scholarly journals Embolized Guidewire into Central Aorta: A Nightmare in the Pediatric Intensive Care Unit

2018 ◽  
Vol 07 (04) ◽  
pp. 210-212
Author(s):  
R.K. Nath ◽  
Manoj Sarowa ◽  
Neeraj Pandit ◽  
Richa Agrawal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ventricular Septal Defect ◽  
Pediatric Intensive Care Unit ◽  
Septal Defect ◽  
Pediatric Intensive Care ◽  
Central Line ◽  
Percutaneous Catheterization ◽  
The Right ◽  
Gooseneck Snare

AbstractA 4-month-old preterm, critically ill infant weighing 3.8 kg was admitted to our pediatric intensive care unit with congestive cardiac failure due to a large ventricular septal defect and its sequelae. During an attempt to insert a central line into the right subclavian vein at bedside, the guidewire inadvertently entered the subclavian artery and embolized distally. After multiple failed retrieval attempts, including surgical femoral cut-down to retrieve the wire, it was removed finally by fluoroscopic-guided percutaneous catheterization with the help of a cardiac bioptome and a gooseneck snare utilizing a novel maneuver.

scholarly journals Evaluation of risk factors affecting morbidity in patients who underwent surgical closure of ventricular septal defect

2021 ◽  
Author(s):  
Gokcen Ozcifci ◽  
Umut Altug ◽  
Fatih Durak ◽  
Ayse Anil ◽  
Pinar Kulluoglu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Ventricular Septal Defect ◽  
Hospital Stay ◽  
Intensive Care Unit Stay ◽  
Pediatric Intensive Care Unit ◽  
Septal Defect ◽  
Pediatric Intensive Care ◽  
Surgical Closure

Objective: Surgical closure of ventricular septal defect is still the most common pediatric cardiac surgical procedure. The aim of this study was to define the risk factors of the complications of ventricular septal defect surgery. Methods: We evaluated the preoperative, perioperative, and postoperative data from echocardiography reports, perfusion reports, and clinical, inpatient, and operative notes of all the patients. The following were the outcome variables for this study: in-hospital death; duration of mechanical ventilation in hours; duration of pediatric intensive care unit stay in days; and duration of hospital stay in days. Herein, we report our single pediatric cardiac center experience between October 2015 and October 2018. Results: A total of 108 patients underwent surgical ventricular septal defect closure during the study period. Prolonged pediatric intensive care unit stay, hospital stay and mechanical ventilation time was associated with younger age and low weight. The patients with genetic syndromes had statistically longer mechanical ventilation time (p < 0.001), pediatric intensive care unit stay (p < 0.001), and hospital stay (p = 0.002). Conclusion: Although genetic syndromes did not affect the complication rates, it affected the lengths of hospital and pediatric intensive care unit stays and mechanical ventilation duration. Young age and lower body weight was a risk factor of prolonged hospitalization, prolonged pediatric intensive care unit stay and prolonged mechanical ventilation. Therefore, these situations should be considered in the postoperative follow-up of patients with ventricular septal defect.

scholarly journals Estratégia Multidimensional na Redução de Infeção Associada a Cateter Venoso Central em Pediatria

2016 ◽  
Vol 29 (6) ◽  
pp. 373
Author(s):  
Jorge Rodrigues ◽  
Andrea Dias ◽  
Guiomar Oliveira ◽  
José Farela Neves
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Venous Catheter ◽  
Central Line ◽  
Central Venous ◽  
Group 2

<p><strong>Introduction:</strong> To determine the central-line associated bloodstream infection rate after implementation of central venous catheter-care practice bundles and guidelines and to compare it with the previous central-line associated bloodstream infection rate.<br /><strong>Material and Methods:</strong> A prospective, longitudinal, observational descriptive study with an exploratory component was performed in a Pediatric Intensive Care Unit during five months. The universe was composed of every child admitted to Pediatric Intensive Care Unit who inserted a central venous catheter. A comparative study with historical controls was performed to evaluate the result of the intervention (group 1 <em>versus</em> group 2).<br /><strong>Results:</strong> Seventy five children were included, with a median age of 23 months: 22 (29.3%) newborns; 28 (37.3%) with recent surgery and 32 (43.8%) with underlying illness. A total of 105 central venous catheter were inserted, the majority a single central venous catheter (69.3%), with a mean duration of 6.8 ± 6.7 days. The most common type of central venous catheter was the short-term, non-tunneled central venous catheter (45.7%), while the subclavian and brachial flexure veins were the most frequent insertion sites (both 25.7%). There were no cases of central-line associated bloodstream infection reported during this study. Comparing with historical controls (group 1), both groups were similar regarding age, gender, department of origin and place of central venous catheter insertion. In the current study (group 2), the median length of stay was higher, while the mean duration of central venous catheter (excluding peripherally inserted central line) was similar in both groups. There were no statistical differences regarding central venous catheter caliber and number of lumens. Fewer children admitted to Pediatric Intensive Care Unit had central venous catheter inserted in group 2, with no significant difference between single or multiple central venous catheter.<br /><strong>Discussion:</strong> After multidimensional strategy implementation there was no reported central-line associated bloodstream infection<br /><strong>Conclusions:</strong> Efforts must be made to preserve the same degree of multidimensional prevention, in order to confirm the effective reduction of the central-line associated bloodstream infection rate and to allow its maintenance.</p>

scholarly journals Central Line-Associated Bloodstream Infections in Pediatric Intensive Care Unit

2017 ◽  
Vol 4 (2) ◽  
pp. 42-46 ◽  
Author(s):  
Tanıl Kendirli ◽  
Ayhan Yaman ◽  
Çağlar Ödek ◽  
Halil Özdemir ◽  
Adem Karbuz ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Bloodstream Infections ◽  
Central Line

Assessment of potential differences between pre-filled and manually prepared syringe use during vascular access device management in a pediatric intensive care unit

2021 ◽  
pp. 112972982110155
Author(s):  
Gokhan Ceylan ◽  
Sevgi Topal ◽  
Nuriye Turgut ◽  
Nihal Ozdamar ◽  
Yeliz Oruc ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Vascular Access ◽  
Pediatric Intensive Care ◽  
Central Line ◽  
Device Management ◽  
Access Device ◽  
Vascular Access Device

Background: Central line-associated bloodstream infection is one of the four primary health-care-associated infections applicable to pediatric intensive care units defined by The Centers for Disease Control and Prevention. According to current guidelines, it is essential to flush vascular access devices before each infusion to assess catheter function and prevent catheter-related complications. Objective: This prospective trial aimed to assess the potential differences between pre-filled and manually prepared saline syringe use during vascular access device management in a pediatric intensive care unit. Methods: Volunteered registered pediatric intensive care unit nurses were asked to implement the flushing solution to an extension line of a central venous catheter in vitro. After the randomization process with opaque sealed envelopes, they have started either with manual preparation or used sterile pre-filled saline syringes. Sterile application steps forms were used for monitoring the manual preparation of saline syringes versus the pre-filled saline syringes phase. Each volunteer repeated the steps for 3, 5, and 10 mL syringe volumes with the manually prepared and pre-filled saline syringes. After completing the procedures, failed steps and durations were transferred into a database to be analyzed by a blinded investigator. Results: A total of 41 nurses volunteered and 123 forms for three attempts per one nurse were filled for each group. In the manual preparation group, the number of at least one failure in the necessary steps was 89 (72.3%) and the same number in the pre-filled syringe group was 6 (4.9%), and significantly lower in the pre-filled saline syringe group ( p < 0.001). The overall time for preparing to flush was 86.0 ± 22.3 s (ranging from 46 to 173 s) for manual prepared syringes and 35.2 ± 9.4 s (ranging from 18 to 100 s) ( p < 0.001) for pre-filled saline syringes. Conclusion: Our results demonstrate that the risk for breaking the aseptic no-touch technic was higher in the manual preparation group. We have also demonstrated that the flushing time was shorter with pre-filled syringes compared to manually prepared ones, which may contribute to decreasing the workload of the nurses and may increase the quality of care in the intensive care units. The use of pre-filled saline syringes may decrease the central line-associated bloodstream infections incidence and may increase the quality of care by saving extra time in the pediatric intensive care unit.

scholarly journals Device-associated infections in the pediatric intensive care unit at the American University of Beirut Medical Center

2016 ◽  
Vol 10 (06) ◽  
pp. 554-562 ◽  
Author(s):  
Ali Ismail ◽  
Abdul-Karim El-Hage-Sleiman ◽  
Marianne Majdalani ◽  
Rima Hanna-Wakim ◽  
Souha Kanj ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Pediatric Intensive Care ◽  
Central Line ◽  
American University ◽  
American University Of Beirut ◽  
Resistance Patterns

Introduction: Device-associated healthcare-associated infections (DA-HAIs) are the principal threat to patient safety in intensive care units (ICUs).  The primary objective of this study was to identify the most common DA-HAIs in the pediatric intensive care unit (PICU) at the American University of Beirut Medical Center (AUBMC). Length of stay (LOS) and mortality, antimicrobial resistance patterns, and suitability of empiric antibiotic choices for DA-HAIs according to the local resistance patterns were also studied. Methodology: This was a retrospective study that included all patients admitted to the PICU at AUBMC between January 2007 and December 2011. All patients admitted to the PICU having a placed central line, an endotracheal tube, and/or a Foley catheter were included. Data was extracted from the patients’ medical records through chart review. A total of 22 patients were identified with 25 central line-associated bloodstream infections (CLABSI), 25 ventilator-associated pneumonia (VAP), and 9 catheter-associated urinary tract infections (CAUTIs). The causing organisms, their resistance patterns, and the appropriateness of empiric antimicrobial therapy were reported. Results: Gram-negative pathogens were found in 53% of the DA-HAIs, Gram-positive ones in 27%, and fungal organisms in 20%. A total of 80% of K. pneumonia isolates were extended-spectrum beta-lactamases (ESBL) producers, and 30% of Pseudomonas isolates were multidrug resistant. No methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) were isolated. Based on culture results, the choice of empiric antimicrobial therapy was appropriate in 64% of the DA-HAIs. Conclusions: After the care bundle approach is adopted in our PICU, DA-HAIs are expected to decrease further.

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