] Open
Abstract
Background Placement of central venous catheters (CVCs) is essential and routine practice in the management of children with congenital heart disease. The purpose of the present protocol is to evaluate the risk for infectious complications in terms of catheter colonization, catheter line–associated bloodstream infections, and catheter-related bloodstream infections (CRBSIs), and the mechanical complications from different central venous access sites in infants and newborns undergoing cardiac surgery. Methods One hundred sixty patients under 1 year of age and scheduled for cardiac surgery will be included in this randomized controlled trial (RCT); patients will be randomly allocated to the jugular or femoral vein arms. CVC insertion will be performed by one of three selected expert operators. Discussion The choice of the insertion site for central venous catheterization can influence the incidence and type of infectious complications in adults but this is not unanimously evidenced in the pediatric setting. The experimental hypothesis of this RCT is that the jugular insertion site is less likely to induce catheter colonization and CRBSI than the femoral site. Trial registration ClinicalTrials.gov Identifier: NCT03282292. Registered on 12 September 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2717-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Simona Silvetti
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy.
| | - Tommaso Aloisio
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | - Anna Cazzaniga
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Milan, Italy
| |
Collapse
|
27
|
Kolaček S, Puntis JWL, Hojsak I. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access. Clin Nutr 2018; 37:2379-2391. [PMID: 30055869 DOI: 10.1016/j.clnu.2018.06.952] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/15/2022]
Affiliation(s)
- S Kolaček
- Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
| | | | - I Hojsak
- Children's Hospital Zagreb, Zagreb, Croatia
| | | |
Collapse
|
28
|
Takhar P, Motilal B, Savita A. Malpositioning of central venous catheter from right to left subclavian vein: A rare complication. Indian J Crit Care Med 2017; 21:799-801. [PMID: 29279646 PMCID: PMC5699013 DOI: 10.4103/0972-5229.218155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Invasive monitoring with central venous catheter (CVC) is a valuable tool now a day in Intensive Care Units and in postoperative hemodynamically unstable patients. It is often employed for administering medications and parenteral nutrition. In most of the instances, these catheters are inserted using proper topographical landmarks and ultrasonography-guided methods. Central venous cannulation is associated now and then with unexpected complications despite the use of all precautions and help of imaging techniques. There is a wide variety of complications related to the central venous cannulation including malpositioning. Malpositioning of the catheter into contralateral subclavian is an extremely unusual event. Here, we report a rare case of malpositioning of CVC from the right to the left subclavian vein also we outline how the misplacement was identified and effectively managed.
Collapse
|
29
|
Rus RR, Premru V, Novljan G, Grošelj-Grenc M, Ponikvar R. Fate of Central Venous Catheters Used for Acute Extracorporeal Treatment in Critically Ill Pediatric Patients: A Single Center Experience. Ther Apher Dial 2017; 20:308-11. [PMID: 27312920 DOI: 10.1111/1744-9987.12442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 11/28/2022]
Abstract
Renal replacement treatment (RRT) is required in severe acute kidney injury, and a functioning central venous catheter (CVC) is crucial. Twenty-eight children younger than 16 years have been treated at the University Medical Centre Ljubljana between 2003 and 2012 with either acute hemodialysis (HD) and/or plasma exchange (PE), and were included in our study. The age of the patients ranged from 2 days to 14.1 years. Sixty-six CVCs were inserted (52% de novo, 48% guide wire). The sites of insertion were the jugular vein in 20% and the femoral vein in 80%. Catheters were in function from 1 day to 27 days. The most common cause for CVC removal or exchange was catheter dysfunction (50%). CVCs were mostly inserted in the femoral vein, which is the preferred site of insertion in acute HD/PE because of the smaller number of complications.
Collapse
Affiliation(s)
- Rina R Rus
- Department of Nephrology, Division of Paediatrics, University Medical Centre, Ljubljana, Slovenia
| | - Vladimir Premru
- Department of Nephrology, Division of Internal Clinics, University Medical Centre, Ljubljana, Slovenia
| | - Gregor Novljan
- Department of Nephrology, Division of Paediatrics, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mojca Grošelj-Grenc
- Department of Paediatric Surgery and Intensive Care, Division of Surgery, University Medical Centre, Ljubljana, Slovenia
| | - Rafael Ponikvar
- Department of Nephrology, Division of Internal Clinics, University Medical Centre, Ljubljana, Slovenia
| |
Collapse
|
30
|
Abstract
OBJECTIVE Pediatric shock represents a major cause of morbidity and mortality in the United States. Standardization of treatment such as volume resuscitation and vasoactive administration has resulted in improved patient outcomes. Vasoactives have been anecdotally associated with peripheral IV infiltration and extravasation. There is a paucity of evidence in pediatrics to determine the ideal route of vasoactive infusions and what, if any, risk factors and harm are associated with peripheral IV infiltration and extravasation. We aim to assess the frequency of and risk factors for peripheral IV infiltration and extravasation during peripheral IV vasoactive infusions in children admitted to the PICU. DESIGN A retrospective, cohort study of all children admitted to a PICU from January 2012 to June 2014. SETTING Forty-four-bed PICU at Children's National Health System. PATIENTS All children 0-18 years old receiving a vasoactive infusion through a peripheral IV for a minimum of 1 hour. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcomes of this study were incidence of peripheral IV infiltration and extravasation and resultant tissue injury. Secondary outcomes were peripheral IV characteristics and vasoactive infusion data. One hundred two patients met inclusion criteria. Sixty-two percent (63/102) were admitted with the diagnosis of septic shock. The most commonly used vasoactive agent was dopamine. The median peak Vasoactive Infusion Score was 10 (6-14). Peripheral IV infiltration and extravasation incidence was 2% (2/102) and neither event resulted in injury requiring medical or surgical intervention. CONCLUSIONS Vasoactive infusions through peripheral IV in children admitted to the PICU with shock were observed to have a low incidence of peripheral IV infiltration and extravasation and resultant tissue injury. Short-term delivery of vasoactives via peripheral IV catheter in a highly monitored PICU setting appears to be safe.
Collapse
|
31
|
Shapiro DR, Dudek CJ, Ho JG. A Toddler With Central Venous Catheter Develops Tachycardia. Clin Pediatr (Phila) 2017; 56:496-499. [PMID: 27466077 DOI: 10.1177/0009922816661331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Douglas Ryan Shapiro
- 1 Department of Pediatrics, University of Florida College of Medicine, Jacksonville
| | - Christopher J Dudek
- 1 Department of Pediatrics, University of Florida College of Medicine, Jacksonville
| | - Jason G Ho
- 2 Pediatric Cardiology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville
| |
Collapse
|
32
|
Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:171-206. [DOI: 10.1007/s00103-016-2487-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
33
|
Fu AB, Hodgman EI, Burkhalter LS, Renkes R, Slone T, Alder AC. Long-term central venous access in a pediatric leukemia population. J Surg Res 2016; 205:419-425. [DOI: 10.1016/j.jss.2016.06.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 05/20/2016] [Accepted: 06/09/2016] [Indexed: 10/21/2022]
|
34
|
Gish J, Wright T, Gadepalli S, Jarboe M. Avoiding postoperative malposition of upper body tunneled central venous catheters in children: Evaluating technique and depth of placement. J Pediatr Surg 2016; 51:1336-40. [PMID: 26926208 DOI: 10.1016/j.jpedsurg.2016.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Suboptimal position of tunneled central venous catheters (Broviacs) decreases long-term catheter longevity, incurring morbidity and cost. We postulated that catheter malposition is related to patient's age, technique used, and initial catheter tip location (CTL). METHODS We performed a retrospective review with 1-year follow-up of Broviacs placed in patients at our children's hospital from 3/2010 to 10/2013. We defined malposition as a noncentral CTL that required replacement, excluding catheters physically dislodged. We used logistic regression to determine whether age, technique and CTL predicted malposition with p-value<0.05 deemed significant. We analyzed line longevity for different insertion techniques by survival analysis. RESULTS Overall, 404 upper body Broviacs were placed in 282 children (median age=1.4years [IQR:0.45-5.35]). Thirty-six (8.9%) were replaced for malposition, at median of 84.5days [IQR:36-159]. We found that older children were less likely to develop malposition (OR=0.91,p=0.002). Adjusting for patient age and placement technique, catheters placed ≥1.5 vertebral bodies below the carina were less likely to be malpositioned (OR=0.37,p=0.015). Cox-regression shows the lateral technique to have the lowest rate of malposition within 90days (HR=0.30,p=0.03). CONCLUSION Older patients and lines placed 1.5 vertebral bodies below the carina are less likely to become malpositioned. Using the lateral approach for insertion improves catheter longevity.
Collapse
Affiliation(s)
- Joshua Gish
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
| | - Tiffany Wright
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Samir Gadepalli
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Marcus Jarboe
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| |
Collapse
|
35
|
Wu T, Zang H. Puncture point-traction method: A novel method applied for right internal jugular vein catheterization. Exp Ther Med 2016; 12:307-311. [PMID: 27347054 DOI: 10.3892/etm.2016.3258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/14/2016] [Indexed: 01/08/2023] Open
Abstract
The ultrasound probe and advancement of the needle during real-time ultrasound-assisted guidance of catheterization of the right internal jugular vein (RIJV) tend to collapse the vein, which reduces the success rate of the procedure. We have developed a novel puncture point-traction method (PPTM) to facilitate RIJV cannulation. The present study examined whether this method facilitated the performance of RIJV catheterization in anesthetized patients. In this study, 120 patients were randomly assigned to a group in which PPTM was performed (PPTM group, n=60) or a group in which it was not performed (non-PPTM group, n=60). One patient was excluded because of internal carotid artery puncture and 119 patients remained for analysis. The cross-sectional area (CSA), anteroposterior diameter (AD) and transverse diameter (TD) of the RIJV at the cricoid cartilage level following the induction of anesthesia and during catheterization were measured, and the number with obvious loss of resistance (NOLR), the number with easy aspiration of blood into syringe (NEABS) during advancement of the needle, and the number of first-pass punctures (NFPP) during catheterization were determined. In the non-PPTM group, the CSA was smaller during catheterization compared with that following the induction of anesthesia (P<0.01). In the PPTM group compared with the non-PPTM group during catheterization, the CSA was larger (P<0.01) and the AD (P<0.01) and TD (P<0.05) were wider; NOLR (P<0.01), NEABS (P<0.01) and NFPP (P<0.01) increased significantly. The findings from this study confirmed that the PPTM facilitated catheterization of the RIJV and improved the success rate of RIJV catheterization in anesthetized patients in the supine position.
Collapse
Affiliation(s)
- Tianliang Wu
- Department of Anesthesia, The First People's Hospital of Fuyang District, Hangzhou, Zhejiang 311400, P.R. China
| | - Hongcheng Zang
- Department of Anesthesia, The First People's Hospital of Fuyang District, Hangzhou, Zhejiang 311400, P.R. China
| |
Collapse
|
36
|
Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016. [DOI: 10.1017/s0899823x00193870] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
Collapse
|
37
|
Hu Y, Guidry CA, Kane BJ, McGahren ED, Rodgers BM, Sawyer RG, Rasmussen SK. Comparative effectiveness of catheter salvage strategies for pediatric catheter-related bloodstream infections. J Pediatr Surg 2016; 51:296-301. [PMID: 26644072 PMCID: PMC4769905 DOI: 10.1016/j.jpedsurg.2015.10.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intravascular catheter salvage may be attempted in clinically suitable cases in pediatric patients with catheter-related bloodstream infections. The purpose of this study was to assess the effectiveness of ethanol and hydrochloric acid (HCl) locks in achieving catheter salvage through decision-analysis modeling. METHODS A Markov decision model was created to simulate catheter salvage using three management strategies: systemic antibiotics alone, antibiotics plus HCl lock, and antibiotics plus ethanol lock. One-way and two-way sensitivity analyses were performed for all model variables. Infection control rates and recurrence rates for each strategy were derived from prospective institutional data and existing pediatric literature. Costs were derived from institutional charges. RESULTS With antibiotics alone, 73% of patients would require line replacement within 100days, compared to only 31% and 19% of patients treated with HCl and ethanol lock, respectively. Incremental cost per additional catheter salvaged is $89 for HCl lock and $456 for ethanol lock. Superior efficacy of adjunct lock therapy is insensitive to changes in the anticipated duration of central access requirement and to clinically relevant variations in all model input variables. CONCLUSION HCl or ethanol locks are cost-effective adjuncts to systemic antibiotics for attempted catheter salvage in the setting of catheter-related bloodstream infections.
Collapse
Affiliation(s)
- Yinin Hu
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States.
| | - Christopher A Guidry
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States.
| | - Bartholomew J Kane
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States.
| | - Eugene D McGahren
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States.
| | - Bradley M Rodgers
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States.
| | - Robert G Sawyer
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States; Division of Acute Care Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States.
| | - Sara K Rasmussen
- Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States.
| |
Collapse
|
38
|
Abstract
Healthcare-associated infections (HAIs) are a leading cause of morbidity and mortality in hospitalized patients. Up to 15% of patients develop an infection while hospitalized in the United States, which accounts for approximately 1.7 million HAIs, 99,000 deaths annually and over 10 billion dollars in costs per year. A significant percentage of HAIs are preventable using evidenced-based strategies. In terms of device-related HAIs it is estimated that 65-70% of catheter-line associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) are preventable. To prevent CLABSIs a bundle which includes hand hygiene prior to insertion and catheter manipulation, use of chlorhexidene alcohol for site preparation and maintenance, use of maximum barrier for catheter insertion, site selection, removing nonessential lines, disinfect catheter hubs before assessing line, and dressing changes are essential elements of basic practices. To prevent CAUTIs a bundle that includes hand hygiene for insertion and catheter or bag manipulation, inserting catheters for appropriate indications, insert using aseptic technique, remove catheters when no longer needed, maintain a close system keeping bag and tubing below the bladder are the key components of basic practices.
Collapse
Affiliation(s)
- Edward J Septimus
- Texas A&M Health Science Center, Houston, Texas, 77005, USA; Clinical Services Group, Hospital Corporation of America, Nashville, Tennessee, 37203, USA
| | - Julia Moody
- Clinical Services Group, Hospital Corporation of America, Nashville, Tennessee, 37203, USA
| |
Collapse
|
39
|
Abstract
Central venous catheters are often filled when not in use with an anticoagulating fluid, usually heparinized saline, known as the locking fluid. However, the use of the locking fluid is associated with known risks because of "leakage" of the lock. A new hypothesis is proposed here to explain the lock fluid leakage: that the leakage is due to advective and diffusive mass transfer by blood flow around the catheter tip in situ. On the basis of previous in vitro experiments, the leakage mechanism has been hypothesized to be fluid motion driven by buoyancy forces between the heavier blood and the lighter locking fluid. The current hypothesis is justified by a simple one-dimensional mass transfer model and more sophisticated three-dimensional computational hemodynamic simulations of an idealized catheter. The results predict an initial, fast (<10 seconds) advection-dominated phase, which may deplete up to 10% of the initial lock, followed by a slow diffusion-limited phase which predicts an additional 1-2% of leakage during a 48 hour period. The current results predict leakage rates that are more consistent with published in vivo data when compared with the buoyancy hypothesis predictions, which tend to grossly overestimate leakage rates.
Collapse
|
40
|
Location of the Central Venous Catheter Tip With Bedside Ultrasound in Young Children: Can We Eliminate the Need for Chest Radiography? Pediatr Crit Care Med 2015; 16:e340-5. [PMID: 26181295 DOI: 10.1097/pcc.0000000000000491] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the use of bedside ultrasound and chest radiography to verify central venous catheter tip positioning. DESIGN Prospective observational study. SETTING PICU of a university hospital. PATIENTS Patients aged 0-14 who required a central venous catheter. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Central venous catheter tip location was confirmed by ultrasound and chest radiography. Central venous catheters were classified as intra-atrial or extra-atrial according to their positions in relation to the cavoatrial junction. Central venous catheters located outside the vena cava were considered malpositioned. The distance between the catheter tip and the cavoatrial junction was measured. The time elapsed from image capture to interpretation was recorded. Fifty-one central venous catheters in 40 patients were analyzed. Chest radiography and ultrasound results agreed 94% of the time (κ coefficient, 0.638; p < 0.001) in determining intra-atrial and extra-atrial locations and 92% of the time in determining the diagnosis of central venous catheter malposition (κ coefficient, 0.670; p < 0.001). Chest radiography indicated a greater distance between the central venous catheter tip and the cavoatrial junction than measured by ultrasound, with a mean difference of 0.38 cm (95% CI, +0.27, +0.48 cm). Three central venous catheters were classified as extra-atrial by chest radiography but as intra-atrial by ultrasound. To locate the central venous catheter tip, ultrasound required less time than chest radiography (22.96 min [20.43 min] vs 2.23 min [1.06 min]; p < 0.001). CONCLUSIONS Bedside ultrasound showed a good agreement with chest radiography in detecting central venous catheter tip location and revealing incorrect positions. Ultrasound could be a preferable method for routine verification of central venous catheter tip and can contribute to increased patient safety.
Collapse
|
41
|
Merchant-Soomar S, Grignani R, Aye WM, Shankar S, Quek SC. "Why are the Saturations Dropping?" The Blalock-Taussig Shunt Revisited. J Cardiothorac Vasc Anesth 2015; 30:753-5. [PMID: 26476683 DOI: 10.1053/j.jvca.2015.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Sanah Merchant-Soomar
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Robert Grignani
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Winn Maung Aye
- Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Sriram Shankar
- Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Swee Chye Quek
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
42
|
Optimal insertion lengths of right and left internal jugular central venous catheters in children. Pediatr Radiol 2015; 45:1206-11. [PMID: 25779826 DOI: 10.1007/s00247-015-3289-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 12/29/2014] [Accepted: 01/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Knowledge of the optimal lengths for central venous catheterization prior to the procedure may lessen the need for repositioning and prevent vascular complications. OBJECTIVE To establish the optimal lengths for non-tunneled central venous catheter insertion through the right and left internal jugular veins. MATERIALS AND METHODS We included 92 children who received US-guided central venous catheterization via right or left internal jugular veins in intensive care units. The calculated distance between the skin and carina was considered the optimal length for right and left internal jugular venous catheterization. Univariate and multivariate linear regression analyses was used to identify predictors. RESULTS Age, height and weight showed significant correlations with optimal insertion lengths for right and left internal jugular vein approaches on univariate analysis, while height was the only significant independent predictor of optimal insertion length. CONCLUSION The optimal insertion lengths (cm) suggested by our data are, for the right internal jugular vein 0.034 × height (cm) + 3.173, and for the left 0.072 × height (cm) + 2.113.
Collapse
|
43
|
Aminnejad R, Razavi SS, Mohajerani SA, Mahdavi SA. Subclavian Vein Cannulation Success Rate in Neonates and Children. Anesth Pain Med 2015; 5:e24156. [PMID: 26161322 PMCID: PMC4493728 DOI: 10.5812/aapm.24156v2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 03/13/2015] [Accepted: 04/27/2015] [Indexed: 12/04/2022] Open
Abstract
Background: Central vein cannulation allows the administration of large volumes of fluids in short times and at high osmolarities for rehydration, volume replacement, chemotherapy, and parenteral nutrition. Percutaneous central venous line insertion has replaced peripheral venous cut-down as the primary mode of short-term venous access in children. Objectives: The aim of our study was to delineate some aspects of this procedure as well as its success rate and relative risk in pediatrics. Patients and Methods: Totally, 3264 subclavian vein cannulations in neonates and children were analyzed regarding successful catheterization attempts and early complication rates after the procedure retrospectively in Mofid Hospital (Tehran, Iran). Results: There were 1340 newborn patients (first 28 days of life) in our study population. In these newborns, only 55 cannulations failed; one patient was complicated with pneumothorax; guide wires malfunctioned in 21 cases; and first- attempt cannulation success was reported in only 981 cases. In the remaining 1924 patients, between one month and 8 years old, only 14 attempts at the cannulation of the subclavian vein failed and 1655 cases had first-attempt cannulation success. Conclusions: The cannulation of the central vein in neonates and children in a skilled hand would be performed with great success rate and low complications.
Collapse
Affiliation(s)
- Reza Aminnejad
- Department of Anesthesiology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Sajjad Razavi
- Department of Anesthesiology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Amir Mohajerani
- Department of Anesthesiology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Alireza Mahdavi
- Department of Anesthesiology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding author: Seyed Alireza Mahdavi, Department of Anesthesiology, Mofid Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel/Fax: +98-2122908383, E-mail:
| |
Collapse
|
44
|
Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update. ACTA ACUST UNITED AC 2015. [DOI: 10.1017/s0195941700095412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
Collapse
|
45
|
Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O'Grady NP, Pettis AM, Rupp ME, Sandora T, Maragakis LL, Yokoe DS. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2015; 35:753-71. [PMID: 25376071 DOI: 10.1086/676533] [Citation(s) in RCA: 293] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
46
|
Blanchard AC, Quach C, Autmizguine J. Staphylococcal infections in infants: updates and current challenges. Clin Perinatol 2015; 42:119-32, ix. [PMID: 25678000 DOI: 10.1016/j.clp.2014.10.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Staphylococci are common pathogens in the neonatal period. Increased survival of premature infants leads to prolonged hospital stay with associated risk factors for developing invasive staphylococcal disease. Challenges of diagnosing coagulase-negative staphylococcal infections result in conflicting definitions and inconsistent clinical practice. Resistance to methicillin influences the choice of empirical therapy.
Collapse
Affiliation(s)
- Ana C Blanchard
- Department of Pediatrics, CHU Sainte Justine, University of Montreal, 3175 Chemin Côte Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Caroline Quach
- Division of Infectious Diseases, Department of Medical Microbiology, The Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, Suite C1242, Montreal, Quebec H3H 1P3, Canada; Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, Suite C1242, Montreal, Quebec H3H 1P3, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada
| | - Julie Autmizguine
- Department of Pediatrics, CHU Sainte Justine, University of Montreal, 3175 Chemin Côte Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; Department of Pharmacology, University of Montreal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec H3T 1J4, Canada; Research Center CHU Sainte-Justine, 3175 Chemin Côte Sainte Catherine, Montreal, Quebec H3T 1C5, Canada.
| |
Collapse
|
47
|
Milstone AM, Sengupta A. Do Prolonged Peripherally Inserted Central Venous Catheter Dwell Times Increase the Risk of Bloodstream Infection? Infect Control Hosp Epidemiol 2015; 31:1184-7. [DOI: 10.1086/656589] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
48
|
Doan TN, Kong DCM, Patel K, Walker P, Spencer A, Kirkpatrick CMJ. Comparison of the probability of target attainment of anidulafungin against Candida spp. in patients with acute leukaemia. Int J Antimicrob Agents 2014; 44:450-7. [PMID: 25261159 DOI: 10.1016/j.ijantimicag.2014.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/18/2014] [Indexed: 10/24/2022]
Abstract
This study aimed to investigate the probability of target attainment (PTA) of various anidulafungin dosing regimens against Candida spp. in patients with acute leukaemia. A Monte Carlo simulation was performed using a previously published population pharmacokinetic model. The following dosing scenarios were evaluated: 200 mg loading dose (LD) on Day 1 then 100 mg daily (manufacturer's recommended dosing regimen); 200 mg LD on Day 1 then 100 mg every 48 h (q48 h); and 200 mg q48 h, 200 mg every 72 h (q72 h) and 300 mg q72 h. For each dosing regimen, free drug concentrations were calculated to evaluate the effect of 99% protein binding. The PTA at various pharmacodynamic (PD) targets was determined as the percentage of subjects who achieved a free drug area under the plasma concentration-time curve over the minimum inhibitory concentration ratio (ƒAUC/MIC) or a free drug maximum plasma concentration over the minimum inhibitory concentration ratio (ƒC(max)/MIC) above the PD targets. PTA expectation values were then calculated for each dosing regimen. The currently recommended dosing regimen of anidulafungin was not optimal for invasive candidiasis in patients with acute leukaemia. Alternate dosing strategies with higher doses and extended dosing intervals (intermittent dosing) achieved better target attainment. This is the first study to optimise therapy with anidulafungin using Monte Carlo simulation. These results provide a rationale in support of future clinical investigation of intermittent dosing of anidulafungin.
Collapse
Affiliation(s)
- Tan N Doan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - David C M Kong
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia.
| | - Kashyap Patel
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - Patricia Walker
- Malignant Haematology and Stem Cell Transplantation Service, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Andrew Spencer
- Malignant Haematology and Stem Cell Transplantation Service, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Clinical Haematology, Monash University, Wellington Road, Clayton, Victoria 3800, Australia
| | - Carl M J Kirkpatrick
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia.
| |
Collapse
|
49
|
Latham GJ, Thompson DR. Thrombotic complications in children from short-term percutaneous central venous catheters: what can we do? Paediatr Anaesth 2014; 24:902-11. [PMID: 24814351 DOI: 10.1111/pan.12410] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 12/16/2022]
Abstract
The reported incidence of venous thromboembolism (VTE) in children has increased dramatically over the past decade, and the primary risk factor for VTE in neonates and infants is the presence of a central venous catheter (CVC). Although the associated morbidity and mortality are significant, very few trials have been conducted in children to guide clinicians in the prophylaxis, diagnosis, and treatment of CVC-related VTE. Furthermore, pediatric guidelines for prophylaxis and management of VTE are largely extrapolated from adult data. How then should the anesthesiologist approach central access in children of different ages to lessen the risk of CVC-related VTE or in children with prior thrombosis and vessel occlusion? A comprehensive review of the pediatric and adult literature is presented with the goal of assisting anesthesiologists with point-of-care decision-making regarding the risk factors, diagnosis, and treatment of CVC-related VTE. Illustrative cases are also provided to highlight decision-making in varying situations. The only risk factor strongly associated with CVC-related VTE formation in children is the duration of the indwelling CVC. Several other factors show a trend toward altering the incidence of CVC-related VTE formation and may be under the control of the anesthesiologist placing and managing the catheter. In particular, because children with VTE may live decades with its sequelae and chronic vein thrombosis, careful consideration of lessening the risk of VTE is warranted in every child. Further studies are needed to form a clearer understanding of the risk factors, prophylaxis, and management of CVC-related VTE in children and to guide the anesthesiologist in lessening the risk of VTE.
Collapse
Affiliation(s)
- Gregory J Latham
- Department of Anesthesiology & Pain Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | | |
Collapse
|
50
|
Gaballah M, Krishnamurthy G, Keller MS, McIntosh A, Cahill AM. Single-incision technique for placement of tunneled internal jugular vein vascular access in children. Pediatr Radiol 2014; 44:1004-10. [PMID: 24615352 DOI: 10.1007/s00247-014-2917-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 11/21/2013] [Accepted: 01/31/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Central venous access is indispensable in caring for children with infections, malignancies and chronic illnesses, and image-guided placement of central venous access devices (CVAD) is increasingly used. A single-incision technique for placement of tunneled central venous access devices at the internal jugular vein has been described; however the technique has not been described exclusively in children. OBJECTIVE To describe our initial experience using the single-incision technique for tunneled central venous access at the internal jugular vein in children. MATERIALS AND METHODS We conducted a retrospective review of the interventional radiology database and electronic medical records of 15 children who received a tunneled central venous access device (CVAD) using a single incision between 2010 and 2012. Patients included eight boys and seven girls with an average age of 11 years (median 13.3 years, range 1-18.7 years) and average weight of 44.2 kg (median 38.3 kg, range 9.6-99.0 kg). RESULTS A total of 17 primary insertions were performed. Technical success was 100%. Total catheter life consisted of 1,416 catheter-days (mean 83.3 days, range 8-502 days). There were no procedure-related or early complications. Seven late complications requiring intervention occurred in three catheters. Total mechanical and infectious complications occurred at rates of 0.28 and 0.21 per 100 catheter-days, respectively. The adjusted rate for infectious complications was 0.14 per 100 catheter-days. Medical salvage procedures (83%) and interventional radiology salvage procedures (17%) prolonged catheter life by an average of 94.5 days (range 10-329 days). CONCLUSION This study demonstrates safe use and technical feasibility of the image-guided single-incision technique for central venous access in children, particularly in children in whom the conventional technique is less desirable.
Collapse
Affiliation(s)
- Marian Gaballah
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA, 19104, USA,
| | | | | | | | | |
Collapse
|