Objective. -To evaluate the use of neonatal central venous catheters (CVC) in 38 french neonatal units and occurrence of pericardial effusion (PCE) over the past 5 years. Materials and methods. -We surveyed 38 units w...Objective. -To evaluate the use of neonatal central venous catheters (CVC) in 38 french neonatal units and occurrence of pericardial effusion (PCE) over the past 5 years. Materials and methods. -We surveyed 38 units with a questionnaire and studied the cases of PCE in five units. Results. -Response rate was 89% (34/38). Accepted CVC tip positions were: junction of right atrium (RA) and vena cava (VC) 76% , VC 58% , RA 11% . Fifty percent of the centers had been exposed to PCE. 16 cases of PCE were studied. Median gestational age was 31 weeks (range: 26.1 to 40 weeks). Median time from insertion: 3.2 days (range: 0.4 13.5). In all cases CVC tipwas intracardiac at insertion with inadequate withdrawing in 13 cases. Sudden cardiac collapse was reported in eight cases, and unexplained cardiorespiratory instability in six cases. Echography showed PCE in 14 cases. One diagnosis was post-mortem. CVC was withdrawn in 12 patients and 13 underwent pericardiocentesis. Four patients died and two had neurological sequelae. Conclusion.-PCE was associated with intracardiac CVC tip. The CVC tip should be controlled with radiography or echography outside the cardiac silhouette. PCE diagnosis must be considered in face of unexplained cardiovascular decompensation of neonate with CVC.展开更多
Long-term tunneled central venous catheters (CVC) are frequently used in the neonatal intensive care unit (NICU) babies. They are placed either in the neck or groin based primarily upon the surgeon’ s preference. The...Long-term tunneled central venous catheters (CVC) are frequently used in the neonatal intensive care unit (NICU) babies. They are placed either in the neck or groin based primarily upon the surgeon’ s preference. There is meager published in-formation available about the relative risks of these lines. This is a retrospective analysis of all the tunneled central venous catheters placed in NICU babies at a children’ s hospital over a nearly 5-year period. Single lumen Broviac catheters were used in all cases. A total of 137 catheters were placed in 126 patients. There were 88 neck lines and 49 groin lines. Age, gestational maturity, and body weight were significantly lower for babies who underwent groin line placement. There was no significant difference in the number of days the catheters were live between the 2 groups. Total complication rates and catheter infection rates were significantly higher with neck lines. The accidental removal rate was higher with neck lines but did not reach statistical significance. Broviac catheters placed in the groin of NICU babies are associated with significantly fewer complications compared with those placed in the neck.展开更多
Objective:Totally implantable devices (TIDs) and external tunneled catheters (ETCs) became a basic requirement in the treatment of pediatric oncologic patients. Techniques for implantation and confirmation of proper p...Objective:Totally implantable devices (TIDs) and external tunneled catheters (ETCs) became a basic requirement in the treatment of pediatric oncologic patients. Techniques for implantation and confirmation of proper position vary among different centers. The article presented different techniques for sonographic guided puncture of the target central vein and confirmation of the proper position of tunneled catheters. Methods:This was an observational study with a single crossover phase, in which operators initially used the open cut down technique and subsequently converted to the ultrasound guided technique. Internal jugular vein (IJV) was used in all cases. Results:In ultrasound guided group, TIDs were inserted in 121 cases while ETCs were inserted in 13 cases. Ultrasound was successful in guiding IJV puncture from the first trial in all cases and in guide-wire localization in the right atrium in 132 cases. There were no reported cases of hematoma, pneumothorax, hemothorax, catheter malposition or surgical-site infection (SSI) in the perioperative period. In the open cut down group, TIDs were inserted in 119 cases. Two patients developed post operative hematoma and one of them developed SSI. The mean time of ultrasound guided TIDs was (30.04 ± 1.1) minutes which was significantly lower than the mean time of cases done by the open cut down technique (45.4 ± 3.1) minutes (P < 0.0001). Conclusion:Ultrasound guidance is helpful for insertion of TIDs and ETCs in the IJV in pediatric oncologic patients. It minimizes the need for open cut downs and fluoroscopy.展开更多
目的探讨将品管手法运用于中央静脉导管相关血流感染(Central line associated bloodstream infections,CLABSI)的预防与控制,提高工作人员对其预防措施落实的依从性,从而降低CLABSI发生。方法选取2015年7月—2016年6月入住ICU留置中央...目的探讨将品管手法运用于中央静脉导管相关血流感染(Central line associated bloodstream infections,CLABSI)的预防与控制,提高工作人员对其预防措施落实的依从性,从而降低CLABSI发生。方法选取2015年7月—2016年6月入住ICU留置中央静脉导管的患者132例作为常规组,2016年7月—2017年6月入住ICU留置中央静脉导管的患者141例作为观察组。运用部分品管手法,对所有再置管患者进行措施干预,在实施集束预防策略的同时,严格细节管理,观察干预后的CLABSI发生率。计数资料比较采用χ~2检验,P<0.05为差异有统计学意义。结果观察组感染率2.20‰低于常规组10.20‰,差异有统计学意义(P<0.05)。结论将品管手法运用于预防中央静脉导管相关血流感染,能有效降低其感染率。展开更多
静脉化疗和长期输液是乳腺癌患者治疗不可缺少的途径,化疗药物对外周静脉产生刺激,药液渗出后损害周围组织及反复静脉穿刺,都将给患者带来痛苦。置入式中央静脉导管系统（central verlous port access system,CVPAS）,简称输液港,是一...静脉化疗和长期输液是乳腺癌患者治疗不可缺少的途径,化疗药物对外周静脉产生刺激,药液渗出后损害周围组织及反复静脉穿刺,都将给患者带来痛苦。置入式中央静脉导管系统（central verlous port access system,CVPAS）,简称输液港,是一种完全置入体内的闭合静脉输液系统,可用于化疗药物、静脉营养液的输注及血样的采集等。展开更多
文摘Objective. -To evaluate the use of neonatal central venous catheters (CVC) in 38 french neonatal units and occurrence of pericardial effusion (PCE) over the past 5 years. Materials and methods. -We surveyed 38 units with a questionnaire and studied the cases of PCE in five units. Results. -Response rate was 89% (34/38). Accepted CVC tip positions were: junction of right atrium (RA) and vena cava (VC) 76% , VC 58% , RA 11% . Fifty percent of the centers had been exposed to PCE. 16 cases of PCE were studied. Median gestational age was 31 weeks (range: 26.1 to 40 weeks). Median time from insertion: 3.2 days (range: 0.4 13.5). In all cases CVC tipwas intracardiac at insertion with inadequate withdrawing in 13 cases. Sudden cardiac collapse was reported in eight cases, and unexplained cardiorespiratory instability in six cases. Echography showed PCE in 14 cases. One diagnosis was post-mortem. CVC was withdrawn in 12 patients and 13 underwent pericardiocentesis. Four patients died and two had neurological sequelae. Conclusion.-PCE was associated with intracardiac CVC tip. The CVC tip should be controlled with radiography or echography outside the cardiac silhouette. PCE diagnosis must be considered in face of unexplained cardiovascular decompensation of neonate with CVC.
文摘Long-term tunneled central venous catheters (CVC) are frequently used in the neonatal intensive care unit (NICU) babies. They are placed either in the neck or groin based primarily upon the surgeon’ s preference. There is meager published in-formation available about the relative risks of these lines. This is a retrospective analysis of all the tunneled central venous catheters placed in NICU babies at a children’ s hospital over a nearly 5-year period. Single lumen Broviac catheters were used in all cases. A total of 137 catheters were placed in 126 patients. There were 88 neck lines and 49 groin lines. Age, gestational maturity, and body weight were significantly lower for babies who underwent groin line placement. There was no significant difference in the number of days the catheters were live between the 2 groups. Total complication rates and catheter infection rates were significantly higher with neck lines. The accidental removal rate was higher with neck lines but did not reach statistical significance. Broviac catheters placed in the groin of NICU babies are associated with significantly fewer complications compared with those placed in the neck.
文摘Objective:Totally implantable devices (TIDs) and external tunneled catheters (ETCs) became a basic requirement in the treatment of pediatric oncologic patients. Techniques for implantation and confirmation of proper position vary among different centers. The article presented different techniques for sonographic guided puncture of the target central vein and confirmation of the proper position of tunneled catheters. Methods:This was an observational study with a single crossover phase, in which operators initially used the open cut down technique and subsequently converted to the ultrasound guided technique. Internal jugular vein (IJV) was used in all cases. Results:In ultrasound guided group, TIDs were inserted in 121 cases while ETCs were inserted in 13 cases. Ultrasound was successful in guiding IJV puncture from the first trial in all cases and in guide-wire localization in the right atrium in 132 cases. There were no reported cases of hematoma, pneumothorax, hemothorax, catheter malposition or surgical-site infection (SSI) in the perioperative period. In the open cut down group, TIDs were inserted in 119 cases. Two patients developed post operative hematoma and one of them developed SSI. The mean time of ultrasound guided TIDs was (30.04 ± 1.1) minutes which was significantly lower than the mean time of cases done by the open cut down technique (45.4 ± 3.1) minutes (P < 0.0001). Conclusion:Ultrasound guidance is helpful for insertion of TIDs and ETCs in the IJV in pediatric oncologic patients. It minimizes the need for open cut downs and fluoroscopy.
文摘目的探讨将品管手法运用于中央静脉导管相关血流感染(Central line associated bloodstream infections,CLABSI)的预防与控制,提高工作人员对其预防措施落实的依从性,从而降低CLABSI发生。方法选取2015年7月—2016年6月入住ICU留置中央静脉导管的患者132例作为常规组,2016年7月—2017年6月入住ICU留置中央静脉导管的患者141例作为观察组。运用部分品管手法,对所有再置管患者进行措施干预,在实施集束预防策略的同时,严格细节管理,观察干预后的CLABSI发生率。计数资料比较采用χ~2检验,P<0.05为差异有统计学意义。结果观察组感染率2.20‰低于常规组10.20‰,差异有统计学意义(P<0.05)。结论将品管手法运用于预防中央静脉导管相关血流感染,能有效降低其感染率。
文摘静脉化疗和长期输液是乳腺癌患者治疗不可缺少的途径,化疗药物对外周静脉产生刺激,药液渗出后损害周围组织及反复静脉穿刺,都将给患者带来痛苦。置入式中央静脉导管系统（central verlous port access system,CVPAS）,简称输液港,是一种完全置入体内的闭合静脉输液系统,可用于化疗药物、静脉营养液的输注及血样的采集等。
