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Patel JR, Vellore Govardhan S, Anton-Martin P. Complications associated with peripherally inserted central catheters in paediatric cardiac patients. Cardiol Young 2022; 33:1-7. [PMID: 35135649 DOI: 10.1017/s1047951122000300] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To characterise the use of peripherally inserted central catheters in paediatric cardiac patients and to identify risk factors associated with their complications. MATERIALS AND METHODS Observational retrospective cohort study in paediatric cardiac patients who underwent peripherally inserted central catheter placement in a tertiary children's hospital from January 2000 to June 2018. RESULTS 1822 cardiac patients underwent 2952 peripherally inserted central catheter placements in the study period. Median age was 29 days, with survival to hospital discharge of 96.4%. Successful placement achieved 94.5% of attempts, with a median line duration of 12 days. Factors associated with successful placement were the use of general anaesthesia (odds ratio 7.52, p < 0.001) and year of placement (odds ratio 1.08, p < 0.001). The incidence of complications was 28.6%, with thrombosis/occlusion being the most frequent (33%). Thrombosis/occlusion were associated with two and three lumens (odds ratio 1.96, p < 0.001 and 4.63, p = 0.037, respectively). Lines placed by interventional radiology had decreased infiltration (odds ratio 0.20, p = 0.002) and lower migration/malposition (odds ratio 0.36, p < 0.001). The use of maintenance intravenous fluids (odds ratio 3.98, p = 0.008) and peripheral tip position (odds ratio 3.82, p = 0.001) were associated with increased infiltration. The probability of infection decreased over time (odds ratio 0.79, p < 0.001). CONCLUSION Peripherally inserted central catheters in paediatric cardiac patients have complication rates similar to other paediatric populations. A prospective assessment of the factors associated with their complications in this patient population may be beneficial in improving outcomes.
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Affiliation(s)
- Jay R Patel
- Department of Medical Education, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Shilpa Vellore Govardhan
- Department of Pediatrics, Division of Cardiology, University of California San Diego School of Medicine/Rady Children's Hospital, San Diego, CA, USA
| | - Pilar Anton-Martin
- Department of Pediatrics, Division of Cardiology, University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, TN, USA
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Liu X, Tao X, Xu Y, Zhang X, Wu L. A Survey of the Practice Status Quo of Ultrasound-Guided ECC Tip Location for Neonatal Patients in 31 Provinces of China. Front Pediatr 2022; 10:879920. [PMID: 35911844 PMCID: PMC9329807 DOI: 10.3389/fped.2022.879920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the status quo of implementing ultrasound (US)-guided epicutaneo-caval catheters (ECC) tip location for neonatal patients in 31 provinces. METHODS The convenience sampling method was used to investigate the nursing managers and ECC (or intravenous therapy) nurses of 91 hospitals in 31 provinces from October 29 to November 10, 2021. RESULTS The survey involved a total of 182 medical staff, including 91 managers and 91 nurses, and 91 institutions, including 22 children's hospitals, 49 general hospitals and 21 maternal and child health care hospitals. Sixteen hospitals (17.6%) carried out US-guided ECC for neonatal patients; 176 subjects (96.7%) of the 91 hospitals had known about or heard of the technology of US-guided ECC. The low awareness of operators of the tip location of ECC catheters in children under ultrasound guidance (OR = 2.690, 95% CI = 1.163-6.221), limited conditions in existing wards (OR = 2.953, 95% CI = 1.285-6.790), and insufficient funds (OR = 2.836, 95% CI = 1.149-7.004) were the independent risk factors responsible for the failure to carry out ultrasonic-guided location of ECC tips in newborns. CONCLUSION The popularity of neonatal US-guided ECC location was seriously hindered by factors such as a low awareness rate of the project, the low qualification certification rate of the nursing staff, a flawed performance allocation system, and the lack of a professional team, among other factors.
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Affiliation(s)
- Xuexiu Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaojun Tao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ye Xu
- Radiology Department, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xianhong Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Liping Wu
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
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Kleidon TM, Schults JA, Wainwright C, Mihala G, Gibson V, Saiyed M, Byrnes J, Cattanach P, Macfarlane F, Graham N, Shevill E, Ullman AJ. Comparison of midline catheters and peripherally inserted central catheters to reduce the need for general anesthesia in children with respiratory disease: A feasibility randomized controlled trial. Paediatr Anaesth 2021; 31:985-995. [PMID: 34053159 DOI: 10.1111/pan.14229] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The optimal intravenous device for antibiotic administration for children with respiratory disease is uncertain. We assessed the feasibility of a randomized controlled trial comparing midline catheters with peripherally inserted central catheters. METHODS Prospective, two-arm, feasibility randomized controlled trial in an Australian tertiary, pediatric hospital. Random assignment of 110 children (<18 years) to receive (i) midline catheter and (ii) peripherally inserted central catheters. Primary outcome was feasibility (eligibility, recruitment, retention, protocol adherence, and acceptability), and the primary clinical outcome was general anesthesia requirement for intravenous catheter insertion. SECONDARY OUTCOMES insertion time, treatment delays, infusion efficiency, device failure, complications, and cost. RESULTS There was 80% recruitment, 100% retention, no missing data, and high patient/staff acceptability. Mean patient experience assessed on a 0-10 numeric rating scale was 8.0 peripherally inserted central catheters and 9.0 (midline catheters), respectively. Participant eligibility was not achieved (49% of screened patients) and moderate protocol-adherence across groups (89% peripherally inserted central catheters vs. 76% midline catheter). Insertion of midline catheter for pulmonary optimization reduced the requirement for general anesthesia compared to peripherally inserted central catheters (10% vs. 69%; odds ratio = 0.01, 95% confidence interval: 0.00-0.09). Midline catheters failed more frequently (18.1 vs. 5.5 peripherally inserted central catheters per 1000 catheter-days); however, this reduced over trial duration. Midline catheter insertion compared to peripherally inserted central catheters saved AUD$1451 per pulmonary optimization episode. CONCLUSIONS An efficacy trial is feasible with expanded eligibility criteria and intensive staff training when introducing a new device. Midline catheter for peripherally compatible infusions is acceptable to patients and staff, might negate the need for general anesthesia and results in significant cost savings.
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Affiliation(s)
- Tricia M Kleidon
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Qld, Australia
| | - Jessica A Schults
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Qld, Australia
| | - Claire Wainwright
- Child Health Research Centre, Queensland Children's Hospital, The University of Queensland and Respiratory Medicine, South Brisbane, Qld, Australia
| | - Gabor Mihala
- Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia.,School of Medicine, Griffith University, Nathan, Qld, Australia.,Menzies Health Institute Group, Centre for Applied Health Economics, Nathan, Qld, Australia
| | - Victoria Gibson
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia
| | - Masnoon Saiyed
- School of Medicine, Griffith University, Nathan, Qld, Australia.,Menzies Health Institute Group, Centre for Applied Health Economics, Nathan, Qld, Australia
| | - Joshua Byrnes
- School of Medicine, Griffith University, Nathan, Qld, Australia.,Menzies Health Institute Group, Centre for Applied Health Economics, Nathan, Qld, Australia
| | - Paula Cattanach
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia
| | - Fiona Macfarlane
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia
| | - Nicolette Graham
- Department of Pharmacy, Queensland Children's Hospital, South Brisbane, Qld, Australia
| | - Elizabeth Shevill
- Child Health Research Centre, Queensland Children's Hospital, The University of Queensland and Respiratory Medicine, South Brisbane, Qld, Australia
| | - Amanda J Ullman
- Department of Anesthesia and Pain Management, Vascular Assessment and Management Service (VAMS, Queensland Children's Hospital, South Brisbane, Qld, Australia.,Menzies Health Institute Queensland, Alliance for Vascular Access Teaching and Research Group, Southport, Qld, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Qld, Australia.,Child Health Research Centre, Queensland Children's Hospital, The University of Queensland and Respiratory Medicine, South Brisbane, Qld, Australia
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