Practice Patterns of Central Venous Catheter Placement and Confirmation in Pediatric Critical Care

2021 ◽  
Author(s):  
Ahmed Veten ◽  
Joshua Davis ◽  
Robert Kavanagh ◽  
Neal Thomas ◽  
Adrian Zurca
Keyword(s):  
Critical Care ◽  
Venous Catheter ◽  
Critically Ill Children ◽  
Central Venous ◽  
Pediatric Critical Care ◽  
X Ray ◽  
Electronic Survey ◽  
Increased Risk ◽  
Wide Variability ◽  
Tip Position

AbstractOptimal practices for the placement of central venous catheters (CVCs) in critically ill children are unclear. This study describes the clinical practice of pediatric critical care medicine (PCCM) providers regarding CVC placement, including site selection, confirmation practices and assessment of complications. Two-hundred fourteen PCCM providers responded to an electronic survey, including 170 (79%) attending physicians, 30 (14%) fellow physicians, and 14 (7%) advanced practice providers. PCCM providers most commonly place internal jugular (IJ) and femoral CVCs, with subclavian CVCs and peripherally inserted central catheters (PICCs) placed less commonly (IJ 99%, femoral 95%, subclavian 40%, PICC 19%). The IJ is the most preferred site (128/214 (60%)); decreased infection risk is the most common reason for preferring this site. The subclavian is the least preferred site (150/214 [70%]) due to concern for increased risk of complications (51%) and personal discomfort with the procedure (49%). One-hundred twenty-six (59%) of respondents reported receiving formal ultrasound (US) or echocardiography training. Respondents reported using dynamic US guidance for placement in 90% of IJ, 86% of PICC, 78% of femoral, and 12% of subclavian CVCs. Plain radiography (X-ray) was the most preferred modality for confirming CVC tip position (85%) compared with US (9%) and no imaging (5%). Most providers reported using X-ray to evaluate for pneumothorax following upper extremity CVC placement, with only 5% reporting use of US and none relying on physical exam alone. This study demonstrates wide variability in PCCM providers' CVC placement practices. Potential training gaps exist for placement of subclavian catheters and use of US.

406: ASSESSING COMPETENCE IN CENTRAL VENOUS CATHETER PLACEMENT BY PEDIATRIC CRITICAL CARE FELLOWS

2018 ◽  
Vol 46 (1) ◽  
pp. 186-186
Author(s):  
Donald Boyer ◽  
Adrian Zurca ◽  
Katherine Mason ◽  
Richard Mink ◽  
Toni Petrillo ◽  
...  
Keyword(s):  
Critical Care ◽  
Central Venous Catheter ◽  
Venous Catheter ◽  
Catheter Placement ◽  
Central Venous ◽  
Central Venous Catheter Placement ◽  
Pediatric Critical Care

scholarly journals Risk Factors Related to Peripherally Inserted Central Venous Catheter Nonselective Removal in Neonates

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Xiaohe Yu ◽  
Shaojie Yue ◽  
Mingjie Wang ◽  
Chuanding Cao ◽  
Zhengchang Liao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Neonatal Intensive Care ◽  
Insertion Site ◽  
Venous Catheter ◽  
Central Venous ◽  
Patient Demographics ◽  
Increased Risk ◽  
Catheter Complications ◽  
Tip Position

We aimed to investigate the incidence and risk factors associated with nonselective removal of peripherally inserted central venous catheter (PICC) in neonates. In this prospective cohort study, neonates who underwent PICC placement at neonatal intensive care units (NICUs) in China from October 2012 to November 2015 were included. The patient demographics, catheter characteristics, catheter duration, PICC insertion site, indication for PICC insertion, infuscate composition, PICC tip location, and catheter complications were recorded in a computerized database. Risk factors for nonselective removal were analyzed. A total of 497 PICCs were placed in 496 neonates. Nonselective removal occurred in 9.3% of PICCs during 10,540 catheter-days (4.6 nonselective removals per 1,000 catheter-days). These included occlusion (3%), infection (1.4%), leakage (2.0%), phlebitis (0.6%), displacement (1%), pleural effusion(0.6%), and breaks (0.6%). Noncentral tip position was independently associated with an increased risk of nonselective removal (odds ratio 2.621; 95% confidence interval, 1.258-5.461) after adjusting for gestational age, sex, birth weight, and PICC dwell time. No significant differences in the rate of complications occurred between silastic and polyurethane PICC or different insertion sites. Noncentral PICC tip position was the only independent risk factor for nonselective removal of PICC.

scholarly journals Epidemiology of Bleeding in Critically Ill Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Jake Sequeira ◽  
Marianne E. Nellis ◽  
Oliver Karam
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critical Care Unit ◽  
Critically Ill Children ◽  
Pediatric Critical Care ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
The Impact ◽  
Bleeding Severity

Objective: Bleeding can be a severe complication of critical illness, but its true epidemiologic impact on children has seldom been studied. Our objective is to describe the epidemiology of bleeding in critically ill children, using a validated clinical tool, as well as the hemostatic interventions and clinical outcomes associated with bleeding.Design: Prospective observational cohort study.Setting: Tertiary pediatric critical care unitPatients: All consecutive patients (1 month to 18 years of age) admitted to a tertiary pediatric critical care unitMeasurements and Main Results: Bleeding events were categorized as minimal, moderate, severe, or fatal, according to the Bleeding Assessment Scale in Critically Ill Children. We collected demographics and severity at admission, as evaluated by the Pediatric Index of Mortality. We used regression models to compare the severity of bleeding with outcomes adjusting for age, surgery, and severity. Over 12 months, 902 critically ill patients were enrolled. The median age was 64 months (IQR 17; 159), the median admission predicted risk of mortality was 0.5% (IQR 0.2; 1.4), and 24% were post-surgical. Eighteen percent of patients experienced at least one bleeding event. The highest severity of bleeding was minimal for 7.9% of patients, moderate for 5.8%, severe for 3.8%, and fatal for 0.1%. Adjusting for age, severity at admission, medical diagnosis, type of surgery, and duration of surgery, bleeding severity was independently associated with fewer ventilator-free days (p < 0.001) and fewer PICU-free days (p < 0.001). Adjusting for the same variables, bleeding severity was independently associated with an increased risk of mortality (adjusted odds ratio for each bleeding category 2.4, 95% CI 1.5; 3.7, p < 0.001).Conclusion: Our data indicate bleeding occurs in nearly one-fifth of all critically ill children, and that higher severity of bleeding was independently associated with worse clinical outcome. Further multicenter studies are required to better understand the impact of bleeding in critically ill children.

Assessing Competence in Central Venous Catheter Placement by Pediatric Critical Care Fellows

2019 ◽  
Vol 47 (8) ◽  
pp. e654-e661 ◽  
Author(s):  
Donald L. Boyer ◽  
Adrian D. Zurca ◽  
Katherine Mason ◽  
Richard Mink ◽  
Toni Petrillo ◽  
...  
Keyword(s):  
Critical Care ◽  
Central Venous Catheter ◽  
Venous Catheter ◽  
Catheter Placement ◽  
Central Venous ◽  
Central Venous Catheter Placement ◽  
Pediatric Critical Care

scholarly journals A Survey of Pediatric Critical Care Providers on the Presence, Severity, and Assessment of Capillary Leak in Critically Ill Children

2016 ◽  
Vol 06 (03) ◽  
pp. 145-151 ◽  
Author(s):  
Peter Luckett ◽  
Edward Faustino ◽  
Richard Pierce
Keyword(s):  
Critical Care ◽  
Cardiopulmonary Bypass ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Care Providers ◽  
Capillary Leak ◽  
Multiple Choice Questions ◽  
Pediatric Critical Care ◽  
Electronic Survey ◽  
Patient Factor

Purpose To determine provider opinions on factors most commonly used to assess the presence and severity of pathologic capillary leak in critically ill children. Methods We conducted an electronic survey of pediatric critical care providers. Patient scenarios were presented to assess opinions on the risk, presence, and clinical significance of capillary leak. Responses were obtained using Likert scales and multiple-choice questions. Results A total of 160 responses were analyzed. Respondents agreed that capillary leak is present in the scenario with septic shock while respondents somewhat agreed that it is also present with poly-trauma, cardiac arrest, or cardiopulmonary bypass. They agreed that physical exam, but neither agreed nor disagreed that laboratory tests, can be used to assess and follow the severity of capillary leak in these children. Generalized edema, increase in weight, and pulmonary crackles were commonly identified parameters for assessing capillary leak. The patient factor most commonly identified with capillary leak was presence of infection, while treatment factors most commonly identified were cardiopulmonary bypass and general anesthesia. Conclusion There is agreement that capillary leak is common in critically ill children and exacerbates disease. The parameters identified in this study may facilitate a more standardized clinical evaluation of pathologic capillary leak for future studies.

scholarly journals Developing a Tool to Assess Placement of Central Venous Catheters in Pediatrics Patients

2016 ◽  
Vol 8 (3) ◽  
pp. 346-352 ◽  
Author(s):  
Geoffrey M. Fleming ◽  
Richard B. Mink ◽  
Christoph Hornik ◽  
Amanda R. Emke ◽  
Michael L. Green ◽  
...  
Keyword(s):  
Critical Care ◽  
Direct Observation ◽  
Assessment Tool ◽  
Venous Catheter ◽  
Critical Care Medicine ◽  
Reference Standard ◽  
Central Venous ◽  
Pediatric Critical Care ◽  
Modified Delphi ◽  
Venous Catheterization

ABSTRACT  Pediatric critical care medicine requires the acquisition of procedural skills, but to date no criteria exist for assessing trainee competence in central venous catheter (CVC) insertion.Background  The goal of this study was to create and demonstrate validity evidence for a direct observation tool for assessing CVC insertion.Objective  Ten experts used the modified Delphi technique to create a 15-item direct observation tool to assess 5 scripted and filmed simulated scenarios of CVC placement. The scenarios were hosted on a dedicated website from March to May 2013, and respondents recruited by e-mail completed the observation tool in real time while watching the scenarios. The goal was to obtain 50 respondents and a total of 250 scenario ratings.Methods  A total of 49 pediatrics intensive care faculty physicians (6.3% of 780 potential subjects) responded and generated 188 scenario observations. Of these, 150 (79.8%) were recorded from participants who scored 4 or more on the 5 scenarios. The tool correctly identified the expected reference standard in 96.8% of assessments with an interrater agreement kappa (standard error) = 0.94 (0.07) and receiver operating characteristic = 0.97 (95% CI 0.94–0.99).Results  This direct observation assessment tool for central venous catheterization demonstrates excellent performance in identifying the reference standard with a high degree of interrater reliability. These assessments support a validity construct for a pediatric critical care medicine faculty member to assess a provider placing a CVC in a pediatrics patient.Conclusions

Sign in / Sign up

Export Citation Format

Share Document