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

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 noncomplicated 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 ultrasoundguided approach,a multidisciplinary teaching program to improve nursing skills,and the use of less invasive devices for patients with cancer.

Predictors of perioperative respiratory adverse events among children with upper respiratory tract infection undergoing pediatric ambulatory ilioinguinal surgery:a prospective observational research

Objectives Anesthesia for children with an upper respiratory tract infection(URI)has an increased risk of perioperative respiratory adverse events(PRAEs)that may be predicted according to the COLDS score.The aims of this study were to evaluate the validity of the COLDS score in children undergoing ilioinguinal ambulatory surgery with mild to moderate URI and to investigate new predictors of PRAEs.Methods This was a prospective observational study including children aged 1-5 years with mild to moderate symptoms of URI who were proposed for ambulatory ilioinguinal surgery.The anesthesia protocol was standardized.Patients were divided into two groups according to the incidence of PRAEs.Multivariate logistic regression was performed to assess predictors for PRAEs.Results In this observational study,216 children were included.The incidence of PRAEs was 21%.Predictors of PRAEs were respiratory comorbidities(adjusted OR(aOR)=6.3,95%CI 1.19 to 33.2;p=0.003),patients postponed before 15 days(aOR=4.3,95%CI 0.83 to 22.4;p=0.029),passive smoking(aOR=5.31,95%CI 2.07 to 13.6;p=0.001),and COLDS score of>10(aOR=3.7,95%CI 0.2 to 53.4;p=0.036).Conclusions Even in ambulatory surgery,the COLDS score was effective in predicting the risks of PRAEs.Passive smoking and previous comorbidities were the main predictors of PRAEs in our population.It seems that children with severe URI should be postponed to receive surgery for more than 15 days.

Rare fatal complication of appendicitis in a child:pylephlebitis

An 11-year old boy without any medical history presented with a 4-day history of vomiting and abdominal pain,followed by appearance of fever and decreased energy.Physical examination showed a blood pressure of 90/60 mm Hg,a pulse rate of 120/min,a temperature of 40℃,oxygen satu-ration of 93%on air,and diffuse abdominal contracture.Laboratory values showed hyperleukocytosis(24,000/mm^(3)),hemoglobin of 15 g/L,prothrombin time of 48%,and creatinine of 127 mmol/L.An abdom-inal computed tomography(CT)showed a thick perforated appendix,an abundant intraperitoneal effusion,and pneumo-peritoneum.

Acute pancreatitis revealing duodenal duplication in a child

A 3-year old female child with a history of intermittent abdominal pain and postprandial vomiting presented with fever,vomiting,and abdominal pain.The epigastrium was mildly sensitive on examination.Laboratory studies showed elevated leukocyte count(13000/L),amylase(667 U/L),and lipase(2332 U/L).Abdominal CT showed pancreatitis with a cystic lesion repressing the pancreatic head.